Lake Erie College of Osteopathic Medicine's independent study pathway program: an alternative medical school curriculum design.

Lake Erie College of Osteopathic Medicine has developed an independent study pathway as an alternative to the traditional medical school curriculum design. Beginning with the 2001-2002 academic year, three equivalent and distinct curriculum pathways will be available to medical students at the Lake Erie College of Osteopathic Medicine: the lecture/discussion pathway, the problem-based learning pathway, and the independent study pathway (ISP). The ISP program will provide flexibility for students during their preclinical years. Using highly structured faculty-developed modules, students in the ISP program will be responsible for their own learning in a self-directed, independent manner, including when, where, what, and how to study. Examinations will be taken when students consider themselves ready. If examinations reveal deficiencies in student preparation, these deficiencies must be remedied before students continue their studies. Faculty will be available, as needed, to assist the students through difficult concepts and material.

Detecting and treating bulimia nervosa: how involved are family physicians?

BACKGROUND: Relatively little is known about bulimia nervosa in the primary care setting. Existing medical literature suggests that primary care physicians have limited experience with bulimia nervosa. METHODS: Experiences of family physicians with bulimia nervosa specifically and eating disorders in general were assessed by a questionnaire mailed to a representative sample (596 subjects) of Ohio family physicians. The response rate was 52.6 percent. RESULTS: Approximately 30 percent of the respondents had never diagnosed bulimia in a patient; 60 percent had no bulimic patients at the time of the survey. The mean career total of bulimic patients per physician was 5.3 (SD = 5.6). Younger physicians and female physicians were more likely to have bulimic patients. Having bulimic patients correlated significantly with having contact with bulimic and with anorexic persons in nonoffice settings. CONCLUSIONS: Despite a general prevalence rate of about 1 percent for bulimia (much greater for the female population, particularly in adolescents and athletes), nearly one third of Ohio family physicians have never diagnosed bulimia in a patient, and nearly two thirds are not currently providing care for bulimic patients. Because screening is quick, inexpensive, and straightforward, all at-risk patients--athletes or those who have concerns related to paucity of menstruation, gastrointestinal symptoms, dieting or weight concerns, and depression--should be screened for bulimia.

HIV-related disease: family physicians' multiple opportunities for preventive intervention.

BACKGROUND: The spread of the human immunodeficiency virus (HIV) and the increasing number of persons with acquired immunodeficiency syndrome (AIDS) are major health problems. HIV risk factors are well documented, and HIV disease is recognized as a chronic illness with a predictable course. METHODS: Since September 1987 the East Central AIDS Education and Training Center for Health Professionals has served Michigan, Ohio, Kentucky, and Tennessee. Activities include (1) educating and training primary health care providers on prevention and treatment of AIDS, (2) training selected individuals to train others, (3) providing guidance in multidisciplinary management of HIV disease, (4) disseminating updates about HIV and AIDS, and (5) serving as a support system through referral activities. RESULTS: Too many primary physicians, including family physicians, are uncomfortable with patients who are at risk for becoming infected with HIV or who are HIV-infected. Long-term concern and attention that might normally be offered to other patients with different chronic or fatal diseases are sometimes avoided. Patients also present barriers to care, making it difficult for family physicians to provide appropriate care. CONCLUSIONS: Understanding the natural history of HIV infection is integral to family physicians' important roles in preventing and dealing with HIV. One role is screening at-risk persons; this function usually has associated opportunities for education. A second role is mainstreaming HIV-related illnesses; if family physicians treat HIV-positive persons, then AIDS is not "someone else's problem." A third role is leadership; as family physicians overcome fear and prejudice, they become role models. Each role is consistent with long-held traditions of family practice.

The twin epidemics of substance use and HIV: a state-level response using a train-the-trainer model.

Use of alcohol and drugs is highly correlated with acquiring the human immunodeficiency virus (HIV), the precursor to developing an AIDS-related condition. Today the USA faces not one but two epidemics, the twin epidemics of substance use and HIV infection. A needs assessment in the state of Ohio of the 300 state-supported drug treatment facilities confirmed a need for HIV-related education and training of the 120 health care personnel, physicians and nurses. Unique train-the-trainer programming was planned and undertaken, including in the same training programme physician and nurse participants dealing both with substance use and HIV/AIDS issues. Significant differences were found in perceived levels of knowledge, and/or attitudes, before and after programme sessions, regarding substance use, HIV/AIDS, and related training issues. To reach all of Ohio's 120 drug treatment facility physicians and nurses required a 2.75 person-hour per trainee expenditure of professional resources.

Preventing substance abuse. An interview paradigm.

In summary, substance use and abuse is a major health problem in the United States affecting adolescents of both sexes and of every socioeconomic level. Family physicians have numerous opportunities to improve the health of future generations by using specific skills and expertise to prevent, identify, and intervene with adolescents' abuse of alcohol and other chemical substances. The first step is taking an effective alcohol and drug-use history.

Family physicians' involvement with dying patients and their families. Attitudes, difficulties, and strategies.

