Absolute cardiovascular risk assessment by Australian early-career general practitioners: a cross-sectional study.

OBJECTIVE: To determine the prevalence and associations of general practice registrars' performing absolute cardio-vascular risk (ACVR) assessment (ACVRa). DESIGN: A cross-sectional study employing data (2017-2018) from the Registrar Clinical Encounters in Training project, an ongoing inception cohort study of Australian GP registrars. The outcome measure was whether an ACVRa was performed. Analyses employed univariable and multivariable regression. Analysis was conducted for all patient problems/diagnoses, then for an 'at-risk' population (specific problems/diagnoses for which ACVRa is indicated). SETTING: Three GP regional training organisations (RTOs) across three Australian states. PARTICIPANTS: GP registrars training within participating RTOs. RESULTS: 1003 registrars (response rate 96.8%) recorded details of 69 105 problems either with Aboriginal and/or Torres Strait patients aged 35 years and older or with non-Indigenous patients aged 45 years and older. Of these problems/diagnoses, 1721 (2.5% (95% CI 2.4% to 2.6%)) involved an ACVRa. An ACVRa was 'plausibly indicated' in 10 384 problems/diagnoses. Of these, 1228 (11.8% (95% CI 11.2% to 12.4%)) involved ACVRa. For 'all problems/diagnoses', on multivariable analysis female gender was associated with reduced odds of ACVRa (OR 0.61 (95% CI 0.54 to 0.68)). There was some evidence for Aboriginal and/or Torres Strait Islander people being more likely to receive ACVRa (OR 1.40 (95% CI 0.94 to 2.08), p=0.10). There were associations with variables related to continuity of care, with reduced odds of ACVRa: if the patient was new to the registrar (OR 0.65 (95% CI 0.57 to 0.75)), new to the practice (OR 0.24 (95% CI 0.15 to 0.38)) or the problem was new (OR 0.68 (95% CI 0.59 to 0.78)); and increased odds if personal follow-up was organised (OR 1.43 (95% CI 1.24 to 1.66)). For 'ACVRa indicated' problems/diagnoses, findings were similar to those for 'all problems/diagnoses'. Association with Aboriginal and/or Torres Strait Islander status, however, was significant at p<0.05 (OR 1.60 (95% CI 1.04 to 2.46)) and association with female gender was attenuated (OR 0.88 (95% CI 0.77 to 1.01)). CONCLUSION: Continuity of care is associated with registrars assessing ACVR, reinforcing the importance of care continuity in general practice. Registrars' assessment of an individual patient's ACVR is targeted to patients with individual risk factors, but this may entail ACVRa underutilisation in female patients and younger age groups.

Doctors' experiences when treating doctor-patients: a scoping review.

BACKGROUND: To work effectively, doctors need to look after themselves. They often delay seeking medical care for a range of reasons. Once they do, there is evidence that the doctors treating them ('treating doctors') can struggle to provide optimal care. AIM: To examine existing literature on what is currently known about experiences for treating doctors, in particular GPs, when their patient is also a doctor. DESIGN & SETTING: A scoping review of articles written in English. METHOD: Using the JBI methodological framework for scoping reviews, five databases (MEDLINE, PsycINFO, CINAHL [Cumulative Index to Nursing & Allied Health], Google Scholar, and Scopus) were searched from the database start date until 31 December 2022. Qualitative and quantitative studies reporting the treating doctor's experience, guidelines for treating doctors, expert opinion articles, and editorials were included. Grey literature was considered, searching the first 10 pages of two Google searches. RESULTS: Forty-eight articles from eight countries met inclusion criteria, of which 12 were research studies. The main areas of focus were as follows: affective responses, which included anxiety about being criticised, concern about upsetting the doctor-patient, and discomfort regarding the acknowledgement that doctors get sick; relational factors, which included boundary issues, over-identifying with the doctor-patient, treating them as a colleague rather than a patient, and role ambiguity; confidentiality, which incorporated both affective and relational aspects; and influence of medical culture and socialisation on dynamics between treating doctor and doctor-patient. These findings have been distilled into a list of key suggestions for the treating doctor. CONCLUSION: Doctors can find treating doctor-patients anxiety-provoking and challenging. The sources of this discomfort are multifaceted, and more empirical research is needed to better understand and address the complex relationship between treating doctor and doctor-patient.

Influenza presentations and use of neuraminidase inhibitors by Australian general practice registrars: a cross-sectional analysis from the ReCEnT study.

