Global Health in Family Medicine Residency Programs: A Nationwide Survey of US Residency Directors: A CERA Study.

BACKGROUND AND OBJECTIVES: Interest in global health (GH) has increased significantly among medical trainees in the past 3 decades. Despite the potential for family medicine to be a major contributor to GH, there are no recent, large-scale studies of GH education and experiences in family medicine training. This study was designed to assess current opportunities, educational activities, resident interest, perceived program benefits, and barriers to international and domestic GH training in US family medicine residencies. METHODS: Data for this study were elicited as part of a 2015 survey conducted by the Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA). The nationwide, web-based survey was sent to 452 family medicine residency program directors. RESULTS: A total of 257 program directors completed the GH portion of the survey. A total of 74.3% of programs offered international or domestic GH experiences. Program directors identified preparing physicians to practice underserved medicine and teaching community medicine or public health as primary goals for GH training. Program directors also reported that GH opportunities were important for attracting future residents. Programs offered a variety of preparatory activities to their residents. Funding and time constraints were identified as the primary barriers to GH training in residency. CONCLUSIONS: Global health continues to be a focus of interest in the training of family medicine residents while attracting the passion of student applicants and residents.

Telemedicine in education: bridging the gap.

BACKGROUND: The increasing cost and inequitable access to quality healthcare, coupled with the merger of the information technology and health service sectors, has given rise to the modern field of telemedicine. Telemedicine, meaning medicine at a distance, allows us to transcend geographic and socioeconomic boundaries to deliver high quality care to remote and/or in-need patients. As technology becomes more affordable and a physician shortage looms, telemedicine is gaining attention as a possible solution to healthcare delivery. Simultaneously, telemedicine holds great promise with regard to medical education. Several studies integrating telemedicine in medical education have shown positive outcomes, demonstrating similar or greater efficacy compared with traditional educational methods with high student-reported enthusiasm. Other domestic and international telemedicine projects, largely spearheaded by universities, have also achieved great success. DISCUSSION: In a novel approach, by pairing medical schools with in-need partner communities, utilizing similar faculty resources as traditional learning methods with standardized patients, students can gain valuable experience and skills while serving actual patients. This progressive approach to medical education fosters collaboration, communication, longitudinal care and teaches students needed skills for their future practices as 21 st Century healthcare providers.

Toward a common framework for rural background.

BACKGROUND AND OBJECTIVES: To develop a standardized framework to discuss rural background, a review of the literature to identify studies regarding the association of rural background with primary care and/or rural health practice was conducted. The various definitions of rural background were collated and from this data a framework for the conceptualization of rural background is proposed. METHODS: The Medline database from 1966-2009 was searched to find citations that included a rural background definition as a variable for rural intent to practice, rural career choice, or rural practice. Studies that included medical school admission outcomes of US medical schools were included if there was (1) a definition of rural background noted, (2) a research-based question, and (3) a defined outcome of rural practice intent or practice in rural area. RESULTS: A full text review was completed for all 45 articles identified. After applying the inclusion and exclusion criteria to the full length articles, there were 15 articles included in the review. The five most common definitions of rural background were (1) a positive answer to the question "Did you grow up in a rural area"? (2) a rural county of birth, (3) grew up in a town of less than 10,000 persons, (4) graduation from a high school located in a town of less than 10,000 persons, and (5) self-declared rural county of residence. CONCLUSIONS: There are multiple terms used in research to elucidate the conceptualization of rural background. Based on a definition of rural as the "anchor," we propose the use of the five most common definitions of rural background as "rural connectors" that can be used to buttress the definition of rural background. The framework of rural connectors can then be used to more closely define rural background.

Braces and splints for musculoskeletal conditions.

Braces and splints can be useful for acute injuries, chronic conditions, and the prevention of injury. There is good evidence to support the use of some braces and splints; others are used because of subjective reports from patients, relatively low cost, and few adverse effects, despite limited data on their effectiveness. The unloader (valgus) knee brace is recommended for pain reduction in patients with osteoarthritis of the medial compartment of the knee. Use of the patellar brace for patellofemoral pain syndrome is neither recommended nor discouraged because good evidence for its effectiveness is lacking. A knee immobilizer may be used for a limited number of acute traumatic knee injuries. Functional ankle braces are recommended rather than immobilization for the treatment of acute ankle sprains, and semirigid ankle braces decrease the risk of future ankle sprains in patients with a history of ankle sprain. A neutral wrist splint worn full-time improves symptoms of carpal tunnel syndrome. Close follow-up after bracing or splinting is essential to ensure proper fit and use.

Examining the adoption of electronic health records and personal digital assistants by family physicians in Florida.

