Kelly, Kimberly M.; Love, Margaret M.; Pearce, Kevin A.; Porter, Kyle; Barron, Mary A.; Andrykowski, Michael
Context: Challenges to the identification of hereditary cancer in primary care may be more pronounced in rural Appalachia, a medically underserved region. Purpose: To examine primary care physicians' identification of hereditary cancers. Methods: A cross-sectional survey was mailed to family physicians in the midwestern and southeastern United…
Whitley, Heather P.
Purpose: To quantify the monetary value of medications provided to rural Alabamians through provision of pharmaceutical manufacturer-sponsored prescription assistance programs (PAPs) provided by a clinical pharmacist in a private Black Belt family medicine clinic during 2007 and 2008. Methods: Patients struggling to afford prescription medications…
Hustedde, Carol; Paladine, Heather; Wendling, Andrea; Prasad, Rupa; Sola, Orlando; Bjorkman, Sarah; Phillips, Julie
The USA needs more rural physicians. Although women represent half of all US trained medical students, the rural physician workforce has remained predominantly male. Insight is needed into what makes rural practice attractive for women and which practice characteristics allow women physicians to practice successfully in rural areas. This study's purpose was to examine aspects of the practice environment that impact women physicians' professional satisfaction and commitment to rural medicine. Twenty-five women family physicians practicing in rural areas of the USA were interviewed by phone using a semi-structured format. Transcribed interviews were analyzed using an immersion and crystallization approach. Emergent themes were identified, coded, and discussed until team consensus was attained. Interviews continued until saturation of themes was reached. Three themes emerged from the data, in relationship to practice and employment attributes that contribute to US women physicians' professional satisfaction and willingness to remain in a rural setting: professional relationships, practice characteristics, and support during times of transition. Participants placed high importance on professional relationships, both within and outside of their rural practice. Rural women physicians enjoyed practicing an expanded scope of care, valued loan repayment opportunities, and appreciated supportive practice partners. Importantly, women physicians who found themselves struggling to maintain rural careers often had experienced difficulty during times of practice transition, including maternity leaves. Understanding practice attributes valued by successful rural women family physicians in the USA will help rural health systems, practices, and physicians-in-training to develop and evaluate opportunities that will best contribute to successful rural practice. Supporting women physicians during periods of practice transition may improve retention.
Heisler, Jean; Huber, Thomas; Huntington, Mark K
The healthcare workforce is a priority in South Dakota. It has been estimated that 8,000 additional healthcare workers beyond those in practice in 2010 will be needed by 2020. In 2016, the South Dakota Department of Health included in its budget funds for the development of a new Rural Family Medicine Residency Training Program as one of the steps toward addressing the physician component of these workforce needs. This new program has just received its accreditation and is recruiting the inaugural class of resident physicians for the spring of 2018. This article provides a concise overview of the program's initial development. Copyright© South Dakota State Medical Association.
Shumer, Gregory; Warber, Sara; Motohara, Satoko; Yajima, Ayaka; Plegue, Melissa; Bialko, Matthew; Iida, Tomoko; Sano, Kiyoshi; Amenomori, Masaki; Tsuda, Tsukasa; Fetters, Michael D
There is growing interest in the use of complementary and alternative medicine (CAM) throughout the world, however previous research done in Japan has focused primarily on CAM use in major cities. The purpose of this study was to develop and distribute a Japanese version of the International Complementary and Alternative Medicine Questionnaire (I-CAM-Q) to assess the use of CAM among people who visit rural Japanese family medicine clinics. Using a Japanese version of the International Complementary and Alternative Medicine Questionnaire (I-CAM-Q), a cross-sectional survey was conducted in three rural family medicine clinics. All patients and those accompanying patients who met inclusion criteria were eligible to participate. Data were entered into SPSS Statistics and analyzed for use by age, gender, and location. Of the 519 respondents who participated in the project, 415 participants reported CAM use in the past 12 months (80.0%). When prayer is excluded, the prevalence of CAM use drops to 77.3% in the past year, or 403 respondents. The most common forms of CAM used by respondents were pain relief pads (n = 170, 32.8%), herbal medicines/supplements (n = 167, 32.2%), and massage by self or family (n = 166, 32.0%). Female respondents, individuals with higher levels of education, and those with poorer overall health status were more likely to use CAM than respondents without these characteristics. Only 22.8% of CAM therapies used were reported to physicians by survey participants. These data indicate that CAM use in rural Japan is common. The results are consistent with previous studies that show that Japanese individuals are more interested in forms of CAM such as pain relief pads and massage, than in mind-body forms of CAM like relaxation and meditation. Due to the high utilization of certain CAM practices, and given that most CAM users do not disclose their CAM use to their doctors, we conclude that physicians in rural Japan would benefit by asking about CAM use
Avery, Daniel M., Jr.; Wheat, John R.; Leeper, James D.; McKnight, Jerry T.; Ballard, Brent G.; Chen, Jia
Purpose: The Rural Medical Scholars Program (RMSP) was created to increase production of rural family physicians in Alabama. Literature review reveals reasons medical students choose careers in family medicine, and these reasons can be categorized into domains that medical schools can address through admission, curriculum, and structural…
Rourke, James; Asghari, Shabnam; Hurley, Oliver; Ravalia, Mohamed; Jong, Michael; Graham, Wendy; Parsons, Wanda; Duggan, Norah; O'Keefe, Danielle; Moffatt, Scott; Stringer, Katherine; Sturge Sparkes, Carolyn; Hippe, Janelle; Harris Walsh, Kristin; McKay, Donald; Samarasena, Asoka
Rural recruitment and retention of physicians is a global issue. The Faculty of Medicine at Memorial University of Newfoundland, Canada, was established as a rural-focused medical school with a social accountability mandate that aimed to meet the healthcare needs of a sparse population distributed over a large landmass as well as the needs of other rural and remote areas of Canada. This study aimed to assess whether Memorial medical degree (MD) and postgraduate (PG) programs were effective at producing physicians for their province and rural physicians for Canada compared with other Canadian medical schools. This retrospective cohort study included medical school graduates who completed their PG training between 2004 and 2013 in Canada. Practice locations of study subjects were georeferenced and assigned to three geographic classes: Large Urban; Small City/Town; and Rural. Analyses were performed at two levels. (1) Provincial level analysis compared Memorial PG graduates practicing where they received their MD and/or PG training with other medical schools who are the only medical school in their province (n=4). (2) National-level analysis compared Memorial PG graduates practicing in rural Canada with all other Canadian medical schools (n=16). Descriptive and bivariate analyses were performed. Overall, 18 766 physicians practicing in Canada completed Canadian PG training (2004-2013), and of those, 8091 (43%) completed Family Medicine (FM) training. Of all physicians completing Canadian PG training, 1254 (7%) physicians were practicing rurally and of those, 1076 were family physicians. There were 379 Memorial PG graduates and of those, 208 (55%) completed FM training and 72 (19%) were practicing rurally, and of those practicing rurally, 56 were family physicians. At the national level, the percentage of all Memorial PG graduates (19.0%) and FM PG graduates (26.9%) practicing rurally was significantly better than the national average for PG (6.4%, p<0.000) and FM (12
Full Text Available Background & purpose: Since 2005, a reform known as Rural Insurance and Family Medicine Scheme has introduced to primary health care network in Iran in rural areas and small towns. The content of the reform implies a substantial change in those aspects of health centers that mainly could be categorized as structural quality. Although, this is the requirement of all health care providers, they are not identical in those items. In this article, we have tried to report the relation between structural quality of health centers and utilization of curative care in Mazandran province. Materials & Methods: This was a cross-sectional study conducted in 2013. Secondary and routinely collected data was used to answer the research questions. The source of original data was provincial health authority’s data set. A check list containing pre-identified variables was used to extract the data. Using SPSS software package, regression analysis was run to measure the role of different independent variable on dependent variable. Results: There were 215 rural health centers affiliated to 16 cities or small towns that the reform has taken place. The outreach area population of these health centers was 1ˏ330ˏ212 of which 834ˏ189 (62.71% were covered by rural insurance solely. Health centers are not identical in terms of the characteristics of health centers and their utilization. Among the variables with significant impact on the utilization of outpatient care, except for number of physician in each health centre and existence of state owned pharmacy that were found in some health centers, the rest of variables had significant positive impact on the demand for physician visit. Conclusion: Structural quality has significant impact on the utilization of curative care of primary healthcare units at rural area in Iran. The reform seems well targeted the quality improvement and utilization of effective primary health care.
Nicholas E. Hagemeier
Full Text Available Purpose: Practice-based research networks (PBRN seek to shorten the gap between research and application in primary patient care settings. Inclusion of community pharmacies in primary care PBRNs is relatively unexplored. Such a PBRN model could improve care coordination and community-based research, especially in rural and underserved areas. The objectives of this study were to: 1 evaluate rural Appalachian community pharmacy key informants’ perceptions of PBRNs and practice-based research; 2 explore key informants’ perceptions of perceived applicability of practice-based research domains; and 3 explore pharmacy key informant interest in PBRN participation. Methods: The sample consisted of community pharmacies within city limits of all Appalachian Research Network (AppNET PBRN communities in South Central Appalachia. A descriptive, cross-sectional, questionnaire-based study was conducted from November 2013 to February 2014. Bivariate and multivariate analyses were conducted to examine associations between key informant and practice characteristics, and PBRN interest and perceptions. Findings: A 47.8% response rate was obtained. Most key informants (88% were very or somewhat interested in participating in AppNET. Enrichment of patient care (82.8%, improved relationships with providers in the community (75.9%, and professional development opportunities (69.0% were perceived by more than two-thirds of respondents to be very beneficial outcomes of PBRN participation. Respondents ranked time constraints (63% and workflow disruptions (20% as the biggest barriers to PBRN participation. Conclusion: Key informants in rural Appalachian community pharmacies indicated interest in PBRN participation. Integration of community pharmacies into existing rural PBRNs could advance community level care coordination and promote improved health outcomes in rural and underserved areas. Type: Original Research
Rourke, James; O'Keefe, Danielle; Ravalia, Mohamed; Moffatt, Scott; Parsons, Wanda; Duggan, Norah; Stringer, Katherine; Jong, Michael; Walsh, Kristin Harris; Hippe, Janelle
To assess Memorial University of Newfoundland's (MUN's) commitment to a comprehensive pathways approach to rural family practice, and to determine the national and provincial effects of applying this approach. Analysis of anonymized secondary data. Canada. Memorial's medical degree (MD) graduates practising family medicine in Newfoundland and Labrador as of January 2015 (N = 305), MUN's 2011 and 2012 MD graduates (N = 120), and physicians who completed family medicine training programs in Canada between 2004 and 2013 and who were practising in Canada 2 years after completion of their postgraduate training (N = 8091). National effect was measured by the proportion of MUN's family medicine program graduates practising in rural Canada compared with those from other Canadian family medicine training programs. Provincial effect was measured by the location of MUN's MD graduates practising family medicine in Newfoundland and Labrador as of January 2015. Commitment to a comprehensive pathways approach to rural family practice was measured by anonymized geographic data on admissions, educational placements, and practice locations of MUN's 2011 and 2012 MD graduates, including those who completed family medicine residencies at MUN. Memorial's comprehensive pathways approach to training physicians for rural practice was successful on both national and provincial levels: 26.9% of MUN family medicine program graduates were in a rural practice location 2 years after exiting their post-MD training from 2004 to 2013 compared with the national rate of 13.3% (national effect); 305 of MUN's MD graduates were practising family medicine in Newfoundland and Labrador as of 2015, with 36% practising in rural areas (provincial effect). Of 114 MD students with known background who graduated in 2011 and 2012, 32% had rural backgrounds. Memorial's 2011 and 2012 MD graduates spent 20% of all clinical placement weeks in rural areas; of note, 90% of all first-year placements and 95% of
Slade, Steve; Ross, Shelley; Lawrence, Kathrine; Archibald, Douglas; Mackay, Maria Palacios; Oandasan, Ivy F.
Abstract Objective To examine trends in family medicine training at a time when substantial pedagogic change is under way, focusing on factors that relate to extended family medicine training. Design Aggregate-level secondary data analysis based on the Canadian Post-MD Education Registry. Setting Canada. Participants All Canadian citizens and permanent residents who were registered in postgraduate family medicine training programs within Canadian faculties of medicine from 1995 to 2013. Main outcome measures Number and proportion of family medicine residents exiting 2-year and extended (third-year and above) family medicine training programs, as well as the types and numbers of extended training programs offered in 2015. Results The proportion of family medicine trainees pursuing extended training almost doubled during the study period, going from 10.9% in 1995 to 21.1% in 2013. Men and Canadian medical graduates were more likely to take extended family medicine training. Among the 5 most recent family medicine exit cohorts (from 2009 to 2013), 25.9% of men completed extended training programs compared with 18.3% of women, and 23.1% of Canadian medical graduates completed extended training compared with 13.6% of international medical graduates. Family medicine programs vary substantially with respect to the proportion of their trainees who undertake extended training, ranging from a low of 12.3% to a high of 35.1% among trainees exiting from 2011 to 2013. Conclusion New initiatives, such as the Triple C Competency-based Curriculum, CanMEDS–Family Medicine, and Certificates of Added Competence, have emerged as part of family medicine education and credentialing. In acknowledgment of the potential effect of these initiatives, it is important that future research examine how pedagogic change and, in particular, extended training shapes the care family physicians offer their patients. As part of that research it will be important to measure the breadth and uptake of
Avery, Daniel M; Hooper, Dwight E; McDonald, John T; Love, Michael W; Tucker, Melanie T; Parton, Jason M
The economic impact of a family physician practicing family medicine in rural Alabama is $1,000,000 a year in economic benefit to the community. The economic benefit of those rural family physicians practicing obstetrics has not been studied. This study was designed to determine whether there was any added economic benefit of rural family physicians practicing obstetrics in rural, underserved Alabama. The Alabama Family Practice Rural Health Board has funded the University of Alabama Family Medicine Obstetrics Fellowship since its beginning in 1986. Family medicine obstetrics fellowship graduates who practice obstetrics in rural, underserved areas were sent questionnaires and asked to participate in the study. The questions included the most common types and average annual numbers of obstetrics/gynecological procedures they performed. Ten physicians, or 77% of the graduates asked to participate in the study, returned the questionnaire. Fourteen common obstetrics/gynecological procedures performed by the graduates were identified. A mean of 115 deliveries were performed. The full-time equivalent reduction in family medicine time to practice obstetrics was 20%. A family physician practicing obstetrics in a rural area adds an additional $488,560 in economic benefit to the community in addition to the $1,000,000 from practicing family medicine, producing a total annual benefit of $1,488,560. The investment of $616,385 from the Alabama Family Practice Rural Health Board resulted in a $399 benefit to the community for every dollar invested. The cumulative effect of fellowship graduates practicing both family medicine and obstetrics in rural, underserved areas over the 26 years studied was $246,047,120. © Copyright 2014 by the American Board of Family Medicine.
Cowell, S.F.; Davison, A.; Logan-Sinclair, P.; Sturt University, Dubbo, NSW; Greenough, R.
Full text: The rapid increase in dementia is directly related to the growing number of aged people in developed countries, such as Australia. This increase heightens the need for accurate dementia diagnosis to ensure treatment resources are appropriately allocated. However, current diagnostic methods are unable to determine specific dementia types limiting the effectiveness of many care plans. The lack of specialist resources in rural Australian communities presents nuclear medicine with an opportunity to make a significant impact on the management of this disease. This investigation aimed to identify how SPECT perfusion imaging could maximise its role in the management of dementia in a rural New South Wales setting. The study reviewed all Technetium 99m HMPAO SPECT brain studies over a three-year period. This included a medical record audit, review of all diagnostic imaging reports and an analysis of referral patterns. The results of this study provide compelling evidence that, even in a rural setting, brain SPECT, in conjunction with neuropsychological testing, offers high accuracy in determining the presence and type of dementia. In addition, the study found more than 30% of referrers had no training in SPECT, emphasising the importance of ensuring that brain SPECT reports, in a rural setting, educate and specify to referrers the significance and exact disease type found in the study. Copyright (2003) The Australian and New Zealand Society of Nuclear Medicine Inc
Family Medicine first formally confronted systems thinking with the adoption of the biopsychosocial model for understanding disease in a holistic manner; this is a description of a natural system. More recently, Family Medicine has been consciously engaged in developing itself as a system for delivering health care, an artificial system. We make…
hospital for a year can be regarded as a rural medical specialist. Most often they realise ... of them, that they leave the public service for ever, for a situation that is ... So for rural medicine, it is an extremely wide set of skills that best describes ...
Bischoff, Thomas; Junod, Michel; Cornuz, Jacques; Herzig, Lilli; Bonvin, Raphael
The Faculty of Biology and Medicine of Lausanne has integrated education of family medicine all along its new undergraduate medical curriculum. The Institute of general medicine is in charge to implement those offers among which two are presented hereafter. In the new module "Generalism" several courses cover the specificities of the discipline as for example medical decision in the practice. A mandatory one-month internship in the medical practice offers an experiential immersion into family medicine for all students. In a meeting at the end of their internship, students discuss in group with their peers their individual experiences and are asked to identify, based on their personal experience, the general concepts of the specialty of family medicine and general practice.
Diaa, Alamir; Popa, Elena; Bacusca, Agnes; Traian, Maria Gabriela; Petrovanu, Rodica; Coman, Adorata Elena
This descriptive epidemiological study included 615 subjects investigated by their family doctor in the interval October 2011- August 2012. Patients were selected according to 2012 IDF diagnostic criteria resulting 304 patients. There was a Gaussian distribution of waist circumference (WC) with a maximum in age-group 70-80 years (46.3%), followed by age- groups 50-60 years (37.8%) and 60-70 years (41.6%). Waist circumference measurement showed an average of 100.76 +/- 11.59 cm, ranges 72 cm - 134 cm, without statistical significance. Mean body mass index (BMI) was 28.25 +/- 4.72 kg/m2 vs. 27.79 +/- 4.48 kg/m2. The difference is statistically significant (p = 0.05). Considering categorical the patients with hypertension (AHT) according to the definition, we found that only 7 cases did not have AHT (4.4%) as compared to a prevalence of AHT of 13.7% in the MS (metabolic syndrome) group. Mean serum triglyceride level was 123.11 +/- 68.55 mg/dl versus 113.75 +/- 65.62 mg/dl in the MS group, significantly higher (p < 0.003). Mean HDL cholesterol was 57.58 +/- 17.11 mg/dl versus 58.54 +/- 15.02 mg/dl, statistically significant difference (p < 0.05). The prevalence of glucoregulation disorders is higher in the MS group. Proportional relationships were found between BMI, WC, and SBP and high blood glucose. Comparison of blood glucose levels at baseline and at 1 year follow up showed significant differences.
Donovan Casas Patiño
Full Text Available In Mexico, the arrangement of clinical practice has been influenced by a decision-making process that seeks to improve health indicators, thus transforming the patient into a number. Family medicine has been practiced within the limits of an institutional biomedical model where the health-disease process is approached from a biologist perspective. On the other hand, collective health understands this process as stemming from the collective sphere and includes social and biological perspectives, giving an important standing to society. Likewise, it puts policy as a determinant in bettering social health bringing together public policy with health matters. Family medicine must become the axis around which health needs are catered to, together with social conditioning factors that affect families and individuals. This leads to a trans-disciplinary approach to communities set free from a mere biomedical profile. In this context, collective health provides theoretical support to the upcoming debate on family medicine.
Full Text Available The concept of evidence based medicine (EBM as the integrationof clinical expertise, patient values and the best evidence was introduced by David Sackett in the 1980’s. Scientific literature in medicine is often marked by expansion, acummulation and quick expiration. Reading all important articles to keep in touch with relevant information is impossible. Finding the best evidence that answers a clinical question in general practice (GP in a short time is not easy. Five useful steps are described –represented by the acronym “5A+E”: assess, ask, acquire, appraise, apply and evaluate.The habit of conducting an evidence search “on the spot’’ is proposed. Although students of medicine at University of Split School of Medicine are taught EBM from the first day of their study and in all courses, their experience of evidence-searching and critical appraisal of the evidence, in real time with real patient is inadequate. Teaching the final-year students the practical use of EBM in a GP’s office is different and can have an important role in their professional development. It can positively impact on quality of their future work in family practice (or some other medical specialty by acquiring this habit of constant evidence-checking to ensure that best practice becomes a mechanism for life-long learning. Conclusion. EBM is a foundation stone of every branch of medicine and important part of Family Medicine as scientific and professional discipline. To have an EB answer resulting from GP’s everyday work is becoming a part of everyday practice.
Mainguy, S; Crouse, B J
To help recruit and retain physicians, especially women, rural family practice groups need to establish policies regarding maternity and other family leaves. Also important are policies regarding paternity leave, adoptive leave, and leave to care for elderly parents. We surveyed members of the American Academy of Family Physicians in rural practice in 1995 to assess the prevalence of leave policies, the degree to which physicians are taking family leave, and the characteristics of ideal policies. Currently, both men and women physicians are taking family leaves of absence, which indicates a need for leave policies. Furthermore, a lack of family leave policies may deter women from entering rural practice.
Srivastava, Shikha; Bharade, Sandeep; Sinha, Vineet; Ananthakrishnan, T.S.; Jindal, G.D.; Prakash, C.
Bhabha Atomic Research Centre (BARC) has developed a handheld Tele-ECG system for providing optimum cardiac care and a Mobile Network Based Telemedicine (MNBT) utility for providing telemedicine services to isolated rural population. The handheld Tele-ECG acquires, saves and transfers the electrocardiographic signal to the expert's mobile for his advice in dealing with cardiac emergencies. Similarly, MNBT utility transfers the medical images and relevant patient data from a PC based instrument to a mobile phone for further transmission to an expert for his advice. This paper summarizes these developments. (author)
Young, Richard A
The purpose of this study was to describe how many rural family physicians (FPs) and other types of providers currently provide maternity care services, and the requirements to obtain privileges. Chief executive officers of rural hospitals were purposively sampled in 15 geographically diverse states with significant rural areas in 2013 to 2014. Questions were asked about the provision of maternity care services, the physicians who perform them, and qualifications required to obtain maternity care privileges. Analysis used descriptive statistics, with comparisons between the states, community rurality, and hospital size. The overall response rate was 51.2% (437/854). Among all identified hospitals, 44.9% provided maternity care services, which varied considerably by state (range, 17-83%; P maternity care, a mean of 271 babies were delivered per year, 27% by cesarean delivery. A mean of 7.0 FPs had privileges in these hospitals, of which 2.8 provided maternity care and 1.8 performed cesarean deliveries. The percentage of FPs who provide maternity care (mean, 48%; range, 10-69%; P maternity care who are FPs (mean, 63%; range, 10-88%; P maternity care services in US rural hospitals, including cesarean deliveries. Some family medicine residencies should continue to train their residents to provide these services to keep replenishing this valuable workforce. © Copyright 2017 by the American Board of Family Medicine.
Full Text Available The profound changes experienced by the Romanian society had a profound social impact on the structure and functions of the rural family. The paper aims to highlight the main trends recorded using a number of indicators: ruralization rate, birth rate, infant mortality rate, percentage of children born outside marriage, fertility rate, percentage of population aged 65 and over. Statistics from censuses and statistical yearbooks were processed to identify the trends of the Romanian rural family: changes in reproductive behavior, increased aging, declining birth rates.
Full Text Available The Family Medicine Development Project in Republic of Srpska was an initiative funded by the Canadian International Development Agency (CIDA. The project introduced family medicine into undergraduate curricula, established three-years long program of residency in family medicine in 1999, created departments of family medicine in both medical schools, helped with the process of establishing a professional association of family physicians, worked with Ministries of health and social welfare to establish supportive policies for these activities, and regularly provided continuing medical education programs for family practitioners during the 13 years of the project. Today, three family medicine teaching centers exist in RS (Primary health care centers Banja Luka, Foča and Bijeljina where more than 600 physicians were educated either through residency or additional training program in family medicine. Almost 1000 primary care nurses completed additional training. Family medicine centered primary health care reform was a complex innovation, involving organizational, financial, clinical and relational changes. An important factor influencing the adoption of this complex innovation in RS was the perceived benefits of the innovation: benefits which accrue to the users, family physicians, nurses and policy makers. With political commitment, an enabling economic environment and equitable distribution of resources, comprehensive primary health has proved to be a better strategy in achieving the goal of health for all. However, although family medicine passed through long journey from imposition to partnership, there is still large place for the improvement.
Full Text Available This articletakes family reunions held among peasants as a focus of study. During these events,keycultural categories come to light from which the analyzed group builds up ideas about kinship and also the relations that are implied in it. We observe that, in these cases, there are also indications of specific elements through which people express a valorization of rurality. To carry out this study, we collected data as part of an ethnographic research project conducted at a family reunion and in a rural community settled by German descendent immigrants, located in Rio Grande do Sul, southern Brazil
Burge, S. K.
Discusses several articles in this issue that demonstrate the influence of gender and power on family medicine education. These articles show that both clinical and learning environments are influenced by gender and power. Recommends the study of gender and power as an overt component in the family medicine curriculum. (SLD)
Zoila Olga de los Milagros Romero Albino
Full Text Available Family medicine in Peru had its origins in 1989, when the first family medicine residency was created; thereafter has had stages of improving and decline, there are currently more than 250 family physician graduated, between 70 and 90 seats of residency in annually, not having even insert family medicine in undergraduate medical schools. The inclusion of family physicians in the health system has been torpid, Peru has a mixed health system with multiple insurers and providers and 30% of the population without coverage, no real compliance characteristics of systems based on attention primary and first contact and access, longitudinality, comprehensiveness and coordination. It is expected to strengthen the specialty improve future training scenarios and developing a united health system.
Purpose: To determine the compliance of patent medicine vendors (PMVs) in rural areas of Lagos State, Nigeria with set guidelines to regulate their practice and its implications for malaria control. Methods: A baseline cross-sectional study was conducted as part of an intervention study in two rural local government areas ...
Attitude of Rural Youths towards Family Farming in Dass, Bauchi State, Nigeria and the ... Majority were males (88 %), single (51 %), literate (99 %) and had rural ... most of them (78 %) said was learned through parents (non-formal sources).
Locke, Amy B; Gordon, Andrea; Guerrera, Mary P; Gardiner, Paula; Lebensohn, Patricia
The use of complementary and alternative medicine (CAM) and Integrative Medicine (IM) has grown steadily over the past decade. Patients seek physician guidance, yet physicians typically have limited knowledge and training. There is some coverage of IM/CAM topics in medical schools and residencies but with little coordination or consistency. In 2008, the Society of Teachers of Family Medicine (STFM) group on Integrative Medicine began the process of designing a set of competencies to educate Family Medicine residents in core concepts of IM. The goal was creation of a set of nationally recognized competencies tied to the Accreditation Council for Graduate Medical Education (ACGME) domains. These competencies were to be achievable by diverse programs, including those without significant internal resources. The group compiled existing curricula from programs around the country and distilled these competencies through multiple reviews and discussions. Simultaneously, the Integrative Medicine in Residency program run by the University of Arizona underwent a similar process. In 2009, these competencies were combined and further developed at the STFM annual meeting by a group of experts. In 2010, the STFM Board approved 19 measurable competencies, each categorized by ACGME domain, as recommended for Family Medicine residencies. Programs have implemented these competencies in various ways given individual needs and resources. This paper reviews the development of IM competencies for residency education in Family Medicine and presents those endorsed by STFM. By educating physicians in training about IM/CAM via competency-based curricula, we aim to promote comprehensive patient-centered care. © 2013 Elsevier Inc. All rights reserved.
Between psychosomatic medicine and psychiatry, FSS (functional somatic syndromes) patients are often visiting a family doctor. For FSS, the role of family physicians is large, but the family physicians are not required for the role of diagnosis and treatment of FSS. Rather, appropriate referral to a specialist to exclude organic disease is important and a role as the coordinator is large to the patient to refuse a psychiatric consultation. To serve as a role for such coordination, a family physician has to response the patient's emotional side and focus on the construction of the doctor-patient relationship and response. I also think of structuralism medicine approach to describe disease from the meta-level as a new procedure to the patient. This approach consists of 4 components, 'entity', 'phenomenon', 'words', and 'I'. This may be a useful approach to family physicians who coordinate the overall for FSS patients' management.
Wendt, Sarah; Hornosty, Jennie
Research on family violence in rural communities in Australia and Canada has shown that women's experience of family violence is shaped by social and cultural factors. Concern for economic security and inheritance for children, closeness and belonging, and values of family unity and traditional gender roles are factors in rural communities that…
Phillips, Julie; Hustedde, Carol; Bjorkman, Sarah; Prasad, Rupa; Sola, Orlando; Wendling, Andrea; Bjorkman, Kurt; Paladine, Heather
Women family physicians experience challenges in maintaining work-life balance while practicing in rural communities. We sought to better understand the personal and professional strategies that enable women in rural family medicine to balance work and personal demands and achieve long-term career satisfaction. Women family physicians practicing in rural communities in the United States were interviewed using a semistructured format. Interviews were recorded, professionally transcribed, and analyzed using an immersion and crystallization approach, followed by detailed coding of emergent themes. The 25 participants described a set of strategies that facilitated successful work-life balance. First, they used reduced or flexible work hours to help achieve balance with personal roles. Second, many had supportive relationships with spouses and partners, parents, or other members of the community, which facilitated their ability to be readily available to their patients. Third, participants maintained clear boundaries around their work lives, which helped them to have adequate time for parenting, recreation, and rest. Women family physicians can build successful careers in rural communities, but supportive employers, relationships, and patient approaches provide a foundation for this success. Educators, employers, communities, and policymakers can adapt their practices to help women family physicians thrive in rural communities. © 2016 Annals of Family Medicine, Inc.
... the desired attitudinal and behavioral changes towards family planning is yet to be ... from selected rural areas in Ibadan towards family planning using the Health ... The study revealed that the socio-economic status of mothers significantly ...
Mahood, S.; Rojas, R.; Andres, D.; Zagozeski, C.; White, G.; Bradel, T.
An educational contract for family medicine residency training and evaluation addresses many of the difficulties and challenges of current postgraduate medical education. This article identifies important principles for developing a contractual approach; describes the contract used in one program and its implementation; and discusses its theory, advantages, and limitations.
Beste, Jason; Asanti, Daniel; Nsabimana, Damien; Anastos, Kathryn; Mutimura, Eugene; Merkatz, Irwin; Sirotin, Nicole; Nathan, Lisa M
To evaluate the perceptions of healthcare and traditional medicine providers regarding the type, indications, side effects, and prevalence of traditional medicine use amongst pregnant women in a rural Rwandan population. Six focus groups with physicians, nurses, and community health workers and four individual in-depth interviews with traditional medicine providers were held. Qualitative data was gathered using a structured questionnaire querying perceptions of the type, indications, side effects, and prevalence of use of traditional medicines in pregnancy. The healthcare provider groups perceived a high prevalence of traditional botanical medicine use by pregnant women (50-80%). All three groups reported similar indications for use of the medicines and the socioeconomic status of the pregnant women who use them. The traditional medicine providers and the healthcare providers both perceived that the most commonly used medicine is a mixture of many plants, called Inkuri. The most serious side effect reported was abnormally bright green meconium with a poor neonatal respiratory drive. Thirty-five traditional medicines were identified that are used during pregnancy. Perceptions of high prevalence of use of traditional medicines during pregnancy with possible negative perinatal outcomes exist in areas of rural Rwanda.
Winter, Robin O.
According to the American Board of Family Medicine, "The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity." What makes the seemingly daunting task of practicing family medicine possible is that family physicians learn to utilize similar clinical reasoning for all of their patients…
Katherine B. Gunter
Full Text Available Among rural families, rates of both child obesity and household food insecurity (FI are higher compared to non-rural families. These disparities result from a complex interplay of social and environmental conditions that influence behavior. The Transtheoretical Model suggests individual readiness to change underlies success in modifying obesity-preventing behaviors; however, whether an association between readiness to change obesity-related behaviors and FI status among rural families exists is unknown. We examined the association between readiness to change family-level nutrition and physical activity (PA behaviors that predict child obesity and family FI status within a sample of rural families to better understand these relationships. Families (n=144 were recruited from six rural Oregon communities in 2013. Families completed a FI screener and the Family Stage of Change Survey (FSOC, a measure of readiness to change family-level nutrition and PA behaviors associated with obesity. Demographic differences by FI status were explored, and regression was applied to examine relationships between FI and FSOC scores, adjusting for relevant covariates. Among FI families (40.2%, more were non-white (77.8% vs. 22.2%; p=0.036 and had lower adult education (30.4% vs. 11.8% with >high school degree; p=0.015 compared to non-FI families. After adjusting for education, race, ethnicity, and eligibility for federal meal programs, readiness to provide opportunities for PA was lower among FI families (p=0.002. These data highlight a need to further investigate how food insecurity and low readiness to provide PA opportunities, i.e. “physical activity insecurity” may be contributing to the higher obesity rates observed among rural children and families. Keywords: Food insecurity, Physical activity, Rural, Childhood obesity
Personality profile and coping resources of family medicine vocational trainees at ... (81.8%) indicated that they mainly experienced work-related stress. ... Keywords: personality; coping resources; family medicine; stress; vocational trainees ...
