A progress report on accelerated residency programs in family practice.

BACKGROUND: In 1991 the American Board of Family Practice (ABFP) approved 12 programs to participate in an experiment in medical education. Selected students in 12 medical schools are able to complete their first year of family practice residency while completing their fourth year of school. This paper reports on the progress of the programs and residents participating in this project. METHOD: Data from the ABFP in-training examination and certification examination were compiled for all trainees and graduates through 1994. Performances were compared with national norms and the performances of traditional residents in the same programs. The program directors were surveyed to assess their experiences, program effectiveness, benefits, liabilities, and implementation problems. RESULTS: Accelerated residents performed better than their peers and national norms on the ABFP in-training and certification examinations. The directors rated the clinical performance of accelerated residents as equal to or better than the clinical performance of traditional residents by the end of the program. Advantages of accelerated residency included improvements in recruiting, image, and morale. Problems occurred in order and prescription writing and acceptance of the accelerated residents by nurses, other residents, and physicians in other disciplines. CONCLUSION: Early entry into residency training of bright, highly motivated, and mature students appears to offer benefits for trainees and programs alike.

Markers of successful recruitment of students to family practice residency programs.

BACKGROUND AND OBJECTIVES: With limited numbers of medical students choosing a primary care specialty, family practice residency programs have had to complete to fill available residency positions. The purpose of this study was to determine the characteristics of the recruiting process used by US family practice residencies and to compare recruiting strategies used by successful and unsuccessful programs. METHODS: We surveyed program directors of all 361 nonmilitary, accredited, US family practice residency programs in existence for more than 2 years. The questionnaire elicited information on program descriptors, recruitment process, and fill rate in the National Resident Matching Program. RESULTS: Seventy-eight percent (282) of the program directors returned usable questionnaires. Success in filling available positions through the Match was significantly associated with high quality of current housestaff and faculty and current residents' positive feelings about the program (P < .01). Program directors perceived successful programs as having an outstanding reputation and being regarded positively by other departments within the institution (P < .01). Programs in the Pacific and Mountain regions of the United States are more successful in recruitment. Programs not filling available positions through the Match spent more effort in recruiting strategies such as mailing and marketing materials (P < .01). CONCLUSION: Having high-quality faculty, housestaff, and residents with good attitudes are markers of success in the Match. Less successful programs appear to try harder to attract residents.

Methods of recruiting and selecting residents for U.S. family practice residencies.

PURPOSE: To describe the strategies used by family practice program directors to recruit and select residents. METHOD: The residency directors of all 361 U.S. accredited nonmilitary family practice programs in 1992-93 were asked to complete three-page questionnaires regarding program descriptors, curriculum, benefits offered, interview process, and factors affecting their selection of residents. Each program was categorized into one of nine geographic regions. Variation of program characteristics across the regions was assessed using chi-square. RESULTS: A total of 282 directors (78%) returned usable questionnaires. The programs did not differ in benefits offered except that (1) those with low fill rates in the 1992 Match of the National Resident Matching Program were more likely to have additional financial incentives and (2) the programs in areas of high competition went to extra effort and expense to market their residencies through the use of advertising materials (e.g., pens, mugs). The most important factor in selecting applicants was listed as the personal interview by 51% of the directors and performance on clinical rotations by 36%. CONCLUSION: The residency directors' selection decisions were highly influenced by candidates' performances in interviews and on clinical rotations. The programs in the most competitive areas were characterized by greater efforts and increased expenditures of resources for recruiting. More research is needed to assess the values of the different strategies used by programs to recruit and select residents.

The Executive Skills Profile: a method for assessing development needs among family medicine faculty.

BACKGROUND AND OBJECTIVES: The purpose of this paper is to report on how the Executive Skills Profile, a measure of job demands and employee skills, can be used as a faculty development tool in academic family medicine departments. METHODS: The Executive Skills Profile (ESP) identifies 72 work activities and groups them into 12 scales, each of which is displayed graphically. Faculty identify the work activities that are relevant to their jobs and then identify the personal skills they must have to carry out those work activities. RESULTS: The ESP successfully characterized the job demands and personal skills of one family medicine department. The evaluation showed that overall perceived job demands were greater than the faculty's perceived personal skills, particularly in the areas of interpersonal and behavioral skills. CONCLUSIONS: The ESP can be used to characterize the job demands and personal skills of faculty.

Bulletin boards for faculty development.

Within the faculty development program of a Department of Family Medicine at a major research university, bulletin boards offer an alternative method for communicating new information, reinforcing knowledge previously acquired, and stimulating faculty to think about new ideas. This paper describes a five-step strategy for integrating bulletin boards into a faculty development program.

The use of key informant networks in assessment of community health.