OBJECTIVE: This study aims to establish prevalence and associations of (1) influenza and influenza-like illness (IILI) presentations to Australian general practice (GP) registrars (trainees) and (2) the use of neuraminidase inhibitors (NAIs) by GP registrars for new presentations of IILI, for the 10 years leading up to the COVID-19 pandemic in Australia (2010-2019). DESIGN: This was a cross-sectional analysis of the Registrar Clinical Encounters in Training ongoing inception cohort study of the in-consultation experience and clinical behaviours of GP registrars. Data are collected by individual registrars three times (from 60 consecutive consultations each time) at 6 monthly intervals. Data include diagnoses/problems managed and medicines prescribed, along with multiple other variables. Univariate and multivariable logistic regression was used to establish associations of registrars seeing patients with IILI and of prescribing NAIs for IILI. SETTING: Teaching practices within the Australian general practitioner specialist vocational training programme. Practices were located in five of the six Australian states (plus one territory). PARTICIPANTS: GP registrars in each of their three compulsory 6-month GP training terms. RESULTS: From 2010 to 2019, 0.2% of diagnoses/problems seen by registrars were IILI. 15.4% of new IILI presentations were prescribed an NAI. IILI diagnoses were less likely in younger (0-14) and older (65+) age groups, and more likely in an area of higher socioeconomic advantage. There was considerable variation in NAI prescribing between regions. There was no significant association of prescribing NAIs with age or Aboriginal and/or Torres Strait Islander patients. CONCLUSIONS: IILI presentations were more likely among working-age adults and not among those groups at higher risk. Similarly, high-risk patient groups who would benefit most were not more likely to receive NAIs. The epidemiology and management of IILI has been distorted by the COVID-19 pandemic, but the burden of influenza in vulnerable populations must not be overlooked. Appropriately targeted antiviral therapy with NAIs influences outcomes for vulnerable patients. General practitioners manage the majority of IILI in Australia, and understanding GP IILI presentation and NAI prescribing patterns is a key first step to enabling sound and rational prescribing decisions for better patient outcomes.

Biopsy of Canada's family physician shortage.

Family physicians provide comprehensive care for the community and are an integral part of the healthcare system. Canada is experiencing a shortage of family physicians, driven in part by overbearing expectations of family physicians, limited support and resources, antiquated physician compensation, and high clinic operating costs. An additional factor contributing to this scarcity is the shortage of medical school and family medicine residency spots, which have not kept pace with population demand. We analysed and compared data on provincial populations and numbers of physicians, residency spots and medical school seats across Canada. Family physician shortages are the highest in the territories (>55%), Quebec (21.5%) and British Columbia (17.7%). Among the provinces, Ontario, Manitoba, Saskatchewan and British Columbia have the fewest family physicians per 100 000 persons in the population. Among the provinces that offer medical education, British Columbia and Ontario have the fewest medical school seats per population, while Quebec has the most. British Columbia has the smallest medical class size and the least number of family medicine residency spots as a function of population, and one of the highest percentages of provincial residents without family doctors. Paradoxically, Quebec has a relatively large medical class size and a high number of family medicine residency spots as a function of population, but also one of the highest percentages of provincial residents without family doctors. Possible strategies to improve the current shortage include encouraging Canadian medical students and international medical graduates to consider family medicine, and reducing administrative burdens for current physicians. Other steps include creating a national data framework, understanding physician needs to guide effective policy changes, increasing seats in medical schools and family residency programmes, providing financial incentives and facilitating entry into family medicine for international medical graduates.

Effectiveness, feasibility, and acceptability of behaviour change tools used by family doctors: a global systematic review.

BACKGROUND: Priority patients in primary care include people from low-income, rural, or culturally and linguistically diverse communities, and First Nations people. AIM: To describe the effectiveness, feasibility, and acceptability of behaviour change tools that have been tested by family doctors working with priority patients. DESIGN AND SETTING: A global systematic review. METHOD: Five databases were searched for studies published from 2000 to 2021, of any design, that tested the effectiveness or feasibility of tangible, publicly available behaviour change tools used by family doctors working with priority patients. The methodological quality of each study was appraised using the Mixed Methods Appraisal Tool. RESULTS: Thirteen of 4931 studies screened met the eligibility criteria, and described 12 tools. The health-related behaviours targeted included smoking, diet and/or physical activity, alcohol and/or drug use, and suicidal ideation. Six tools had an online/web/app-based focus; the remaining six utilised only printed materials and/or in-person training. The effectiveness of the tools was assessed in 11 studies, which used diverse methods, with promising results for enabling behaviour change. The nine studies that assessed feasibility found that the tools were easy to use and enhanced the perceived quality of care. CONCLUSION: Many of the identified behaviour change tools were demonstrated to be effective at facilitating change in a target behaviour and/or feasible for use in practice. The tools varied across factors, such as the mode of delivery and the way the tool was intended to influence behaviour. There is clear opportunity to build on existing tools to enable family doctors to assist priority patients towards achieving healthier lifestyles.