Martínez-González, Adrián; Gómez-Clavelina, Francisco J; Hernández-Torres, Isaías; Flores-Hernández, Fernando; Sánchez-Mendiola, Melchor
In Mexico there is no systematic evaluation of teachers in medical specialties. It is difficult to identify appropriate teaching practices. The lack of evaluation has limited the recognition and improvement of teaching. The objective of this study was to analyze feedback from students about teaching activities of teachers-tutors responsible for the specialization course in family medicine, and evaluate the evidence of reliability and validity of the instrument applied online. It was an observational and cross-sectional study. Seventy eight teachers of Family Medicine of medical residency were evaluated by 734 resident´s opinion. The anonymous questionnaire to assess teaching performance by resident's opinion and it is composed of 5 dimensions using a Likert scale. Descriptive and inferential statistics (t test, one-way ANOVA and factor analysis) were used. Residents stated that teaching performance is acceptable, with an average of 4.25 ± 0.93. The best valued dimension was "Methodology" with an average of 4.34 ± .92 in contrast to the "assessment" dimension with 4.16 ± 1.04. Teachers of specialization in family medicine have acceptable performance by resident's opinion. The online assessment tool meets the criteria of validity and reliability.
Background: Traditional medicine plays a major role in the primary health care of many people living in rural areas. South Africa is a home to over 30,000 species of higher plants and 3,000 of these species have been found to be used in traditional medicine across the country. South African medicinal plants are decreasing ...
Martin, James C; Avant, Robert F; Bowman, Marjorie A; Bucholtz, John R; Dickinson, John R; Evans, Kenneth L; Green, Larry A; Henley, Douglas E; Jones, Warren A; Matheny, Samuel C; Nevin, Janice E; Panther, Sandra L; Puffer, James C; Roberts, Richard G; Rodgers, Denise V; Sherwood, Roger A; Stange, Kurt C; Weber, Cynthia W
Recognizing fundamental flaws in the fragmented US health care systems and the potential of an integrative, generalist approach, the leadership of 7 national family medicine organizations initiated the Future of Family Medicine (FFM) project in 2002. The goal of the project was to develop a strategy to transform and renew the discipline of family medicine to meet the needs of patients in a changing health care environment. A national research study was conducted by independent research firms. Interviews and focus groups identified key issues for diverse constituencies, including patients, payers, residents, students, family physicians, and other clinicians. Subsequently, interviews were conducted with nationally representative samples of 9 key constituencies. Based in part on these data, 5 task forces addressed key issues to meet the project goal. A Project Leadership Committee synthesized the task force reports into the report presented here. The project identified core values, a New Model of practice, and a process for development, research, education, partnership, and change with great potential to transform the ability of family medicine to improve the health and health care of the nation. The proposed New Model of practice has the following characteristics: a patient-centered team approach; elimination of barriers to access; advanced information systems, including an electronic health record; redesigned, more functional offices; a focus on quality and outcomes; and enhanced practice finance. A unified communications strategy will be developed to promote the New Model of family medicine to multiple audiences. The study concluded that the discipline needs to oversee the training of family physicians who are committed to excellence, steeped in the core values of the discipline, competent to provide family medicine's basket of services within the New Model, and capable of adapting to varying patient needs and changing care technologies. Family medicine education
Al-Khaldi, Yahia M; Al-Ghamdi, Essam A; Al-Mogbil, Tariq I; Al-Khashan, Hesham I
The objectives of this study were to assess the current situation of the teaching and training of undergraduate and postgraduate programs in family medicine in KSA, assess the current practice of family medicine, and draw a roadmap to achieve Saudi vision 2020. This study was conducted with the support and collaboration of the Primary Health Care Department of the Ministry of Health, Saudi Arabia, and World Health Organization (EMRO) in November 2015. Based on the literature review of previous studies conducted for similar purposes, relevant questionnaires were developed. These consisted of four forms, each of which was directed at a different authority to achieve the above-mentioned objectives. Data of all questionnaires were coded, entered, and analyzed using SPSS version 16. There are 2282 primary health-care centers (PHCCs), 60% of which are in rural areas. More than half of the PHCCs have a laboratory and more than one-third have a Radiology Department. Out of the 6107 physicians, 636 are family physicians (10%). All medical colleges have a family medicine department with a total staff of 170 medical teachers. Thirteen departments run family medicine courses of 4-8 weeks' duration for students. Fourteen colleges have internship programs in family medicine and four colleges have postgraduate centers for family medicine (27%). There are 95 training centers for Saudi Board (Saudi Board of Family Medicine [SBFM]) and 68 centers for Saudi Diploma (Saudi Diploma of Family Medicine [SDFM]). The total number of trainers was 241, while the total trainees were 756 in SBFM and 137 in SDFM. This survey showed that there is a shortage of qualified family physicians in all health sectors in Saudi Arabia as a result of the lack of a strategic plan for the training of family physicians. A national strategic plan with specific objectives and an explicit budget are necessary to deal with this shortage and improve the quality of health-care services at PHCCs.
Gardiner, Paula; Filippelli, Amanda C; Lebensohn, Patricia; Bonakdar, Robert
Little is known about the incorporation of integrative medicine (IM) and complementary and alternative medicine (CAM) into family medicine residency programs. The Society for Teachers of Family Medicine (STFM) approved a set of CAM/IM competencies for family medicine residencies. We hope to evaluate whether residency programs are implementing such competencies into their curriculum using an online survey tool. We also hope to assess the knowledge and attitudes of Residency Directors (RDs) on the CAM/IM competencies. A survey was distributed by the Council of Academic Family Medicine (CAFM) Educational Research Alliance to RDs via e-mail. The survey was distributed to 431 RDs. Of those who received it, 212 responded, giving a response rate of 49.1%. Questions assessed the knowledge and attitudes of CAM/IM competencies and incorporation of CAM/IM into the residency curriculum. Forty-five percent of RDs were aware of the competencies. In terms of RD attitudes, 58% reported that CAM/IM is an important component of residents' curriculum; yet, 60% report not having specific learning objectives for CAM/IM in their residency curriculum. Among all programs, barriers to CAM/IM implementation included time in residents' schedules (77%); faculty training (75%); access to CAM experts (43%); lack of reimbursement (43%); and financial resources (29%). While many RDs are aware of the STFM CAM/IM competencies and acknowledge their role in residence education, there are many barriers that prevent residencies from implementing the STFM CAM/IM competencies. © 2013 Elsevier Inc. All rights reserved.
Planning a Family: Priorities and Concerns in Rural Tanzania. T Marchant, AK Mushi, R Nathan, O Mukasa, S Abdulla, C Lengeler, JRM Armstrong Schellenberg. Abstract. A fertility survey using qualitative and quantitative techniques described a high fertility setting (TFR 5.8) in southern Tanzania where family planning use ...
Shaklee, Harriet; Bigbee, Jeri; Wall, Misty
Chronic shortages of health, social service, and mental health professionals in rural areas necessitate creative partnerships in support of families. Cooperative extension professionals in Family and Consumer Sciences and community health nurses, who can bring critical skills to human services teams, are introduced as trusted professionals in…
The continued presence of the family physician within hospital systems is key to family medicine remaining an attractive, viable specialty in the ever-evolving world of medicine. One physician muses about her place in this complex ecosystem and believes that family physicians lose their voice and thus risk their own extinction when they opt out of hospital practice. PMID:18626038
Family medicine training and practice in Malawi: History, progress, and the anticipated role of the family physician in the Malawian health system. ... The idea of formal family medicine training and practice in Malawi started as early as 2001 but did not come to fruition until 2011, with the start of the undergraduate clerkship in ...
Eden, Aimee R; Peterson, Lars E
Advanced maternity care training in family medicine is highly variable at both the residency and fellowship levels. Declining numbers of family physicians providing maternity care services may exacerbate disparities in access to maternal and child care, especially in rural and other underserved communities. Accreditation of maternity care fellowships and board certification may be one potential avenue to address this trend. This study sought to understand the perceptions and beliefs of key family medicine stakeholders in advanced maternity care regarding the formalization of maternity care training through fellowship accreditation and the creation of a certificate of added qualification (CAQ). In 2014 and 2015, the authors conducted semi-structured interviews with 51 key stakeholders in family medicine maternity care. Transcribed interviews were coded using an iterative process to identify themes and patterns until saturation was reached. Participants generally supported both maternity care fellowship accreditation and a CAQ and recognized multiple advantages such as legitimization of training. Many had concerns about potential negative unintended consequences such as a loss of curricular flexibility; however, most felt that these could be mediated. Only a few did not support one or both aspects of formalization. Most participants interviewed support formalizing maternity care fellowship training in family medicine through accreditation and a subsequent CAQ, if implemented with attention to minimizing the potential negative consequences. Such formalization would recognize the advanced skill and training of family physicians practicing advanced maternity care and could address some access issues to essential maternity care services for rural and other underserved populations.
Abstract. Background and Objective: Some universities in sub-Saharan Africa have initiated Family Medicine (FM) residency programs. ... were for information technology (78%) and HIV (46%) training. Conclusion: ..... Emergency medicine. 32.
Gouveia, Eneline Ah; Braga, Taciana D; Heráclio, Sandra A; Pessoa, Bruno Henrique S
Worldwide, half the population lives in rural or remote areas; however, less than 25% of doctors work in such regions. Despite the continental dimensions of Brazil and its enormous cultural diversity, only some medical schools in this country offer students the opportunity to acquire work experience focused on medicine in rural or remote areas. The objective of the present study was to develop a framework of competencies for a longitudinal medical training program in rural medicine as an integrated part of medical training in Brazil. Two rounds of a modified version of the Delphi technique were conducted. Initially, a structured questionnaire was elaborated, based on a literature review. This questionnaire was submitted to the opinion of 20 panelists affiliated with the Rural Medicine Working Party of the Brazilian Society of Family and Community Medicine. The panelists were asked to evaluate the relevance of the competencies using a five-point Likert-type scale. In this study, the consensus criterion for a competency to be included in the framework was it being deemed 'very important' or 'indispensable' by a simple majority of the participants, while the criterion for excluding a competency was that a simple majority of the panel members considered that it 'should not be included' or was 'of little importance'. When a consensus was not reached regarding a given competency, it was submitted to a second round to enable the panelists to re-evaluate the now dichotomized questions. Compliance in responding to the questionnaire was better among the panelists predominantly involved in teaching activities (85%; n=12) compared to those working principally in patient care (45%; n=8). The questionnaire consisted of 26 core competencies and 165 secondary competencies. After evaluation by the specialists, all the 26 core competencies were classified as relevant, with none being excluded and only eight secondary competencies failing to achieve a consensus. No new competencies
Reitz, Randall; Sudano, Laura; Siler, Anne; Trimble, Kristopher
Great variety exists in the roles that family medicine residency faculty fill in the lives of their residents. A family medicine-specific model has never been created to describe and promote effective training relationships. This research aims to create a consensus model for faculty development, ethics education, and policy creation. Using a modified grounded theory methods, researchers conducted phone interviews with 22 key informants from US family medicine residencies. Data were analyzed to delineate faculty roles, common role conflicts, and ethical principles for avoiding and managing role conflicts. Key informants were asked to apply their experience and preferences to adapt an existing model to fit with family medicine residency settings. The primary result of this research is the creation of a family medicine-specific model that describes faculty roles and provides insight into how to manage role conflicts with residents. Primary faculty roles include Role Model, Advisor, Teacher, Supervisor, and Evaluator. Secondary faculty roles include Friendly Colleague, Wellness Supporter, and Helping Hand. The secondary roles exist on a continuum from disengaged to enmeshed. When not balanced, the secondary roles can detract from the primary roles. Differences were found between role expectations of physician versus behavioral science faculty and larger/university/urban residencies versus smaller/community/rural residencies. Diversity of opinion exists related to the types of roles that are appropriate for family medicine faculty to maintain with residents. This new model is a first attempt to build consensus in the field and has application to faculty development, ethics education, and policy creation.
Phillips, Robert L; Pugno, Perry A; Saultz, John W; Tuggy, Michael L; Borkan, Jeffrey M; Hoekzema, Grant S; DeVoe, Jennifer E; Weida, Jane A; Peterson, Lars E; Hughes, Lauren S; Kruse, Jerry E; Puffer, James C
More than a decade ago the American Academy of Family Physicians, American Academy of Family Physicians Foundation, American Board of Family Medicine, Association of Departments of Family Medicine, Association of Family Practice Residency Directors, North American Primary Care Research Group, and Society of Teachers of Family Medicine came together in the Future of Family Medicine (FFM) to launch a series of strategic efforts to "renew the specialty to meet the needs of people and society," some of which bore important fruit. Family Medicine for America's Health was launched in 2013 to revisit the role of family medicine in view of these changes and to position family medicine with new strategic and communication plans to create better health, better health care, and lower cost for patients and communities (the Triple Aim). Family Medicine for America's Health was preceded and guided by the development of a family physician role definition. A consulting group facilitated systematic strategic plan development over 9 months that included key informant interviews, formal stakeholder surveys, future scenario testing, a retreat for family medicine organizations and stakeholder representatives to review strategy options, further strategy refinement, and finally a formal strategic plan with draft tactics and design for an implementation plan. A second communications consulting group surveyed diverse stakeholders in coordination with strategic planning to develop a communication plan. The American College of Osteopathic Family Physicians joined the effort, and students, residents, and young physicians were included. The core strategies identified include working to ensure broad access to sustained, primary care relationships; accountability for increasing primary care value in terms of cost and quality; a commitment to helping reduce health care disparities; moving to comprehensive payment and away from fee-for-service; transformation of training; technology to support
Audétat, Marie-Claude; Voirol, Christian; Béland, Normand; Fernandez, Nicolas; Sanche, Gilbert
Abstract Objective To assess use of the remediation instrument that has been implemented in training sites at the University of Montreal in Quebec to support faculty in diagnosing and remediating resident academic difficulties, to examine whether and how this particular remediation instrument improves the remediation process, and to determine its effects on the residents’ subsequent rotation assessments. Design A multimethods approach in which data were collected from different sources: remediation plans developed by faculty, program statistics for the corresponding academic years, and students’ academic records and rotation assessment results. Setting Family medicine residency program at the University of Montreal. Participants Family medicine residents in academic difficulty. Main outcome measures Assessment of the content, process, and quality of remediation plans, and students’ academic and rotation assessment results (successful, below expectations, or failure) both before and after the remediation period. Results The framework that was developed for assessing remediation plans was used to analyze 23 plans produced by 10 teaching sites for 21 residents. All plans documented cognitive problems and implemented numerous remediation measures. Although only 48% of the plans were of good quality, implementation of a remediation plan was positively associated with the resident’s success in rotations following the remediation period. Conclusion The use of remediation plans is well embedded in training sites at the University of Montreal. The residents’ difficulties were mainly cognitive in nature, but this generally related to deficits in clinical reasoning rather than knowledge gaps. The reflection and analysis required to produce a remediation plan helps to correct many academic difficulties and normalize the academic career of most residents in difficulty. Further effort is still needed to improve the quality of plans and to support teachers.
The paper discusses the effects of the changes of rural income level on family planning practice based a survey of 200 rural families in a affluent vegetable producing area of suburban Beijing. In 1984, 99.7% of child birth followed the local birth planning, and 99.1% of families with one child received One Child Certificates. The annual per capita income of the 200 families was 1,092 yuan (1 US$ = 3.7 yuan) in 1984 even higher than the community average. The number of children was negatively associated with the per capita income and per capita consumption except families with 4 children, most of whom have grown up. The rural mechanization in the community has greatly increased the need for skills and technology rather than strong laborers. The provision of community welfare programs and the increased living standard changed the value of children and also changed people's perception in favor of gender equality. Among families with 1 or 2 children, most preferred to have girls. And among families with more children, the preferred family size is smaller than the actual size, which shows a tendency towards favoring a small family. Among 1 child families, 58.7% considered 1 boy and 1 girl to be ideal, and 37.7% was happy with the only child. As the community becomes richer, both the community and individual families increased their investment in education. The spending on education per child was over 2 times as high in 1 child families than the families with more children. The educational status of parents is positively associated with the exception of children's future education and current spending on education. The concern of parents over children's education is an important factor in improving the quality of labor force. Women of higher education status are more acceptable to contraception and family planning policy. The relatively high level of education of the community has been conducive to it fertility decline.
Background: Family Medicine is the medical specialty that provides ... the World Health Organization (WHO) has acknowledged the critical importance and positive ... This study evaluated the awareness, knowledge and perception of Family ...
Biringer, Anne; Forte, Milena; Tobin, Anastasia; Shaw, Elizabeth; Tannenbaum, David
Abstract Objective To ascertain how program leaders in family medicine characterize success in family medicine maternity care education and determine which factors influence the success of training programs. Design Qualitative research using semistructured telephone interviews. Setting Purposive sample of 6 family medicine programs from 5 Canadian provinces. Participants Eighteen departmental leaders and program directors. METHODS Semistructured telephone interviews were conducted with program leaders in family medicine maternity care. Departmental leaders identified maternity care programs deemed to be “successful.” Interviews were audiorecorded and transcribed verbatim. Team members conducted thematic analysis. Main findings Participants considered their education programs to be successful in family medicine maternity care if residents achieved competency in intrapartum care, if graduates planned to include intrapartum care in their practices, and if their education programs were able to recruit and retain family medicine maternity care faculty. Five key factors were deemed to be critical to a program’s success in family medicine maternity care: adequate clinical exposure, the presence of strong family medicine role models, a family medicine–friendly hospital environment, support for the education program from multiple sources, and a dedicated and supportive community of family medicine maternity care providers. Conclusion Training programs wishing to achieve greater success in family medicine maternity care education should employ a multifaceted strategy that considers all 5 of the interdependent factors uncovered in our research. By paying particular attention to the informal processes that connect these factors, program leaders can preserve the possibility that family medicine residents will graduate with the competence and confidence to practise full-scope maternity care. PMID:29760273
Varela-Rueda, Carlos E; Reyes-Morales, Hortensia; Albavera-Hernández, Cidronio; Ochoa-Díaz-López, Héctor; Gómez-Dantés, Héctor; García-Peña, Carmen
Analyzing the challenges and the future scenario of Family Medicine is a priority to address challenges such as the reduction of benefits granted by social security; to adapt their practice to the changing health profile; and to curb demand for specialized services and contain the high costs of care in the second and third level. The program is aimed at three professional roles: medical care, research, and education. It is imperative review these in the light of changing demographic conditions, the type of health needs arising from new social determinants, the public expectations for greater participation in their care, and the evolution of the health system itself with the advancement of technology and a variety of organizational options with frequently limited resources. For primary care, as the core of a health system that covers principles of equity, solidarity, universality, participation, decentralization, and intra- and inter-sectorial coordination, it is necessary to put at the center of the primary care team the family doctor and not an administrator, who plays an important role in supporting the care team, but can not take the lead.
Venegas Ochoa, Urbicio; Muñoz Pérez, Esteban; Navarro Solares, Alhondra; Nuño Gutiérrez, Bertha Lidia; Navarro Núñez, Carlos
prevalence of violence against women in Mexico fluctuate within 30 to 60%, but health and court administration institutions' numbers are under real ones, they only include extreme violence or pressed charges against them aggressor. To asses the level of knowledge on the norms and procedures for the attention of domestic violence in family practitioners workers of the Instituto Mexicano del Seguro Social in Colima, México. A cross-sectional study was conducted during the September-December 2005 period. The indicator was obtained of a self-administered questionnaire. The data collection instrument was design to asses the level of knowledge in five areas: definition, norms, classification, risk factors and domestic violence indicators. An knowledge index was constructed and analyzed using frequencies distribution and percentages. The age average was 41 years; medical practice 20 years. 72% men, 28% women; 91% had sentimental couple; 53% was family medicine specialist and 2% mastery; 53% worked in the morning shift and 47% in the evening one. The 91% didn't know the Mexican official norm; 91% without training on domestic violence, 74% ignored the types that exist; 76% ignored the cycles; 63% didn't register it as diagnostic in the clinical file; 52% know that the integral attention health registration leaf has a specific item for this problem. The average of guessed right answers was of 19 (range 15-24). The level of knowledge on the norms and procedures for the attention of domestic violence in family practitioners workers of the Instituto Mexicano del Seguro Social in Colima, México; was low degree in 0%, moderate in 81% and highly in 19%.
Rohan-Minjares, Felisha; Alfero, Charles; Kaufman, Arthur
The discipline of family medicine is essential to improving quality and reducing the cost of care in an effective health care system. Yet the slow growth of this field has not kept pace with national demand. In their study, Rodríguez and colleagues report on the influence of the social environment and academic discourses on medical students' identification with family medicine in four countries-the United Kingdom, Canada, France, and Spain. They conclude that these factors-the social environment and discursive activity within the medical school-influence students' specialty choices. While the discourses in Canada, France, and Spain were mostly negative, in the United Kingdom, family medicine was considered a prestigious academic discipline, well paying, and with a wide range of practice opportunities. Medical students in the United Kingdom also were exposed early and often to positive family medicine role models.In the United States, academic discourses about family medicine are more akin to those in Canada, France, and Spain. The hidden curriculum includes negative messages about family medicine, and "badmouthing" primary care occurs at many medical schools. National education initiatives highlight the importance of social determinants in medical education and the integration of public health and medicine in practice. Other initiatives expose students to family medicine role models and practice during their undergraduate training and promote primary care practice through new graduate medical education funding models. Together, these initiatives can reduce the negative effects of the social environment and create a more positive discourse about family medicine.
Presenting national statistics on single-parent families, this article illustrates the need for serious study of this phenomenon, suggesting that changing divorce laws, increased single-parent adoptions, and an increase in the number of supportive services for single-parent families are contingencies having significant bearing upon the…
Girardon-Perlini, Nara Marilene Oliveira; Ângelo, Margareth
To understand the meanings of cancer within the experience of rural families and how such meanings influence family dynamics. Qualitative study guided by Symbolic Interactionism as a theoretical framework and Grounded Theory as a methodological framework. Six rural families (18 participants) undergoing the experience of having a relative with cancer participated in the interview. Constant comparative analysis of data allowed the elaboration of an explanatory substantive theory, defined by the main category Caregiving to support the family world, which represents the family's symbolic actions and strategies to reconcile care for the patient and care for family life. Throughout the experience, rural families seek to preserve the interconnected symbolic elements that provide support for the family world: family unit, land, work and care. Compreender os significados do câncer presentes na experiência de famílias rurais e como esses significados influenciam a dinâmica familiar. Estudo qualitativo orientado pelo Interacionismo Simbólico como referencial teórico e pela Teoria Fundamentada nos Dados como referencial metodológico. Participaram, por meio de entrevista, seis famílias rurais (18 participantes) que estavam vivendo a experiência de ter um familiar com câncer. A análise comparativa constante dos dados permitiu a elaboração de uma teoria substantiva explicativa da experiência, definida pela categoria central Cuidando para manter o mundo da família amparado, que representa as ações e estratégias simbólicas da família visando a conciliar o cuidado do familiar doente e o cuidado da vida familiar. Ao longo da experiência, a família rural procura preservar os elementos simbólicos que, conectados, constituem o amparo do mundo da família: a unidade familiar, a terra, o trabalho e o cuidado.
Full Text Available Background Despite common usage of traditional medicines in rural populations, the data of their uses along with hypertension medications are limited. Aims To quantify the use of traditional medicines and to identify factors associated with its use among people with hypertension in a low-resource setting. Methods Data were collected using a researcher-administered questionnaire from people with hypertension in rural underdeveloped villages in Indonesia. Results Two hundred sixty-three of 384 participants (68.5 per cent used traditional medicines intended to lower blood pressure; about half (n=134 used only traditional medicines, whereas the others (n=129 also took antihypertensive medications. Seventy-four (19.2 per cent participants took only anti-hypertensive medications, and 47 (12.2 per cent did not use traditional medicines or antihypertensive medications. Herbal medicines were the most frequent products used, mainly in the form of herbs and herbal materials, which were obtained from traditional markets (n=169, 44 per cent, family members (n=100, 26 per cent or their own garden (n=88, 23 per cent. The use of traditional medicines was not associated with any sociodemographic variables. However, among traditional medicines users, participants with a lower formal educational level were twice as likely to not take antihypertensive medications compared with those with a higher educational level. Conclusion To treat their hypertension, these rural villagers used traditional medicines more often than anti-hypertensive medications. Health professionals in rural areas should be aware of how the use of traditional medicine might affect hypertension management.
Background: The Master's in Family Medicine (M Fam Med) is a postgraduate training programme in family medicine at Medunsa. M Fam Med students have to write patient studies as part of requirements to complete their degree. This research was undertaken to develop a deeper understanding of their perceptions about ...
Jetty, Anuradha; Moore, Miranda A; Coffman, Megan; Petterson, Stephen; Bazemore, Andrew
Telehealth has the potential to reduce health inequities and improve health outcomes among rural populations through increased access to physicians, specialists, and reduced travel time for patients. Although rural telehealth services have expanded in several specialized areas, little is known about the attitudes, beliefs, and uptake of telehealth use in rural American primary care. This study characterizes the differences between rural and urban family physicians (FPs), their perceptions of telehealth use, and barriers to further adoption. Nationally representative randomly sampled survey of 5,000 FPs. Among the 31.3% of survey recipients who completed the survey, 83% practiced in urban areas and 17% in rural locations. Rural FPs were twice as likely to use telehealth as urban FPs (22% vs. 10%). Logistic regressions showed rural FPs had greater odds of reporting telehealth use to connect their patients to specialists and to care for their patients. Rural FPs were less likely to identify liability concerns as a barrier to using telehealth. Telemedicine allows rural patients to see specialists without leaving their communities and permits rural FPs to take advantage of specialist expertise, expand their scope of practice, and reduce the feeling of isolation experienced by rural physicians. Efforts to raise awareness of current payment policies for telehealth services, addressing the limitations of current reimbursement policies and state regulations, and creating new avenues for telehealth reimbursement and technological investments are critical to increasing primary care physician use of telehealth services.
Rayess, Fadya El; Filip, Anna; Doubeni, Anna; Wilson, Calvin; Haq, Cynthia; Debay, Marc; Anandarajah, Gowri; Heffron, Warren; Jayasekera, Neil; Larson, Paul; Dahlman, Bruce; Valdman, Olga; Hunt, Vince
Many US medical schools and family medicine departments have responded to a growing interest in global health by developing global health fellowships. However, there are no guidelines or consensus statements outlining competencies for global health fellows. Our objective was to develop a mission and core competencies for Family Medicine Global Health Fellowships. A modified Delphi technique was used to develop consensus on fellowship competencies. A panel, comprised of 13 members with dual expertise in global health and medical education, undertook an iterative consensus process, followed by peer review, from April to December 2014. The panel developed a mission statement and identified six domains for family medicine global health fellowships: patient care, medical knowledge, professionalism, communication and leadership, teaching, and scholarship. Each domain includes a set of core and program-specific competencies. The family medicine global health competencies are intended to serve as an educational framework for the design, implementation, and evaluation of individual family medicine global health fellowship programs.
Foshee, Vangie A; Chang, Ling-Yin; McNaughton Reyes, H Luz; Chen, May S; Ennett, Susan T
Rural adolescents are at high risk for dating violence victimization (DVV), which has serious negative consequences. Understanding more about the conditions that increase DVV risk for rural adolescents is needed to inform prevention efforts. In response to calls for examining the influence of upper levels of the social ecology on adolescent dating violence, this study examined whether associations between the family context and physical DVV were conditioned by the characteristics of the neighborhoods in which the family resided. Data were from a multi-wave longitudinal study of 3,236 rural adolescents nested in 65 block groups, which defined neighborhoods. Data were collected between 2003 and 2005. Multilevel growth curve modeling was conducted in 2014 to test hypothesized synergistic effects of the family and neighborhood on trajectories of physical DVV from grade 8 to 12. Low parental closeness was a DVV risk in residentially stable (pFamily aggression was a DVV risk, regardless of neighborhood characteristics (p=0.001). Low parental monitoring and rule setting were not DVV risks and their effects were not moderated by neighborhood characteristics. Neighborhood ethnic heterogeneity was significantly (pviolence were not associated with DVV. None of the effects varied by sex of the adolescent, across time (grade), or by the combination of sex and time. Findings demonstrate the importance of considering the family and neighborhood, and particularly their synergistic effects in efforts to prevent adolescent DVV. Copyright © 2015 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
Ventres, William; Gross, Paul
In this article we introduce family medicine educators to storytelling as an important teaching tool. We describe how stories are a critical part of the work of family physicians. We review the rationales for family medicine educators to become skilled storytellers. We present the components of effective stories, proposing two different perspectives on how to imagine, construct, and present them. We provide a list of resources for getting started in storytelling and offer two personal vignettes that articulate the importance of storytelling in the authors' respective professional developments. We point the way forward for family medicine educators interested in integrating storytelling into their repertoire of teaching skills.
De Winter, A. M.
Decision-making and family planning were studied in the rural city of Durazno, Uruguay, by means of answers to questions by both husbands and wives. A sample size of 268 couples in which at least one partner was between 21 and 50 years of age was used. Data were collected by means of a pretested and precoded interview schedule. Major conclusions…
Eriksson, Tor Viking; Qiang, Zhang Ying
This paper provides estimates of brother income correlations for rural China. Brother correlations are a parsimonious measure of the importance of family and community background as determinants of individuals' economic status. We find internationally high levels of income similarity for brothers...
Behavioral medicine brings knowledge and skills from the social sciences to the practice of medicine. Modifying behavior which causes a health problem, disease prevention and health promotion, improving the relationship between patients and health professionals, understanding cultural and ethical issues, and the effect of illness on behavior are all aspects of behavioral medicine. Such `whole person' medicine fits well into family practice. However, careful consideration of the risks, challen...
Wardle, Jon; Lui, Chi-Wai; Adams, Jon
Contexts: The consumption of complementary and alternative medicine (CAM) in rural areas is a significant contemporary health care issue. An understanding of CAM use in rural health can provide a new perspective on health beliefs and practice as well as on some of the core service delivery issues facing rural health care generally. Purpose: This…
Full Text Available Several species of the family Caryophyllaceae are widely used by many ethnic communities as traditional medicine throughout the world. The highest number of plants of the family are used in Chinese traditional medicine. The ethnopharmacologial studies of this family indicate that plants of the family possess anticancer, antibacterial, antifungal, antiviral, antioxidant, and anti-inflammatory properties. Other miscellaneous properties reported are ribosome inactivation properties, inhibition of prostatic enlargement in rats, and inhibition of intestinal enzyme carboxyelasterase in rats, cerebro-protective activity, and antiobesity in rats. Few reviews have been published yet, providing information regarding medicinal plants of the family and their biomedical properties. All published reviews have focused either on a particular taxa or a few species. The present review is focused on the traditional medicinal uses of the plants of the family Caryophyllaceae along with phytochemical and pharmacological studies of the family. A study of the literature revealed significant traditional medicinal importance of the family. Major chemical constituents of Caryophyllceae are saponins, Phytoecdysteroids, benzenoids, phenyl propanoids, and nitrogen containing compounds. The most important property of plants of the family is anticancer activity and is shown by the large number of plant species studied. This review of traditional medicinal and pharmacological uses of plants of the family, provide a ground for future research in the family.
Full Text Available Context: Currently, family medicine is not taught as a part of the undergraduate medical curriculum in India. In this context, the perceptions and attitudes of Indian medical students regarding family medicine as a career choice were studied. Aims: This study aims to study the perceptions and attitudes prevalent among Indian medical students regarding family medicine as a career choice and discuss its future implications. Settings and Design: Cross-sectional survey study design. Methods and Material: We conducted a cross-sectional survey of undergraduate medical (MBBS students attending the 2016 medical student conference DEMEDCON at Sri Devaraj Urs Medical College in Kolar, Karnataka, India. Besides demographics, the survey included questions pertaining to awareness, exposure, and interest in family medicine in India. We also asked an open-ended question regarding the respondent's perception of the future of family medicine in India. Statistical Analysis: Simple statistics such as mean and frequency (% were calculated. Given the small sample size, no formal tests for statistical significance were performed. Results: Responses were collected from 45 students between the ages of 18–24 from 6 medical colleges across Karnataka and Puducherry. The majority (64% of respondents were in their 3rd or 4th year of medical college. 98% of respondents expressed a desire to learn more about family medicine as a specialty, and 82% expressed a need to introduce it as a subject in medical college. However, only 58% were aware of the Medical Council of India accredited status of family medicine in India. Conclusions: There exists a significant lack of awareness and inadequate exposure among Indian medical students toward family medicine. Nonetheless, there is widespread optimism and a desire to learn more about the subject. Increased awareness and avenues for exposure to family medicine in the formal undergraduate medical curriculum is the need of the hour.