Program planning requires the acquisition of current, reliable information to accurately define the need for the program and to aid in developing its basic structure. In a time of financial restraint, a cost- and time-efficient method for collecting information for program development is important. This paper presents a strategy, borrowed from anthropology, that develops a network of key individuals in the community as a source of information and as a potential resource in program development. The effectiveness of this approach as a method for data collection is illustrated through application to a health and medical needs assessment of a geriatric population. A community diagnosis of this population was obtained.

Preoperative evaluation of the elderly surgical patient.

Family physicians are often requested to provide preoperative evaluation of elderly patients. Age independently increases the risk of morbidity and mortality in the perioperative period. In addition, the altered physiology of the older patient, in combination with the increased number of disease processes, increases the potential for complications. A comprehensive preoperative assessment includes an evaluation of the patient's present physiological functioning and attempts to detect the presence and status of any disease processes. Evaluation includes a thorough history, physical examination, and laboratory testing. Special considerations in preoperative assessment of the elderly patient include the assessment of nutrition, functional capabilities, and evaluation of the cognitive and emotional status of the patient. Special concerns include prophylaxis for deep vein thrombosis and pulmonary embolus, and antibiotic prophylaxis for endocarditis and for patients with joint prostheses.

Health and function in the old and very old.

This report advocates conceptual separation and parallel assessment of medically diagnosed health conditions and functional disability in clinical and epidemiological studies of the aged. Data from a study of urban elderly are presented to demonstrate how this can be done and to reexamine the meaning of self-reported illness and disability. One hundred thirteen subjects 74 to 95 years old, recruited from a longitudinal study of a representative sample of the elderly population of Cleveland, Ohio, participated in structured interviews and epidemiologically based medical examinations, conducted by a physician-nurse team at the place of residence. The presence or absence of 11 common chronic conditions was determined according to preestablished criteria, by self-report and, separately, by medical diagnostic evaluation. Functional disability was estimated by self-report and by physician-nurse assessment, using established measures of mobility and activities of daily living. Results indicate that interview self-report can provide useful estimates of the prevalence of medical conditions and functional disabilities in elderly populations, although self-report alone is not a sufficiently sensitive measure to be used for case-finding or diagnosis. When functional disabilities are matched against the specific medical conditions that cause them and disease-specific mortality is also taken into account, a three-dimensional classification results that has implications for future clinical and survey work with the elderly.

An anthropological approach to community diagnosis in family practice.

Developing a community oriented family practice requires gathering information about the community, its health problems and resources, and organizing these data into a community diagnosis. Viewing the community from both the insider and outsider perspectives allows the clinician to use social indicator data as well as subjective data from residents in the community. This paper describes the application of anthropological concepts in the process of community diagnosis within an urban teaching family practice.

Clinically applied anthropology: concepts for the family physician.

The incorporation of the sociobehavioral sciences into the teaching and practice of medicine has been a hallmark of family practice. The strong ecological orientation that family medicine shares with anthropology provides a unifying framework for incorporating anthropological concepts and techniques into clinical family practice. This paper presents an ecologically oriented framework for organizing and integrating individual, family (primary group), neighborhood (community), and societal level variables. Core anthropological concepts are presented within the context of this framework. The application of this approach is illustrated using case material derived from a five-year multidisciplinary experience in teaching these concepts to family practice residents.

Clinical magic and the art of examining children.

In examining children, clinical skills are a blend of specific examination techniques and a perceptive approach to a child during a clinical encounter. This paper applies the concepts of awareness, contact, and closure to the physician-patient relationship and describes specific techniques and behaviors that can aid in the achievement of the major objectives of the clinical encounter: (1) performance of an examination and obtaining the necessary diagnostic information, (2) development of a positive physician-patient relationship, and (3) observation of the parent-child subsystem during the office visit.

The geriatric patient in ecological perspective.

A hallmark of family medicine is the concern for the individual in the context of family and local community. For the geriatric patient in particular, these concerns far exceed the capabilities of the traditional biomedical model. A problem-solving approach to clinical problems is proposed which extends beyond pathophysiology to include biographical and ecological considerations. A case of an older couple is presented that serves to illustrate the importance of a multilevel approach to patient care and management.

An approach to locating a family practice office in a metropolitan area.

A simple, economically feasible approach to locating a family practice office within a metropolitan area is presented. The Grand Rapids area serves as the population base for this investigation. An Office Location-Population Profile is determined from census tract population data and known physician office distrubution. Based on this information, a subsegment of the total area is delineated as a possible neighborhood for an office location and a physician-opulation ratio for this subsegment is determined. This is compared with recommended ratios. A statistical profile of the population, within the area considered as a possible site location, is developed using information available through census bureau statistics. Finally, a direct survey of a random sample of households within the selected area is performed. This format provides an objective approach to facilitate rational decision making in locating a family practice office in a metropolitan area.