Impact of Australian general practice alcohol and other drugs education: a qualitative evaluation.

BACKGROUND: Many GPs are challenged to deliver safe and effective care for patients who use alcohol and other drugs (AOD). The Royal Australian College of General Practitioners (RACGP) developed the AOD GP Education Programme to support Australian GPs and optimise AOD care in the community. How the programme impacted GP participants is not yet fully understood. AIM: To explore the views and experiences of GP participants who completed the AOD GP Education Programme, and AOD experts who were involved in the programme as a presenter or mentor. DESIGN & SETTING: Situated in the constructivist paradigm, this qualitive descriptive study engaged GPs across Australia. METHOD: This study employed semi-structured, online, focus groups interviews. Data were analysed thematically. RESULTS: Five focus groups were held with a total of 35 GP participants. Five themes developed, which illustrated that the study participants viewed the programme design as comprehensive and flexible. It has also been shown that participants' individual learning needs were addressed. Impacts of the programme on clinical practice included the following: confidence to care for patients who use AOD; confidence to collaborate with colleagues in delivery of AOD care; confidence to develop AOD professional networks in their community setting; and confidence to manage complex AOD presentations. CONCLUSION: Participants described the AOD programme as a high quality and positive educational experience. The prioritisation of core treatment skills (whole-person care and structured approaches to behavioural change) was a feature of the professional development programme. The AOD programme design is a practical model to implement for future AOD GP education and continuing professional development.

Estrategia intersectorial para el perfeccionamiento del programa de médico y enfermera de la familia

Introducción: La Medicina Familiar cubana se enfrenta hoy a nuevos retos para su perfeccionamiento, esto implica realizar un fortalecimiento del primer nivel de atención para garantizar mejoría en la calidad de los servicios para lo cual la intersectorialidad se ha consolidado como pilar fundamental. Objetivo: Diseñar y evaluar una estrategia de intervención intersectorial para perfeccionar el programa del médico y la enfermera de la familia. Métodos: Se realizó un estudio cuasi experimental de intervención a través de una estrategia intersectorial para perfeccionar el programa del médico y enfermera de la familia, en el período de diciembre de 2019 a diciembre de 2022 en la provincia Las Tunas. El universo estuvo conformado por 867 trabajadores del cual se seleccionó una muestra de 330. Se realizó en cuatro etapas: diagnóstica, de intervención, validación y de evaluación. Se empleó como medida de resumen para variables cualitativas el porcentaje, para la validación estadística de los cambios antes y después la prueba de Mc Nemar y para la validación teórica de la estrategia intersectorial se utilizó la matriz de Chanlat. Resultados: La aplicación de la estrategia mejoró el nivel de conocimientos en los equipos básicos de salud y en los actores sociales, se revitalizaron el 93,5 % de las acciones comunitarias e intersectoriales, se modificó el cuadro de salud en el 89,4 % y se elevó en un 94,1 % el nivel de satisfacción de la comunidad con los servicios prestados por el consultorio médico de la familia. Se demostró que es pertinente la aplicación de la estrategia en la práctica social mediante los resultados de la efectividad esperada. Conclusiones: La estrategia permitió perfeccionar el programa del médico y enfermera de la familia a través de la puesta en práctica de un programa intersectorial de forma integral, consciente, participativo y sistemático.

Introduction: Cuban Family Medicine faces today new challenges for its improvement; this implies strengthening the first level of care to guarantee improvement in the quality of services for which intersectorality has been consolidated as a fundamental pillar. Objective: To design and to evaluate an intersectoral intervention strategy to improve the program of the family doctor and nurse. Methods: A quasi-experimental intervention study was carried out through an intersectoral strategy to improve the family doctor and nurse program, from December 2019 to December 2022 in Las Tunas. The universe consisted of 867 workers from which a sample of 330 was selected. It was carried out in four stages: diagnostic, intervention, validation and evaluation. The percentage was used as a summary measure for qualitative variables, for the statistical validation of the changes before and after the Mc Nemar test and for the theoretical validation of the intersectoral strategy the Chanlat matrix was used. Results: With the application of the strategy, the level of knowledge in the basic health teams and in the social actors was improved, 93.5 % of the community and intersectoral actions were revitalized, modified the health picture in 89.4 % and the level of satisfaction of the community with the services provided by the CMF increased by 94.1 %. It was demonstrated that the application of the strategy in social practice through the results of the expected effectiveness of the strategy. Conclusions: The strategy made it possible to improve the family doctor and nurse program through the implementation of an intersectoral program in a comprehensive, conscious, participatory and systematic way.