Alison C. Essary
Full Text Available The increasing focus on high performance, patient-centered, team-based care calls for a strategy to evaluate cost-effective primary care. The trend toward physician practice consolidation further challenges the primary care health care system. Productivity measures establish provider value and help inform decision making regarding resource allocation in this evolving health care system. In this national survey of family medicine practices, physician assistant (PA productivity, as defined by mean annual patient encounters, exceeds that of both nurse practitioners (NPs and physicians in physician-owned practices and of NPs in hospital or integrated delivery system-owned practices. Total compensation, defined as salary, bonus, incentives, and honoraria for physicians, is significantly more compared to both PAs and NPs, regardless of practice ownership or productivity. Physician assistants and NPs earn equivalent compensation, regardless of practice ownership or productivity. Not only do these data support the value and role of PAs and NPs on the primary care team but also highlight differences in patient encounters between practice settings. Rural and underserved community practices, where physician-owned practices persist, also merit further consideration. Further research is needed to inform both organizational and policy decisions for the provision of high-quality, cost-effective, and accessible primary health care.
Folk medicinal practitioners form the first tier of primary health-care providers to most of the rural population of Bangladesh. They are known locally as Kavirajes and rely almost solely on oral or topical administration of whole plants or plant parts for treatment of various ailments. Also about 2% of the total population of ...
Almen medicin, Family Medicine, undergraduate Courses, the UK, Ireland, the Netherlands, the Nordic Countries......Almen medicin, Family Medicine, undergraduate Courses, the UK, Ireland, the Netherlands, the Nordic Countries...
Murphy, Rachel; Tao, Ran; Lu, Xi
This article draws on a survey conducted in six provinces in summer 2008 to investigate the determinants of son preference in rural China. The analysis confirms the conventional wisdom that son preference is embedded within patrilineal family structures and practices. We extend our analysis by exploring specific aspects of variation within patrilineal family culture. We find that the patrilineal group (clan) composition of villages and family participation in practices such as building ancestral halls and updating genealogies significantly influence son preference. Yet even though son preference is embedded within patrilineal family culture, our analysis suggests that over time the attenuation of son preference is likely. This is because determinants associated with socioeconomic change—for instance, higher levels of education, direct exposure to official policy education materials, higher income (a proxy for rural industrialization), and agricultural mechanization—all attenuate son preference. Being younger and female are also associated with weaker son preference, and both characteristics are likely to interact with education and industrialization to further dilute son preference in the longer term. Nevertheless, our findings suggest that concerted efforts are needed to ameliorate institutional discrimination against rural people in welfare provisioning and in labor markets, and to promote multiple dimensions of gender equality, including in land rights, wage rates, and education.
Xiaoling SONG; Dan YANG; Xiaohong SONG
Taking 20 relative poor families in Hechuan District of Chongqing Municipality as survey samples,taking 275 households of rural families selected by stratified sampling method as research objects,and taking family education investment behavior of this rural area as research content,this paper studied current situations of rural family education investment behavior in Hechuan District,difference in investment behavior and related influence factors. It is intended to provide references for family education investment of rural areas in Hechuan District and even Chongqing Municipality,and promote development of rural education undertaking in China.
Traditional Herbal Medicine Use Associated with Liver Fibrosis in Rural Rakai, Uganda Brandon J. Auerbach1,2*, Steven J. Reynolds3,4, Mohammed...Background: Traditional herbal medicines are commonly used in sub-Saharan Africa and some herbs are known to be hepatotoxic. However little is known...about the effect of herbal medicines on liver disease in sub-Saharan Africa. Methods: 500 HIV-infected participants in a rural HIV care program in Rakai
Sep 14, 2009 ... A cross-sectional study of 44 out of 45 (98% response rate) family medicine vocational trainees at the Medical ... b Department of Psychology, University of Limpopo (Medunsa Campus), Pretoria ... The cultural diversity of the.
The purpose of this paper is to analyze the Erasmus exchange of students at the University of Ljubljana, Department of family medicine in the period from 2005 to 2010. The beginnings of an Erasmus exchange in the field of family medicine in Europe are described. Ljubljana Medical School has currently 60 bilateral agreements with universities or medical faculties in the EU and EFTA countries. We collected data of all students who come from the foreign faculties to the Department of family medicine and those from Slovenia who went to study abroad. In addition to basic descriptive statistics, we used the elements of qualitative analysis, where we reviewed the reports of the Slovenian Erasmus students, who went on exchange in the field of family medicine. Department of family medicine cooperated with 14 foreign medical schools since 2005. 42 Slovenian students went on academic exchange in the field of family medicine. 21 foreign students came to Department of family medicine in Ljubljana. Female students were more frequent in exchange compared with male students. The largest proportion of students went abroad in 2009. Most foreign students visited Department of Family medicine in Ljubljana in 2011. Reports of students show that they learned a lot. Students were able to compare the organization of health care in a foreign country and Slovenian health care system. Erasmus exchange has proven to be an important addition to the existing educational system. Students are acquainted with the progress of health care in Europe in this way. They are able to compare the benefits and disadvantages of foreign health care systems with home health care organization. Copyright 2012 by Academy of Sciences and Arts of Bosnia and Herzegovina.
Burman, Mary E.
Directors of family nurse practitioner education programs (n=141) reported inclusion of some complementary/alternative medicine content (CAM), most commonly interviewing patients about CAM, critical thinking, evidence-based medicine, laws, ethics, and spiritual/cultural beliefs. Definition of CAM was medically, not holistically based. More faculty…
Burke, Meghan M.
Latino students and their families are the fastest growing minority group in the country, yet it is unclear whether rural (vs. urban) Latino families of students with disabilities have different needs. In this pilot study, 65 Latino family members of students with disabilities (15 rural; 50 urban) responded to a questionnaire about empowerment,…
Pavličević, Ivančica; Barać, Lana
This study aimed at synthesizing funding opportunities in the field of family medicine by determining the number of family medicine projects, as well as number of project leaderships and/ or participations by each country. This was done in order to encourage inclusion of physicians in countries with underdeveloped research networks in successful research networks or to encourage them to form new ones. We searched the Community Research and Development Information Service project database in February 2013. Study covered the period from years 1992 - 2012, selecting the projects within the field of general/family medicine. The search was conducted in February 2013. First search conducted in the CORDIS database came up with a total of 466 projects. After excluding 241 projects with insufficient data, we analysed 225 remaining projects; out of those, 22 (9.8%) were in the field of family medicine and 203 (90.2%) were from other fields of medicine. Sorted by the number of projects per country, Dutch institutions had the highest involvement in family medicine projects and were partners or coordinators in 18 out of 22 selected projects (81.8%), followed by British institutions with 15 (68.8%), and Spanish with 10 projects (45.5%). Croatia was a partner in a single FP7 Health project. Research projects in family medicine funded by the European Union show significant differences between countries. Constant and high-quality international cooperation in family medicine is the prerequisite for improvement and development of scientific research and the profession. Copyright © 2014 by Academy of Sciences and Arts of Bosnia and Herzegovina.
Harvey, Bart J; Moloughney, Brent W; Iglar, Karl T
Public health situations faced by family physicians and other primary care practitioners, such as severe acute respiratory syndrome (SARS) and more recently H1N1, have resulted in an increased interest to identify the public health competencies relevant to family medicine. At present there is no agreed-on set of public health competencies delineating the knowledge and skills that family physicians should possess to effectively face diverse public health challenges. Using a multi-staged, iterative process that included a detailed literature review, the authors developed a set of public health competencies relevant to primary care, identifying competencies relevant across four levels, from "post-MD" to "enhanced." Feedback from family medicine and public health educator-practitioners regarding the set of proposed "essential" competencies indicated the need for a more limited, feasible set of "priority" areas to be highlighted during residency training. This focused set of public health competencies has begun to guide relevant components of the University of Toronto's Family Medicine Residency Program curriculum, including academic half-days; clinical experiences, especially identifying "teachable moments" during patient encounters; resident academic projects; and elective public health agency placements. These competencies will also be used to guide the development of a family medicine-public health primer and faculty development sessions to support family medicine faculty facilitating residents to achieve these competencies. Once more fully implemented, an evaluation will be initiated to determine the degree to which these public health competencies are being achieved by family medicine graduates, especially whether they attained the knowledge, skills, and confidence necessary to effectively face diverse public health situations-from common to emergent. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
Naugler, Christopher T
To review the relevance of evolutionary medicine to family practice and family physician training. Articles were located through a MEDLINE search, using the key words evolution, Darwin, and adaptation. Most references presented level III evidence (expert opinion), while a minority provided level II evidence (epidemiologic studies). Evolutionary medicine deals with the interplay of biology and the environment in the understanding of human disease. Yet medical schools have virtually ignored the need for family physicians to have more than a cursory knowledge of this topic. A review of the main trends in this field most relevant to family practice revealed that a basic knowledge of evolutionary medicine might help in explaining the causation of diseases to patients. Evolutionary medicine has also proven key to explaining the reasons for the development of antibiotic resistance and has the potential to explain cancer pathogenesis. As an organizing principle, this field also has potential in the teaching of family medicine. Evolutionary medicine should be studied further and incorporated into medical training and practice. Its practical utility will be proven through the generation of testable hypotheses and their application in relation to disease causation and possible prevention.
Salehi-Isfahani, Djavad; Abbasi-Shavazi, M Jalal; Hosseini-Chavoshi, Meimanat
During the first few years of the Islamic Revolution of 1979, and aided by pro-natal government policies, Iranian fertility was on the rise. In a reversal of its population policy, in 1989, the government launched an ambitious and innovative family planning program aimed at rural families. By 2005, the program had covered more than 90% of the rural population and the average number of births per rural woman had declined to replacement level from about 8 births in the mid 1980s. In this paper, we evaluate the impact of a particular feature of the program - health houses - on rural fertility, taking advantage of the variation in the timing of their construction across the country. We use three different methods to obtain a range of estimates for the impact of health houses on village-level fertility: difference-in-differences (DID), matching DID, and length of exposure. We find estimates of impact ranging from 4 to 20% of the decline in fertility during 1986-1996. (c) 2010 John Wiley & Sons, Ltd.
Rutherford, Kimberly; Oda, Joanna
Background Almost three-quarters of family practice residents in British Columbia (BC) meet criteria for burnout. We sought to understand how burnout is perceived and experienced by family medicine residents, and to identify both contributory and protective factors for resident burnout. Method Two semi-structured focus groups were conducted with ten family practice residents from five distinct University of British Columbia training sites. Participants completed the Maslach Burnout Inventory (MBI). The data were analyzed using a thematic analysis approach. Results Seventy percent of the focus group participants met criteria for burnout using the MBI. The experience of burnout was described as physical and emotional exhaustion, loss of motivation, isolation from loved ones, and disillusionment with the medical profession. Contributory factors included high workload, burned-out colleagues, perceived undervaluing of family medicine, lack of autonomy, and inability to achieve work-life balance. Protective factors included strong role models in medicine, feeling that one’s work is valued and rotations in family medicine. Conclusions The high level of burnout in family medicine residents in BC is a multifactorial and complex phenomenon. Training programs and faculty should be aware of burnout risk factors and strive to implement changes to reduce burnout, including allowing residents increased control over scheduling, access to counseling services and training for resident mentors. PMID:26451218
Gowin, Ewelina; Horst-Sikorska, Wanda; Michalak, Michał; Avonts, Dirk; Buczkowski, Krzysztof; Lukas, Witold; Korman, Tomasz; Litwiejko, Alicja; Chlabicz, Sławomir
In many developed countries tuning supply and demand of medical doctors is a continuous challenge to meet the ever changing needs of community and individual patients. The long study period for medical doctors creates the opportunity to observe the current career preferences of medical students and evolution in time. To investigate the career choices of Polish students in different stages of their medical education. Medical students at five Polish medical universities were questioned about their career aspirations in the first, third and sixth year. A total of 2020 students were recruited for the survey. Among first year students 17% preferred family medicine as final career option, compared to 20% in the third year, and 30% in the sixth year (significant trend, P family medicine: 71% women versus 62% women in the group with a preference for a non-family medicine orientation (P = 0.008). Medical students rejecting a career as a family doctor stated that the impossibility to work in a hospital environment was the determining factor. The opportunity for professional development seems to be an important determining factor in the choice of a medical specialty in Poland. The proportion of Polish students choosing family medicine increases during their progress in medical education, with one third of students interested in a career in family medicine by year six.
Rutherford, Kimberly; Oda, Joanna
Almost three-quarters of family practice residents in British Columbia (BC) meet criteria for burnout. We sought to understand how burnout is perceived and experienced by family medicine residents, and to identify both contributory and protective factors for resident burnout. Two semi-structured focus groups were conducted with ten family practice residents from five distinct University of British Columbia training sites. Participants completed the Maslach Burnout Inventory (MBI). The data were analyzed using a thematic analysis approach. Seventy percent of the focus group participants met criteria for burnout using the MBI. The experience of burnout was described as physical and emotional exhaustion, loss of motivation, isolation from loved ones, and disillusionment with the medical profession. Contributory factors included high workload, burned-out colleagues, perceived undervaluing of family medicine, lack of autonomy, and inability to achieve work-life balance. Protective factors included strong role models in medicine, feeling that one's work is valued and rotations in family medicine. The high level of burnout in family medicine residents in BC is a multifactorial and complex phenomenon. Training programs and faculty should be aware of burnout risk factors and strive to implement changes to reduce burnout, including allowing residents increased control over scheduling, access to counseling services and training for resident mentors.
Hamit Sirri Keten
Material and Method: A total of 170 family physicians working in Kahramanmaras were included in the study. After obtaining informed consent a questionnaire comprising questions regarding socio-demographic properties, conveying contracted family physicians as family medicine specialists and organization of the training program was applied to participants. Results: Among physicians participating in the study 130 (76.5% were male and 40 (23.5% were female, with a mean age of 40.7±7.1 (min = 26 years, max = 64 years. The mean duration of professional experience of physicians was 15.3±7.0 (min = 2 years, max = 40 years years. Of all, 91 (53.5% participants had already read the decree on family medicine specialist training program for contracted family physicians. A hundred and fifteen (67.6% family physicians supported that Family Medicine Specialty program should be taken part-time without interrupting routine medical tasks. Only 51 (30.0% participants stated the requirement of an entrance examination (TUS for family medicine specialty training. Conclusion: Family medicine specialty training program towards family physicians should be considered in the light of scientific criteria. In family medicine, an area exhibited a holistic approach to the patient; specialty training should be through residency training instead of an education program. For this purpose, family medicine departments in medical faculties should play an active role in this process. Additionally further rotations in needed branches should be implemented with a revision of area should be performed. In medicine practical training is of high importance and distant or part-time education is not appropriate, and specialist training shall be planned in accordance with the medical specialty training regulations. [Cukurova Med J 2014; 39(2.000: 298-304
Kipp, Walter; Tindyebwa, Denis; Rubaale, Tom; Karamagi, Ednah; Bajenja, Ellen
We conducted 16 in-depth interviews with family caregivers of AIDS patients in three rural districts in western Uganda. They were selected from a client visitation list of the home-based care program for AIDS patients, based on volunteer participation. Family caregivers reported huge problems associated with providing the necessary psychological, social, and economic care. They also said that the physical and emotional demands of caregiving are overwhelming daily challenges. Most support to AIDS patients provided by family, friends, and the churches. The study highlights the great burden of caregivers, in sub-Saharan Africa who most often are elderly women and young girls. This study examine, the burden and related health issues of family caregivers, primarily women, for AIDS patients in Uganda. It was part of a broad research project using qualitative methods on family caregiving in the home environment in sub-Saharan Africa. As the requirements for family care giving are often overwhelming for women under the conditions as they exist in Uganda and in other developing countries, it constitutes a gender issue of great importance that has not been appreciated fully in the international literature. Family caregiving is also of international relevance, as HIV/AIDS is a global pandemic of previously unknown proportions. In many poor countries, family caregiving is the most common and often the only care that AIDS patients receive, because clinic-based care often is not available close to home or is not affordable. Therefore, family caregiver support programs to alleviate this burden are essential for all those countries where HIV/AIDS is prevalent. Family caregiver burden encompasses medical, social, and economic issues at the household level, which requires an interdisciplinary approach in order to fully understand and appreciate the different dimensions of the family caregiver burden and its negative impact on the lives of so many women in so many countries.
Kates, Nick; Toews, John; Leichner, Pierre
Family physicians may spend up to 50% of their time diagnosing and managing mental disorders and emotional problems, but this is not always reflected in the training they receive. This study of the teaching of psychiatry in the 16 family medicine residency programs in Canada showed that although the majority of program directors are reasonably satisfied with the current training, they see room for improvement—particularly in finding psychiatrists with a better understanding of family practice...
Lundgren, Rebecka I; Gribble, James N; Greene, Margaret E; Emrick, Gail E; de Monroy, Margarita
A pilot project in rural El Salvador tested the integration of family planning into a water and sanitation program as a strategy for increasing male involvement in family planning decison making and use. The organizations involved posited that integrating family planning into a resource management and community development project would facilitate male involvement by diffusing information, by referring men and women to services, and by expanding method choice to include the new Standard Days Method through networks established around issues men cared about and were already involved in. This article examines data from a community-based household survey to assess the impact of the intervention and finds significant changes in contraceptive knowledge, attitudes, and behavior from baseline to endline. Because the differences between baseline and endline are greater than the differences between participants and nonparticipants at endline, the study demonstrates the power of informal networks for spreading information.
Silk, Hugh; Shields, Sara
Humanities in medicine (HIM) is an important aspect of medical education intended to help preserve humanism and a focus on patients. At the University of Massachusetts Family Medicine Residency Program, we have been expanding our HIM curriculum for our residents including orientation, home visit reflective writing, didactics and a department-wide…
The author comments on the theories and empirical evidence which aid in understanding the determinants of the reproductive behavior of farmers in China. The issues are defined, and discussion expands on the needs for a specific number of children in rural versus urban areas, M. Cain's risk insurance hypothesis, the importance of modes of production for the farm family, the farmer's security versus risks, and the balance between risk projection and the maximization of interest. The significance of risk projection is presented as are the implications for policy making. Neither theory of farmer's reproductive behavior, 1) the economic cost and benefit theory or 2) the need for labor theory is considered suitable. The idea that benefits exceed the costs of rearing children cannot justify the repeated cycle of poverty among farmers with many children. The Hubei Province, Danjiankou City, study which estimates rearing costs of 3360 yuan/child benefits of 305 yuan/year to the parents in old age is considered incorrect. The second theory agrees that children are needed for production but recognized surplus labor and does not account for the fact that the more children, the poorer the family. Micro demographic theories identify factors affecting demographic behavior, the extent to which factors affect fertility, and the interrelatedness of factors. The rural family feels jeopardized with one child, and the lowest tolerable number of children is 2-3 in rural areas. Manual labor is the basis of the traditional peasant economy. In this economy, loss of income is a threat whether due to crop failure, weather changes, or market changes. Payment occurs at the end of the year only. Child health is a risk due to poor nutrition and poor health facilities. Following a one-child policy might jeopardize perpetuation of the family line and provision for parents by sons. Urban risks are different. Rural families limit risk by keeping material resources, enlarging and strengthening the
Porcerelli, John H; Fowler, Shannon L; Murdoch, William; Markova, Tsveti; Kimbrough, Christina
This article will describe a training curriculum for family medicine residents to practice collaboratively with psychology (doctoral) trainees at the Wayne State University/Crittenton Family Medicine Residency program. The collaborative care curriculum involves a series of patient care and educational activities that require collaboration between family medicine residents and psychology trainees. Activities include: (1) clinic huddle, (2) shadowing, (3) pull-ins and warm handoffs, (4) co-counseling, (5) shared precepting, (6) feedback from psychology trainees to family medicine residents regarding consults, brief interventions, and psychological testing, (7) lectures, (8) video-observation and feedback, (9) home visits, and (10) research. The activities were designed to teach the participants to work together as a team and to provide a reciprocal learning experience. In a brief three-item survey of residents at the end of their academic year, 83% indicated that they had learned new information or techniques from working with the psychology trainees for assessment and intervention purposes; 89% indicated that collaborating with psychology trainees enhanced their patient care; and 89% indicated that collaborating with psychology trainees enhanced their ability to work as part of a team. Informal interviews with the psychology trainees indicated that reciprocal learning had taken place. Family medicine residents can learn to work collaboratively with psychology trainees through a series of shared patient care and educational activities within a primary care clinic where an integrated approach to care is valued.
Sianko, Natallia; Hedge, Jasmine M.; McDonell, James R.
This study examines differences in psychological adjustment in a sample of rural adolescents who have been exposed to family violence. Self-report questionnaires were administered to 580 adolescents and their primary caregivers. The results revealed that over two thirds of the study participants (68.8%) had been exposed to violence in their families. As hypothesized, cluster analysis identified several profiles among adolescents, distinguished by their psychological and emotional functioning: well adjusted (46.2%), moderately adjusted (44.3%), and struggling (9.5%). Discriminant function analysis confirmed the groupings and revealed that family functioning was among the most influential factors explaining adjustment differences. Multivariate analyses of variance (MANOVAs) further showed that adolescents from each of the three adjustment profiles reported significantly different levels of family social support, parental involvement, and perceived neighborhood safety. Overall, the results confirm heterogeneity of adolescent adaptation in the aftermath of family violence and provide insights into family and neighborhood factors that account for variability in adolescents’ reactions to violence. Implications for future research and practical interventions are discussed. PMID:27106255
Sianko, Natallia; Hedge, Jasmine M; McDonell, James R
This study examines differences in psychological adjustment in a sample of rural adolescents who have been exposed to family violence. Self-report questionnaires were administered to 580 adolescents and their primary caregivers. The results revealed that over two thirds of the study participants (68.8%) had been exposed to violence in their families. As hypothesized, cluster analysis identified several profiles among adolescents, distinguished by their psychological and emotional functioning: well adjusted (46.2%), moderately adjusted (44.3%), and struggling (9.5%). Discriminant function analysis confirmed the groupings and revealed that family functioning was among the most influential factors explaining adjustment differences. Multivariate analyses of variance (MANOVAs) further showed that adolescents from each of the three adjustment profiles reported significantly different levels of family social support, parental involvement, and perceived neighborhood safety. Overall, the results confirm heterogeneity of adolescent adaptation in the aftermath of family violence and provide insights into family and neighborhood factors that account for variability in adolescents' reactions to violence. Implications for future research and practical interventions are discussed. © The Author(s) 2016.
Győrffy, Zsuzsa; Kalabay, László; Mohos, András; Márkus, Bernadett; Nánási, Anna; Rinfel, József; Girasek, Edmond; Torzsa, Péter
The issue of gratuity is one of the most important health policy issues in Hungary. The authors' aim is to investigate the attitude of Hungarian family medicine trainees towards gratitude payment. Quantitative, paper-based survey among trainees from four Departments of Family Medicine in Hungary (n = 152). More than 50 percent of the residents do not approve of accepting gratitude money. Men (pgratitude patients feel (52%). According to the participants, the least influencing factor was the low salary of physicians (14.4%). They believe that accepting gratuity is a corruption, and it's humiliating for doctors (80-80%). Family medicine residents approve of gratitude money even less as compared to the results of previous studies, but related to other gratitude payment issues we have found similar opinions. Orv Hetil. 2017; 158(26): 1028-1035.
Carol L. Elam
Full Text Available Background: Despite efforts to construct targeted medical school admission processes using applicant-level correlates of future practice location, accurately gauging applicants’ interests in rural medicine remains an imperfect science. This study explores the usefulness of textual analysis to identify rural-oriented themes and values underlying applicants’ open-ended responses to admission essays. Methods: The study population consisted of 75 applicants to the Rural Physician Leadership Program (RPLP at the University of Kentucky College of Medicine. Using WordStat, a proprietary text analysis program, applicants’ American Medical College Application Service personal statement and an admission essay written at the time of interview were searched for predefined keywords and phrases reflecting rural medical values. From these text searches, derived scores were then examined relative to interviewers’ subjective ratings of applicants’ overall acceptability for admission to the RPLP program and likelihood of practicing in a rural area. Results: The two interviewer-assigned ratings of likelihood of rural practice and overall acceptability were significantly related. A statistically significant relationship was also found between the rural medical values scores and estimated likelihood of rural practice. However, there was no association between rural medical values scores and subjective ratings of applicant acceptability. Conclusions: That applicants’ rural values in admission essays were not related to interviewers’ overall acceptability ratings indicates that other factors played a role in the interviewers’ assessments of applicants’ acceptability for admission.
Elam, Carol L; Weaver, Anthony D; Whittler, Elmer T; Stratton, Terry D; Asher, Linda M; Scott, Kimberly L; Wilson, Emery A
Despite efforts to construct targeted medical school admission processes using applicant-level correlates of future practice location, accurately gauging applicants' interests in rural medicine remains an imperfect science. This study explores the usefulness of textual analysis to identify rural-oriented themes and values underlying applicants' open-ended responses to admission essays. The study population consisted of 75 applicants to the Rural Physician Leadership Program (RPLP) at the University of Kentucky College of Medicine. Using WordStat, a proprietary text analysis program, applicants' American Medical College Application Service personal statement and an admission essay written at the time of interview were searched for predefined keywords and phrases reflecting rural medical values. From these text searches, derived scores were then examined relative to interviewers' subjective ratings of applicants' overall acceptability for admission to the RPLP program and likelihood of practicing in a rural area. The two interviewer-assigned ratings of likelihood of rural practice and overall acceptability were significantly related. A statistically significant relationship was also found between the rural medical values scores and estimated likelihood of rural practice. However, there was no association between rural medical values scores and subjective ratings of applicant acceptability. That applicants' rural values in admission essays were not related to interviewers' overall acceptability ratings indicates that other factors played a role in the interviewers' assessments of applicants' acceptability for admission.
Neale, Anne Victoria; Bowman, Marjorie A; Seehusen, Dean A
Ringing in the new year 2017! This may finally be the year of real practice improvement after many false starts. Research into practice transformation has informed both local work and national policy. Human factors and payment structures are key. And payment structures depend on how quality is measured. Large gaps between practicing physician recommendations for the most important quality measures and those currently imposed externally are exposed in this issue. Also see information on in-practice social work consultations and their outcomes and recommendations from innovators in integrated care, and for chronic opioid therapy management based on visits to many family medicine offices. Visit entropy is negative for hospital readmissions. Another article reaffirms the importance of family physicians in rural obstetrics, including Cesarean deliveries. Two articles address changing Latino health care access. New Mexico's innovative health extension agent implementation now includes research in ways that benefit all. And a glass half-full: the growth in the diversity of family medicine faculty is above average, but is not occurring as quickly as in the general population. © Copyright 2017 by the American Board of Family Medicine.
Al-Turki, Nouf; Afify, Ayman AM; AlAteeq, Mohammed
Nouf Al-Turki,1 Ayman AM Afify,1 Mohammed AlAteeq2 1Family Medicine Department, Prince Sultan Military Medical City, 2Department of Family Medicine and PHC, King Abdul-Aziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia Background: Health care violence is a significant worldwide problem with negative consequences on both the safety and well-being of health care workers as well as workplace activities. Reports examining health care violence in Saudi Arabia are lim...
Wincewicz, Andrzej; Lebard Zamenhof, Pierre; Zaleski-Zamenhof, Maryse Wanda; Zaleski-Zamenhof, Ludwik Krzysztof; Lieberman, James; Zamenhof, Robert; Grzybowski, Andrzej; Sulkowska, Mariola; Sulkowski, Stanislaw
The Zamenhof family is famous for Dr Ludwik Lejzer Zamenhof (1859-1917), who created the artificial language Esperanto and who initiated a social movement for peace and against any sort of discrimination. Ludwik was an ophthalmologist. Adam, Leon, Alexander, and Julian Zamenhof were medical doctors and noted surgeons, while Sophia Zamenhof was a paediatrician. Ludwik Zamenhof often referred to the biblical story of the Tower of Babel, in which diversity of languages was the punishment for builders who were arrogant and uncaring. With the help of Esperanto, the Zamenhofs metaphorically wanted to overcome the curse of Babel and restore the sense of human unity.
Cronholm, Peter F; Singh, Vijay; Fogarty, Colleen T; Ambuel, Bruce
Violence is a significant public health issue with far-reaching implications for the health of individuals and their communities. Our objective was to describe trends in violence-related training in family medicine residency programs since the last national survey was conducted in 1997. Surveys were sent to 337 US family medicine residency programs with the program director having active Society of Teachers of Family Medicine (STFM) membership. Measures included residency setting and characteristics, violence-related curricular content, teaching techniques and personnel, timing of content, and impact of changes in Residency Review Committee (RRC) and Accreditation Council for Graduate Medical Education (ACGME) requirements. Descriptive statistics and bivariate analyses comparing measures across time were used. A total of 201 (60%) surveys were completed. The most common violence curricula was child (83%) and elder abuse (76%), and the most common teachers of violence-related content were family physicians, psychologists, and social workers. The most common teaching methods were clinical precepting (94%), lectures (90%), case vignettes (71%), and intimate partner violence (IPV) shelter experiences (67%). ACGME and RRC changes were not reflected in self-reported measures of curricular emphasis or time. Violence curricular content and number of hours has been constant in family medicine residencies over time. An increase in the reported use of active learning strategies was identified as a trend across surveys. Next steps for violence curricula involve assessment of residents' competency to identify and intervene in violence.
Abrams, H K
Japan emerged from feudalism a century ago. Farmers comprise 20 percent of the population of 110 million. The agricultural cooperative movement sponsors 118 hospitals in rural areas. Of these, the Saku Central Hospital is the largest, and provides leadership to a vigorous rural health movement. Its unique outreach program and its contributions to rural health are described, together with remarks about Japan's health situation generally. There may be lessons here for America.
González, Martha Rocío; Trujillo, Angela; Pereda, Noemí
To reveal the prevalence of corporal punishment in a rural area of Colombia and its correlates to family structure and other socio-demographic variables. A survey about childrearing and childcare was developed for this study, including a specific question about corporal punishment that was developed based on the Conflict Tactics Scale (CTS). Family structure was categorized as follows, based on previous literature: 'nuclear family,' 'single parent' family, 'extended family,' 'simultaneous family' and 'composed family.' Forty-one percent of the parents surveyed admitted they had used corporal punishment of their children as a disciplinary strategy. The type of family structure, the number of children living at home, the age of the children, the gender of the parent who answered the survey, and the age and gender of the partner were significant predictors of corporal punishment. Family structure is an important variable in the understanding of corporal punishment, especially in regard to nuclear families that have a large number of children and parents who started their parental role early in life. Copyright © 2013 Elsevier Ltd. All rights reserved.
In this article, Xin Xiang investigates what dushu, or "schooling," means for rural senior secondary school students in a high-poverty county in southwestern China. With the persistence of China's rural-urban education inequality and alarming reports about secondary school dropout rates, rural students' and their families' attitudes…
Elshof, Hans; Bailey, Ajay
Population decline in rural areas has an impact on rural villages. This research investigates to what extent families with children in rural villages experience consequences of population decline, in which ways they respond to these experiences, and how that plays a role in their individual social
Full Text Available Information about medicinal plants that is available in text documents is generally quite easy to access, however, one needs some efforts to use it. This research was aimed at utilizing crucial information taken from a text document to identify the family of several species of medicinal plants using a heuristic approach, i.e. genetic programming. Each of the species has its unique features. The genetic program puts the characteristics or special features of each family into a tree form. There are a number of processes involved in the investigated method, i.e. data acquisition, booleanization, grouping of training and test data, evaluation, and analysis. The genetic program uses a training process to select the best individual, initializes a generate-rule process to create several individuals and then executes a fitness evaluation. The next procedure is a genetic operation process, which consists of tournament selection to choose the best individual based on a fitness value, the crossover operation and the mutation operation. These operations have the purpose of complementing the individual. The best individual acquired is the expected solution, which is a rule for classifying medicinal plants. This process produced three rules, one for each plant family, displaying a feature structure that distinguishes each of the families from each other. The genetic program then used these rules to identify the medicinal plants, achieving an average accuracy of 86.47%.
Introduction: Undergraduate medical education requires the studying of a wide range of medical specialties to produce the future workforce of the healthcare system. Family medicine (FM), a relatively new specialty in Nigeria, aims at supplying doctors capable of providing comprehensive healthcare for the majority of the ...