PURPOSE: The purpose of this paper is to comprehensively characterise the current use of electronic health records (EHRs) and personal digital assistants (PDAs) among family physicians in Florida; and to compare family physicians with other doctors with respect to the functions commonly used on their EHR and PDA systems. METHODS: A postal survey was sent to family physicians (n=2076) and other doctors with a clear and active licence in Florida (total n=14 921). To examine factors among family physicians related to EHR and PDA use, binary logistic regression modelling techniques were utilised. Chi-square analysis was used to compare EHR and PDA functions between family physicians and other doctors. RESULTS: A total of 4203 responses, of which 756 were from family physicians, were available for the current study (28.2% overall response rate). EHR use among family physicians was significantly related to large practice size, urban location and young physician age, after controlling for confounders. Likewise, PDA usage among family physicians was independently associated with male gender and younger physician age. Additionally, even though no differences in overall EHR adoption were found, family physicians, when compared with other physicians, were significantly more likely to be using a more robust set of EHR functions. This included allergy and medication lists, diagnosis, problem lists, patient scheduling and educational materials, preventive services reminders and access to reference material. CONCLUSIONS: Even though family physicians utilise many EHR and PDA functions more commonly than other physician groups, the overall level of EHR adoption among family physicians remains low. Until more barriers to the use of EHR are minimised, the goals of the Future of Family Medicine Report to broadly implement EHR and other health IT functions will not be fully realised.

Heat illness in athletes: the dangerous combination of heat, humidity and exercise.

In 1980, 1700 people died during a prolonged heat wave in a region under-prepared for heat illness prevention. Dramatically underreported, heat-related pathology contributes to significant morbidity as well as occasional mortality in athletic, elderly, paediatric and disabled populations. Among US high school athletes, heat illness is the third leading cause of death. Significant risk factors for heat illness include dehydration, hot and humid climate, obesity, low physical fitness, lack of acclimatisation, previous history of heat stroke, sleep deprivation, medications (especially diuretics or antidepressants), sweat gland dysfunction, and upper respiratory or gastrointestinal illness. Many of these risk factors can be addressed with education and awareness of patients at risk. Dehydration, with fluid loss occasionally as high as 6-10% of bodyweight, appears to be one of the most common risk factors for heat illness in patients exercising in the heat. Core body temperature has been shown to rise an additional 0.15-0.2 degrees C for every 1% of bodyweight lost to dehydration during exercise. Identifying athletes at risk, limiting environmental exposure, and monitoring closely for signs and symptoms are all important components of preventing heat illness. However, monitoring hydration status and early intervention may be the most important factors in preventing severe heat illness.

Effects of physician supply on melanoma incidence and mortality in Florida.

BACKGROUND: Increasing supplies of dermatologists and family physicians have been associated with earlier detection of malignant melanoma. We investigated whether physician supply was similarly related to incidence and mortality rates of malignant melanoma. METHODS: Using the state tumor registry, we determined melanoma incidence and mortality rates for the years 1993 to 1995 for each Florida county. We measured physician supply for each Florida county using data from the 1994 American Medical Association Physician Masterfile. Multiple linear regression analysis was used to determine relationships between physician supply and melanoma incidence and mortality rates, controlling for other county-level characteristics. RESULTS: Among male patients, an increasing supply of family physicians was associated with higher melanoma incidence and lower melanoma mortality. Increasing supplies of dermatologists were associated with lower overall melanoma mortality rates, and increasing supplies of general internists were associated with higher overall melanoma mortality. CONCLUSION: We found that melanoma incidence and mortality rates varied substantially among Florida's 67 counties, and that differences in physician supply explained some of this variability. Further study is needed to confirm these findings and to elucidate possible mechanisms that would account for these associations.

Sun protection of children at the beach.

BACKGROUND: We wanted to determine the frequency with which sun protection measures are used by children at the beach. METHODS: A cross-sectional study was undertaken that combined a brief, structured interview with direct observation of the sun protection methods (sunscreen, clothing, hats, shade) used for children at a public beach in Florida. RESULTS: Of the 139 children observed, 97 (69.8%) had some form of sun protection used on all three body regions (head, torso, legs), while only 8 (5.8%) had none of the three body regions protected. Sunscreen was the most common method of sun protection (84.9%), and other methods were less frequently used (shirt 11.5%, pants 26.6%, hat 8.6%, shade 14.4%). Sun protection use differed by sex, with girls having better protection of their head and torso, and boys slightly better protection of their legs. CONCLUSIONS: Using direct observation, we found that parents frequently use sun protection measures (mainly sunscreen) for their children while at the beach. Parents primarily rely on the use of sunscreen, rather than such measures as avoiding the sun, using shade, or protective clothing.