Reasons for No Colonoscopy After an Unfavorable Screening Result in Dutch Colorectal Cancer Screening: A Nationwide Questionnaire.

PURPOSE: We aimed to assess participant-reported factors associated with non-follow-up with colonoscopy in colorectal cancer (CRC) screening. METHODS: In May 2019, we distributed a nationwide cross-sectional questionnaire (n = 4,009) to participants in the Dutch CRC screening program who received a positive fecal immunochemical test (FIT). Among respondents who reported no colonoscopy, we assessed the presence of a contraindication, and those without were compared with those who reported colonoscopy by logistic regression analysis. RESULTS: Of 2,225 respondents (56% response rate), 730 (33%) reported no colonoscopy. A contraindication was reported by 55% (n = 404). Decisional difficulties (odds ratio [OR] = 0.29; 95% CI, 0.18-0.47), lacking the opportunity to discuss the FIT outcome (OR = 0.45; 95% CI, 0.28-0.72), and a low estimated risk of CRC (OR = 0.45; 95% CI, 0.26-0.76) were negatively associated with follow-up. Knowledge items negatively associated with follow-up included having an alternative explanation for the positive FIT (OR = 0.3; 95% CI, 0.21-0.43), having trust in the ability to self-detect CRC (OR = 0.42; 95% CI, 0.27-0.65), and thinking that polyp removal is ineffective (OR = 0.59; 95% CI, 0.43-0.82). The belief that the family physician would support colonoscopy showed the strongest positive association with follow-up (OR = 2.84; 95% CI, 2.01-4.02) CONCLUSIONS: Because decisional difficulties and certain convictions regarding CRC and screening are associated with non-follow-up, personalized screening counseling might be an intervention worth exploring as a means of improving follow-up in the Dutch CRC screening program. Involving family physicians might also prove beneficial.

[Communicative competence in family physicians in a family medicine unit]. / Competencia comunicativa de médicos familiares en una unidad de medicina familiar.

Background: Communication in the health field is essential, since it depends on it that the physician has complete and accurate information to carry out the fulfillment of his functions. The relationship with the medical staff leads the patient to feel listened to and cared for, in order to understand their state of health. Objective: To know the perception of patients about the communicative competence of family physicians during the consult at the Family Medicine Unit No. 27. Material and methods: Descriptive and cross-sectional study that identifies patients who attended Family Medicine Unit No. 27 in Tijuana in September 2021. The Communication Assessment Tool was applied to participants to measure the perception of communicative competence of doctors. The responses obtained were collected and analyzed with descriptive statistics. Results: 200 patients who met selection criteria were studied, made up of patients on morning and afternoon shifts equally. 54.6% of the studied population considers the communicative competence of family doctors to be excellent. Conclusions: The communicative competence in the family physicians of the studied unit had a better result than others studies of several countries; however, it has areas of opportunity to optimize this competence, since medical knowledge must include the area of communication and interpersonal relationships.

Introducción: la comunicación en el ámbito de la salud es fundamental, pues de ella depende que el médico cuente con información completa y precisa para realizar el cumplimiento de sus funciones. La vinculación con el personal médico conlleva al paciente a sentirse escuchado y atendido, a fin de que se comprenda su estado de salud. Objetivo: conocer la percepción de los pacientes acerca de la competencia comunicativa de los médicos familiares durante la consulta en la Unidad de Medicina Familiar No. 27. Material y métodos: estudio descriptivo y transversal en el que se identifica a pacientes que acudieron a la Unidad de Medicina Familiar No. 27 de Tijuana en septiembre de 2021. Se aplicó el instrumento Communication Assessment Tool a participantes para medir la percepción de la competencia comunicativa de los médicos. Se recolectaron las respuestas obtenidas y se analizaron con estadística descriptiva. Resultados: se estudiaron 200 pacientes que cumplieron criterios de selección, conformados por pacientes de turno matutino y vespertino equitativamente. El 54.6% de la población estudiada considera excelente la competencia comunicativa de los médicos familiares. Conclusiones: la competencia comunicativa en los médicos familiares de la unidad estudiada tuvo un mejor resultado que el de varios países; sin embargo, cuenta con áreas de oportunidad para optimizarla, ya que el conocimiento médico debe incluir el rubro de de comunicación y relaciones interpersonales.