Binczyk, Natalia M; Babenko, Oksana; Schipper, Shirley; Ross, Shelley
Residents in difficulty are costly to programs in both time and resources, and encountering difficulty can be emotionally harmful to residents. Approximately 10% of residents will encounter difficulty at some point in training. While there have been several studies looking at common factors among residents who encounter difficulty, some of the findings are inconsistent. The objective of this study was to determine whether there are common factors among the residents who encounter difficulty during training in a large Canadian family medicine residency program. Secondary data analysis was performed on archived resident files from a Canadian family medicine residency program. Residents who commenced an urban family medicine residency program between the years of 2006 and 2014 were included in the study. Five hundred nine family medicine residents were included in data analysis. Residents older than 30 years were 2.33 times (95% CI: 1.27-4.26) more likely to encounter difficulty than residents aged 30 years or younger. Nontransfer residents were 8.85 times (95% CI: 1.17-66.67) more likely to encounter difficulty than transfer residents. The effects of sex, training site, international medical graduate status, and rotation order on the likelihood of encountering difficulty were nonsignificant. Older and nontransfer residents may be facing unique circumstances and may benefit from additional support from the program.
Conclusions: The high level of burnout in family medicine residents in BC is a multifactorial and complex phenomenon. Training programs and faculty should be aware of burnout risk factors and strive to implement changes to reduce burnout, including allowing residents increased control over scheduling, access to counseling services and training for resident mentors.
Objectives: To assess the attitude and knowledge of family medicine practitioners (FMPs) towards the association between periodontal disease and obesity. Materials and Methods: A cross-sectional study was performed and a 13-item survey questionnaire was given to FMPs practicing in 12 different teaching hospitals in ...
Kim, Curi; Fetters, Michael D; Gorenflo, Daniel W
The value of the morbidity and mortality conference (M&MC) has received little examination in the primary care literature. We sought to understand the educational content of M&MCs by examining data from a family medicine training program. Archived morbidity and mortality conference data (July 2001-July 2003) were retrieved from two University of Michigan family medicine adult inpatient services (one community based and one university based). We used chi-square and t test to compare demographic variables and adverse events between hospital sites. We qualitatively analyzed written comments about adverse events. Both family medicine services shared similar diagnoses, patient volume, length of stay, and gender distribution of patients, but the community hospital had an older average patient age (67.9 years versus 52.9 years) and a higher outpatient complication rate. Analysis of the qualitative data revealed patterns of adverse events, such as an association between avoidable admissions and inadequate pain control, that could be improved through educational intervention. Although family medicine residents' experiences in university and community hospitals were comparable, there were differences in patient populations and case complexity. Modifying the M&MC format could enhance its effectiveness as an educational tool about adverse events.
With the advent of a postgraduate program, in General Medical Practice (GMP) the faculty is changing its outlook so as to differentiate Fellows from other graduates of medicine who are classed as General Practitioners (GPs). The postgraduate trained general practitioner (GP) wants to be known and addressed as a Family ...
Eniola, Kehinde; Evarts, Lori
Cases of child maltreatment (CM) in the United States remain high, and primary care providers lack the confidence and training to diagnose these cases. This study provides recommendations to improve family medicine physicians' confidence in diagnosing CM. We e-mailed an electronic survey to family medicine residents and physicians practicing in the United States. Responses were collected during August and September 2015. Respondents were asked about their familiarity and competence level regarding the diagnosis of CM. They also were asked about the frequency of their correctly diagnosing CM, timeliness of diagnosis, barriers to a diagnosis or early diagnosis of CM, and receipt of adequate CM training. Of the 420 surveys emailed, 258 (61%) were completed. The majority of respondents stated their self-reported level of competence in diagnosing CM as average or below average, with few (8%) indicating a competence level of above average. A timely diagnosis of child maltreatment was reported by 46% of respondents, whereas 54% were either late (19.2%) in diagnosing or could not recall (34.6%). The barriers to diagnosis cited by responders were inexperience (58%), lack of confidence and certainty (50%), lack of diagnosis protocol (43.3%), lack of confidence in communicating with parents (38.3%), and inadequate training (34.9%). The introduction of CM training into the family medicine residency training curriculum, coupled with the development of a standardized CM diagnosis protocol, may improve self-reported family medicine physicians' confidence and competence levels in diagnosing CM.
Williams, Brent C; Warshaw, Gregg; Fabiny, Anne Rebecca; Lundebjerg Mpa, Nancy; Medina-Walpole, Annette; Sauvigne, Karen; Schwartzberg, Joanne G; Leipzig, Rosanne M
Physician workforce projections by the Institute of Medicine require enhanced training in geriatrics for all primary care and subspecialty physicians. Defining essential geriatrics competencies for internal medicine and family medicine residents would improve training for primary care and subspecialty physicians. The objectives of this study were to (1) define essential geriatrics competencies common to internal medicine and family medicine residents that build on established national geriatrics competencies for medical students, are feasible within current residency programs, are assessable, and address the Accreditation Council for Graduate Medical Education competencies; and (2) involve key stakeholder organizations in their development and implementation. Initial candidate competencies were defined through small group meetings and a survey of more than 100 experts, followed by detailed item review by 26 program directors and residency clinical educators from key professional organizations. Throughout, an 8-member working group made revisions to maintain consistency and compatibility among the competencies. Support and participation by key stakeholder organizations were secured throughout the project. The process identified 26 competencies in 7 domains: Medication Management; Cognitive, Affective, and Behavioral Health; Complex or Chronic Illness(es) in Older Adults; Palliative and End-of-Life Care; Hospital Patient Safety; Transitions of Care; and Ambulatory Care. The competencies map directly onto the medical student geriatric competencies and the 6 Accreditation Council for Graduate Medical Education Competencies. Through a consensus-building process that included leadership and members of key stakeholder organizations, a concise set of essential geriatrics competencies for internal medicine and family medicine residencies has been developed. These competencies are well aligned with concerns for residency training raised in a recent Medicare Payment Advisory
Bazemore, Andrew; Wingrove, Peter; Peterson, Lars; Petterson, Stephen
Family physicians are increasingly incorporating other health care providers into their practice teams to better meet the needs of increasingly complex and comorbid patients. While a majority of family physicians report working with a nurse practitioner, only 21% work with a behavioral health specialist. A better understanding of optimal team composition and function in primary care is essential to realizing the promise of a patient-centered medical home and achieving the triple aim. © Copyright 2016 by the American Board of Family Medicine.
Kates, N; Toews, J; Leichner, P
Family physicians may spend up to 50% of their time diagnosing and managing mental disorders and emotional problems, but this is not always reflected in the training they receive. This study of the teaching of psychiatry in the 16 family medicine residency programs in Canada showed that although the majority of program directors are reasonably satisfied with the current training, they see room for improvement-particularly in finding psychiatrists with a better understanding of family practice, in integrating the teaching to a greater degree with clinical work, thereby increasing its relevance, and in utilizing more suitable clinical settings.
Full Text Available Despite the increasing popularity of primary care sports medicine fellowships, as evidenced by the more than two-fold increase in family medicine sports medicine fellowships from a total of 31 accredited programs during the 1998/1999 academic year (ACGME, 1998 to 63 during the 2003/2004 academic year (ACGME, 2006, there are few empirical studies to support the efficacy of such programs. To the best of our knowledge, no studies have been conducted to assess the impact of primary care sports medicine fellowships on family medicine residents' learning of non-musculoskeletal sports medicine topics. Rigorous evaluations of the outcomes of such programs are helpful to document the value of such programs to both the lay public and interested medical residents. In order to evaluate such programs, it is helpful to apply the same objective standards to residents trained across multiple programs. Hence, we would like to know if there is a learning effect with respect to non-musculoskeletal sports medicine topics identified on yearly administered American Board of Family Medicine (ABFM in-training exams (ITE to family medicine residents in family medicine residency programs in the United States with and without primary care sports medicine fellowship programs. Review and approval for the research proposal was granted by the ABFM, who also allowed access to the required data. Permission to study and report only non-musculoskeletal sports medicine topics excluding musculoskeletal topics was granted at the time due to other ongoing projects at the ABFM involving musculoskeletal topics. ABFM allowed us access to examinations from 1998 to 2003. We were given copies of each exam and records of responses to each item (correct or incorrect by each examinee (examinees were anonymous for each year.For each year, each examinee was classified by the ABFM as either (a belonging to a program that contained a sports medicine fellowship, or (b not belonging to a program
Kosteniuk, Julie; Morgan, Debra; Innes, Anthea; Keady, John; Stewart, Norma; D'Arcy, Carl; Kirk, Andrew
Little is known about the views of rural family physicians (FPs) regarding collaborative care models for patients with dementia. The study aims were to explore FPs' views regarding this issue, their role in providing dementia care, and the implications of providing dementia care in a rural setting. This study employed an exploratory qualitative design with a sample of 15 FPs. All rural FPs indicated acceptance of collaborative models. The main disadvantages of practicing rural were accessing urban-based health care and related services and a shortage of local health care resources. The primary benefit of practicing rural was FPs' social proximity to patients, families, and some health care workers. Rural FPs provided care for patients with dementia that took into account the emotional and practical needs of caregivers and families. FPs described positive and negative implications of rural dementia care, and all were receptive to models of care that included other health care professionals.
Moosa, Shabir; Downing, Raymond; Essuman, Akye; Pentz, Stephen; Reid, Stephen; Mash, Robert
The World Health Organisation has advocated for comprehensive primary care teams, which include family physicians. However, despite (or because of) severe doctor shortages in Africa, there is insufficient clarity on the role of the family physician in the primary health care team. Instead there is a trend towards task shifting without thought for teamwork, which runs the risk of dangerous oversimplification. It is not clear how African leaders understand the challenges of implementing family medicine, especially in human resource terms. This study, therefore, sought to explore the views of academic and government leaders on critical human resource issues for implementation of family medicine in Africa. In this qualitative study, key academic and government leaders were purposively selected from sixteen African countries. In-depth interviews were conducted using an interview guide. All interviews were audio-recorded, transcribed and thematically analysed. There were 27 interviews conducted with 16 government and 11 academic leaders in nine Sub-Saharan African countries: Botswana, Democratic Republic of Congo, Ghana, Kenya, Malawi, Nigeria, Rwanda, South Africa and Uganda. Respondents spoke about: educating doctors in family medicine suited to Africa, including procedural skills and holistic care, to address the difficulty of recruiting and retaining doctors in rural and underserved areas; planning for primary health care teams, including family physicians; new supervisory models in primary health care; and general human resource management issues. Important milestones in African health care fail to specifically address the human resource issues of integrated primary health care teamwork that includes family physicians. Leaders interviewed in this study, however, proposed organising the district health system with a strong embrace of family medicine in Africa, especially with regard to providing clinical leadership in team-based primary health care. Whilst these
Durham, Judith A.; Miah, M. Mizanur Rahman
Literature review addresses the status of farm families; farm stresses and their effects; dysfunctional family relationships; and the unique attitudes, behaviors, and perceptions of rural culture toward social service intervention. By implementing coordinated service programs and initiating new legislation that addresses rural health care issues,…
At the Medical faculty of the University of Sarajevo in the 11th semester of the instruction is organized the turnus training from family medicine, and according to the instructive plan and programme of the medical faculty defined in the statute from 1991 year, as well as the rest turnus instruction which the students of medicine pass in the sixth year of studies, and this instruction is imagined as a way and the path that the future physicians as better as possible prepare for the individual work with the patients after acquiring of the diploma. The instruction obligations according to this form of the instruction as that which is being produced are getting performed in the frame of the subject the social medicine and the organization of the healthcare protection. True, the subject family medicine will be independent of the school year 2005/06 for the registration generation 200/01. The momentary plan and programmee (turn) instruction is coinciped so that the teachers and assistants perform 20 hours of the theoretic instruction in the amphitheaters of the Medical faculty and the practical instructions perform the assistants for the family medicine by the fund from 75 hours of the instruction in units of the Health center on the localities Visnjik and Grbavica. The content of the programme encircles the method units which have lead professor Hodgets and the collaborators from Quins' university in Canada and according to the project concipied according to the regulations inter-university agreement of the mentioned university in Canada and the ours in Sarajevo, and the agreement between the Federal ministry of health in Sarajevo and Canada government and which we shall shortly present in this paper. After the heard theoretical and performed practical instruction is being performed the evaluation of knowledge by the corresponding test, which well also be shortly explained in this article. True, there are the definite misunderstandings and the different attitudes
Huber, Douglas; Saeedi, Nika; Samadi, Abdul Khalil
Afghan women have one of the world's highest lifetime risks of maternal death. Years of conflict have devastated the country's health infrastructure. Total fertility was one of the world's highest, contraceptive use was low and there were no Afghan models of success for family planning. We worked closely with communities, providing information about the safety and non-harmful side-effects of contraceptives and improving access to injectable contraceptives, pills and condoms. Regular interaction with community leaders, mullahs (religious leaders), clinicians, community health workers and couples led to culturally acceptable innovations. A positive view of birth spacing was created by the messages that contraceptive use is 300 times safer than pregnancy in Afghanistan and that the Quran (the holy book of Islam) promotes two years of breastfeeding. Community health workers initiated the use of injectable contraceptives for the first time. The non-for-profit organization, Management Sciences for Health, Afghan nongovernmental organizations and the Ministry of Public Health implemented the Accelerating Contraceptive Use project in three rural areas with different ethnic populations. The contraceptive prevalence rate increased by 24-27% in 8 months in the project areas. Men supported modern contraceptives once they understood contraceptive safety, effectiveness and non-harmful side-effects. Injectable contraceptives contributed most to increases in contraceptive use. Community health workers can rapidly increase contraceptive use in rural areas when given responsibility and guidance. Project innovations were adopted as best practices for national scale-up.
Full Text Available Background: Organizing the health system around family medicine (FM has been a productive approach for developed countries. The aim of this study, which was concurrent with the Iran Health Transform Plan (HTP and the establishment of the family physician in Iran, was to discuss the sufficiency of a family physician training program for their roles and increase their competency.Methods: This descriptive study was conducted in the Psychosomatic Research Center affiliated to Isfahan University of Medical Science, Iran, with the assistance of the Iranian Institute of Higher Health (2015. An expert panel consisting of 6 individuals including specialists, trainers, and researchers in FM and psychosomatic medicine was held for this purpose. Using the World Organization of Family Doctors (WONCA website for the definition of a family physician, the curriculum developed by the Ministry of Health and Medical Education was studied. Data were summarized in one table.Results: The current FM curriculum, with this content and method, does not seem to be capable of enabling physicians to perform their multidisciplinary roles. it still has a reductionist approach and disease orientation instead of a clinical reasoning method and systematic viewpoint. The psychosomatic approach is applicable at all prevention levels and in all diseases, since it is basically designed for this longitudinal (between all preventive levels and horizontal (bio-physical–social-spiritual intervention integration.Conclusion: Psychosomatic medicine, not as a biomedical specialty, but rather as a systems thinking model in health, had a rapid rise during previous decades. Now, its services have been integrated into all medical fields. This means that it should be adopted in the core of health care services (i.e., the family physician position before other sections. This would help the implementation of this approach in the health system, and the reduction of patients' pain and
Stearns, Jeffrey A; Stearns, Marjorie A; Davis, Ardis K; Chessman, Alexander W
In the original contract for the Family Medicine Curricular Resource Project (FMCRP), the Health Resources and Services Administration (HRSA), Division of Medicine and Dentistry, charged the FMCRP executive committee with reviewing recent medical education reform proposals and relevant recent curricula to develop an analytical framework for the project. The FMCRP executive and advisory committees engaged in a review and analysis of a variety of curricular reform proposals generated during the last decade of the 20th century. At the same time, in a separate and parallel process, representative individuals from all the family medicine organizations, all levels of learners, internal medicine and pediatric faculty, and the national associations of medical and osteopathic colleges (Association of American Medical Colleges and the American Association of Colleges of Osteopathic Medicine) were involved in group discussions to identify educational needs for physicians practicing in the 21st century. After deliberation, a theoretical framework was chosen for this undergraduate medical education resource that mirrors the Accreditation Council for Graduate Medical Education (ACGME) competencies, a conceptual design originated for graduate medical education. In addition to reflecting the current environment calling for change and greater accountability in medical education, use of the ACGME competencies as the theoretical framework for the FMCR provides a continuum of focus between the two major segments of physician education: medical school and residency.
Full Text Available Abstract Background As more integrative medicine educational content is integrated into conventional family medicine teaching, the need for effective evaluation strategies grows. Through the Integrative Family Medicine program, a six site pilot program of a four year residency training model combining integrative medicine and family medicine training, we have developed and tested a set of competency-based evaluation tools to assess residents' skills in integrative medicine history-taking and treatment planning. This paper presents the results from the implementation of direct observation and treatment plan evaluation tools, as well as the results of two Objective Structured Clinical Examinations (OSCEs developed for the program. Methods The direct observation (DO and treatment plan (TP evaluation tools developed for the IFM program were implemented by faculty at each of the six sites during the PGY-4 year (n = 11 on DO and n = 8 on TP. The OSCE I was implemented first in 2005 (n = 6, revised and then implemented with a second class of IFM participants in 2006 (n = 7. OSCE II was implemented in fall 2005 with only one class of IFM participants (n = 6. Data from the initial implementation of these tools are described using descriptive statistics. Results Results from the implementation of these tools at the IFM sites suggest that we need more emphasis in our curriculum on incorporating spirituality into history-taking and treatment planning, and more training for IFM residents on effective assessment of readiness for change and strategies for delivering integrative medicine treatment recommendations. Focusing our OSCE assessment more narrowly on integrative medicine history-taking skills was much more effective in delineating strengths and weaknesses in our residents' performance than using the OSCE for both integrative and more basic communication competencies. Conclusion As these tools are refined further they will be of value both in improving
Renouf, Tia; Alani, Sabrina; Whalen, Desmond; Harty, Chris; Pollard, Megan; Morrison, Megan; Coombs-Thorne, Heidi; Dubrowski, Adam
To examine perceived communication barriers between urban consultants and rural family physicians practising routine and emergency care in remote subarctic Newfoundland and Labrador (NL). This study used a mixed-methods design. Quantitative and qualitative data were collected through exploratory surveys, comprised of closed and open-ended questions. The quantitative data was analysed using comparative statistical analyses, and a thematic analysis was applied to the qualitative data. 52 self-identified rural family physicians and 23 urban consultants were recruited via email. Rural participants were also recruited at the Family Medicine Rural Preceptor meetings in St John's, NL. Rural family physicians and urban consultants in NL completed a survey assessing perceived barriers to effective communication. Data confirmed that both groups perceived communication difficulties with one another; with 23.1% rural and 27.8% urban, rating the difficulties as frequent (p=0.935); 71.2% rural and 72.2% urban as sometimes (p=0.825); 5.8% rural and 0% urban acknowledged never perceiving difficulties (p=0.714). Overall, 87.1% of participants indicated that perceived communication difficulties impacted patient care. Primary trends that emerged as perceived barriers for rural physicians were time constraints and misunderstanding of site limitations. Urban consultants' perceived barriers were inadequate patient information and lack of native language skills. Barriers to effective communication are perceived between rural family physicians and urban consultants in NL. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
This research investigates e-learning readiness level of family medicine physicians (FM) in Turkey. The study measures the level of e-learning readiness of Turkish FM physicians by an online e-learning readiness survey. According to results five areas are ready at Turkish FM physicians but need a few improvements:…
Full Text Available Introduction: One of the most important duties of a family physician is to provide primary health care. This is completely considered in the Family Physician Program for a target population. The aim of this study was to systematically review the Family Physician and Referral System strength and weakness in rural area of Iran. Methods: In this systematic review, Scientific Information Database (SID, Science Direct, and PubMed databases were searched and Google search engine was employed using key words such as family medicine, family physician, and referral system for the period of January 2005 to June 2013, both in English and Persian. For identifying duplicated references, Endnote Software was used and for summarizing results of fully assessed articles extraction table was employed. Results: Strengths and weaknesses of Family Physician Program and referral system in rural areas of Iran were extracted from 28 studies. In total, 115 weaknesses (3.96 per study and 103 strengths (3.55 per study were obtained. Content analysis was used and 218 items were summarized into 29 items. Strengths of Family Physician Program were: access of villagers to health services, filling health document for clients, improving services for pregnant mothers, and family planning; while its obvious weaknesses included repeated unnecessary referral of clients as well as lack of providing job stability. Conclusion: Results of studies conducted in Iran showed that Family Physician and Referral System in rural area of Iran could not be successful enough and has many shortcomings. Therefore, a growing body of effective changes must be made for a better performance and to obtain better outcomes.
Pust, Ronald E
North American family physicians leaving for less-developed countries (LDCs) may not be aware of internationally validated diagnostic and treatment technologies originating in LDCs. Thus they may bring with them inappropriate models and methods of medical care. More useful "exports" are based in sharing our collaborative vocational perspective with dedicated indigenous generalist clinicians who serve their communities. More specifically, Western doctors abroad can promote local reanalyses of international evidence-based medicine (EBM) studies, efficient deployment of scarce clinical resources, and a family medicine/generalist career ladder, ultimately reversing the "brain drain" from LDCs. Balancing these exports, we should import the growing number of EBM best practices originated in World Health Organization and other LDCs research that are applicable in developed nations. Many generalist colleagues, expatriate and indigenous, with long-term LDC experience stand ready to help us import these practices and perspectives.
Full Text Available Abstract Background Residents are one of the key stakeholders of specialty training. The Turkish Board of Family Medicine wanted to pursue a realistic and structured approach in the design of the specialty training programme. This approach required the development of a needs-based core curriculum built on evidence obtained from residents about their needs for specialty training and their needs in the current infrastructure. The aim of this study was to obtain evidence on residents' opinions and views about Family Medicine specialty training. Methods This is a descriptive, cross-sectional study. The board prepared a questionnaire to investigate residents' views about some aspects of the education programme such as duration and content, to assess the residents' learning needs as well as their need for a training infrastructure. The questionnaire was distributed to the Family Medicine Departments (n = 27 and to the coordinators of Family Medicine residency programmes in state hospitals (n = 11 by e-mail and by personal contact. Results A total of 191 questionnaires were returned. The female/male ratio was 58.6%/41.4%. Nine state hospitals and 10 university departments participated in the study. The response rate was 29%. Forty-five percent of the participants proposed over three years for the residency duration with either extensions of the standard rotation periods in pediatrics and internal medicine or reductions in general surgery. Residents expressed the need for extra rotations (dermatology 61.8%; otolaryngology 58.6%; radiology 52.4%. Fifty-nine percent of the residents deemed a rotation in a private primary care centre necessary, 62.8% in a state primary care centre with a proposed median duration of three months. Forty-seven percent of the participants advocated subspecialties for Family Medicine, especially geriatrics. The residents were open to new educational methods such as debates, training with models, workshops and e
Jansen, Kate L; Rosenbaum, Marcy E
Communication skills are essential to medical training and have lasting effects on patient satisfaction and adherence rates. However, relatively little is reported in the literature identifying how communication is taught in the context of residency education. Our goal was to determine current practices in communication curricula across family medicine residency programs. Behavioral scientists and program directors in US family medicine residencies were surveyed via email and professional organization listservs. Questions included whether programs use a standardized communication model, methods used for teaching communication, hours devoted to teaching communication, as well as strengths and areas for improvement in their program. Analysis identified response frequencies and ranges complemented by analysis of narrative comments. A total of 204 programs out of 458 family medicine residency training sites responded (45%), with 48 out of 50 US states represented. The majority of respondents were behavioral scientists. Seventy-five percent of programs identified using a standard communication model; Mauksch's patient-centered observation model (34%) was most often used. Training programs generally dedicated more time to experiential teaching methods (video review, work with simulated patients, role plays, small groups, and direct observation of patient encounters) than to lectures (62% of time and 24% of time, respectively). The amount of time dedicated to communication education varied across programs (average of 25 hours per year). Respondent comments suggest that time dedicated to communication education and having a formal curriculum in place are most valued by educators. This study provides a picture of how communication skills teaching is conducted in US family medicine residency programs. These findings can provide a comparative reference and rationale for residency programs seeking to evaluate their current approaches to communication skills teaching and
Ie, Kenya; Tahara, Masao; Murata, Akiko; Komiyama, Manabu; Onishi, Hirotaka
Despite recent developments in post-graduate family medicine training in Japan, the numbers of junior doctors entering family medicine residencies are still limited. The objective of this qualitative study was to investigate the possible factors associated to the career choice of family medicine, especially in the context of the newly established family medicine programs in Japan. From December 2010 to January 2011, we distributed a semi-structured questionnaire about career choice to 58 physician members of the Japan Primary Care Association, and 41 of them responded. Four researchers used the Modified Grounded Theory Approach (Kinoshita, 2003) for three-stage conceptualization. We extracted a conceptual model of the choice of newly established family medicine as a career in Japan, consisting of six categories and 77 subordinate concepts from 330 variations. The subcategories of personal background affecting the family-medicine career choice were characteristics ("self-reliance," "pioneering spirit"), career direction ("community/rural-orientedness," "multifaceted orientation") and experience (e.g., "discomfort with fragmented care"). We divided the influencing factors that were identified for career choice into supporters (e.g., "role model"), conflict of career choice (e.g., "anxiety about diverse/broad practice"), and the dawn of a new era in family medicine in Japan (e.g., "lack of social recognition," "concern about livelihood," and "too few role models"). Although the dawn of a new era seemed a rather negative influencer, it was unique to our study that the dawn itself could attract those with a "pioneering spirit" and an "attitude of self-training." Unlike previous studies, the positive factors such as lifestyle and the short residency program were not shown to be part of family medicine's attractiveness. In contrast, "concern about livelihood" was specific among our respondents and was related to career choice in the dawn period. "Community
Keeley, R; Smith, M; Miller, J
To examine whether somatoform symptoms, specifically symptoms of conversion, somatization, and hypochondriasis, are associated with side-effect reporting and treatment nonadherence in depressed family medicine outpatients, and to measure whether symptoms improve with pharmacotherapy. Inception cohort study with 14-week follow-up. Inner-city family medicine residency clinic. Thirty-nine consecutive adults with major depressive disorder were asked to participate, and 30 consented. Antidepressants for 14 weeks. The Personality Assessment Inventory (PAI) was administered before treatment. The PAI is a self-reported inventory compatible with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, designed to measure a broad range of personality characteristics. After 14 weeks, the side-effect incidence and treatment nonadherence rates were determined, and 12 patients were readministered the PAI. Depressed family medicine patients demonstrated trends toward elevated Somatic Complaints scale and conversion subscale scores and a lower Suicidal Ideation scale score relative to those of a standardized depressed psychiatric patient profile. Conversion and hypochondriacal symptoms were associated with side-effect reporting and treatment nonadherence. Somatization and hypochondriacal symptoms improved clinically and statistically during treatment for depression. Somatoform distress is a complex, common, and understudied phenomenon in primary care that can adversely affect the treatment of depression. Somatoform symptoms of conversion and hypochondriasis, but not somatization, were found to be risk factors for treatment nonadherence. Somatization and hypochondriacal symptoms may represent personality states that improve with pharmacotherapy, and conversion symptoms may be a personality trait resistant to medical treatment for depression.
Waning, Brenda; Maddix, Jason; Tripodis, Yorghos; Laing, Richard; Leufkens, Hubert Gm; Gokhale, Manjusha
A rural pharmacy initiative (RPI) designed to increase access to medicines in rural Kyrgyzstan created a network of 12 pharmacies using a revolving drug fund mechanism in 12 villages where no pharmacies previously existed. The objective of this study was to determine if the establishment of the RPI resulted in the unforeseen benefit of triggering medicine price competition in pre-existing (non-RPI) private pharmacies located in the region. We conducted descriptive and multivariate analyses on medicine insurance claims data from Kyrgyzstan's Mandatory Health Insurance Fund for the Jumgal District of Naryn Province from October 2003 to December 2007. We compared average quarterly medicine prices in competitor pharmacies before and after the introduction of the rural pharmacy initiative in October 2004 to determine the RPI impact on price competition. Descriptive analyses suggest competitors reacted to RPI prices for 21 of 30 (70%) medicines. Competitor medicine prices from the quarter before RPI introduction to the end of the study period decreased for 17 of 30 (57%) medicines, increased for 4 of 30 (13%) medicines, and remained unchanged for 9 of 30 (30%) medicines. Among the 9 competitor medicines with unchanged prices, five initially decreased in price but later reverted back to baseline prices. Multivariate analyses on 19 medicines that met sample size criteria confirm these findings. Fourteen of these 19 (74%) competitor medicines changed significantly in price from the quarter before RPI introduction to the quarter after RPI introduction, with 9 of 19 (47%) decreasing in price and 5 of 19 (26%) increasing in price. The RPI served as a market driver, spurring competition in medicine prices in competitor pharmacies, even when they were located in different villages. Initiatives designed to increase equitable access to medicines in rural regions of developing and transitional countries should consider the potential to leverage medicine price competition as a means
Wenghofer, Elizabeth F; Hogenbirk, John C; Timony, Patrick E
The "rural pipeline" suggests that students educated in rural, or other underserviced areas, are more likely to establish practices in such locations. It is upon this concept that the Northern Ontario School of Medicine (NOSM) was founded. Our analysis answers the following question: Are physicians who were educated at NOSM more likely to practice in rural and northern Ontario compared with physicians who were educated at other Canadian medical schools? We used data from the College of Physicians and Surgeons of Ontario. We compared practice locations of certified Ontario family physicians who had graduated from NOSM vs. other Canadian medical schools in 2009 or later. We categorized the physicians according to where they completed their undergraduate (UG) and postgraduate (PG) training, either at NOSM or elsewhere. We used logistic regression models to determine if the location of UG and PG training was associated with rural or northern Ontario practice location. Of the 535 physicians examined, 67 had completed UG and/or PG medical education at NOSM. Over two thirds of physicians with any NOSM education were practicing in northern areas and 25.4% were practicing in rural areas of Ontario compared with those having no NOSM education, with 4.3 and 10.3% in northern and rural areas, respectively. Physicians who graduated from NOSM-UG were more likely to have practices located in rural Ontario (OR = 2.57; p = 0.014) whereas NOSM-PG physicians were more likely to have practices in northern Ontario (OR = 57.88; p education was associated with an increased likelihood of practicing in rural (NOSM-UG) and northern (NOSM-PG) Ontario.
Full Text Available Four physicians working in private family medicine offices in Dalmatian Hinterland described their first hand experience of teaching sixthyear medical students. They supervised students during the 2010/2011 academic year, in an area that is economically undeveloped, rural, and where a number of people live in extended families. Although hesitant at first, the patients came to like the interaction with students, and later even yearned to provide students with as much information as possible. They also liked the letters that students had to write to them about their illness, because they could take them home and look for information without needing to see the doctor. The students showed diverse attitudes to different types of work in family medicine offices, mostly depending on their plans for future career. In general, they either complained or hesitated to perform duties that they did not fully master during earlier education, especially working with children. They needed several days to adapt to direct contact with the patients, and were more relaxed and cooperative when working in pairs than alone. The physicians themselves felt that they profited both from the novelty in the everyday routine and from the exchange of their experiences with the students. They liked their young colleagues and admitted they could not objectively review their own work, knowledge and skills.
Petek Šter, Marija; Švab, Igor; Klemenc-Ketiš, Zalika; Kersnik, Janko
The development of the EURACT (European Academy of Teachers in General Practice) Educational Agenda helped many family medicine departments in development of clerkship and the aims and objectives of family medicine teaching. Our aims were to develop and validate a tool for assessment of students’ attitudes towards family medicine and to evaluate the impact of the clerkship on students’ attitudes regarding the competences of family doctor. In the pilot study, experienced family doc...
Ross, David; Schipper, Shirley; Westbury, Chris; Linh Banh, Hoan; Loeffler, Kim; Allan, G Michael; Ross, Shelley
Our objective was to determine the relationship between critical thinking skills and objective measures of academic success in a family medicine residency program. This prospective observational cohort study was set in a large Canadian family medicine residency program. Intervention was the California Critical Thinking Skills Test (CCTST), administered at three points in residency: upon entry, at mid-point, and at graduation. Results from the CCTST, Canadian Residency Matching Service file, and interview scores were compared to other measures of academic performance (Medical Colleges Admission Test [MCAT] and College of Family Physicians of Canada [CCFP] certification examination results). For participants (n=60), significant positive correlations were found between critical thinking skills and performance on tests of knowledge. For the MCAT, CCTST scores correlated positively with full scores (n=24, r=0.57) as well as with each section score (verbal reasoning: r=0.59; physical sciences: r=0.64; biological sciences: r=0.54). For CCFP examination, CCTST correlated reliably with both sections (n=49, orals: r=0.34; short answer: r=0.47). Additionally, CCTST was a better predictor of performance on the CCFP exam than was the interview score at selection into the residency program (Fisher's r-to-z test, z=2.25). Success on a critical thinking skills exam was found to predict success on family medicine certification examinations. Given that critical thinking skills appear to be stable throughout residency training, including an assessment of critical thinking in the selection process may help identify applicants more likely to be successful on final certification exam.
