The current state of flexible sigmoidoscopy training in family medicine residency programs.

BACKGROUND AND OBJECTIVES: The US Preventive Services Task Force has recommended that adults ages 50 and over be screened for colorectal cancer. Flexible sigmoidoscopy (FS) is one available screening option. This study determined the current state of FS training in US family medicine residencies. METHODS: Directors of the Accreditation Council for Graduate Medical Education-accredited family medicine residencies were surveyed regarding FS training. RESULTS: Of 486 mailed surveys, 370 (76%) were completed and returned. Fifty-two percent of responding residency programs trained at least one resident in FS in 2003. Residents in these programs performed a mean of 20.1 +/- 1.2 FSs during their training. In 2003, 44% of family medicine graduates from these programs were certified by their programs as competent to perform FS. Fewer residents were certified in FS by programs in the eastern versus western United States. Military programs certified more residents than did nonmilitary programs. CONCLUSIONS: More than half of programs offered FS training, but less than half of family medicine graduates were certified by their programs as competent. There were significant differences for FS training by region and program type.

Evaluating perceptions of community-based physicians from a high-retention clerkship.

OBJECTIVE: This study's objective was to ascertain factors contributing to high retention of community-based sites and their physicians in a 3-decade-old family medicine clerkship. METHODS: Focus groups were conducted with community-based physicians from the Medical College of Georgia's family medicine clerkship. Transcripts were analyzed using an iterative process regarding physicians' initial and ongoing motivations for participating in the clerkship. RESULTS: Thirteen physicians participated. Six themes were generated: family medicine promotion, valued role of teaching, leadership style, clerkship ownership, resources, and challenges. CONCLUSIONS: In addition to intrinsic motivators such as valuing the role of teaching the next generation of physicians and promoting the family medicine specialty, the participative leadership style of a clerkship may be an important factor in physicians' decision to teach in a clerkship. The physicians in this study described having collegial working relationships with the clerkship leaders and receiving consistent support in implementing objectives. Physicians attributed their high level of involvement and investment as a product of being respected partners in defining the clerkship. Financial support and teaching resources were also considered salient. A follow-up study with a larger population is warranted to support the importance of leadership style and other external motivating factors toward a clerkship's physician retention.

The current state of colonoscopy training in family medicine residency programs.

BACKGROUND AND OBJECTIVES: The US Preventive Services Task Force has recommended that all adults ages 50 and over be screened for colorectal cancer. Colonoscopy is the most accurate screening procedure, but the feasibility of colonoscopy as a screening tool is limited by the number of physicians trained to perform it. This study determined the current state of colonoscopy training in US family medicine residency programs. METHODS: We surveyed program directors of all Accreditation Council for Graduate Medical Education-approved family medicine residency programs regarding colonoscopy training. RESULTS: The response rate was 94% (426 of 455). Forty-eight percent (n=201) of directors reported that their program offered colonoscopy training, but only 18% (n=75) of all respondents had actually trained one or more residents to do colonoscopies. Nationally, the mean number of colonoscopies performed per resident was 42.6 +/- 3.9. Regional differences were reported; residents trained in the western United States performed a mean of 69.8 +/- 12.8 colonoscopies per resident. Gastroenterologists in hospital-based gastroenterology suites trained approximately 75% of family medicine residents. Fifteen percent (n=64) of directors reported that 133 (4%) of their July 2002 graduates sought credentials to perform colonoscopy. CONCLUSIONS: Only a minority of family medicine graduates seek credentials to perform colonoscopy, and significant regional differences in training exist.

Medical students as health coaches.

OBJECTIVES: The purpose of this project was to teach students how to work effectively with patients in the area of health-behavior change. As part of the patient-doctor course, first-year medical students worked with diabetic patients who were selected by their primary physicians. In preparation for their patient interactions, students were taught basic communication concepts and the role of the relationship in improving patient outcomes, and continuity issues were addressed as students learned to collaboratively develop behavioral-change plans with their patients and then followed their patients' progress over the course of the year. DESCRIPTION: An educational research trial was conducted to compare the traditional community placement track (shadowing) with the health-coaches track. Students were randomly assigned to the two educational tracks. Health coaches were assigned in pairs to a family medicine patient with diabetes. Under supervision by the patient's medical provider, student pairs worked with the patient in an area of health-behavior change (i.e., weight loss, smoking cessation, exercise, or adherence to medication regimen). Students were required to have at least six patient contacts over the course of a year, consisting of at least three face-to-face visits and including one home visit. Didactic sessions with health coaches taught by either a behavioral consultant or health educator covered the basics of diabetes and behavior-change areas appropriate to respective patients. Students were also given reading assignments from communication and health-behavior change literature and handouts for patients. Behavior-change specialists were available as needed for consultation. In support of the health coaching process, students participated in eight small-group discussion sessions (eight students each) led by a behavioral change specialist. Small-group sessions lasted approximately 90 minutes each and contained didactic and experiential elements. Topics were: "Getting Started" (interviewing, the patient's story), "Fundamentals of a Home Visit," "Changing Behaviors" (stages of change, relapse prevention), "Home Visit Feedback" (report and reflections), "Challenging Patients to Change" (difficulties, challenging irrational ideas), "Giving Direct Guidance," "Non-verbal Skills," "Ending and Celebrating" (terminating the helping relationship). Evaluation methods included a pre- and post-physician belief scale completed by students, pre- and post-provider's evaluation of patient, and a patient-completed health behavior questionnaire. As available, patients' HbA1C levels were compared pre- and post-intervention. DISCUSSION: As expected, initially some health coach students complained about their perceived increased workloads compared with the workloads of students in the shadowing track. Some students also expressed reservations about their abilities to be effective with their patients, but these complaints diminished as students made contact with patients. For many, this opportunity to establish continuity relationships with patients helped students begin to understand difficulties inherent in effecting health-behavior change. Some students expressed appreciation for the opportunity to discuss their increased self-awareness about communication as well as relationship difficulties and strengths during the small-group sessions. Data analysis is under way. Lessons learned from this project influenced a major first-year curriculum revision the following year, resulting in increased emphasis on basic communication skills and the use of small groups to reach a variety of curricular objectives.