Strength, Weakness, Opportunities and Treaths at Family and Community Medicine Residency Program in São Paulo state: a view of preceptors. / Forças, Oportunidades, Fraquezas e Ameaças a Programas de Residência em Medicina de Família e Comunidade no estado de São Paulo: um olhar dos preceptores.

Introduction: In the last decade, there has been an increase in vacancies in Residency Programs in Family and Community Medicine (RPFCM) in Brazil, without evaluation of their quality. Objective: To analyze aspects of the development of RPFCM in the state of São Paulo and its insertion in Primary Health Care from the perception of preceptors. Methodology: Descriptive study with the application of a quali-quantitative questionnaire with preceptors with the elaboration of the Strengths, Weaknesses, Opportunities and Threats (SWOT) matrix superimposing the Donabedian Triad (DT) from the Content Analysis. Descriptive statistics for preceptors' profile. Results: 67 people in 27 programs responded with a median age of 37 years and 52% were women. On average, there are 2 residents per preceptor and 67% work with graduation. 56.7% of the preceptors performed medical residency and 13.4% have degrees, 82% have preceptorship courses. The result of the qualitative analysis generated three major areas of interest: preceptor-resident relationship, preceptor-unit and preceptor-management, linked to DT. Discussion: The population studied is qualified for the position, with more than 70% specialists in the area and more than 80% trained to work in adult education. The perceptions of the preceptors built in the SWOT define the points of structure, process, and results of the programs, being essential in this moment of increase of vacancies in Brazil.

Introdução: Na última década houve aumento de vagas de Programas Residência em Medicina de Família e Comunidade (PRMFC) no Brasil, sem avaliação da qualidade deles. Objetivo: Analisar aspectos do desenvolvimento dos PRMFC no estado de São Paulo e sua inserção na Atenção Primária à Saúde a partir da percepção de preceptores. Metodologia: Estudo descritivo com aplicação de questionário quali-quantitativo com preceptores com a elaboração da matriz Forças, Oportunidades, Fraquezas e Ameaças (FOFA) sobrepondo a Tríade de Donabedian (TD) a partir da Análise de Conteúdo. Estatística descritiva para perfil dos preceptores. Resultados: 67 pessoas em 27 programas responderam com mediana de idade de 37 anos e 52% de mulheres. Em média, são 2 residentes por preceptor e 67% atuam com a graduação. 56,7% dos preceptores realizaram residência médica e 13,4% são titulados, 82% têm cursos de preceptoria. O resultado da análise qualitativa gerou três grandes áreas de interesse: relação preceptor-residente, preceptor-unidade e preceptor-gestão, vinculados a TD. Discussão: A população estudada é qualificada para o cargo, com mais de 70% especialistas na área e mais de 80% formada para atuar na educação de adultos. As percepções dos preceptores construídas na FOFA definem os pontos de estrutura, processo e resultados dos programas, sendo que essenciais nesse momento de aumento de vagas no Brasil.

Acceptability of a task sharing and shifting model between family physicians and physiotherapists in French multidisciplinary primary healthcare centres: a cross-sectional survey.

OBJECTIVES: The rising prevalence of musculoskeletal disorders increases pressure on primary care services. In France, patients with musculoskeletal disorders are referred to physiotherapist (PT) by family physician (FP). To improve access to musculoskeletal care, a new model of task sharing and shifting is implemented between FPs and PTs for patients with acute low back pain. This new model enables French PTs to expand their usual scope of practice by receiving patients as first-contact practitioner, diagnosing low back pain, prescribing sick leave and analgesic medication. The aim of this study is to investigate the acceptability of FPs and PTs regarding this new model. DESIGN: A cross-sectional survey design was used. Acceptability was measured using a questionnaire on the perception of the model and the perception of PTs' skills to manage low back pain. Descriptive analyses were performed to compare results among participants. SETTING: French FPs and PTs working in multidisciplinary primary healthcare centres were invited to complete an online survey. PARTICIPANTS: A total of 174 respondents completed the survey (81 FPs and 85 PTs). RESULTS: A majority of participants had a positive perception of the task sharing and shifting model. A majority of the participants were mostly or totally favourable towards the implementation of the model (FPs: n=46, 82% and PTs: n=40, 82%). The perceived level of competencies of PTs to manage acute low back pain was high. The confidence level of FPs was higher than that of PTs regarding PTs' ability to adequately diagnose low back pain, refer patient to physiotherapy and prescribe sick leave or analgesic medication. CONCLUSION: Based on this limited sample of participants, there appears to be good acceptability of the task sharing and shifting model for acute low back pain. Additional studies are needed to better determine the factors affecting the acceptability of such a model.