Angstman, Kurt B; Horn, Jennifer L; Bernard, Matthew E; Kresin, Molly M; Klavetter, Eric W; Maxson, Julie; Willis, Floyd B; Grover, Michael L; Bryan, Michael J; Thacher, Tom D
The demand for comprehensive primary health care continues to expand. The development of team-based practice allows for improved capacity within a collective, collaborative environment. Our hypothesis was to determine the relationship between panel size and access, quality, patient satisfaction, and cost in a large family medicine group practice using a team-based care model. Data were retrospectively collected from 36 family physicians and included total panel size of patients, percentage of time spent on patient care, cost of care, access metrics, diabetic quality metrics, patient satisfaction surveys, and patient care complexity scores. We used linear regression analysis to assess the relationship between adjusted physician panel size, panel complexity, and outcomes. The third available appointments (P size. Patient satisfaction, cost, and percentage fill rate were not affected by panel size. A physician-adjusted panel size larger than the current mean (2959 patients) was associated with a greater likelihood of poor-quality rankings (≤25th percentile) compared with those with a less than average panel size (odds ratio [OR], 7.61; 95% confidence interval [CI], 1.13-51.46). Increased panel size was associated with a longer time to the third available appointment (OR, 10.9; 95% CI, 1.36-87.26) compared with physicians with panel sizes smaller than the mean. We demonstrated a negative impact of larger panel size on diabetic quality results and available appointment access. Evaluation of a family medicine practice parameters while controlling for panel size and patient complexity may help determine the optimal panel size for a practice. © Copyright 2016 by the American Board of Family Medicine.
Ariff, Kamil M; Beng, Khoo S
Understanding the sociocultural dimension of a patient's health beliefs is critical to a successful clinical encounter. Malaysia with its multi-ethnic population of Malay, Chinese and Indian still uses many forms of traditional health care in spite of a remarkably modern rural health service. The objective of this paper is discuss traditional health care in the context of some of the cultural aspects of health beliefs, perceptions and practices in the different ethnic groups of the author's rural family practices. This helps to promote communication and cooperation between doctors and patients, improves clinical diagnosis and management, avoids cultural blind spots and unnecessary medical testing and leads to better adherence to treatment by patients. Includes traditional practices of 'hot and cold', notions of Yin-Yang and Ayurveda, cultural healing, alternative medicine, cultural perception of body structures and cultural practices in the context of women's health. Modern and traditional medical systems are potentially complementary rather than antagonistic. Ethnic and cultural considerations can be integrated further into the modern health delivery system to improve care and health outcomes.
Brennan, Julie; McGrady, Angele
Family medicine residents are at risk for burnout due to extended work hours, lack of control over their work schedule, and challenging work situations and environments. Building resiliency can prevent burnout and may improve a resident's quality of life and health behavior. This report describes a program designed to build resiliency, the ability to bounce back from stress, in family medicine residents in a medium sized U.S. residency training program. Interactive sessions emphasized building self-awareness, coping skills, strengths and meaning in work, time management, self-care, and connections in and outside of medicine to support resident well-being. System changes which fostered wellness were also implemented. These changes included increasing the availability of fresh fruits in the conference and call room, purchasing an elliptical exercise machine for the on call room, and offering a few minutes of mindfulness meditation daily to the inpatient residents. Results to date show excellent acceptance of the program by trainees, increased consumption of nutritious foods, more personal exercise, and self-reported decreased overreactions to stress. Resiliency programs can effectively serve to meet accreditation requirements while fostering residents' abilities to balance personal and professional demands. © The Author(s) 2015.
Krztoń-Królewiecka, Anna; Jarczewska, Dorota Łucja; Windak, Adam
Family medicine has been recognized as the key element of a good health care system. Despite the significance of the family physician's role the number of medical students choosing to train in family medicine has been declining in recent years. The aim of this study was to describe opinions about family medicine and family medicine teaching among medical students. A cross sectional study with an anonymous questionnaire was carried out. The study population was all sixth-year students in Faculty Medicine of Jagiellonian University Medical College, who completed family medicine course in winter semester of academic year 2012/2013. 111 students filled in the questionnaire. The response rate was 84.1%. Less than one third of respondents (30.6%) considered family medicine as a future career choice. Almost all students recognized responsibility of the family doctor for the health of community. 52% of respondents agreed that the family doctor is competent to provide most of the health care an individual may require. Experience from family medicine course was according to the students the most important factor influencing their opinions. Medical students appreciate the social role of family doctors. Family medicine teachers should not only pass on knowledge, but they also should encourage medical students to family medicine as a future career choice.
Gueye, E H
Poultry production has existed for many generations in Africa, and almost every village household keeps chickens. The rural family poultry (RFP) are generally raised in free-range and/or backyard systems, which are traditional extensive husbandry systems. The development of an intensive poultry production has been the goal of the African government over the years. Despite efforts aiming for such goal, RFP is still very important in African countries that are both poor and net importers of food. It is a valuable asset because it can contribute significantly in alleviating poverty, securing food supply, and promoting gender equality. In view of this, interventions to improve RFP production systems should take into account the sociocultural issues, specifically gender-based aspects. It is noted that such interventions might, in addition to food security and poverty alleviation, also serve to promote gender equality. RFP development programs should be more women-friendly in order to facilitate women's participation, as RFP production in the region is generally a woman's business. Moreover, efforts to empower village women has to be envisaged cautiously as there is a serious risk of men taking over once the poultry sector becomes more profitable.
Grierson, Lawrence E M; Fowler, Nancy; Kwan, Matthew Y W
To assess residents' practice intentions since the introduction of the College of Family Physicians of Canada's Triple C curriculum, which focuses on graduating family physicians who will provide comprehensive care within traditional and newer models of family practice. A survey based on Ajzen's theory of planned behaviour was administered on 2 occasions. McMaster University in Hamilton, Ont. Residents (n = 135) who were enrolled in the Department of Family Medicine Postgraduate Residency Program at McMaster University in July 2012 and July 2013; 54 of the 60 first-year residents who completed the survey in 2012 completed it again in 2013. The survey was modeled so as to measure the respondents' intentions to practise with a comprehensive scope; determine the degree to which their attitudes, subjective norms, and perceptions of control about comprehensive practice influence those intentions; and investigate how these relationships change as residents progress through the curriculum. The survey also queried the respondents about their intentions with respect to particular medical services that underpin comprehensive practice. The responses indicate that the factors modeled by the theory of planned behaviour survey account for 60% of the variance in the residents' intentions to adopt a comprehensive scope of practice upon graduation, that there is room for curricular improvement with respect to encouraging residents to practise comprehensive care, and that targeting subjective norms about comprehensive practice might have the greatest influence on improving resident intentions. The theory of planned behaviour presents an effective approach to assessing curricular effects on resident practice intentions while also providing meaningful information for guiding further program evaluation efforts in the Department of Family Medicine at McMaster University.
Wang, Jingying; Li, Hui; Wang, Dan
This study examines the effects of family involvement on the literacy gap between rural and urban Chinese primary students via mediation analysis. Altogether, 1080 students in Grades 1, 3, and 5 were randomly sampled from three urban and three rural primary schools from Shandong and Guizhou Provinces, representing eastern and western China,…
Smith, Darren P.; Higley, Rebecca
Although there is recurring empirical evidence of gentrifier families with young children, the importance of education-related factors in the migration and residential decision-making of rural gentrifiers have yet to be fully examined. Using the case study of Cranbrook, Kent, processes of education-led rural gentrification are revealed that are…
After short-lived growth in the early 1990s, Russia’s private family farming sector has been characterized by stagnation, while ownership of former collective and state farms is increasingly concentrated in the hands of the rural elite. This accumulation turns the rural dwellers, who (formally) had
McGrail, Matthew R; Russell, Deborah J; O'Sullivan, Belinda G
Reduced opportunities for children's schooling and spouse's/partner's employment are identified internationally as key barriers to general practitioners (GPs) working rurally. This paper aims to measure longitudinal associations between the rurality of GP work location and having (i) school-aged children and (ii) a spouse/partner in the workforce. Participants included 4377 GPs responding to at least two consecutive annual surveys of the Medicine in Australia: Balancing Employment and Life (MABEL) national longitudinal study between 2008 and 2014. The main outcome, GP work location, was categorised by remoteness and population size. Five sequential binary school-age groupings were defined according to whether a GP had no children, only preschool children (aged 0-4 years), at least one primary-school child (aged 5-11 years), at least one child in secondary school (aged 12-18 years), and all children older than secondary school (aged ≥ 19). Partner in the workforce was defined by whether a GP had a partner who was either currently working or looking for work, or not. Separate generalised estimating equation models, which aggregated consecutive annual observations per GP, tested associations between work location and (i) educational stages and (ii) partner employment, after adjusting for key covariates. Male GPs with children in secondary school were significantly less likely to work rurally (inclusive of > 50 000 regional centres through to the smallest rural towns of locations were not significantly associated with the educational stage of their children. Having a partner in the workforce was not associated with work location for male GPs, whereas female GPs with a partner in the workforce were significantly less likely to work in smaller rural/remote communities (location is related to key family needs which differ according to GP gender and educational stages of children. Such non-professional factors are likely to be dynamic across the GP's lifespan and
Hana, Jan; Rudebeck, Carl Edvard
OBJECTIVE. To explore the personal experiences of and conceptions regarding leading rural primary care in Northern Norway. DESIGN. Qualitative content analysis of focus-group interviews. SETTING. Lead primary care physicians in the three northernmost counties. Subjects. Four groups with 22 out of 88 municipal lead physicians in the region. RESULTS. Three main categories were developed and bound together by an implicit theme. Demands and challenges included the wide leadership span of clinical services and public health, placed in a merged line/board position. Constraints of human resources and time and the ever changing organizational context added to the experience of strain. Personal qualifications indicates the lack of leadership motivation and training, which was partly compensated for by a leader role developed through clinical undergraduate training and then through the responsibilities and experiences of clinical work. In Exercising the leadership, the participants described a vision of a coaching and coordinating leadership and, in practice, a display of communication skills, decision-making ability, result focusing, and ad hoc solutions. Leadership was made easier by the features of the small, rural organization, such as overview, close contact with cooperating partners, and a supportive environment. There was incongruence between demands and described qualifications, and between desired and executed leadership, but nevertheless the organization was running. Leadership demonstrated a "working inadequacy". CONCLUSION. Under resource constraints, leadership based on clinical skills favours management by exception which, in the long run, appears to make the leadership less effective. Leadership training which takes into account the prominent features of rural and decentralized primary care is strongly needed.
Hana, Jan; Rudebeck, Carl Edvard
Objective To explore the personal experiences of and conceptions regarding leading rural primary care in Northern Norway. Design Qualitative content analysis of focus-group interviews. Setting Lead primary care physicians in the three northernmost counties. Subjects Four groups with 22 out of 88 municipal lead physicians in the region. Results Three main categories were developed and bound together by an implicit theme. Demands and challenges included the wide leadership span of clinical services and public health, placed in a merged line/board position. Constraints of human resources and time and the ever changing organizational context added to the experience of strain. Personal qualifications indicates the lack of leadership motivation and training, which was partly compensated for by a leader role developed through clinical undergraduate training and then through the responsibilities and experiences of clinical work. In Exercising the leadership, the participants described a vision of a coaching and coordinating leadership and, in practice, a display of communication skills, decision-making ability, result focusing, and ad hoc solutions. Leadership was made easier by the features of the small, rural organization, such as overview, close contact with cooperating partners, and a supportive environment. There was incongruence between demands and described qualifications, and between desired and executed leadership, but nevertheless the organization was running. Leadership demonstrated a “working inadequacy”. Conclusion Under resource constraints, leadership based on clinical skills favours management by exception which, in the long run, appears to make the leadership less effective. Leadership training which takes into account the prominent features of rural and decentralized primary care is strongly needed. PMID:21526921
Porter, Maribeth; Hagan, Helen; Klassen, Rosemary; Yang, Yang; Seehusen, Dean A; Carek, Peter J
Nearly one-half (46%) of physicians report at least one symptom of burnout. Family medicine residency program directors may have similar and potentially unique levels of burnout as well as resiliency. The primary aims of this study were to examine burnout and resiliency among family medicine residency directors and characterize associated factors. The questions used were part of a larger omnibus survey conducted by the Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA) in 2016. Program and director-specific characteristics were obtained. Symptoms of burnout were assessed using two single-item measures adapted from the full Maslach Burnout Inventory, and level of resiliency was assessed using the Brief Resilience Scale. The overall response rate for the survey was 53.7% (245/465). Symptoms of high emotional exhaustion or high depersonalization were reported in 27.3% and 15.8% of program directors, respectively. More than two-thirds of program directors indicated that they associated themselves with characteristics of resiliency. Emotional exhaustion and depersonalization were significantly correlated with never having personal time, an unhealthy work-life balance, and the inability to stop thinking about work. The presence of financial stress was significantly correlated with higher levels of emotional exhaustion and depersonalization. In contrast, the level of resiliency reported was directly correlated with having a moderate to great amount of personal time, healthy work-life balance, and ability to stop thinking about work, and negatively correlated with the presence of financial stress. Levels of emotional exhaustion, depersonalization, and resiliency are significantly related to personal characteristics of program directors rather than characteristics of their program.
Mishori, Ranit; Levy, Brendan; Donvan, Benjamin
The use of social media is expanding in medicine. A few articles sought to describe participant behavior using Twitter at scientific conferences. Family physicians are known as active participants in social media, but their behavior and practices at conferences have not been methodically described. We recorded all public tweets at the 2013 Society of Teachers of Family Medicine (STFM) Annual Spring Conference bearing the hashtag #STFM13, using commercially available services. We created a transcript of all tweets for the 5 days of the conference and 3 days before and after. We looked at the total number of tweets, number of original tweets and re-tweets, active users, most prolific users, and impressions. We categorized the content based on (1) Session related, (2) Social, (3) Logistics, (4) Ads, and (5) Other. We compared major metrics (but not content) to the 2012 STFM Annual Spring Conference. There were a total of 1,818 tweets from 181 user accounts: 13% of the conference registrants. The top tweeter accounted for over 15% of the total tweets, and the top 10 accounted for over 50% of the total volume. Most original tweets (69.7%) were related to session content. Social content came in second (14.2%), followed by other, logistics, and advertisement (7.6%, 6.9%, 1.6%). This preliminary analysis provides an initial snapshot of twitter activity at a family medicine conference. It may suggest avenues for further inquiry: trend identification, "influencer" identification, and qualitative analysis. Interdisciplinary research should focus on evaluation methods that can assess the quality, value, and impact of tweeting.
Klee, David; Covey, Carlton; Zhong, Laura
Incorporation of social media (SM) use in medicine is gaining support. The Internet is now a popular medium for people to solicit medical information. Usage of social networks, such as Facebook and Twitter, is growing daily and provides physicians with nearly instantaneous access to large populations for both marketing and patient education. The benefits are myriad, but so are the inherent risks. We investigated the role providers' age and medical experience played in their beliefs and use of SM in medicine. Using multiple state-wide and national databases, we assessed social media use by family medicine residents, faculty, and practicing family physicians with a 24-question online survey. Descriptive data is compared by age and level of medical experience. A total of 61 family medicine residents and 192 practicing family physicians responded. There is a trend toward higher SM utilization in the younger cohort, with 90% of resident respondents reporting using SM, half of them daily. A total of 64% of family physician respondents over the age of 45 have a SM account. An equal percentage of senior physicians use SM daily or not at all. Practicing physicians, more than residents, agree that SM can be beneficial in patient care. The vast majority of residents and physicians polled believe that SM should be taught early in medical education. The high utilization of SM by younger providers, high prevalence of patient use of the Internet, and the countless beneficial opportunities SM offers should be catalysts to drive curriculum development and early implementation in medical education. This curriculum should focus around four pillars: professional standards for SM use, SM clinical practice integration, professional networking, and research.
AlKot, Mohammad Mahmoud; Gouda, Mohamed Alaa; KhalafAllah, Mahmoud Tawfik; Zahran, Mohamed Salah; Kallaf, Mostafa Mohamed; Zayed, Ahmed Medhat
PHENOMENON: Attitudes of medical students toward family medicine as a specialty choice can provide information on the future supply of family physicians. Due to the current worldwide shortage of family physicians, these attitudes, with their subsequent effects on the state and dynamics of the healthcare system, are important to investigate. A web-based questionnaire was sent to 600 medical students, selected by a systematic random sampling technique, in 7 Egyptian medical schools. Participants were surveyed to assess their perception of the family medicine specialty as a future career and explore the impact of different factors, including undergraduate family medicine clerkships, on their attitudes toward family medicine. We had a response rate of 75.2% (n = 451). Although 90.7% of students believed in the vital role that family medicine can play in Egypt's healthcare system, only 4.7% showed an intention to choose it as a future career. Students choosing family medicine as a first-career choice were more likely to have a prior contact with family physicians as consumers. Exposure to an undergraduate family medicine curriculum was associated with increased knowledge about family medicine but not the intentions to pursue it as a career. INSIGHTS: Medical students in Egypt have a positive perception of family medicine as an important specialty but low interest in its choice as a future career.
Full Text Available Background: In response to transforming healthcare and pursuit of the Triple Aim, many health systems have added team members to expand the capabilities and effectiveness of the team to facilitate these aims. The objective of this study was to explore knowledge and perceptions of pharmacist-physician collaboration among family medicine residents (FMR, family medicine faculty (FMF, and pharmacist faculty and residents in a practice where clinical pharmacy services were relatively new. Understanding the nuances of pharmacist-physician interactions will provide insight into how to improve FMR education to prepare learners for patient-centered, team-based practice. Methods: An exploratory descriptive qualitative study design was used to articulate perceptions of professional roles and team-based care in an interprofessional family medicine community-based clinical practice. Five, 60-minute focus groups were conducted in a clinical training setting that focuses on preparing family medicine physicians for collaborative rural primary care practice. Results: Twenty-one FMRs, eight FMF, and six clinical pharmacists participated. Three themes emerged from the focus groups and were consistent across the groups: 1 roles of pharmacists recognized by physicians in different settings, 2 benefits to collaboration, and 3 keys to successful pharmacist-physician collaboration which include a developing the relationship, b optimizing communication, c creating beneficial clinical workflow, d clarifying roles and responsibilities, and e increasing opportunities for meaningful interactions. Conclusion: This study demonstrated that by co-locating physicians and pharmacists in the same environment, and providing a basic structure for collaboration, a collaborative working relationship can be initiated. Practices looking to have more effective collaborative working relationships should strive to increase the frequency of interactions of the professions, help the
Donovan Casas Patiño
Full Text Available The central ideas of this research paper are related to the practice of family medicine as a specialty. It focuses in its origins, problems, unique characteristics, limitations, scope, management, and processes within the context of primary care of the Mexican Social Security System. This approach was based on a qualitative, hermeneutical study closely related to the Structural Functionalism Theory. Within this framework, medical practice is seen as an equation: Meaning = action + function/structure. This offers an approach to the understanding of reality through surveys and observations in five categories: identity, activity, purpose, values/norms, and power/relationship. The practice of family medicine is defined as a medical act in the Mexican Social Security Institute. This act is limited to a brief encounter and a prescription, which makes it a short, fleeting, medicalized interaction. The result is a negative social imaginary of the physician, the patient and the whole of society. Thus, individuals and society host a negative social imaginary bestowed on doctors and users of the health system.
Muñoz-Cortés, Gerardo; García-Zavala, Guadalupe Ulises; Estrada-Andrade, María Elena
influenza is a highly contagious respiratory disease. Surveillance in Mexico is based on the detection of Influenza-Like Illness (ILI) and antiviral treatment should begin within 48 hours to avoid the main complication, pneumonia. The aim was to describe the experience of treatment of ILI in a family medicine unit. a descriptive study included patients presented to the emergency room with ILI (38°C fever, headache and cough accompanied by other symptoms). We reviewed the reporting formats of Influenza. To follow up, we contacted them by telephone. Data are expressed as mean ± standard deviation. there were 537 patients attended with diagnosis of upper airway infection, 1.3 % met criteria for ILI. 85.7 % were men. The mean age was 18 ± 24.21 years. The patients were seen in a mean time of 19.14 hours after the symptoms have started; 100 % of the patients received treatment with oseltamivir and zanamivir; 14.3 % developed pneumonia. All the patients recovered without concomitant disease or complications. The use of a protocol in patients with influenza in a family medicine unit led an early diagnosis and treatment that favored the patients' health restoration.
Fisher, Carla L; Ledford, Christy J W; Moss, David A; Crawford, Paul
Integrating complementary therapies (acupuncture) into conventional medicine has garnered recent support. Given the health benefits, low cost, and minimal risks, the military has advocated for acupuncture and begun training family medicine physicians. Little is known about the role of physician communication in patients' acupuncture engagement (uptake and adherence) in conventional medicine settings. We interviewed physicians (N = 15) and patients (N = 17) to capture physician communication they perceived affected treatment engagement. Data for each group were thematically analyzed. Physicians and patients prioritized different communication approaches and associated strategies. Physicians identified four approaches that enhance treatment engagement: (1) using shared decision-making (e.g., treatment options); (2) not being pushy (e.g., in tone); (3) carefully choosing language (e.g., Eastern versus Western terms); and (4) explaining treatment outcomes (e.g., efficacy). Patients also prioritized explaining treatment outcomes but differently (e.g., timing clarity), with two additional approaches: (5) talking with the same physician (e.g., continuity) and (6) being responsive to patient (e.g., flexibility). Findings highlight how physicians and patients prioritize patient-centered communication differently and how it is embedded within a unique, complex therapy. Data showcase authentic narratives that could be translated into physician communication skills training to promote treatment engagement in integrative care.
The papers of this thesis are not available in Munin I: Hana, J. & Rudebeck, C. A.: 'Leadership in rural medicine: The organization on thin ice?', Scandinavian Journal of Primary Health Care, 2011; 29: 122–128. Available at http://dx.doi.org/10.3109/02813432.2011.577148 II: Hana, J. & Kirkhaug, R.: ‘Physicians’ leadership styles in rural primary medical care: how are they perceived by staff?’, Scandinavian Journal of Primary Health Care, 2014; 32: 4–10. Available at http://dx.doi.org/10.3109/...
Ben-Arye, Eran; Israely, Pesi; Baruch, Erez; Dagash, Jamal
In this paper, we describe the case study of a 27 year-old Arab female patient receiving palliative care for advanced breast cancer who was referred to complementary medicine (CM) consultation provided within a conventional oncology department. We explore the impact of the integrative CM practitioners' team of three family physicians and one Chinese medicine practitioner on the patient's well-being and specifically on the alleviation of her debilitating hot flashes and insomnia. This quality of life improvement is also affirmed by comparing the Edmonton Symptom Assessment Scale (ESAS) and Measure Yourself Concerns and Well-being (MYCAW) questionnaires administered at the initial and follow-up assessment sessions. In conclusion, we suggest that family physicians trained in evidence-based complementary medicine are optimal integrators of holistic patient-centered supportive care. The inclusion of trained CM practitioners in a multi-disciplinary integrative team may enhance the bio-psycho-social-spiritual perspective, and provide additional practical therapies that improve the quality of life of patients confronting cancer. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Hekmat, F; Kabacoff, R I; Klein, H E
A sample of 384 husbands and wives were randomly selected and interviewed to investigate the implication of fertility norms and motivations for childbearing on fertility and family planning behavior among Iranian families in urban and rural areas of Iran, after the Islamic Revolution of 1979. The term "fertility behavior" refers to actual family size, which is defined as number of children the respondent has living at the time of the interview. "Family planning behavior" refers to the duration of time that the subject has used any birth control method(s). Rural families demonstrated larger actual and ideal family sizes than urban families. The rural sample had a median actual family size of 3.5 children and a median ideal family size of 4.7 children. For the urban sample these figures were 2.2 and 2.3, respectively. The median number of years married was 12.33 for rural and 13.91 for urban respondents. Urban respondents tended to emphasize the psychological and emotional benefits and liabilities associated with having children while rural respondents tended to emphasize both economic and security related motivations. Both groups endorsed infant mortality as a motivation for having more children. Male and female respondents were remarkably similar in their endorsed motivations. There was a significant positive correlation between desired and ideal family size. The correlations among ideal/desired family size and practicing birth control methods were the same and significant at the .001 level. The relationship between motivations for childbearing and years of practicing birth control methods was also significant at the .001 level. Stepwise regression analyses were performed to examine the important predictors of fertility and family planning behavior. For both actual family size and years on birth control, males and females were very similar in terms of predictor importance. Those respondents with less education and large ideal family size tended to have larger
Weber, Bruce A.
The past decade has seen a number of studies of how the poverty incidence (the percentage of families below the poverty line) of certain demographic groups changes in response to economic growth. The question of whether regional economic growth trickles down to rural and rural poor families was examined by statistically estimating the relationship…
Biringer, Anne; Forte, Milena; Tobin, Anastasia; Shaw, Elizabeth; Tannenbaum, David
To ascertain how program leaders in family medicine characterize success in family medicine maternity care education and determine which factors influence the success of training programs. Qualitative research using semistructured telephone interviews. Purposive sample of 6 family medicine programs from 5 Canadian provinces. Eighteen departmental leaders and program directors. Semistructured telephone interviews were conducted with program leaders in family medicine maternity care. Departmental leaders identified maternity care programs deemed to be "successful." Interviews were audiorecorded and transcribed verbatim. Team members conducted thematic analysis. Participants considered their education programs to be successful in family medicine maternity care if residents achieved competency in intrapartum care, if graduates planned to include intrapartum care in their practices, and if their education programs were able to recruit and retain family medicine maternity care faculty. Five key factors were deemed to be critical to a program's success in family medicine maternity care: adequate clinical exposure, the presence of strong family medicine role models, a family medicine-friendly hospital environment, support for the education program from multiple sources, and a dedicated and supportive community of family medicine maternity care providers. Training programs wishing to achieve greater success in family medicine maternity care education should employ a multifaceted strategy that considers all 5 of the interdependent factors uncovered in our research. By paying particular attention to the informal processes that connect these factors, program leaders can preserve the possibility that family medicine residents will graduate with the competence and confidence to practise full-scope maternity care. Copyright© the College of Family Physicians of Canada.
Full Text Available Nouf Al-Turki,1 Ayman AM Afify,1 Mohammed AlAteeq2 1Family Medicine Department, Prince Sultan Military Medical City, 2Department of Family Medicine and PHC, King Abdul-Aziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia Background: Health care violence is a significant worldwide problem with negative consequences on both the safety and well-being of health care workers as well as workplace activities. Reports examining health care violence in Saudi Arabia are limited and the results are conflicting.Objective: To estimate the prevalence and determine the demographic and occupational characteristics associated with workplace violence in primary care centers in Riyadh, Saudi Arabia.Methods: A cross-sectional study included 270 health care workers in 12 family medicine centers in Riyadh during November and December 2014. A structured self-administered questionnaire was used to estimate the frequency, timing, causes, reactions, and consequences of workplace violence plus participants’ demographic and occupational data.Results: A total 123 health care workers (45.6% experienced some kind of violence over 12 months prior to the study. These included physical (6.5% and nonphysical violence (99.2%, including verbal violence (94.3% and intimidation (22.0%. Offenders were patients (71.5% in the majority of cases, companions (20.3%, or both (3.3%. Almost half (48.0% of health care workers who experienced violence did nothing, 38.2% actively reported the event, and 13.8% consulted a colleague. A significant association of workplace violence was found with working multiple shifts, evening or night shift, and lack of an encouraging environment to report violence.Conclusion: Workplace violence is still a significant problem in primary care centers. The high frequency of violence together with underreporting may indicate the inefficiency of the current safety program. More safety programs and training activities for health care
Nour-Eldein, Hebatallah; Mansour, Nadia M; Abdulmajeed, Abdulmajeed A
The completion of a thesis is a significant requirement for both a Master's and a doctorate degree in general practice/family medicine (GP/FM). A postgraduate thesis is a well-planned, time-intensive activity carried out over several years. The quality of the theses can be judged by the proportion of published papers. This study aimed to describe Master's and doctoral theses in family medicine and their publications between 1982 and 2014. GP/FM degree theses were reviewed at the Faculty of Medicine and central Suez Canal libraries. Several characteristics were extracted from each thesis relating to the main researcher, supervisors, themes, and study methods according to predefined criteria. Publications from the theses were described. Over 33 years, 208 theses were completed by 173 GP/FM researchers. The majority of the theses were for Master's degrees (84.1%). Regarding the study design, most of the degree theses were cross-sectional studies (76.9%). The adult population was targeted in 33.7% of research theses. Nonprobability sampling was used in 51%. Rural communities were the setting of research in 43.8%, and primary health center (PHC)-based studies in 59.1%. The "Patient" category exceeded the other categories (28.4%). Publication from theses started in the second decade of research production. Of the degree theses, 21.6% original articles were published. Only 13.3% of articles from theses were published in PubMed-indexed journals. The researcher was first author in 62.2% of published articles. The production of GP/FM theses and their publications are going to increase. Continuous assessment and planning for GP/FM studies are recommended.
Jackson, Jennifer A.; Smit, Ellen; Branscum, Adam; Gunter, Katherine; Harvey, Marie; Manore, Melinda M.; John, Deborah
Background. Family homes are a key setting for developing lifelong eating and physical activity habits, yet little is known about how family home nutrition and physical activity (FNPA) environments influence food insecurity (FI) and childhood obesity, particularly in rural settings. Aims. This study examined associations among FNPA, FI, and body…
Results: Fifty (17.2%) respondents were using at least one family planning method. One hundred and ninety-eight (68.3%) respondents had used at least one family planning method at some point in time. Reasons given for not using any family planning method included “Family planning is against my religious beliefs” ...
Charles, Lesley; Triscott, Jean A.C.; Dobbs, Bonnie M.; McKay, Rhianne
Background There is a growing mandate for Family Medicine residency programs to directly assess residents’ clinical competence in Care of the Elderly (COE). The objectives of this paper are to describe the development and implementation of incremental core competencies for Postgraduate Year (PGY)-I Integrated Geriatrics Family Medicine, PGY-II Geriatrics Rotation Family Medicine, and PGY-III Enhanced Skills COE for COE Diploma residents at a Canadian University. Methods Iterative expert panel...
Buono, Nicola; Thulesius, Hans; Petrazzuoli, Ferdinando; Van Merode, Tiny; Koskela, Tuomas; Le Reste, Jean-Yves; Prick, Hanny; Soler, Jean Karl
To document family medicine research in the 25 EGPRN member countries in 2010. Semi-structured survey with open-ended questions. Academic family medicine in 23 European countries, Israel, and Turkey. 25 EGPRN national representatives. Demographics of the general population and family medicine. Assessments, opinions, and suggestions. EGPRN has represented family medicine for almost half a billion people and > 300,000 general practitioners (GPs). Turkey had the largest number of family medicine departments and highest density of GPs, 2.1/1000 people, Belgium had 1.7, Austria 1.6, and France 1.5. Lowest GP density was reported from Israel 0.17, Greece 0.18, and Slovenia 0.4 GPs per 1000 people. Family medicine research networks were reported by 22 of 25 and undergraduate family medicine research education in 20 of the 25 member countries, and in 10 countries students were required to do research projects. Postgraduate family medicine research was reported by 18 of the member countries. Open-ended responses showed that EGPRN meetings promoted stimulating and interesting research questions such as comparative studies of chronic pain management, sleep disorders, elderly care, healthy lifestyle promotion, mental health, clinical competence, and appropriateness of specialist referrals. Many respondents reported a lack of interest in family medicine research related to poor incentives and low family medicine status in general and among medical students in particular. It was suggested that EGPRN exert political lobbying for family medicine research. Since 1974, EGPRN organizes biannual conferences that unite and promote primary care practice, clinical research and academic family medicine in 25 member countries.
Jellinek, E H
The past 100 years have seen a transition from a total ban in Britain on all advertising by doctors to the laity to almost total freedom of medical information, with probable benefit to public health but also a risk of loss of privacy. The Family Encyclopaedia of Medicine, written by Dr Hugh Howard Riddle and published by Lord Northcliffe's Daily Mail in 1914, started a flood of medical journalism in the press and the newer media. The lavishly advertised misattribution of its authorship to 'thirty eminent specialists', including Clifford Allbutt and William Osler, caused a major rumpus in the London Royal College of Physicians, but the fortnightly publication continued and became a four-volume book, popular with a public avid for more and more medical information.