OBJECTIVE: To determine family physicians' perceptions of the difficulty in caring for dying patients and how prepared they are to provide such care relative to strategies used with difficulties encountered, personal need for support and development, and cooperation with other caregivers. DESIGN: Exploratory. SETTING: Physicians' offices. SUBJECTS: Thirty-five randomly selected family physicians (doctors of medicine and doctors of osteopathy) representative of family physicians practicing in Franklin County, Ohio. INTERVENTIONS: None. MAJOR OUTCOME MEASURES: A semistructured interview guide corresponding to a three-dimensional theoretical model developed prior to the study was used to determine family physicians' perceptions regarding care of dying patients and their families. The three dimensions include family physicians' involvement with dying patients and their families, their personal needs and development, and their cooperation with other caregivers. RESULTS: Participants agreed that the care of dying patients and their families is an important and special component of practicing family medicine. Generally seeing themselves as adequately prepared, they still found such care difficult and desired more education and training to increase comfort of their patients and of themselves. Their perceptions regarding the care of dying patients and their families could be categorized in terms of communication as part of the care process, family issues, legal and ethical issues, coordination of care, physicians' feelings, and physicians' influence and support. CONCLUSIONS: Family physicians require formal training in death issues and need to find a way to maximize learning through personal experiences. Discussion of cases in a support group may be beneficial.

Why do patients continue to see the same physician?

In this study we examined the meaning that patients attach to continuity of care, an important construct of family practice and primary care. Structured oral interviews were conducted with 60 patients who were 35 years of age or older and who had sought health care from a single family physician for at least 15 years. The data included 10 domains that characterize patients' perceptions regarding long-term continuous care. The interview data were analyzed using ethnographic techniques. The main factors contributing to the maintenance of a continuous care relationship seemed to be patient familiarity with the physician, physician knowledge of the patient, patient satisfaction with care received, and patient confidence in the physician. Other factors were personal attributes of the physician, friendship with the physician, ease of communication with the physician, and professional growth of the physician. The availability of the physician and the location of the practice appeared to be reasons to start consulting a physician rather than to continue the relationship with a physician.

The family physician's role in caring for the dying patient and family: a comprehensive theoretical model.

Care for the dying patient is a difficult task which arouses many emotions in all participants. Many physicians feel inadequately prepared to cope with the many diverse challenges. A three-dimensional model is described which intends to help physicians better define their role in caring for dying patients. The model comprises direct involvement with the dying patients and their families, the physician's own needs and personal development and the co-operation with other care-givers. This model can be implemented at three levels, according to the physician's experience, skills, feelings, and the situation. The model can serve as a basis for extensive research and as a foundation for curricular innovation for students, residents and continuing medical education.

Dietary prevention and treatment of disease.

Diet is a major factor in five of the 10 leading causes of death in the United States and is a contributing factor in many other diseases and health conditions. Certain diseases can be prevented and general health can be maintained or improved if patients are willing to follow advice about nutrition. Hence, nutrition-related consideration of fiber, cholesterol, carbohydrates and energy should be integral to the management of health conditions.

Quality of care and black American patients.

Even with major advancements in medical knowledge and significant improvements in health sciences technology, evidence still exists that blacks do not enjoy as full a measure of health as do other racial and ethnic groups. To attempt a better understanding of this situation, literature was reviewed to consider relationships between being black and issues related to quality of health care. It was determined that these relationships have not been studied to any great extent, either in quantity or quality. When such studies have been undertaken, they have been limited to mostly qualitative designs, and appropriate controls for confounding variables have been minimal. The psychiatric literature reports most of the studies with very few studies found in the literature of other specialties. A conceptual model is presented regarding race-related research. It is argued that a first step might be to study whether the quality of care differs when the physician and the patient are members of different racial groups compared with when the physician and patient are members of the same racial group. In all race-related research, it is necessary to carefully consider specific variables that may confound results, eg, diagnostic errors, age, sex, socioeconomic status, level of education, geographic locale, and method of payment for health-care services.

Research process. Reporting results of the research.

The preparation of a manuscript to report a research project is the final stage of the research process. Recommendations are made in this article related to preparing to write, getting started, guarding against problems and frustrations by making early decisions, and developing each component of the manuscript. This article is the last in a series of six on the research process, in which the collective purpose has been to offer guidance regarding the spectrum of skills required to produce quality research reports.

Research process. Concluding the research project.

This fifth article in a series of six on the research process provides guidelines for concluding a research project. Attention is directed toward a need for the researcher to be sensitive to the persons who supported the project. The other significant aspect of concluding a research project involves activities associated with analyzing the data, preparing the results, and finalizing the findings.

Research process. Conducting the research project.

Conducting the research study should be a methodical process in which the details of the planning process are executed. This fourth article in a series of six on the research process presents guidelines with supporting recommendations to increase the likelihood that the study indeed will be conducted as planned. The guidelines emphasize the importance of 1) record-keeping systems, 2) detailed work schedules, 3) communications, and 4) monitoring progress.

Research process. Preparing a research proposal.

The preparation of a research proposal is often a necessary step in the research process. Research proposals are used to secure permission to undertake a study, to ensure protection of subjects, to secure needed resources, and to achieve a refined perspective of the proposed study. This third article of a series of six on the research process describes the steps involved in preparing a research proposal, demonstrating a parallel to the research planning process.

Research process. Planning the research project.

This second article in a series of six on the research process provides a guide to planning a research project from start to finish. By description and illustration, 13 steps are outlined. Although the guide is comprehensive, advice is offered at strategic points regarding the value of consulting with a research specialist or a colleague experienced in research to gain assistance or insight into the planning process. Additionally, an admonition underlies the whole process: keep it simple and succinct.

Research process. An overview.

It has been suggested that podiatric education, training, and practice too often are not well understood outside of the profession. If this is the case, a potential remedy is for more podiatric health professionals to publish work that has significance. Beginning with this article and continuing through a total of six articles, the research process is used as a paradigm for enhancing podiatric literature in the future.