Development and validation of the scale for measuring biopsychosocial approach of family physicians to their patients.

OBJECTIVE: While other models focus more on disease and pathophysiology, the biopsychosocial approach emphasises the importance of human health and disease in their fullest contexts. If we are to gain an insight into physical and psychological health needs, and address them quickly and adequately, it is important that we recognise them already at the family practice stage. An approach that assesses needs at patient level could also be seen as patient-centred care, which is one of the key elements of high-quality care. To the best of our knowledge, no scale for measuring the biopsychosocial approach of family physicians has yet been developed. DESIGN: The aim of this study was to develop and validate a scale that measures the biopsychosocial approach of family physicians to their patients through the Delphi and validation process. SETTING: The scale was developed through the Delphi study and validated by means of significant statistical methods. Pearson's correlation coefficient, Cronbach's alpha, the intracorrelation coefficient, the Spearman-Brown coefficient and exploratory factor analysis were applied. PARTICIPANTS: Five family physicians took part in a brainstorming process and 24 family medicine experts took part in the Delphi study. For the first part of the validation process, there were 31 family medicine trainees in the first group and 32 in the second group. For the last part of the validation process, 164 family physicians completed the scale. RESULT: Through the Delphi study, 39 final items covering three areas within the biopsychosocial approach were identified. Construct validity was high, with positive linear correlation and good face validity. The intraclass correlation coefficient for test-retest reliability was 0.862. The Spearman-Brown coefficient was the highest (0.931) on an even and odd division. Factor rotation showed that three factors on 35 items explained 39.5% of variances. The final internal consistency on 35 items was 0.911. CONCLUSION: The developed scale measures the biopsychosocial dimension of family physicians' work with high Cronbach's alpha measures and good validity.

Study on the influence of residents′ psychological contracts on their behavioral intentions from the perspective of incomplete contracts / 中华医院管理杂志

Objective:To analyze the psychological contract satisfaction of contracted residents and its impact on their behavioral intentions under the guidance of incomplete contract theory, for reference in improving the effectiveness of contracted family doctor services.Methods:1 100 contracted residents from nine townships/streets in Shandong province were selected as subjects according to stratified random sampling from September 2019 to June 2020, and a questionnaire survey on the level of satisfaction of contracted residents′ psychological contracts(24 items) and assessment of behavior intentions(9 items) was conducted, and the model of the effect of contracted residents′ psychological contracts on behavior intentions was established and analyzed. The correlation was validated by Pearson test and the structural equation method was used for verifying the model.Results:998 valid questionnaires were recovered. The psychological contract satisfaction score of the contracted residents was 3.45±0.56 and the behavioral intention was 2.81±0.29. Both transactional and relational psychological contracts were correlated with all dimensions of behavioral intention( P<0.01). Concerning the impacts of residents′ psychological contracts on behavioral intentions, the effect coefficients of transactional psychological contracts on loyalty intention, voice intention, exit intention and neglect intention were 0.33, 0.24, -0.25 and -0.49 respectively, with an indirect effect on neglect intention; the effect coefficients of relational psychological contracts on loyalty intention, voice intention, exit intention and neglect intention were 0.26, 0.10, -0.14 and -0.50 respectively, with an indirect effect on advice intention and neglect intention. Conclusions:Residents′ psychological contract has yet not been effectively satisfied. Satisfying and improving the residents′ psychological contract can directly enhance their loyalty intention and reduce their exit intention, indirectly influencing the voice and neglect intentions. In order to enhance the effectiveness of family doctor contracted services and improve the healthcare experience of contracted residents, it is suggested that the relevant departments should actively take the following measures, including carrying out a survey on the psychological contract of contracted residents, building a provincial-city-county-township collaborative linkage platform, and so on.