Tonka Poplas Susič
Full Text Available Background: Primary health care has undergone great changes as a consequence of demographic changes, growing patients’ awareness and organizational changes in the healthcare system. Declining interest in family medicine specialization further worsens the situation. In the period of lack of GPs and their overloading, it is necessary to include a diploma graduate nurse in the team of GPs and to define competencies and activities in such a way that encourage more active approach to the patients, meeting the indicators of quality.The purpose of the article is to describe the project of model practice in Slovenia and to present some results.Methods: A model practice introduces a new concept in the areas of human resource standards (to existing team, a diploma graduate nurse is included on a part-time basis; work competences (use of protocols for the treatment of chronic patients, extended and well-defined preventive screenings, establishing registers of chronic patients and assessing quality by means of quality indicators and work management (redistribution of workload .Results: Due to great interest of general practitioners, a total of 271 model practices were introduced in 2011 and 2012. MPs have been distributed evenly through different regions inSlovenia. Registers of patients with chronic diseases (COPD, asthma and diabetes have been established and during the preventive screening, on average 2 patients with a chronic disease and 15 patients with risk factors have been detected. Patients are treated actively according to their needs rather than their preferences.Conclusions: The project of MPs enables a high quality and cost effectiveness of patients’ treatment in family medicine. With a gradual introducing of new MPs, a well planed and monitored patients’ care will be implemented in the practice. In a long run, disburdening of a secondary care level and more rational consumption of drugs are expected
Butler, Dennis J; Holloway, Richard L; Fons, Dominique
This article describes the development of a Behavioral Medicine track in a family medicine residency designed to train physicians to proactively and consistently apply advanced skills in psychosocial medicine, psychiatric care, and behavioral medicine. The Behavioral Medicine track emerged from a behavioral science visioning retreat, an opportunity to restructure residency training, a comparative family medicine-psychiatry model, and qualified residents with high interest in behavioral science. Training was restructured to increase rotational opportunities in core behavioral science areas and track residents were provided an intensive longitudinal counseling seminar and received advanced training in psychopharmacology, case supervision, and mindfulness. The availability of a Behavioral Medicine track increased medical student interest in the residency program and four residents have completed the track. All track residents have presented medical Grand Rounds on behavioral science topics and have lead multiple workshops or research sessions at national meetings. Graduate responses indicate effective integration of behavioral medicine skills and abilities in practice, consistent use of brief counseling skills, and good confidence in treating common psychiatric disorders. As developed and structured, the Behavioral Medicine track has achieved the goal of producing "assertive practitioners of behavioral science in family medicine" residents with advanced behavioral science skills and abilities who globally integrate behavioral science into primary care.
Riana Rahmawati; Beata Bajorek
Background Despite common usage of traditional medicines in rural populations, the data of their uses along with hypertension medications are limited. Aims To quantify the use of traditional medicines and to identify factors associated with its use among people with hypertension in a low-resource setting. Methods Data were collected using a researcher-administered questionnaire from people with hypertension in rural underdeveloped villages in Indonesia. Result...
Joseph, A E; Phillips, D R
The majority of China's population lives in rural areas and a pattern is emerging of very uneven provision of support for rural elderly people. Local economic conditions and broad demographic trends are creating diversity in the ability both of rural families to care for their elderly kin and in the capacity of communities to support their elderly residents and family carers. In part as a consequence of China's population policy and the 'one-child policy', future Chinese families will have fewer members and be 'older', but they will continue to be regarded emotionally and in policy as the main source of economic and social support for the elderly. The increasing involvement of women in the paid workforce and the changing geographical distribution of family members resulting from work-related migration, are reducing the ability of families to care for their elderly relatives. The availability of resources other than the family for the care of older persons therefore becomes a key issue. Communities in more prosperous, modernising rural areas are often able to provide their elderly residents with welfare and social benefits previously found almost exclusively in urban areas. However, in poorly developed rural areas, provision is either very patchy or non-existent and the local economy cannot support expansion or improvement. A case study in Zhejiang Province illustrates the favourable provision for ageing in a prosperous modernising rural community, in which entitled elderly residents are provided with an impressive array of financial and social benefits. The paper concludes with a consideration of the policy implications of the growing differentiation of the social and economic capacity of rural communities to support their elderly members.
Leufkens Hubert GM
Full Text Available Abstract Background A rural pharmacy initiative (RPI designed to increase access to medicines in rural Kyrgyzstan created a network of 12 pharmacies using a revolving drug fund mechanism in 12 villages where no pharmacies previously existed. The objective of this study was to determine if the establishment of the RPI resulted in the unforeseen benefit of triggering medicine price competition in pre-existing (non-RPI private pharmacies located in the region. Methods We conducted descriptive and multivariate analyses on medicine insurance claims data from Kyrgyzstan's Mandatory Health Insurance Fund for the Jumgal District of Naryn Province from October 2003 to December 2007. We compared average quarterly medicine prices in competitor pharmacies before and after the introduction of the rural pharmacy initiative in October 2004 to determine the RPI impact on price competition. Results Descriptive analyses suggest competitors reacted to RPI prices for 21 of 30 (70% medicines. Competitor medicine prices from the quarter before RPI introduction to the end of the study period decreased for 17 of 30 (57% medicines, increased for 4 of 30 (13% medicines, and remained unchanged for 9 of 30 (30% medicines. Among the 9 competitor medicines with unchanged prices, five initially decreased in price but later reverted back to baseline prices. Multivariate analyses on 19 medicines that met sample size criteria confirm these findings. Fourteen of these 19 (74% competitor medicines changed significantly in price from the quarter before RPI introduction to the quarter after RPI introduction, with 9 of 19 (47% decreasing in price and 5 of 19 (26% increasing in price. Conclusions The RPI served as a market driver, spurring competition in medicine prices in competitor pharmacies, even when they were located in different villages. Initiatives designed to increase equitable access to medicines in rural regions of developing and transitional countries should consider the
Schrager, Sarina; Bouwkamp, Carla; Mundt, Marlon
Despite increasing numbers of women attending medical school and completing residencies, women continue to lag behind men in academic achievement. Other specialties have found that women publish fewer journal articles than men. While family medicine is becoming increasingly gender balanced, the aim of this study was to evaluate the gender balance of published material within family medicine journals. All original articles were reviewed in five family medicine journals published in the United States (Family Medicine, Journal of Family Practice, Journal of the American Board of Family Medicine, Annals of Family Medicine, and American Family Physician) between 2006-2008. The articles were categorized based on type of publication and gender of first author. The editorial boards of each of the journals were examined to determine gender breakdown. A total of 2,126 articles were included in the study. Females were first author on 712 (33.5%) of the articles, and males authored 1,414 (66.5%). There was no significant difference between years. More female authors wrote original research, and fewer wrote letters to the editor. Only Family Medicine had gender parity on its editorial board. Female authors wrote about a third of all original publications in family medicine journals between 2006-2009 even though they comprise 44% of the faculty. Further research can evaluate reasons for this gender disparity.
Tanasugarn, Chanuantong; Thongbunjob, Krid
Community diagnosis and approach has shifted from a professional focus to a community focus. The information system has also been developed to reflect socio-cultural information. This new system has been established throughout the country and is being recorded in the computer system. However these data still lack human capital information to promote community mobilization. The present study aims to develop a process which reflects human capital from the insider and outsider points of view and which builds on the existing work system of primary care service, family medicine, and community medicine. The present study applies the participatory action research design with mixed methods including community grand-tour, household survey socio-metric questionnaire and focus group discussion in order to gather insider view of human capital. A key instrument developed in the present study is the socio-metric questionnaire which was designed according to the community grand tour and household survey results. The findings indicate that the process is feasible and the insider point of view given a longer evidence based list of the human capital. The model enhanced a closer relationship between professional and community people and suggested the realistic community mobilizer name list. Human capital identification process is feasible and should be recommended to integrate in the existing work process of the health staff in family and community practice.
Starling, Suzanne P; Heisler, Kurt W; Paulson, James F; Youmans, Eren
The objective of this study was to determine the level of knowledge, comfort, and training related to the medical management of child abuse among pediatrics, emergency medicine, and family medicine residents. Surveys were administered to program directors and third-year residents at 67 residency programs. The resident survey included a 24-item quiz to assess knowledge regarding the medical management of physical and sexual child abuse. Sites were solicited from members of a network of child abuse physicians practicing at institutions with residency programs. Analyzable surveys were received from 53 program directors and 462 residents. Compared with emergency medicine and family medicine programs, pediatric programs were significantly larger and more likely to have a medical provider specializing in child abuse pediatrics, have faculty primarily responsible for child abuse training, use a written curriculum for child abuse training, and offer an elective rotation in child abuse. Exposure to child abuse training and abused patients was highest for pediatric residents and lowest for family medicine residents. Comfort with managing child abuse cases was lowest among family medicine residents. On the knowledge quiz, pediatric residents significantly outperformed emergency medicine and family medicine residents. Residents with high knowledge scores were significantly more likely to come from larger programs and programs that had a center, provider, or interdisciplinary team that specialized in child abuse pediatrics; had a physician on faculty responsible for child abuse training; used a written curriculum for child abuse training; and had a required rotation in child abuse pediatrics. By analyzing the relationship between program characteristics and residents' child abuse knowledge, we found that pediatric programs provide far more training and resources for child abuse education than emergency medicine and family medicine programs. As leaders, pediatricians must
González Lopez-Valcarcel, Beatriz; Ortún, Vicente; Barber, Patricia; Harris, Jeffrey E
To determine if there are significant differences between universities in the proclivity to choose Family and Community Medicine (FCM), given the constraints imposed by the number of choice. To test the hypothesis that the Schools of Medicine that have the FCM as a compulsory subject in the degree (3 of 27) had the highest preference for this specialty. Observational study on the data file of all the individuals taking the MIR examination between 2003 and 2011. Spain. All those who sat the examinations called by MIR 2003-2011. Position in the ranking of each candidate, elected position (specialty and center), post code of residence, sex, nationality and university in which they studied, and post code location for the residence chosen. The percentage electing FCM is highly correlated with the position in the ranking: 8% of graduates for the 'best' college, 46% for the worst. Very noticeable and consistent differences in the preparation for the MIR among the 27 medical schools. Ranking in the exam, female and foreigner, help predict the choice of FCM. The FCM compulsory curriculum from three universities does not seem to exert any influence. The convenient yardstick competition between the schools of medicine, FCM in their curriculum and the emphasis on the most attractive attributes of the specialty can contribute to the necessary renewal of FCM. Copyright © 2013 Elsevier España, S.L. All rights reserved.
ZHANG Jin-hua; YU Mei-lian; WU Fang-wei; CHEN Wei
This research focuses on the impact of family’s human capital on social mobility in China’s rural community. Empirical research is conducted based on data from surveying a typical rural community in the past 20 yr. The study indicates that social mobility in rural area is active in the past 20 yr, and the human capital of family, represented by primary labor’s education level, has played an essential role in mobility of low social class. Meanwhile, socio-economic development and the change of supply and demand in labor market dims the signaling role of degree education, but the impact of occupational training is increasingly remarkable. Therefore, the change from sole degree education to multi-leveled education including occupational education and training is a main way for China’s rural families in low class to realize social mobility.
Sammut, Mario R.; Abela, Gunther
The Specialist Training Programme in Family Medicine (STPFM) – Malta was drawn up by the Malta College of Family Doctors in 2006, approved by Malta’s Specialist Accreditation Committee, and launched in 2007 by the Primary Health Care Department and the Malta College of Family Doctors. This article regarding the work-based assessment of specialist training in family medicine in Malta was prepared by consulting various local / international documents and publications tha...
Baillot, Aurélie; Baillargeon, Jean-Patrice; Paré, Alex; Poder, Thomas G; Brown, Christine; Langlois, Marie-France
To determine how often primary health care providers (PHCPs) in family medicine groups (FMGs) assess physical activity (PA) levels, provide PA counseling (PAC), and refer patients to exercise professionals; to describe patients' PA levels, physical fitness, and satisfaction regarding their PA management in FMGs; to describe available PA materials in FMGs and PHCPs' PAC self-efficacy and PA knowledge; and to identify characteristics of patients and PHCPs that determine the assessment of PA and PAC provided by PHCPs. Cross-sectional study using questionnaires and a medical chart audit. Ten FMGs within the Integrated University Health Network of the Centre hospitalier universitaire de Sherbrooke in Quebec. Forty FPs, 24 nurses, and 439 patients. Assessment of PA level and PAC provided by PHCPs. Overall, 51.9% of the patients had had their PA level assessed during the past 18 months, but only 21.6% received PAC from at least 1 of the PHCPs. Similar percentages were found among the inactive (n = 244) and more active (n = 195) patients. The median PAC self-efficacy score of PHCPs was 70.2% (interquartile range 52.0% to 84.7%) and the median PA knowledge score was 45.8% (interquartile range 41.7% to 54.2%), with no significant differences between nurses and FPs. In multivariate analysis, 34% of the variance in PAC provided was explained by assessment of PA level, overweight or obese status, type 2 diabetes or prediabetes, less FP experience, lower patient annual family income, more nurse encounters, and a higher patient physical component summary of quality of life. The rates of assessment of PA and provision of PAC in Quebec FMGs were low, even though most of the patients were inactive. Initiatives to support PHCPs and more resources to assess PA levels and provide PAC should be implemented. Copyright© the College of Family Physicians of Canada.
Eliason, B C; Schubot, D B
Personal social values have been identified as important determinants of generalists' specialty choice. However, the personal values or "guiding principles" of generalist physicians have not been identified scientifically. To establish a benchmark, we measured the personal values of exemplary family physicians because they serve as role models for current and future physicians. We also explored the relationship between personal values and practice satisfaction. We obtained a list of 330 family physicians nominated for the American Academy of Family Physicians' (AAFP) Family Doctor of the Year award for the years 1988 through 1993. We asked them to complete the Schwartz Values Questionnaire, a 56-item instrument for measuring personal values. They also answered three questions concerning practice satisfaction. The return rate was 83%. The physicians' mean age was 63 years. They had been in practice an average of 34 years, 93% were male, and 52% practiced in rural areas. Honesty was rated as the most important of the 56 values, and social power as the least important. Of the 10 value types (groups of common values), the responding physicians rated "Benevolence" as most important and "Power" as least important. Practice satisfaction correlated positively with the Benevolence value type (r = .21, P = .001) and negatively with the Power value type (r = -.15, P = .023). Of the 10 value types, Benevolence was rated the most important and Power the least important by exemplary family physicians, and both value types also correlated, positively and negatively, respectively, with their practice satisfaction. These results have implications for the selection, training, and career satisfaction of generalist physicians.
Wilson, Stephan M.; Peterson, Gary W.
Examined possible predictors of life satisfaction among 322 low-income young adults from rural Appalachia. Both objective and subjective conditions of life were predictors of life satisfaction: financial resources, self-esteem, and proximity to childhood home were positive predictors; frustrations about limited job opportunities and community size…
Full Text Available Background: Majority of Indian population is dependent on general practitioners (GPs for medical services at primary care level in India. They are most preferred and considered to be first contact person for medical services at primary care level. But advances in medical science has put more emphasis on specialist culture and average Bachelor of Medicine and Bachelor of Surgery (MBBS graduates who are working as general physician are gradually feeling themselves less competent because they are less exposed to latest advances in treatment of diseases. Amidst such scenario, Christian Medical College (CMC has come up with an idea: "The refer less and resolve more initiative". It has started a decentralized 2-year family medicine distance diploma course (Postgraduate Diploma in Family Medicine (PGDFM now accredited by Dr. MGR Medical University, Chennai, Tamil Nadu, that trains the GPs to become family medicine specialist. Materials and Methods: As component of PGDFM course, this study was conducted to provide better understanding of prevalent ailments and common treatment provided by the GPs in the community at present giving key insight of current practice in rural area by a registered family medicine practitioner. Results: As part of study, among 500 patients evaluated, three most common diagnosis were upper respiratory infections (URIs; 18%, acute gastroenteritis including water-borne diseases (15.8%, and anemia (10.4%. Treatment given to these patients comprised of mostly of antipyretic, analgesic, and antimicrobial agents. Most common drug prescribed was paracetamol for fever. Other common drugs prescribed were amoxicillin/clavulanic acid, chloroquine, artemisin derivative, doxycycline, co-trimoxazole, miltefosine, cephalexin, ceftriaxone sodium, cefixime, oral rehydration salts, ranitidine, omeprazole, pantoprazole, metronidazole, albendazole, ondansetron, diclofenac sodium, piroxicam, ibuprofen, diphenhydramine, codeine-sulfate, amlodipine
Šter, Marija Petek; Švab, Igor; Klemenc-Ketiš, Zalika; Kersnik, Janko
The development of the EURACT (European Academy of Teachers in General Practice) Educational Agenda helped many family medicine departments in development of clerkship and the aims and objectives of family medicine teaching. Our aims were to develop and validate a tool for assessment of students' attitudes towards family medicine and to evaluate the impact of the clerkship on students' attitudes regarding the competences of family doctor. In the pilot study, experienced family doctors were asked to describe their attitudes towards family medicine by using the Educational Agenda as a template for brainstorming. The statements were paraphrased and developed into a 164-items questionnaire, which was administered to 176 final-year students in academic year 2007/08. The third phase consisted of development of a final tool using statistical analysis, which resulted in the 60-items questionnaire in six domains which was used for the evaluation of students' attitudes. At the beginning of the clerkship, person-centred care and holistic approach scored lower than the other competences. Students' attitudes regarding the competences at the end of 7 weeks clerkship in family medicine were more positive, with exception of the competence regarding primary care management. The students who named family medicine as his or her future career choice, found holistic approach as more important than the students who did not name it as their future career. With the decision tree, which included students' attitudes to the competences of family medicine, we can successfully predict the future career choice in family medicine in 93.5% of the students. This study reports on the first attempt to develop a valid and reliable tool for measuring attitudes towards family medicine based on EURACT Educational Agenda. The questionnaire could be used for evaluating changes of students' attitudes in undergraduate curricula and for prediction of students' preferences regarding their future professional
Kaltman, Stacey; WinklerPrins, Vincent; Serrano, Adriana; Talisman, Nicholas
Despite the prevalence of unhealthy behaviors among patients in the healthcare system, traditional medical training involves little or no exposure to effective behavior change techniques such as Motivational Interviewing. An online learning community for enhanced training in Motivational Interviewing was developed for 3rd-year medical students. The website included educational materials about Motivational Interviewing as well as problematic health behaviors, a repository of exemplar videos and student videos with feedback, and a discussion board. Student participants were given the opportunity to record an encounter with a patient and to receive feedback on their use of Motivational Interviewing from a faculty member. Student volunteers in the Family Medicine Clerkship at Georgetown University School of Medicine were randomized to enhanced training, which included the online learning community, or training as usual. All student volunteers completed a questionnaire assessing self-efficacy initially and at the end of the clerkship. Students also participated in an Observed Structured Clinical Exam, which was subsequently coded by a blinded rater for behavioral counts of Motivational Interviewing techniques, key steps in Motivational Interviewing, and overall Motivational Interviewing style. Students in the enhanced training arm were rated as having significantly higher scores in Motivational Interviewing style in the Observed Structured Clinical Exam than training as usual students. A significant increase in self-efficacy from pre- to posttest in the overall sample was observed but between-group differences were not significant. Student feedback was particularly positive regarding video recorded practice sessions with patients and individualized feedback. The results of this study as well as student feedback suggest that future work should include patient practice sessions and individualized feedback in developing Motivational Interviewing curricula.
Mims, Lisa D; Bressler, Lindsey C; Wannamaker, Louise R; Carek, Peter J
In 1985, the American Osteopathic Association (AOA) Board of Trustees agreed to allow residency programs to become dually accredited by the AOA and Accreditation Council for Graduate Medical Education (ACGME). Despite the increase in such programs, there has been minimal research comparing these programs to exclusively ACGME-accredited residencies. This study examines the association between dual accreditation and suggested markers of quality. Standard characteristics such as regional location, program structure (community or university based), postgraduate year one (PGY-1) positions offered, and salary (PGY-1) were obtained for each residency program. In addition, the faculty to resident ratio in the family medicine clinic and the number of half days residents spent in the clinic each week were recorded. Initial Match rates and pass rates of new graduates on the ABFM examination from 2009 to 2013 were also obtained. Variables were analyzed using chi-square and Student's t test. Logistic regression models were then created to predict a program's 5-year aggregate initial Match rate and Board pass rate in the top tertile as compared to the lowest tertile. Dual accreditation was obtained by 117 (27.0%) of programs. Initial analyses revealed associations between dually accredited programs and mean year of initial ACGME program accreditation, regional location, program structure, tracks, and alternative medicine curriculum. When evaluated in logistic regression, dual accreditation status was not associated with Match rates or ABFM pass rates. By examining suggested markers of program quality for dually accredited programs in comparison to ACGME-only accredited programs, this study successfully established both differences and similarities among the two types.
Wright, Katherine M; Ryan, Elizabeth R; Gatta, John L; Anderson, Lauren; Clements, Deborah S
Residency program selection is a significant experience for emerging physicians, yet there is limited information about how applicants narrow their list of potential programs. This study examines factors that influence residency program selection among medical students interested in family medicine at the time of application. Medical students with an expressed interest in family medicine were invited to participate in a 37-item, online survey. Students were asked to rate factors that may impact residency selection on a 6-point Likert scale in addition to three open-ended qualitative questions. Mean values were calculated for each survey item and were used to determine a rank order for selection criteria. Logistic regression analysis was performed to identify factors that predict a strong interest in urban, suburban, and rural residency programs. Logistic regression was also used to identify factors that predict a strong interest in academic health center-based residencies, community-based residencies, and community-based residencies with an academic affiliation. A total of 705 medical students from 32 states across the country completed the survey. Location, work/life balance, and program structure (curriculum, schedule) were rated the most important factors for residency selection. Logistic regression analysis was used to refine our understanding of how each factor relates to specific types of residencies. These findings have implications for how to best advise students in selecting a residency, as well as marketing residencies to the right candidates. Refining the recruitment process will ensure a better fit between applicants and potential programs. Limited recruitment resources may be better utilized by focusing on targeted dissemination strategies.
Glowa, Patricia T; Olson, Ardis L; Johnson, Deborah J
The role of adverse childhood experiences (ACEs) in predicting later adverse adult health outcomes is being widely recognized by makers of public policy. ACE questionnaires have the potential to identify in clinical practice unaddressed key social issues that can influence current health risks, morbidity, and early mortality. This study seeks to explore the feasibility of implementing the ACE screening of adults during routine family medicine office visits. At 3 rural clinical practices, the 10-question ACE screen was used before visits with 111 consecutive patients of 7 clinicians. Clinician surveys about the use of the results and the effect on the visits were completed immediately after the visits. The presence of any ACE risk and "high-risk" ACE scores (≥4) were compared with clinician survey responses. A risk of ACEs was present in 62% of patients; 22% had scores ≥4. Clinicians were more likely to have discussed ACE issues for high-risk patients (score 0-3, 36.8%; score ≥4, 83.3%; P =. 00). Clinicians also perceived that they gained new information (score 0-3, 35.6%; score ≥4, 83.3%; P = .00). Clinical care changed for a small proportion of high-risk patients, with no change in immediate referrals or plan for follow-up. In 91% of visits where a risk of ACEs was present, visit length increased by ≤5 minutes. Incorporation of ACE screening during routine care is feasible and merits further study. ACE screening offers clinicians a more complete picture of important social determinants of health. Primary care-specific interventions that incorporate treatment of early life trauma are needed. © Copyright 2016 by the American Board of Family Medicine.
Conclusions: The prevalence of burnout syndrome among family medicine trainees is high and consistent with data from other studies among the physicians worldwide using the same instrument. Family medicine trainees are at risk of burnout regardless of their demographic characteristics. Increased workload affects EE and D.
Mauksch, Hans O.; And Others
A study of the choice of specialty by medical students suggests that Family Medicine depends on students whose choice predates medical school; the number of those interested diminishes significantly over the four years. Interviews suggest several characteristics of the medical school that mitigate against the choice of family medicine and steer…
Hogenbirk, John C; Timony, Patrick E; French, Margaret G; Strasser, Roger; Pong, Raymond W; Cervin, Catherine; Graves, Lisa
To assess the effect of different levels of exposure to the Northern Ontario School of Medicine's (NOSM's) distributed medical education programs in northern Ontario on FPs' practice locations. Cross-sectional design using longitudinal survey and administrative data. Canada. All 131 Canadian medical graduates who completed FP training in 2011 to 2013 and who completed their undergraduate (UG) medical degree or postgraduate (PG) residency training or both at NOSM. Exposure to NOSM's medical education program at the UG (n = 49) or PG (n = 31) level or both (n = 51). Primary practice location in September of 2014. Approximately 16% (21 of 129) of FPs were practising in rural northern Ontario, 45% (58 of 129) in urban northern Ontario, and 5% (7 of 129) in rural southern Ontario. Logistic regression found that more rural Canadian background years predicted rural practice in northern Ontario or Ontario, with odds ratios of 1.16 and 1.12, respectively. Northern Canadian background, sex, marital status, and having children did not predict practice location. Completing both UG and PG training at NOSM predicted practising in rural and northern Ontario locations with odds ratios of 4.06 to 48.62. Approximately 61% (79 of 129) of Canadian medical graduate FPs who complete at least some of their training at NOSM practise in northern Ontario. Slightly more than a quarter (21 of 79) of these FPs practise in rural northern Ontario. The FPs with more years of rural background or those with greater exposure to NOSM's medical education programs had higher odds of practising in rural northern Ontario. This study shows that NOSM is on the road to reaching one of its social accountability milestones.
Ellis, Gail Johnston
Epilepsy affects approximately one percent of the population, with most cases having onset during childhood. School personnel can best incorporate the child with epilepsy into the classroom and provide support for families by becoming familiar with the types of seizure disorders, the issues that epilepsy presents for children and families, and the…
Riley, Margaret; Skye, Eric; Reed, Barbara D
Lack of quality mentorship has been identified as an impediment to a successful academic career. This study serves as a needs assessment to understand baseline mentoring among faculty in an academic department of family medicine and the existing relationships between mentorship, job satisfaction, and academic productivity before the department begins a structured mentorship program. All faculty received an anonymous online survey inquiring about their current mentorship and their perception of the importance of mentorship, in addition to measures of job satisfaction and academic productivity. Of 62 faculty members completing the survey (83% of faculty), almost all indicated it is very or somewhat important to have a mentor (97%, n=60), although only 45% (n=28) reported having a current mentor. Junior faculty were less likely than senior faculty to be satisfied with their mentorship, particularly if they did not have a current mentor. Job satisfaction was high and was not associated with having a mentor. Faculty members with mentors were more likely to have presented a talk or poster nationally, to have taken on a new educational or leadership role, and to have had a greater volume of academic activities overall. Although faculty believe mentorship is important, less than half have a current mentor. Junior faculty are disproportionately dissatisfied by lack of mentorship. Mentorship was associated with some elements of academic productivity but not with job satisfaction. Further study of the impact of a more structured mentorship program is needed.
Smith, Sunny; Malinak, David; Chang, Jinnie; Schultz, Amanda; Brownell, Kristin
Food insecurity is associated with poor health outcomes, yet is not routinely addressed in health care. This study was conducted to determine if education regarding food insecurity as a health issue could modify knowledge, attitudes, and clinical behavior. Educational sessions on food insecurity and its impact on health were conducted in 2015 at three different family medicine residency programs and one medical school. A pre/post survey was given immediately before and after this session. Attendees were encouraged to identify and implement individual and system-based changes to integrate food insecurity screening and referrals into their clinical practices. Participants completed follow-up surveys approximately 1 year later, and the authors obtained systems-level data from electronic health records and databases. Pre/post means (SD) were compared using t-tests. The numbers of patients screened and referred were calculated. Eighty-five participants completed the pre/post survey during the educational sessions (51 medical students, 29 residents, 5 faculty). Self-reported knowledge of food insecurity, resources, and willingness to discuss with patients increased (Pinsecurity during clinical visits and referrals to food resources. Over 1,600 patients were screened for food insecurity as a result of systems-based changes. Educational interventions focused on the role of food insecurity in health can produce improvements in knowledge and attitudes toward addressing food insecurity, increase discussions with patients about food insecurity, and result in measurable patient and systems-level changes.
Eubank, Daniel; Geffken, Dominic; Orzano, John; Ricci, Rocco
Health care reform calls for patient-centered medical homes built around whole person care and healing relationships. Efforts to transform primary care practices and deliver these qualities have been challenging. This study describes one Family Medicine residency's efforts to develop an adaptive leadership curriculum and use coaching as a teaching method to address this challenge. We review literature that describes a parallel between the skills underlying such care and those required for adaptive leadership. We address two questions: What is leadership? Why focus on adaptive leadership? We then present a synthesis of leadership theories as a set of process skills that lead to organization learning through effective work relationships and adaptive leadership. Four models of the learning process needed to acquire such skills are explored. Coaching is proposed as a teaching method useful for going beyond information transfer to create the experiential learning necessary to acquire the process skills. Evaluations of our efforts to date are summarized. We discuss key challenges to implementing such a curriculum and propose that teaching adaptive leadership is feasible but difficult in the current medical education and practice contexts.
Kozakowski, Stanley M; Eiff, M Patrice; Green, Larry A; Pugno, Perry A; Waller, Elaine; Jones, Samuel M; Fetter, Gerald; Carney, Patricia A
New skills are needed to properly prepare the next generation of physicians and health professionals to practice in medical homes. Transforming residency training to address these new skills requires strong leadership. We sought to increase the understanding of leadership skills useful in residency programs that plan to undertake meaningful change. The Preparing the Personal Physician for Practice (P4) project (2007-2014) was a comparative case study of 14 family medicine residencies that engaged in innovative training redesign, including altering the scope, content, sequence, length, and location of training to align resident education with requirements of the patient-centered medical home. In 2012, each P4 residency team submitted a final summary report of innovations implemented, overall insights, and dissemination activities during the study. Six investigators conducted independent narrative analyses of these reports. A consensus meeting held in September 2012 was used to identify key leadership actions associated with successful educational redesign. Five leadership actions were associated with successful implementation of innovations and residency transformation: (1) manage change; (2) develop financial acumen; (3) adapt best evidence educational strategies to the local environment; (4) create and sustain a vision that engages stakeholders; and (5) demonstrate courage and resilience. Residency programs are expected to change to better prepare their graduates for a changing delivery system. Insights about effective leadership skills can provide guidance for faculty to develop the skills needed to face practical realities while guiding transformation.
Naimer, Sody; Press, Yan; Weissman, Charles; Zisk-Rony, Rachel Yaffa; Weiss, Yoram G; Tandeter, Howard
In Israel, there is a shortage of family medicine (FM) specialists that is occasioned by a shortage of students pursuing a FM career. A questionnaire, based on methods adapted from marketing research, was used to provide insight into the medical specialty selection process. It was distributed to 6 th -year medical students from two Israeli medical schools. A response rate of 66% resulted in collecting 218 completed questionnaires. Nineteen of the students reported that they were interested in FM, 68% of them were women. When compared to students not interested in FM, the selection criteria of students interested in FM reflected greater interest in a bedside specialty which provides direct long-term patient care. These latter students were also more interested in a controllable lifestyle that allowed time to be with family and children and working outside the hospital especially during the daytime. These selection criteria aligned with their perceptions of FM, which they perceived as providing them with a controllable lifestyle, allowing them to work limited hours with time for family and having a reasonable income to lifestyle ratio. The students not interested in FM, agreed with those interested in FM, that the specialty affords a controllable lifestyle and the ability to work limited hours Yet, students not interested in FM more often perceived FM as being a boring specialty and less often perceived it as providing a reasonable income to lifestyle ratio. Additionally, students not interested in FM rated the selection criteria, academic opportunities and a prestigious specialty, more highly than did students interested in FM. However, they perceived FM as neither being prestigious nor as affording academic opportunities CONCLUSION: This study enriches our understanding of the younger generation's attitudes towards FM and thus provides administrators, department chairs and residency program directors with objective information regarding selection criteria and the
This paper examines the influence of informal banking club participation on family planning practices in rural Ghana. Research from Asia suggests that family planning practices are improved by club participation. This study examines this thesis in an African context, using rural Ghana as a case study. A sample of 204 women (19 years and older) was drawn from Abokobi village, Ghana. Multivariate analyses of direct, mediating and moderating effects of women’s demographic background characteristics, membership status and length, and women’s empowerment status as predictors of family planning practices are assessed. Findings suggest that club membership and membership length is not associated with family planning practices; however, age, education level, number of children and empowerment status are.
Full Text Available The paper seeks to analyse family businesses in rural areas, family business strategies and re-registration of sole proprietors with the Centre of Registers and Information Systems (hereinafter Commercial Register in 2009, and to provide an overview of entrepreneurship policies targeted at Estonian rural businesses. Layoffs have increased the number of unemployed; some of those who have lost employment opt for social assistance benefits, but some others decide to become entrepreneurs. Many enterprising people in Estonia have set up a family enterprise, mainly in the sphere of services, agriculture and tourism. The Estonian entrepreneurship policy supports enterprising people and approves of entrepreneurship as a promoter of national economic development. One of the most positive qualities of family enterprises is their short decision-making chain, which ensures rapid implementation of the strategy.
Hoekzema, Grant S; Maxwell, Lisa; Gravel, Joseph W; Mills, Walter W; Geiger, William; Honeycutt, J David
In 2013, the World Organisation of Family Doctors published training standards for post-graduate medical education (GME) in Family Medicine/General Practice (FP/GP). GME quality has not been well-defined, other than meeting accreditation standards. In 2009, the Association of Family Medicine Residency Directors (AFMRD) developed a tool that would aid in raising the quality of family medicine residency training in the USA. We describe the development of this quality improvement tool, which we called the residency performance index (RPI), and its first three years of use by US family medicine residency (FMR) programmes. The RPI uses metrics specific to family medicine training in the USA to help programmes identify strengths and areas for improvement in their educational activities. Our review of three years of experience with the RPI revealed difficulties with collecting data, and lack of information on graduates' scope of practice. It also showed the potential usefulness of the tool as a programme improvement mechanism. The RPI is a nationwide, standardised, programme quality improvement tool for family medicine residency programmes in the USA, which was successfully launched as part of AFMRD's strategic plan. Although some initial challenges need to be addressed, it has the promise to aid family medicine residencies in their internal improvement efforts. This model could be adapted in other post-graduate training settings in FM/GP around the world.
Sammut, Mario R.
Introduction: As a result of Malta’s EU accession in 2004, family medicine was accepted as a speciality and the Malta College of Family Doctors prepared a Specialist Training Programme in Family Medicine. To facilitate its launch, potential GP trainers and trainees participated in its preimplementation evaluation. Method: Participants’ views were gathered quantitatively through a questionnaire using scales to rate closed statements regarding the programme and its sections. Qualitative openend...
Full Text Available The study was assessed to determine the effects of rural-urban youth migration on farm families in Benue state, Nigeria during November 2014 to June 2015. Interview schedule was used to collect data from a sample of 80 respondents. Data were analyzed using frequency, percentage, mean scores and standard deviation. Results indicate that majority (76.3% of the respondents were males, middle aged and married. Major causes of rural-urban youth migration indicated by the respondents include inadequate employment opportunities in rural areas (M=3.6, search for better education (M=3.5, inadequate social infrastructure such as schools (M=3.4, poor medical care services in rural areas (M=3.4, looking for money through labour (M=3.4, apprenticeship programme (M=3.2, etc. Findings of the study also indicate that reduction of agricultural labour force (M=3.5, low agricultural productivity (M=3.3, high cost of labour (M= 3.3, reduction on demand for locally grown foods (M=2.9, decrease in dependency ratio in the rural areas (M=2.7, reduction on number of mouths to feed (M=2.7, among others were major effects of rural-urban youth migration among farm families. The study recommends that Nigerian government should provide adequate physical and social infrastructure in rural areas in order to encourage youths to remain in agriculture, reduce rural-urban youth migration as well as sustain agriculture for enhanced food security.
Herbitter, Cara; Bennett, Ariana; Schubert, Finn D; Bennett, Ian M; Gold, Marji
Reproductive health care, including treatment of early pregnancy failure (EPF) and induced abortion, is an integral part of patient-centered care provided by family physicians, but data suggest that comprehensive training is not widely available to family medicine residents. The purpose of this study was to assess EPF and induced abortion management practices and attitudes of family medicine physician educators throughout the United States and Canada. These data were collected as part of a cross-sectional survey conducted by the Council of Academic Family Medicine Educational Research Alliance that was distributed via E-mail to 3152 practicing physician members of Council of Academic Family Medicine organizations. The vast majority of respondents (88.2%) had treated EPF, whereas few respondents (15.3%) had provided induced medication or aspiration abortions. Of those who had treated EPF, most had offered medication management (72.7%), whereas a minority had provided aspiration management (16.4%). Almost all respondents (95%) agreed that EPF management is within the scope of family medicine, and nearly three-quarters (73.2%) agreed that early induced abortion is within the scope of family medicine. Our findings suggest that family physician educators are more experienced with EPF management than elective abortion. Given the overlap of skills needed for provision of these services, there is the potential to increase the number of family physician faculty members providing induced abortions.
Kozakowski, Stanley M; Fetter, Gerald; Bentley, Ashley
This is the 34th national study conducted by the American Academy of Family Physicians (AAFP) that reports retrospectively the percentage of graduates from US MD-granting and DO-granting medical schools who entered Accreditation Council for Graduate Medical Education (ACGME)-accredited family medicine residency programs as first-year residents in 2014. Approximately 8.5% of the 18,241 students graduating from US MD-granting medical schools between July 2013 and June 2014 entered a family medicine residency. Of the 1,458 graduates of the US MD-granting medical schools who entered a family medicine residency in 2014, 80% graduated from 69 of the 131 schools. Eleven schools lacking departments or divisions of family medicine produced only a total of 26 students entering family medicine. In aggregate, medical schools west of the Mississippi River represent less than a third of all US MD-granting schools but have an aggregate rate of students selecting family medicine that is two-thirds higher than schools to the east of the Mississippi. A rank order list of US MD-granting medical schools was created based on the last 3 years' average percentage of graduates who became family medicine residents, using the 2014 and prior AAFP census data. US MD schools continue to fail to produce a primary care workforce, a key measure of social responsibility as measured by their production of graduates entering into family medicine. DO-granting and international medical school graduates filled the majority of ACGME-accredited family medicine first-year resident positions in 2014.
Full Text Available Background: Healthy population is indispensable for national development. Adequate food intake by people is the key determinant to keep up their health. Malnutrition nevertheless remains pervasive in developing countries, undermining people’s health, productivity, and often their survival. Food insecurity and hunger remain persistent in Nepal. Prevalence of low calories intake by rural family is widespread throughout the country population. Mainly marginalized communities, ethnic group with poor economic status, traditional societies and lower cast people are exposed to food defi cit. Objective: to investigate the prevalence of low calories intake by rural families and its associated determinants in Palpa district. Materials and methods: The cross-sectional study was designed to achieve objective of the research. A random sample of 339 families was selected from rural areas (DUMRE, DAMKADA, GORKHEKOT and TELGHA villages of this district. Data were analyzed by using the SPSS software for Windows (version 16.0. Results: The existence of inadequate food calorie intake among rural families was most common. Most of them were malnourished. Conclusion: low calorie intake by ethnic group was considerably higher than other groups in community.
Brody, Gene H.; Flor, Douglas L.
Tested a model linking maternal/family characteristics to child cognitive and psychosocial competence in African-American 6- to 9-year olds in rural single-mother-headed households. Found that maternal education, religiosity, and financial resources were linked with parenting style, mother-child relationship, and maternal school involvement.…
PROF. BARTH EKWEME
This study was conducted to provide empirical evidence of the effect of farming on the poverty status of rural farm families in Uyo, Akwa ... Reducing poverty in developing economies is a ... is one of the poorest among the poor countries of the.
A questionnaire was used to discover what 350 rural Tswanas believed the ideal number of children to be; results were tabulated according to age and sex. It appears· that older people tend to want more children and, more surprisingly, that men and women agree on the ideal number of children in a family; this is contrary to ...
Previous research on digital storytelling (DST) has focused chiefly on children and youth, but we know little about how it is used in non-formal adult education. This article analyzes a DST class in rural Ireland, which was organized by a family literacy program and offered for parents at an elementary school. Data sources included fieldnotes,…
Spann, Stephen J.
PURPOSE To foster redesigning the work and workplaces of family physicians, this Future of Family Medicine task force was created to formulate and recommend a financial model that sustains and promotes a thriving New Model of care by focusing on practice reimbursement and health care finances. The goals of the task force were to develop a financial model that assesses the impact of the New Model on practice finances, and to recommend health care financial policies that, if implemented, would be expected to promote the New Model and the primary medical care function in the United States for the next few decades. METHODS The members of the task force reflected a wide range of professional backgrounds and expertise. The group met in person on 2 occasions and communicated by e-mail and conference calls to achieve consensus. A marketing study was carried out using focus groups to test the concept of the New Model with consumers. External consultants with expertise in health economics, health care finance, health policy, and practice management were engaged to assist the task force with developing the microeconomic (practice level) and macroeconomic (societal level) financial models necessary to achieve its goals. Model assumptions were derived from the published medical literature, existing practice management databases, and discussions with experienced physicians and other content experts. The results of the financial modeling exercise are included in this report. The initial draft report of the findings and recommendations was shared with a reactor panel representing a broad spectrum of constituencies. Feedback from these individuals was reviewed and incorporated, as appropriate, into the final report. RESULTS The practice-level financial model suggests that full implementation of the New Model of care within the current fee-for-service system of reimbursement would result in a 26% increase in compensation (from $167,457 to $210,288 total annual compensation) for
Spann, Stephen J
To foster redesigning the work and workplaces of family physicians, this Future of Family Medicine task force was created to formulate and recommend a financial model that sustains and promotes a thriving New Model of care by focusing on practice reimbursement and health care finances. The goals of the task force were to develop a financial model that assesses the impact of the New Model on practice finances, and to recommend health care financial policies that, if implemented, would be expected to promote the New Model and the primary medical care function in the United States for the next few decades. The members of the task force reflected a wide range of professional backgrounds and expertise. The group met in person on 2 occasions and communicated by e-mail and conference calls to achieve consensus. A marketing study was carried out using focus groups to test the concept of the New Model with consumers. External consultants with expertise in health economics, health care finance, health policy, and practice management were engaged to assist the task force with developing the microeconomic (practice level) and macroeconomic (societal level) financial models necessary to achieve its goals. Model assumptions were derived from the published medical literature, existing practice management databases, and discussions with experienced physicians and other content experts. The results of the financial modeling exercise are included in this report. The initial draft report of the findings and recommendations was shared with a reactor panel representing a broad spectrum of constituencies. Feedback from these individuals was reviewed and incorporated, as appropriate, into the final report. The practice-level financial model suggests that full implementation of the New Model of care within the current fee-for-service system of reimbursement would result in a 26% increase in compensation (from 167,457 dollars to 210,288 dollars total annual compensation) for prototypical
Jiang, Chunhong; Ma, Jingdong; Zhang, Xiang; Luo, Wujin
As the world's largest developing country, China has entered into the epidemiological phase characterized by high life expectancy and high morbidity and mortality from chronic diseases. Cardiovascular diseases, chronic obstructive pulmonary diseases, and malignant tumors have become the leading causes of death since the 1990s. Constant payments for maintaining the health status of a family member who has chronic diseases could exhaust household resources, undermining fiscal support for other necessities and eventually resulting in poverty. The purpose of this study is to probe to what degree health expenditure for chronic diseases can impoverish rural families and whether the New Cooperative Medical Scheme can effectively protect families with chronic patients against catastrophic health expenditures. We used data from the 4th National Health Services Survey conducted in July 2008 in China. The rural sample we included in the analysis comprised 39,054 households. We used both households suffering from medical impoverishment and households with catastrophic health expenditures to compare the financial protection for families having a chronic patient with different insurance coverage statuses. We used a logistic regression model to estimate the impact of different benefit packages on health financial protection for families having a chronic patient. An additional 10.53% of the families with a chronic patient were impoverished because of healthcare expenditure, which is more than twice the proportion in families without a chronic patient. There is a higher catastrophic health expenditure incidence in the families with a chronic patient. The results of logistic regression show that simply adding extra benefits did not reduce the financial risks. There is a lack of effective financial protection for healthcare expenditures for families with a chronic patient in rural China, even though there is a high coverage rate with the New Cooperative Medical Schemes. Given the
Vlasova, N.V.; Rozhko, A.V.; Stavrov, V.V.
Full text: Despite correct evaluation of agricultural land contamination of a settlement and the activity of foodstuffs, it is impossible to explain dose formation in rural community. And without this knowledge it is impossible to estimate correctly decision-making. The dose formation research was provided earlier in rural community based on the concept describing that the individual with his personal characteristics, social and economic statuses during his practical activity interacting with the contaminated environment, actively contributes to dose formation. Such approach only partly allows revealing dose formation mechanisms though there are some unclear issues: for example, high doses at some children. At the same time children, as well as all residents are the members of families. Direct consumption of food stuffs is provided within a family. It is preceded with the formation of psycho-emotional perception of radiation danger factor. There have been used the data of internal doses of the inhabitants obtained by the results of WBC-measurements. Simultaneously with performing of WBC measurements by interviewing of adult members of a family there was revealed the frequency of visits to forest and consumption rate of its 'gifts'. The method of a family analysis of internal dose formation is the classification of families by set of the informative attributes describing dose formation in a family such as an average internal dose at a member of a family; family total dose; the description of a family 'contact' with a forest; the number of family members; the number of children in a family; average age and the educational level of adult members of a family; gender and occupation of the head of a family; age and education of the head of a family. As a result of multivariate classification of families in the settlement there was obtained 10 different classes providing complete imagination about a variety of families' types. The average doses in classes essentially
Sinožić, T; Katić, M; Kovačević, J
satisfaction with the results achieved. Family doctors are involved in the care of chronic wound patients as part of the multidisciplinary team of experts. Additional specific knowledge and skills are required for such care in order to ensure overall quality care as a supplement of the existing knowledge, skills and working experience in family medicine.
Al-Turki, Nouf; Afify, Ayman AM; AlAteeq, Mohammed
Background Health care violence is a significant worldwide problem with negative consequences on both the safety and well-being of health care workers as well as workplace activities. Reports examining health care violence in Saudi Arabia are limited and the results are conflicting. Objective To estimate the prevalence and determine the demographic and occupational characteristics associated with workplace violence in primary care centers in Riyadh, Saudi Arabia. Methods A cross-sectional study included 270 health care workers in 12 family medicine centers in Riyadh during November and December 2014. A structured self-administered questionnaire was used to estimate the frequency, timing, causes, reactions, and consequences of workplace violence plus participants’ demographic and occupational data. Results A total 123 health care workers (45.6%) experienced some kind of violence over 12 months prior to the study. These included physical (6.5%) and nonphysical violence (99.2%), including verbal violence (94.3%) and intimidation (22.0%). Offenders were patients (71.5%) in the majority of cases, companions (20.3%), or both (3.3%). Almost half (48.0%) of health care workers who experienced violence did nothing, 38.2% actively reported the event, and 13.8% consulted a colleague. A significant association of workplace violence was found with working multiple shifts, evening or night shift, and lack of an encouraging environment to report violence. Conclusion Workplace violence is still a significant problem in primary care centers. The high frequency of violence together with underreporting may indicate the inefficiency of the current safety program. More safety programs and training activities for health care workers, efficient reporting system, and zero tolerance policies need to be implemented to minimize workplace violence against health workers. PMID:27330300
Al-Turki, Nouf; Afify, Ayman Am; AlAteeq, Mohammed
Health care violence is a significant worldwide problem with negative consequences on both the safety and well-being of health care workers as well as workplace activities. Reports examining health care violence in Saudi Arabia are limited and the results are conflicting. To estimate the prevalence and determine the demographic and occupational characteristics associated with workplace violence in primary care centers in Riyadh, Saudi Arabia. A cross-sectional study included 270 health care workers in 12 family medicine centers in Riyadh during November and December 2014. A structured self-administered questionnaire was used to estimate the frequency, timing, causes, reactions, and consequences of workplace violence plus participants' demographic and occupational data. A total 123 health care workers (45.6%) experienced some kind of violence over 12 months prior to the study. These included physical (6.5%) and nonphysical violence (99.2%), including verbal violence (94.3%) and intimidation (22.0%). Offenders were patients (71.5%) in the majority of cases, companions (20.3%), or both (3.3%). Almost half (48.0%) of health care workers who experienced violence did nothing, 38.2% actively reported the event, and 13.8% consulted a colleague. A significant association of workplace violence was found with working multiple shifts, evening or night shift, and lack of an encouraging environment to report violence. Workplace violence is still a significant problem in primary care centers. The high frequency of violence together with underreporting may indicate the inefficiency of the current safety program. More safety programs and training activities for health care workers, efficient reporting system, and zero tolerance policies need to be implemented to minimize workplace violence against health workers.
Mosena, Patricia Wimberley
Results indicated that women whose desired family size is equal to or less than their actual family size have significantly greater frequencies practicing family planning than women whose desired size exceeds their actual size. (Author)
Warner, Morton M.
In an attempt to find out if the physician perceives the same strengths and weaknesses in today's practice of family medicine as does the consumer, the Lay Advisory Committee of the College's B.C. Chapter initiated a survey of physicians' and consumers' attitudes. This article, the fourth and last in a series, presents some of the results of the survey as they relate to preventive-medicine, professional satisfaction and the rise of consumerism.
Hixon, Allen L; Buenconsejo-Lum, Lee E; Racsa, C Philip
Access to care for patients in Hawai'i is compromised by a significant primary care workforce shortage. Not only are there not enough primary care providers, they are often not practicing in locations of high need such as rural areas on the neighbor islands or in the Pacific. This study used geographic information systems (GIS) spatial analysis to look at practice locations for 86 University of Hawai'i Family Medicine and Community Health graduates from 1993 to the 2010. Careful alumni records were verified and entered into the data set using the street address of major employment. Questions to be answered were (1) what percentage of program graduates remain in the state of Hawai'i and (2) what percentage of graduates practice in health professional shortage areas (HPSAs) throughout the United States. This study found that 73 percent of graduates remain and practice in Hawai'i with over 36 percent working in Health Professional Shortage Areas. Spatial analysis using GIS residency footprinting may be an important analytic tool to ensure that graduate medical education programs are meeting Hawai'i's health workforce needs.
Background: Family physician plan (FPP) and referral system (RS) is one of the major plans in Iran's health system with the aim of increasing the accountability in the health market, enhancing the public's access to the health services, lowering the unnecessary costs and equitable distribution of health across the society.
Laube, Justin G R; Shapiro, Martin F
Health history questionnaires (HHQs) are a set of self-administered questions completed by patients prior to a clinical encounter. Despite widespread use, minimal research has evaluated the content of HHQs used in general internal medicine and family medicine (GIM/FM), integrative medicine, and complementary and alternative medicine (CAM; chiropractic, naturopathic, and Traditional Chinese Medicine [TCM]) clinics. Integrative medicine and CAM claim greater emphasis on well-being than does GIM/FM. This study investigated whether integrative medicine and CAM clinics' HHQs include more well-being content and otherwise differ from GIM/FM HHQs. HHQs were obtained from GIM/FM (n = 9), integrative medicine (n = 11), naturopathic medicine (n = 5), chiropractic (n = 4), and TCM (n = 7) clinics in California. HHQs were coded for presence of medical history (chief complaint, past medical history, social history, family history, surgeries, hospitalizations, medications, allergies, review of systems), health maintenance procedures (immunization, screenings), and well-being components (nutrition, exercise, stress, sleep, spirituality). In HHQs of GIM/FM clinics, the average number of well-being components was 1.4 (standard deviation [SD], 1.4) compared with 4.0 (SD, 1.1) for integrative medicine (p medicine (p = 0.04), 2.0 (SD, 1.4) for chiropractic (p = 0.54), and 2.0 (SD, 1.5) for TCM (p = 0.47). In HHQs of GIM/FM clinics, the average number of medical history components was 6.4 (SD, 1.9) compared with 8.3 (SD, 1.2) for integrative medicine (p = 0.01), 9.0 (SD, 0) for naturopathic medicine (p = 0.01), 7.1 (SD, 2.8) for chiropractic (p = 0.58), and 7.1 (SD, 1.7) for TCM (p = 0.41). Integrative and naturopathic medicine HHQs included significantly more well-being and medical history components than did GIM/FM HHQs. Further investigation is warranted to determine the optimal HHQ content to support the clinical and preventive
Full Text Available Introduction. Family planning is an important aspect of population policy at the state level, because the demographic trends in Serbia are very unfavorable. Objective. The objective of this study was to examine the differences in family planning between the women in rural and urban areas of Serbia. Methods. This study represents the secondary analysis of the National Health Survey of the population in Serbia from 2006, which was conducted as a cross sectional study, on a representative sample of the population. Results. The respondents who used condoms as a method of contraception, were often younger, better educated, had better financial status, lived in Vojvodina, and had no children. Conclusion. Our study showed that there were differences in terms of family planning between the women of urban and rural areas, however, these differences could be explained by differences in age and education. [Projekat Ministarstva nauke Republike Srbije, br. 175025: National Health Survey of the Population of Serbia
Willis Jon A
Full Text Available Abstract Background Complementary and alternative medicines (CAMs are being used increasingly across the world. In Australia, community pharmacists are a major supplier of these products but knowledge of the products and interactions with other medicines is poor. Information regarding the use of CAMs by metropolitan pharmacists has been documented by the National Prescribing Service (NPS in Australia but the views of rural/regional community pharmacists have not been explored. The aim of this pilot study was to explore the knowledge, attitudes and information seeking of a cohort of rural community pharmacists towards CAMs and to compare the findings to the larger NPS study. Methods A cross sectional self-administered postal questionnaire was mailed to all community pharmacists in one rural/regional area of Australia. Using a range of scales, data was collected regarding attitudes, knowledge, information seeking behaviour and demographics. Results Eighty eligible questionnaires were returned. Most pharmacists reported knowing that they should regularly ask consumers if they are using CAMs but many lacked the confidence to do so. Pharmacists surveyed for this study were more knowledgeable in regards to side effects and interactions of CAMs than those in the NPS survey. Over three quarters of pharmacists surveyed reported sourcing CAM information at least several times a month. The most frequently sought information was drug interactions, dose, contraindications and adverse effects. A variety of resources were used to source information, the most popular source was the internet but the most useful resource was CAM text books. Conclusions Pharmacists have varied opinions on the use of CAMs and many lack awareness of or access to good quality CAMs information. Therefore, there is a need to provide pharmacists with opportunities for further education. The data is valuable in assisting interested stakeholders with the development of initiatives to
most of the primary care in the public sector, is much less engaged with family ... On the other hand the weaknesses of the educational system include a ... different policies. Within the private sector family physicians have not been fully.
Kozakowski, Stanley M; Travis, Alexandra; Bentley, Ashley; Fetter, Gerald
This is the 35th national study conducted by the American Academy of Family Physicians (AAFP) that reports retrospectively the percentage of graduates from MD-granting and DO-granting medical schools who entered Accreditation Council for Graduate Medical Education (ACGME)-accredited family medicine residency programs as first-year residents. Approximately 8.7% of the 18,929 students graduating from US MD-granting medical schools and 15.5% of the 5,314 students graduating from DO-granting medical schools between July 2014 and June 2015 entered an ACGME family medicine residency in 2015. Together, 10.2% of graduates of MD- and DO-granting schools entered family medicine. Of the 1,640 graduates of the MD-granting medical schools who entered a family medicine residency in 2015, 80% graduated from 70 of the 134 schools (52%). In 2015, DO-granting medical schools graduated 823 into ACGME-accredited family medicine residencies, 80% graduating from 19 of the 32 schools (59%). In aggregate, medical schools west of the Mississippi River represent less than a third of all MD-granting schools but have a rate of students selecting family medicine that is 40% higher than schools located east of the Mississippi. Fifty-one percent (24/47) of states and territories containing medical schools produce 80% of the graduates entering ACGME-accredited family medicine residency programs. A rank order list of MD-granting medical schools was created based on the last 3 years' average percentage of graduates who became family medicine residents, using the 2015 and prior AAFP census data.
Charles, Lesley; Triscott, Jean A C; Dobbs, Bonnie M; McKay, Rhianne
There is a growing mandate for Family Medicine residency programs to directly assess residents' clinical competence in Care of the Elderly (COE). The objectives of this paper are to describe the development and implementation of incremental core competencies for Postgraduate Year (PGY)-I Integrated Geriatrics Family Medicine, PGY-II Geriatrics Rotation Family Medicine, and PGY-III Enhanced Skills COE for COE Diploma residents at a Canadian University. Iterative expert panel process for the development of the core competencies, with a pre-defined process for implementation of the core competencies. Eighty-five core competencies were selected overall by the Working Group, with 57 core competencies selected for the PGY-I/II Family Medicine residents and an additional 28 selected for the PGY-III COE residents. The core competencies follow the CanMEDS Family Medicine roles. Both sets of core competencies are based on consensus. Due to demographic changes, it is essential that Family Physicians have the required skills and knowledge to care for the frail elderly. The core competencies described were developed for PGY-I/II Family Medicine residents and PGY-III Enhanced Skills COE, with a focus on the development of geriatric expertise for those patients that would most benefit.
Sileo, Katelyn M; Wanyenze, Rhoda K; Lule, Haruna; Kiene, Susan M
Uganda has one of the highest unmet needs for family planning globally, which is associated with negative health outcomes for women and population-level public health implications. The present cross-sectional study identified factors influencing family planning service uptake and contraceptive use among postpartum women in rural Uganda. Participants were 258 women who attended antenatal care at a rural Ugandan hospital. We used logistic regression models in SPSS to identify determinants of family planning service uptake and contraceptive use postpartum. Statistically significant predictors of uptake of family planning services included: education (AOR = 3.03, 95 % CI 1.57-5.83), prior use of contraceptives (AOR = 7.15, 95 % CI 1.58-32.37), partner communication about contraceptives (AOR = 1.80, 95 % CI 1.36-2.37), and perceived need of contraceptives (AOR = 2.57, 95 % CI 1.09-6.08). Statistically significant predictors of contraceptive use since delivery included: education (AOR = 2.04, 95 % CI 1.05-3.95), prior use of contraceptives (AOR = 10.79, 95 % CI 1.40-83.06), and partner communication about contraceptives (AOR = 1.81, 95 % CI 1.34-2.44). Education, partner communication, and perceived need of family planning are key determinants of postpartum family planning service uptake and contraceptive use, and should be considered in antenatal and postnatal family planning counseling.
Rita de Cássia Gabrielli Souza Lima; Marta Inez Machado Verdi
This study reflects on solidarity in the practice of family medicine in two realities. The objective is to search for solidarity as an ethical principle in the relationship between family doctor and subject. It is a descriptive exploratory research carried out in Florianópolis, state of Santa Catarina, Brazil, and in the Province of Rome, Lazio Region, Italy. It included fourteen Brazilian family doctors and fifteen Italian family doctors. The theoretical framework consisted of Pierre Bourdie...
Rainsford, Suzanne; MacLeod, Roderick D; Glasgow, Nicholas J; Phillips, Christine B; Wiles, Robert B; Wilson, Donna M
End-of-life care must be relevant to the dying person and their family caregiver regardless of where they live. Rural areas are distinct and need special consideration. Gaining end-of-life care experiences and perspectives of rural patients and their family caregivers is needed to ensure optimal rural care. To describe end-of-life care experiences and perspectives of rural patients and their family caregivers, to identify facilitators and barriers to receiving end-of-life care in rural/remote settings and to describe the influence of rural place and culture on end-of-life care experiences. A systematic literature review utilising the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four databases (PubMed, CINAHL, Scopus and Web of Science) were searched in January 2016, using a date filter of January 2006 through January 2016; handsearching of included article references and six relevant journals; one author contacted; pre-defined search terms and inclusion criteria; and quality assessment by at least two authors. A total of 27 articles (22 rural/remote studies) from developed and developing countries were included, reporting rural end-of-life care experiences and perspectives of patients and family caregivers. Greatest needs were informational (developed countries) and medications (developing countries). Influence of rural location included distances, inaccessibility to end-of-life care services, strong community support and importance of home and 'country'. Articulation of the rural voice is increasing; however, there still remain limited published rural studies reporting on patient and family caregivers' experiences and perspectives on rural end-of-life care. Further research is encouraged, especially through national and international collaborative work.
Schubert, Finn D; Akse, Sarp; Bennett, Ariana H; Glassman, Nancy R; Gold, Marji
Family physicians are critical providers of reproductive health care in the United States, and family physicians and trainees refer to textbooks as a source of clinical information. This study evaluates the coverage of reproductive health topics in current family medicine textbooks. We identified 12 common family medicine textbooks through a computerized literature search and through the recommendations of a local family medicine clerkship and evaluated 24 areas of reproductive health content (comprising contraceptive care, management of early pregnancy loss, and provision of induced abortion) for accuracy and thoroughness using criteria that we created based on the latest guidelines. All contraceptive methods evaluated were addressed in more than half of the textbooks, though discrepancies existed by method, with intrauterine devices (IUDs), external (male) condoms, and diaphragms addressed most frequently (10/12 texts) and male and female sterilization addressed least frequently (8/12 texts). While most contraceptive methods, when addressed, were usually addressed accurately, IUDs were often addressed inaccurately. Coverage of early pregnancy loss management was limited to 7/12 texts, and coverage of early abortion methods was even more limited, with only 4/12 texts addressing the topic. Family medicine textbooks do not uniformly provide correct and thorough information on reproductive health topics relevant to family medicine, and attention is needed to ensure that family physicians are receiving appropriate information and training to meet the reproductive health needs of US women.
Donovan Casas Patiño
Full Text Available Family medicine is the essence of medical care. It is the main access to primary health care and the gateway to the largest health system in Latin America: the Mexican Institute of Social Security. This condition leads to complexity in the organizational model of health care. The question, thus, is what constraints are set from the hegemonic biomedical State system that allows and promotes family medicine with limits? Deconstruction is a theoretical framework that can defragment study elements of a whole, allowing us to approach the development and redefinition of a new family medicine. This article looks at the model of Mexican family medicine from the standpoint of deconstruction theory, specifically looking at the case of the Mexican Institute of Social Security.
Elder, Nancy C.; Jacobson, C. Jeffrey; Bolon, Shannon K.; Fixler, Joseph; Pallerla, Harini; Busick, Christina; Gerrety, Erica; Kinney, Dee; Regan, Saundra; Pugnale, Michael
PURPOSE The clinician-colleague relationship is a cornerstone of relationship-centered care (RCC); in small family medicine offices, the clinician–medical assistant (MA) relationship is especially important. We sought to better understand the relationship between MA roles and the clinician-MA relationship within the RCC framework. METHODS We conducted an ethnographic study of 5 small family medicine offices (having informed by clinicians’ roles in hiring and managing MAs and the social familiarity of MAs and clinicians. Within the RCC framework, these findings can be seen as previously undefined constraints and freedoms in what is known as the Complex Responsive Process of Relating between clinicians and MAs. CONCLUSIONS Improved understanding of clinician-MA relationships will allow a better appreciation of how clinicians and MAs function in family medicine teams. Our findings may assist small offices undergoing practice transformation and guide future research to improve the education, training, and use of MAs in the family medicine setting. PMID:24615311
Thomas, Evert; Vandebroek, Ina; Sanca, Sabino; Van Damme, Patrick
Medicinal plant use was investigated in Apillapampa, a community of subsistence farmers located in the semi-arid Bolivian Andes. The main objectives were to identify the culturally most significant medicinal plant families and species in Apillapampa. A total of 341 medicinal plant species was inventoried during guided fieldtrips and transect sampling. Data on medicinal uses were obtained from fifteen local Quechua participants, eight of them being traditional healers. Contingency table and binomial analyses of medicinal plants used versus the total number of inventoried species per family showed that Solanaceae is significantly overused in traditional medicine, whereas Poaceae is underused. Also plants with a shrubby habitat are significantly overrepresented in the medicinal plant inventory, which most likely relates to their year-round availability to people as compared to most annual plants that disappear in the dry season. Our ranking of medicinal species according to cultural importance is based upon the Quality Use Agreement Value (QUAV) index we developed. This index takes into account (1) the average number of medicinal uses reported for each plant species by participants; (2) the perceived quality of those medicinal uses; and (3) participant consensus. According to the results, the QUAV index provides an easily derived and valid appraisal of a medicinal plant's cultural significance.
Background: There is a hierarchical organisation of knowledge in the use of medicinal plants in communities. Medicinal use knowledge starts in the home and is passed on to family members. Next in the hierarchy are neighbours, village elders and finally, traditional healers being the most knowledgeable. For primary ...