Profile and Migration of Members of Residency Programs in Family Medicine / Perfil e migração de membros dos Programas de Residência em Medicina de Família e Comunidade

ABSTRACT OBJECTIVE To describe the sociodemographic profile and analyze the migratory characteristics of the members of the Residency Programs in Family Medicine in 2020 in Brazil. METHODS The study follows a cross-sectional observational design of a quantitative nature from the perspective of the members of the Residency Programs in Family Medicine. Questionnaires adapted for each participating group were developed, applied through an online platform. RESULTS Most participants are female and white. Most supervisors and preceptors were residents of Residency Programs in Family Medicine, however, there are some who are not specialists in the field. Most participants are based in capitals or metropolitan regions. In relation to retention, 41.1% of supervisors and 73.1% of preceptors are affiliated to a program in the same municipality where they lived. For most resident physicians, the place of residence coincides with the place of birth and/or graduation (57.4%), and 48.5% are in the same place of graduation. CONCLUSIONS The research reinforces the need for policies to promote the migration of residents to Residency Programs in Family Medicine outside capital cities and metropolitan regions, as well as encouraging the retention of graduates trained outside large urban centers so that they can contribute to distribution and provision of doctors where they are still needed.

RESUMO OBJETIVO Caracterizar o perfil sociodemográfico e analisar as características migratórias dos integrantes dos Programas de Residência em Medicina de Família e Comunidade em 2020 no Brasil. MÉTODOS O estudo segue um delineamento observacional transversal de natureza quantitativa a partir da perspectiva dos integrantes dos Programas de Residência em Medicina de Família e Comunidade. Foram desenvolvidos questionários adaptados para cada grupo participante, aplicados por meio de plataforma on-line. RESULTADOS A maioria dos participantes é do sexo feminino e de cor branca. A maioria dos supervisores e preceptores foi residente de Programas de Residência em Medicina de Família e Comunidade, contudo, há alguns que não são especialistas na área. A maior parte dos participantes está vinculada às capitais ou regiões metropolitanas. Em relação à fixação, 41,1% dos supervisores e 73,1% dos preceptores estão vinculados a um programa no mesmo município onde foram residentes. Para a maioria dos médicos residentes, o local da residência coincide com o local de nascimento e/ou graduação (57,4%), sendo que 48,5% estão no mesmo local de graduação. CONCLUSÕES A pesquisa reforça a necessidade de políticas de promoção da migração de residentes para Programas de Residência em Medicina de Família e Comunidade fora das capitais e regiões metropolitanas, bem como estimula a fixação dos egressos formados fora dos grandes centros urbanos para que eles possam contribuir com a distribuição e com o provimento de médicos onde ainda é necessário.

Uso de la biblioteca médica por residentes de Medicina General Integral del municipio de Niquero / Use of the medical library by residents of Comprehensive General Medicine specialty in Niquero municipality

RESUMEN Fundamento: Las bibliotecas constituyen una fuente indispensable de recursos instructivos para la sociedad en general. En el campo de las Ciencias Médicas contribuyen a la formación de especialistas en Medicina General Integral. Objetivo: Determinar el uso que hacen de la Biblioteca Médica los residentes de la especialidad de Medicina General Integral del Policlínico "Ernesto Guevara" de Niquero. Metodología: Se realizó un estudio observacional descriptivo, de corte transversal. El universo de estudio estuvo conformado por los 51 residentes de esta especialidad. Se utilizaron métodos teóricos, empíricos y estadísticos-matemáticos (frecuencia absoluta y porcentaje). Las variables estudiadas fueron: frecuencia de visita, uso de los servicios prestados y las fuentes de información consultadas. Resultados: Predominaron los residentes que visitaban la biblioteca ocasionalmente (56.9 %). El servicio más demandado fue la búsqueda de información (92.2 %). La fuente de información que más se usó fue la consulta de revistas, el 96.1 % de los encuestados. Conclusiones: Teniendo en cuenta los resultados, existen fisuras en la interacción de los usuarios (médicos-residentes) con las oportunidades opciones que ofrece la Biblioteca Médica del municipio de Niquero, lo cual se evidencia en el limitado aprovechamiento que realizan de este servicio los futuros especialistas en Medicina General Integral.

ABSTRACT Background: Libraries are an indispensable source of instructional resources for society in general. In the field of Medical Sciences, they contribute to the training of specialists in Comprehensive General Medicine. Objective: To determine the use that residents of the Comprehensive General Medicine specialty of the `` Ernesto Guevara '' Polyclinic in Niquero make of the Medical Library. Methodology: A cross-sectional, descriptive observational study was carried out. The study universe was made up of the 51 residents of this specialty. Theoretical, empirical and statistical-mathematical methods (absolute frequency and percentage) were used. The variables studied were: frequency of visits, use of the services provided and the sources of information consulted. Results: Residents who visited the library occasionally predominated, 56.9%. The information search was the service mostly known by them, 92.2%. The most requested source of information was the consultation of magazines, 96.1% of those surveyed. Conclusions: According to the results of the study, it is necessary to take full advantage of the strengths offered by the Medical Library in the municipality of Niquero to increase the informational competencies in residents of the Comprehensive General Medicine specialty, for their training with great scientificity.

Lower Likelihood of Burnout Among Family Physicians From Underrepresented Racial-Ethnic Groups.

PURPOSE: We investigated whether physician race and ethnicity were associated with burnout among a nationally representative sample of family physicians. METHODS: We undertook a cross-sectional observational study using survey data from 1,510 American Board of Family Medicine recertification applicants in 2017 and 1,586 respondents to the 2017 National Graduate Survey. Of the 3,096 total family physicians, 450 (15%) were from racial and ethnic groups underrepresented in medicine. We used structural equation models to test the effects of underrepresented status on single-item measures of emotional exhaustion and depersonalization. RESULTS: Family physicians underrepresented in medicine were significantly less likely than their non-underrepresented counterparts to report emotional exhaustion (adjusted odds ratio = 0.82; 95% CI, 0.69-0.99; total effect) and depersonalization (adjusted odds ratio = 0.54; 95% CI, 0.41-0.71; total effect). The underrepresented physicians were more likely than non-underrepresented peers to practice in more racially and ethnically diverse counties and less likely to practice obstetrics, both of which partly mediated the protective effect of underrepresented status on depersonalization. CONCLUSIONS: Although factors such as racism might be expected to adversely affect the well-being of underrepresented clinicians, underrepresented family physicians reported a lower frequency of emotional exhaustion and depersonalization. The mediating protective effect of working in more racially and ethnically diverse counties is consistent with evidence of the beneficial effect of cultural diversity on health outcomes for minorities. Because physician burnout is a known predictor of job turnover and may also be associated with poorer quality of care, the lower burnout observed among underrepresented family physicians may be an asset for the health care system as a whole.

Characterising generalism in clinical practice: a systematic mixed studies review protocol.

BACKGROUND: Generalist physician care is associated with improved patient outcomes. Despite initiatives to promote generalism in educational settings, recruitment to generalist disciplines remains less than required to serve societal needs. Increasingly this impacts not just general practice but also generalist specialties such as internal medicine, surgery, and paediatrics. One potential factor for this deficit is a lack of explicit attention to generalism as a praxis, including clarifying key aspects of generalist expertise. AIM: To examine empirical clinical literature on generalism, and characterise how generalism is described and delivered by physicians in primary and secondary care. DESIGN & SETTING: A systematic mixed studies review (SMSR) including quantitative, qualitative, mixed-methods studies, and systematic reviews of physician generalist practice. METHOD: MEDLINE, Psycinfo, SocINDEX, Embase, Ovid HealthSTAR, Scopus, and Web of Science will be searched for English language studies from 1999 to present, using a structured search. Given study heterogeneity, quality appraisal will not be performed. Two reviewers will perform study selection for each study. Data extraction will focus on how generalism is defined and characterised, including the clinical care provided by generalists and patient experiences of generalist care. Quantitative and qualitative data will be summarised in tabular and narrative form. Convergent synthesis design will then be used to synthesise quantitative and qualitative data. CONCLUSION: Findings will characterise generalism and generalist practice from a grassroots clinical perspective. By identifying similarities and differences across generalist disciplines, this work will inform more focused educational initiatives on generalism at undergraduate and postgraduate level, including collaborations between generalist disciplines.

Perspectives on expert generalist practice among Japanese family doctor educators: a qualitative study.

BACKGROUND: Expert generalist practice (EGP) is increasingly being viewed as the defining expertise of generalist care. In Japan, several prominent family doctors consider it important and relevant in the Japanese context. However, no study has examined Japanese family doctor educators' perceptions of EGP. AIM: To explore Japanese family doctor educators' perceptions of EGP. DESIGN & SETTING: A qualitative study among family doctor educators in Japan. METHOD: Focus group interviews were conducted using a semi-structured interview guide following a short lecture on EGP. A qualitative description method was adopted and the framework method was used to conduct thematic analysis. RESULTS: Participants were 18 family medicine doctor educators, including 11 directors and six associate directors of family medicine training programmes. The results suggested that the concept of EGP was important and applicable to primary care in Japan. Participants' perceptions on EGP pertained to the following four areas: impact of EGP, triggers for EGP, enablers for EGP, and educational strategies for EGP. CONCLUSION: The concept of EGP may be useful in clinical practice in Japan, especially in complex patient care. A clearer framework for or description of EGP, and of non-traditional methods, such as ascetic practice and awareness of the self, were proposed as possible educational strategies.