Research has identified the lack of acceptance of a two-child-family norm as the biggest obstacle to achieving replacement-level fertility in Egypt. This analysis examines norms about desired family size for 1,366 males and 1,367 females aged 15-24 in 2004 in rural Minya governorate. Two-level random-effects multivariate logistic regression models, stratified by sex and grouped by neighborhood, are used to assess normative influence at the household and neighborhood levels, controlling for individual- and household-level covariates. In the final model, young males in neighborhoods where more people desire a small family are 33 percent more likely to desire a small family than are young males in other neighborhoods. Young females in households with one or more adults preferring a small family are 78 percent more likely to desire a small family, and young females in households with one or more young people who prefer a small family are 37 percent more likely to desire a small family themselves, compared with those living with adults or with young people, respectively, who do not prefer a small family. Programs aiming to reduce fertility should be aware of gender differences in the sources of normative influence on desired family size.
Taylor, Jaime L; Aalsma, Matthew C; Gilbert, Amy L; Hensel, Devon J; Rickert, Vaughn I
The study objective was to identify commonalities amongst family medicine physicians who endorse annual adolescent visits. A nationally weighted representative on-line survey was used to explore pediatrician (N = 204) and family medicine physicians (N = 221) beliefs and behaviors surrounding adolescent wellness. Our primary outcome was endorsement that adolescents should receive annual preventive care visits. Pediatricians were significantly more likely (p family medicine physicians, bivariate comparisons were conducted between those who endorsed an annual visit (N = 164) compared to those who did not (N = 57) with significant predictors combined into two multivariate logistic regression models. Model 1 controlled for: patient race, proportion of 13-17 year olds in provider's practice, discussion beliefs scale and discussion behaviors with parents scale. Model 2 controlled for the same first three variables as well as discussion behaviors with adolescents scale. Model 1 showed for each discussion beliefs scale topic selected, family medicine physicians had 1.14 increased odds of endorsing annual visits (p family medicine physicians had 1.15 increased odds of also endorsing the importance of annual visits (p Family medicine physicians that endorse annual visits are significantly more likely to affirm they hold strong beliefs about topics that should be discussed during the annual exam. They also act on these beliefs by talking to parents of teens about these topics. This group appears to focus on quality of care in thought and deed.
Sairenji, Tomoko; Wilson, Stephen A; D'Amico, Frank; Peterson, Lars E
Home visits have been shown to improve quality of care, save money, and improve outcomes. Primary care physicians are in an ideal position to provide these visits; of note, the Accreditation Council for Graduate Medical Education no longer requires home visits as a component of family medicine residency training. To investigate changes in home visit numbers and expectations, attitudes, and approaches to training among family medicine residency program directors. This research used the Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of family medicine program directors in 2015. Questions addressed home visit practices, teaching and evaluation methods, common types of patient and visit categories, and barriers. There were 252 responses from 455 possible respondents, representing a response rate of 55%. At most programs, residents performed 2 to 5 home visits by graduation in both 2014 (69% of programs, 174 of 252) and 2015 (68%, 172 of 252). The vast majority (68%, 172 of 252) of program directors expect less than one-third of their graduates to provide home visits after graduation. Scheduling difficulties, lack of faculty time, and lack of resident time were the top 3 barriers to residents performing home visits. There appeared to be no decline in resident-performed home visits in family medicine residencies 1 year after they were no longer required. Family medicine program directors may recognize the value of home visits despite a lack of few formal curricula.
Cláudio Pinheiro Machado Filho
Full Text Available Abstract The rural production in Brazil has experienced a significant competitive impact with the stabilization of the economy promoted by the Real Plan in 1994. Indeed, the Brazilian agriculture has achieved efficiency gains in terms of technology, economies of scale and general modernization of the activity in the field. In this context, the professional management of rural production evolved. However, the governance process does not evolve in the same dimension, and the “governance risk” is still poorly addressed in the rural environment, which often limits the potential of operations. In this study, we sought to deepen the understanding of the factors that impact the implementation of governance practices in rural properties in Brazil. Based on a convenience and non-probability sample, this study seeks to understand the evolution of the governance process on farms and its correlation with the management practices. This study found a correlation between the existence of some formal management processes (for example, strategic planning and more robust accounting systems and advances in the governance mechanisms and processes, such as the establishment of a board of directors, clearer rules regarding the separation between corporate and family assets and more transparency in income statements. This study also found a lack of clarity in the separation of return on capital (dividend and compensation for work (compensation for services provided for partners, heirs and other family members. In summary, we concluded that there is the adoption of some governance mechanisms in the rural sector, but they are still poorly developed among rural producers, hence the need to stimulate them.
Ocvirk, Soeren; Kistler, Martin; Khan, Shusmita; Talukder, Shamim Hayder; Hauner, Hans
The usage of medicinal plants is traditionally rooted in Bangladesh and still an essential part of public healthcare. Recently, a dramatically increasing prevalence brought diabetes mellitus and its therapy to the focus of public health interests in Bangladesh. We conducted an ethnobotanical survey to identify the traditional medicinal plants being used to treat diabetes in Bangladesh and to critically assess their anti-diabetic potentials with focus on evidence-based criteria. In an ethnobotanical survey in defined rural and urban areas 63 randomly chosen individuals (health professionals, diabetic patients), identified to use traditional medicinal plants to treat diabetes, were interviewed in a structured manner about their administration or use of plants for treating diabetes. In total 37 medicinal plants belonging to 25 families were reported as being used for the treatment of diabetes in Bangladesh. The most frequently mentioned plants were Coccinia indica, Azadirachta indica, Trigonella foenum-graecum, Syzygium cumini, Terminalia chebula, Ficus racemosa, Momordica charantia, Swietenia mahagoni. Traditional medicinal plants are commonly used in Bangladesh to treat diabetes. The available data regarding the anti-diabetic activity of the detected plants is not sufficient to adequately evaluate or recommend their use. Clinical intervention studies are required to provide evidence for a safe and effective use of the identified plants in the treatment of diabetes.
Wilson Mark C; Mustafa Reem; Gunukula Sameer; Akl Elie A; Symons Andrew; Moheet Amir; Schünemann Holger J
Abstract Background The evidence supporting the effectiveness of educational games in graduate medical education is limited. Anecdotal reports suggest their popularity in that setting. The objective of this study was to explore the support for and the different aspects of use of educational games in family medicine and internal medicine residency programs in the United States. Methods We conducted a survey of family medicine and internal medicine residency program directors in the United Stat...
Chang, Feng; Paramsothy, Thivaher; Roche, Matthew; Gupta, Nishi S
Aim To conduct an environmental scan of a rural primary care clinic to assess the feasibility of implementing an e-communications system between patients and clinic staff. Increasing demands on healthcare require greater efficiencies in communications and services, particularly in rural areas. E-communications may improve clinic efficiency and delivery of healthcare but raises concerns about patient privacy and data security. We conducted an environmental scan at one family health team clinic, a high-volume interdisciplinary primary care practice in rural southwestern Ontario, Canada, to determine the feasibility of implementing an e-communications system between its patients and staff. A total of 28 qualitative interviews were conducted (with six physicians, four phone nurses, four physicians' nurses, five receptionists, one business office attendant, five patients, and three pharmacists who provide care to the clinic's patients) along with quantitative surveys of 131 clinic patients. Findings Patients reported using the internet regularly for multiple purposes. Patients indicated they would use email to communicate with their family doctor for prescription refills (65% of respondents), appointment booking (63%), obtaining lab results (60%), and education (50%). Clinic staff expressed concerns about patient confidentiality and data security, the timeliness, complexity and responsibility of responses, and increased workload. Clinic staff members are willing to use an e-communications system but clear guidelines are needed for successful adoption and to maintain privacy of patient health data. E-communications might improve access to and quality of care in rural primary care practices.
Simpson, Peggy Burrows
To explore beliefs about diet and traditional Chinese medicine related to the breast cancer experience of Hong Kong Chinese women and their families. Interpretive phenomenology. Hong Kong, China. A purposive sample of 20 Hong Kong Chinese women diagnosed with breast cancer at various stages of the illness trajectory and at least one other family member. A semistructured, three-hour interview was translated, transcribed, and back-translated. Many women and their family members believed that diet was responsible for their cancer and recurrence. They integrated their cultural beliefs about diet and traditional Chinese medicine to manage illness symptoms and prevent recurrence. Families were anxious and confused about conflicting messages from various sources about dietary practices to promote their health and prevent recurrence. Food and diet alternatives should be discussed with the understanding that beliefs about diet and traditional Chinese medicine are embedded in culture and that many Chinese women and their families seek a combination of Eastern Chinese medicine and Western medicine strategies to manage the illness trajectory. Many Chinese families have different beliefs about food and diet and the role that food plays in managing the cancer experience. Often, Chinese people will not seek clarification if they do not understand information. If information does not fit with their predominant belief systems, families may not implement it, nor will they discuss a situation if they think the conversation will result in a relationship of conflict with healthcare providers.
Wulifan, Joseph K; Jahn, Albrecht; Hien, Hervé; Ilboudo, Patrick Christian; Meda, Nicolas; Robyn, Paul Jacob; Saidou Hamadou, T; Haidara, Ousmane; De Allegri, Manuela
Unmet need for family planning has implications for women and their families, such as unsafe abortion, physical abuse, and poor maternal health. Contraceptive knowledge has increased across low-income settings, yet unmet need remains high with little information on the factors explaining it. This study assessed factors associated with unmet need among pregnant women in rural Burkina Faso. We collected data on pregnant women through a population-based survey conducted in 24 rural districts between October 2013 and March 2014. Multivariate multilevel logistic regression was used to assess the association between unmet need for family planning and a selection of relevant demand- and supply-side factors. Of the 1309 pregnant women covered in the survey, 239 (18.26%) reported experiencing unmet need for family planning. Pregnant women with more than three living children [OR = 1.80; 95% CI (1.11-2.91)], those with a child younger than 1 year [OR = 1.75; 95% CI (1.04-2.97)], pregnant women whose partners disapproves contraceptive use [OR = 1.51; 95% CI (1.03-2.21)] and women who desired fewer children compared to their partners preferred number of children [OR = 1.907; 95% CI (1.361-2.672)] were significantly more likely to experience unmet need for family planning, while health staff training in family planning logistics management (OR = 0.46; 95% CI (0.24-0.73)] was associated with a lower probability of experiencing unmet need for family planning. Findings suggest the need to strengthen family planning interventions in Burkina Faso to ensure greater uptake of contraceptive use and thus reduce unmet need for family planning.
Hyder, S S; Amundson, Mary
Recruitment of hospitalists and primary care physicians for Critical Access Hospitals and tertiary care hospitals in North Dakota is difficult. To address this challenge, 2 programs were implemented in Bismarck, North Dakota. St. Alexius Medical Center created a hospitalist fellowship training program in collaboration with the University of North Dakota School of Medicine and Health Sciences and physicians willing to work in Critical Access Hospitals were offered a joint appointment to teach hospitalist fellows and obtain a clinical academic appointment at the university. Since it was created in 2012, 84 physicians have applied for 13 fellowships. Of the 11 fellows who have completed the program, 64% (7/11) remained in North Dakota to practice. Physicians are more likely to work in a rural Critical Access Hospital if they spend time working at a tertiary care center and have clinical academic appointments. Where recruitment is challenging, hospitalist fellowship programs are helpful in meeting the health care workforce demand.
Sarker, P C
This paper is based on data taken from the study entitled Social Structure and Fertility Behavior in a Rural Community of Bangladesh. The field-work was carried out during 1985-86 in Kamnagar, a village in the north-eastern corner of Rajshahi metropolitan city, with a total population of 884. 54.4% of the villagers had no education. Basic information was collected from every household by questionnaires interviewing the head of the household. In the 2nd phase questionnaires were administered to 140 eligible husbands and 140 wives separately to collect information on fertility behavior. 56.8% of the families were nuclear. 12.1% of the families were supplementary nuclear, with parents and their unmarried children including 1 or more additional members. 24.9% of the families were joint, in which related males belonging to 2 or 3 generations lived together with their dependents. 6.2% of the families were extended. As far as the authority structure was concerned, 68.1% of the families were patriarchal, 9.9% of the families were matriarchal, and 22% of the families were egalitarian. The egalitarian authority system is increasing with the spread of female literacy, economic activities outside the home, and women's mobility. Couples in nuclear families are more free to decide on the number of children, birth spacing, and adoption of contraception than those in joint, extended, and supplementary nuclear families with patriarchal and matriarchal authority structures. In nuclear families with an egalitarian authority structure, husband-wife communication can help decide about the number of children wanted, the acceptance of contraceptives, and child spacing. Nuclear families favor lower fertility than supplementary nuclear, joint, and extended families with a patriarchal or matriarchal authority structure. The number of traditional joint and extended families is on the decline with the trend to nuclear families as a result of the increasing landlessness in rural Bangladesh
Lacasse, Miriam; Théorêt, Johanne; Tessier, Sylvie; Arsenault, Louise
The CanMEDS-Family Medicine (CanMEDS-FM) framework defines the expected terminal enabling competencies (EC) for family medicine (FM) residency training in Canada. However, benchmarks throughout the 2-year program are not yet defined. This study aimed to identify expected time frames for achievement of the CanMEDS-FM competencies during FM residency training and create a developmental benchmarks scale for family medicine residency training. This 2011-2012 study followed a Delphi methodology. Selected faculty and clinical teachers identified, via questionnaire, the expected time of EC achievement from beginning of residency to one year in practice (0, 6, 12, […] 36 months). The 15-85th percentile intervals became the expected competency achievement interval. Content validity of the obtained benchmarks was assessed through a second Delphi round. The 1st and 2nd rounds were completed by 33 and 27 respondents, respectively. A developmental benchmarks scale was designed after the 1st round to illustrate expectations regarding achievement of each EC. The 2nd round (content validation) led to minor adjustments (1.9±2.7 months) of intervals for 44 of the 92 competencies, the others remaining unchanged. The Laval Developmental Benchmarks Scale for Family Medicine clarifies expectations regarding achievement of competencies throughout FM training. In a competency-based education system this now allows identification and management of outlying residents, both those excelling and needing remediation. Further research should focus on assessment of the scale reliability after pilot implementation in family medicine clinical teaching units at Laval University, and corroborate the established timeline in other sites.
Suk, Min Hyun; Oh, Won-Oak; Im, YeoJin
With the recent growth of multicultural families in the Korean society, the importance of the role of qualified visiting nurses in the delivery of culturally sensitive health care has grown dramatically. As the primary health care provider for multicultural families enrolled in public community-based health care centers, the cultural competence of visiting nurses is an essential qualification for the provision of quality health care for multicultural families, especially in rural areas. Cultural competence of visiting nurses is based on their cultural awareness and empathetic attitude toward multicultural families. This study aimed to examine the levels of cultural competence, empowerment, and empathy in visiting nurses, and to verify the factors that affect the cultural competence of visiting nurses working with rural multicultural families in South Korea. Employing a cross-sectional descriptive study design, data from 143 visiting nurses working in rural areas were obtained. Data collection took place between November 2011 and August 2012. The measurement tools included the modified Korean version of the Cultural Awareness Scale, the Text of Items Measuring Empowerment, and the Interpersonal Reactivity Index to measure the level of empathy of visiting nurses. Analyses included descriptive statistics, a t-test, an ANOVA, a Pearson correlation coefficient analysis, and a multiple linear regression analysis. The cultural competence score of the visiting nurses was 3.07 on a 5-point Likert scale (SD = 0.30). The multiple regression analysis revealed that the cultural competence of visiting nurses was significantly influenced by experience of cultural education, empathy, and scores on the meaning subscale of the empowerment tool (R 2 = 10.2%). Institutional support to enhance visiting nurses' empowerment by assuring the significance of their job and specific strategies to enhance their empathy would be helpful to improve the cultural competence of visiting
Chen, Xinyin; Li, Dan
Due to the requirements of the competitive, market-oriented urban society, parents in urban and urbanized families are more likely than parents in rural families to encourage initiative-taking in child rearing in China. The socialization experiences of children from different types of families may be related to their adjustment. This study examined parental socialization attitudes, social and school adjustment, and their relations in Chinese children from rural, urban, and urbanized families. Participants were elementary school students (N = 1,033; M age = 11 years) and their parents in China. Data were obtained from parental reports, peer evaluations, teacher ratings, and school records. A multivariate analysis of variance revealed that parents in urban and urbanized families had higher scores than parents in rural families on encouragement of initiative-taking. Urban children, particularly girls, were more sociable, obtained higher social status, and had fewer school problems than their rural counterparts. Children from urbanized families were different from rural children and similar to urban children in social and school adjustment. Moreover, multigroup invariance tests showed that parental encouragement of initiative-taking was associated more strongly with children's sociable-assertive behavior and social standing in the urban and urbanized groups than in the rural group. The results indicate that particular socialization attitudes may vary in their adaptive value in child development as a function of specific social and cultural requirements in changing societies. PsycINFO Database Record (c) 2012 APA, all rights reserved.
Ledford, Christy J W; Fisher, Carla L; Crawford, Paul
As evidence establishes the efficacy of medical acupuncture, more family physicians and family medicine residents may receive medical acupuncture training and need to know how to effectively communicate about the treatment option with patients. By identifying how physicians talk about acupuncture treatment with their patients, we aimed to develop a model for physician training that could enhance their ability to integrate and practice medical acupuncture in conventional clinical settings. To capture the communication process that family physicians engage in when integrating acupuncture treatment into a clinical environment, we sought both physicians' and patients' perspectives. We conducted interviews with 17 family physicians and 15 patients in a US family medicine clinic that has integrated medical acupuncture into its practice. Audio recordings were transcribed and analyzed by two members of the study team in ATLAS.ti, using the constant comparative method. Integrating acupuncture into family medicine entailed a three-phase communication process: (1) introduce acupuncture, (2) explain the medical process, and (3) evaluate treatment outcomes. The emerging three-phase process of communicating acupuncture described here provides an initial model for teaching communication in the context of medical acupuncture. Given the exploratory nature of this initial study and the rarity of acupuncture treatment integrated into family medical settings, this is a first step in building knowledge in this realm of practice. Future research is needed to better understand the experience of patients who do not report notable results of acupuncture and to extend this study into other family medicine settings.
Klemenc Ketiš Zalika
Full Text Available Cinemeducation is a teaching method where popular movies or movie clips are used. We aimed to determine whether family physicians’ competencies as listed in the Educational Agenda produced by the European Academy of Teachers in General Practice/Family Medicine (EURACT can be found in movies, and to propose a template for teaching by these movies.
771 children from Baras, Rizal, and Pasay City, Philippines were studied. House interviews of mothers using precoded questionnaires were conducted and the children were given a complete physical examination. The study objectives were to compare the health and nutritional status of children in a rural and an urban area in greater Manila and to determine how family size affects the nutritional status of children 3 years and younger. The following were among the study results: 1) the weight curves of both urban and rural groups were similar until age 4-1/2 years, but beyond this age the mean weight curve of the rural group exceeded that of the urban group; 2) urban children between ages 1-5 enjoyed a height advantage; 3) there was a positive correlation between malnutrition and excessive family size; 4) the high prevalence of malnutrition among children 1-4 years of age was due to food deprivation because of poverty, parental ignorance, inappropriate folklores, oversized families, high episodes of illnesses, and inadequate medical care; and 5) dietary assessment of both groups showed the inadequacy of the quality and quantity of basic nutrients and elements needed for growth, development, and repair of tissues.
Fernandes, Gisele Cristina Manfrini; Boehs, Astrid Eggert; Denham, Sharon A; Nitschke, Rosane Gonçalves; Martini, Jussara Gue
Natural disasters affect populations in various parts of the world. The impacts of disasters can cause many problems to the health of people and disruption to family life, potentially leading to an unexpected transition. The objective of this paper is to present the unexpected transitional experiences of rural families following a natural disaster. A multiple case study of six families was conducted with children and adolescents in a rural area affected by a 2008 disaster in southern Brazil. For data collection, we used participant observation, narrative interviews, genograms, ecomaps and an instrument called calendar routine. The analysis of the data resulted in different family interpretations about the changes resulting from the storm and compared life before and after the disaster. The loss of homes and loved ones, migration, unemployment, and losses from the farm were the main changes associated with new development tasks. The experiences of family transition after the disaster revealed that losses influenced social lives, daily routines and the preservation of cultural values.
Gisele Cristina Manfrini Fernandes
Full Text Available Abstract: Natural disasters affect populations in various parts of the world. The impacts of disasters can cause many problems to the health of people and disruption to family life, potentially leading to an unexpected transition. The objective of this paper is to present the unexpected transitional experiences of rural families following a natural disaster. A multiple case study of six families was conducted with children and adolescents in a rural area affected by a 2008 disaster in southern Brazil. For data collection, we used participant observation, narrative interviews, genograms, ecomaps and an instrument called calendar routine. The analysis of the data resulted in different family interpretations about the changes resulting from the storm and compared life before and after the disaster. The loss of homes and loved ones, migration, unemployment, and losses from the farm were the main changes associated with new development tasks. The experiences of family transition after the disaster revealed that losses influenced social lives, daily routines and the preservation of cultural values.
Jennings, Elyse A; Barber, Jennifer S
Large families can have a negative impact on the health and well-being of women, children, and their communities. Seventy-three percent of the individuals in our rural Nepalese sample report that two children is their ideal number, yet about half of the married women continue childbearing after their second child. Using longitudinal data from the Chitwan Valley Family Study, we explore the influence of women's and neighbors' family size preferences on women's progression to high parity births, comparing this influence across two cohorts. We find that neighbors' family size preferences influence women's fertility, that older cohorts of women are more influenced by their neighbors' preferences than are younger cohorts of women, and that the influence of neighbors' preferences is independent of women's own preferences. © 2013 The Population Council, Inc.
Lent, Megan D; Petrovic, Lindsay E; Swanson, Josephine A; Olson, Christine M
Little is known about the causal relationship between and the mechanisms linking depression and food insecurity. Our purpose was to examine these knowledge gaps. Chi-squared analysis of longitudinal data from 29 rural upstate New York families followed for three years and qualitative analysis of interviews were used to identify associations and mechanisms. Depressive symptoms (p=.009) and poor mental health (p=.01) in mothers limited the likelihood families would leave food insecurity. This relationship was mediated through limiting the employment of adult family members and operated in three ways: preventing the depressed household member from working, preventing a different household member from working, and limiting access to childcare for depressed children so adults could work. Poor mental health is associated with keeping families food-insecure by limiting their employment. High-quality, accessible mental health care is needed for poverty-associated food insecurity to be alleviated.
Since 2001 the World Health Organization Europe's family health nurse (FHN) role has been developing in remote and rural areas of Scotland. In 2003, an independent evaluation identified a need for facilitation of the FHN role and family-health orientated approaches with local primary health care teams. The Scottish Executive Health Department appointed three part-time, regionally-based family health practice development facilitators (FHPDFs) in December 2003 to work over an 18-month period. This article presents findings from a small study which sought these FHPDFs' judgements on individual FHN autonomy and supportive colleague action at 24 sites where FHNs were practising. These judgements reveal a picture of mixed progress that is consistent with findings from other related research. This collective overview is presented in the form of a new typology and the resultant implications for future development of family health nursing are discussed.
Two generations of a family who lived in mid-nineteenth rural Sweden are described. Domestic violence was a common feature in the first generation family. The salient feature there was undoubtedly the incestuous father-daughter relationships. The way incest appeared in Sweden about 150 years ago, the role of local authorities, and the serious consequences to those victimized is analyzed with reference to both the cultural context of that time and to modern theories of incest. Seemingly puzzling violence committed by a second generation family member is related to the domestic violence in the previous generation. Due to the extraordinary character of the incest cases and the specific church council sessions in which the incest case was treated, aspects of family life normally hidden behind curtains of conventions were made public. Reaction patterns drawn from this case indicate a patriarchal system of oppression and badly-directed considerations.
Etokidem, A J; Ndifon, W; Etowa, J; Asuquo, E F
Nigeria is the most populous nation in Africa and the seventh most populous in the world. Despite a high fertility rate of 5.5 per woman and a high population growth rate of 3.2%, Nigeria's contraceptive prevalence is 15%, which is one of the lowest in the world. The objective of this study was to determine the knowledge of family planning and family planning preferences and practices of rural community women in Cross River State of Nigeria. This was a cross-sectional study involving 291 rural women. Convenience sampling method was used. The women were assembled in a hall and a semi-structured questionnaire was administered to every consenting woman until the sample size was attained. Data obtained from the study were analyzed using the Statistical Package for the Social Sciences version 20 and presented in tables as frequencies and percentages as well as figures. Association between categorical variables was explored using chi-square test. Binary logistic regression was also performed to determine predictors of use of at least one family planning method at some point in time. Fifty (17.2%) respondents were using at least one family planning method. One hundred and ninety-eight (68.3%) respondents had used at least one family planning method at some point in time. Reasons given for not using any family planning method included "Family planning is against my religious beliefs" (56%); "it is against our culture" (43.8%); "I need more children" (64.9%); "my partner would not agree" (35.3%); "family planning does not work" (42.9%); "it reduces sexual enjoyment" (76%); and "it promotes unfaithfulness/infidelity" (59%). Binary logistic regression conducted to predict the use of at least one family planning method at some point in time using some independent variables showed that who makes the decision regarding family planning use was the strongest predictor of family planning use (OR = 0.567; 95% CI = 0.391-0.821). This suggests that family planning uptake is more
Stryamets, Nataliya; Elbakidze, Marine; Ceuterick, Melissa; Angelstam, Per; Axelsson, Robert
There are many ethnobotanical studies on the use of wild plants and mushrooms for food and medicinal treatment in Europe. However, there is a lack of comparative ethnobotanical research on the role of non-wood forest products (NWFPs) as wild food and medicine in local livelihoods in countries with different socio-economic conditions. The aim of this study was to compare the present use of wild food and medicine in three places representing different stages of socio-economic development in Europe. Specifically we explore which plant and fungi species people use for food and medicine in three selected rural regions of Sweden, Ukraine and the Russian Federation. We studied the current use of NWFPs for food and medicine in three rural areas that represent a gradient in economic development (as indicated by the World Bank), i.e., Småland high plain (south Sweden), Roztochya (western Ukraine), and Kortkeros (Komi Republic in North West Russia). All areas were characterised by (a) predominating rural residency, (b) high forest coverage, and (c) free access to NWFPs. A total of 205 in-depth semi-structured interviews were conducted with local residents in the three study areas. The collected NWFPs data included (1) the species that are used; (2) the amount harvested, (3) uses and practices (4) changes over time, (5) sources of knowledge regarding the use of NWFPs as wild food and medicine and (6) traditional recipes. In Sweden 11 species of wild plant and fungi species were used as food, and no plant species were used for medicinal purposes. In Ukraine the present use of NWFPs included 26 wild foods and 60 medicinal species, while in Russia 36 food and 44 medicinal species were reported. In the economically less developed rural areas of Ukraine and Russia, the use of NWFPs continues to be an important part of livelihoods, both as a source of income and for domestic use as food and medicine. In Sweden the collection of wild food has become mainly a recreational activity
Klemenc Ketiš, Zalika; Švab, Igor
Cinemeducation is a teaching method where popular movies or movie clips are used. We aimed to determine whether family physicians' competencies as listed in the Educational Agenda produced by the European Academy of Teachers in General Practice/Family Medicine (EURACT) can be found in movies, and to propose a template for teaching by these movies. A group of family medicine teachers provided a list of movies that they would use in cinemeducation. The movies were categorised according to the key family medicine competencies, thus creating a framework of competences, covered by different movies. These key competencies are Primary care management, Personcentred care, Specific problem-solving skills, Comprehensive approach, Community orientation, and Holistic approach. The list consisted of 17 movies. Nine covered primary care management. Person-centred care was covered in 13 movies. Eight movies covered specific problem-solving skills. Comprehensive approach was covered in five movies. Five movies covered community orientation. Holistic approach was covered in five movies. All key family medicine competencies listed in the Educational Agenda can be taught using movies. Our results can serve as a template for teachers on how to use any appropriate movies in family medicine education.
Tušek-Bunc, Ksenija; Petek, Davorina
Family medicine plays an important role in quality of care (QoC) of coronary heart disease (CHD) patients. This study's aim was to determine the quality of secondary cardiovascular disease prevention in the everyday practice of family physicians. This study was observational cross-sectional. About 36 randomly selected family medicine practices stratified by size and location in Slovenia. CHD patients randomly selected from a patient register available in family medicine practices. The instrument for assessment of quality included a form for collecting data from medical records, a general practice assessment questionnaire and a patient questionnaire. QoC was defined by two composite variables, namely risk factor registration and CHD patient process of care, as the two care outcomes. In multivariate analysis, we performed multilevel regression analysis to identify the associations between QoC, the patient and the practice characteristics. The final sample included 423 CHD patients from 36 family medicine practices. Risk factor registration was associated with the practice organisation score (P = 0.004), practice size (P = 0.042), presence of comorbid atherosclerotic diseases (P = 0.043) and a lower age of CHD patients (P = 0.001). CHD patient process of care was associated with the practice organisation score (0.045) and a lower age of CHD patients (P = 0.035). The most important factors affecting the quality of CHD patient care were linked to the organisational characteristics of the family medicine practices.
Abstract Introduction Cinemeducation is a teaching method where popular movies or movie clips are used. We aimed to determine whether family physicians’ competencies as listed in the Educational Agenda produced by the European Academy of Teachers in General Practice/Family Medicine (EURACT) can be found in movies, and to propose a template for teaching by these movies. Methods A group of family medicine teachers provided a list of movies that they would use in cinemeducation. The movies were categorised according to the key family medicine competencies, thus creating a framework of competences, covered by different movies. These key competencies are Primary care management, Personcentred care, Specific problem-solving skills, Comprehensive approach, Community orientation, and Holistic approach. Results The list consisted of 17 movies. Nine covered primary care management. Person-centred care was covered in 13 movies. Eight movies covered specific problem-solving skills. Comprehensive approach was covered in five movies. Five movies covered community orientation. Holistic approach was covered in five movies. Conclusions All key family medicine competencies listed in the Educational Agenda can be taught using movies. Our results can serve as a template for teachers on how to use any appropriate movies in family medicine education. PMID:28289469
Nduwimana, Estella; Mukunzi, Sylvere; Ng, Lauren C; Kirk, Catherine M; Bizimana, Justin I; Betancourt, Theresa S
Fostering children is common in sub-Saharan Africa, but few studies examine these children's mental health needs. This study investigated the impact of living in a foster family on the mental health of HIV-positive, HIV-affected and HIV-unaffected children (n = 681 aged 10-17) in rural Rwanda. Regression analyses assessed the impact of living in a foster family on mental health, parenting, and daily hardships; multiple mediation analyses assessed whether family factors mediated the association between foster status and mental health. HIV-positive children were eight times more likely to live in foster families than HIV-unaffected children. Being HIV-affected was predictive of depression and irritability symptoms after controlling for family factors. Controlling for HIV-status, foster children had more symptoms of depression, anxiety, and irritability than non-fostered children. Positive parenting fully mediated the association between foster status and mental health. Mental health and parenting interventions for foster children and HIV-affected children may improve child outcomes.
Schwiebert, L P; Aspy, C B
Despite the increased prominence of family medicine clerkships in required third- and fourth-year clinical rotations in US allopathic medical schools, the content of these clerkships varies markedly among institutions, and there is little in the literature concerning the current or desired content of family medicine clerkships. This study explores the didactic content of a national sample of required family medicine clerkships to assess what and how this important aspect of clerkship curriculum is taught. Using an original survey instrument, we surveyed US medical schools through mailings and follow-up phone contacts. We categorized free-form responses using a coding dictionary specific to this study and computed descriptive statistics. Of 127 medical schools contacted, 105 (83%) responded. Among respondents, 86 (82%) had a required family medicine clerkship, 80% of them in the third year. Mean clerkship length was 5.3 weeks (median = 4 weeks), and the mean number of didactic sessions was about 2 per week. Almost 80% of clerkships had sessions in the broad area of family medicine, and prevention was the most frequent individual topic, taught in 32 (37%) of clerkships. Seventy-one percent of sessions used methodologies other than lectures. The mean time devoted to teaching 24 of the top 26 topics identified in the survey was between 1.2 and 3.1 hours/rotation, although case presentations and common problems each averaged more than 7 hours on clerkships teaching these topics. This survey provided more detailed information than previously available about the didactic content of required US allopathic family medicine clerkships. The survey also documented the lack of agreement among these clerkships on didactic content. Most didactic sessions used interactive rather than lecture format. The information from this first detailed survey provides family medicine clerkship directors with national comparisons of didactic content and methodology as a foundation for further
Tomayko, Emily J; Mosso, Kathryn L; Cronin, Kate A; Carmichael, Lakeesha; Kim, KyungMann; Parker, Tassy; Yaroch, Amy L; Adams, Alexandra K
High food insecurity has been demonstrated in rural American Indian households, but little is known about American Indian families in urban settings or the association of food insecurity with diet for these families. The purpose of this study was to examine the prevalence of food insecurity in American Indian households by urban-rural status, correlates of food insecurity in these households, and the relationship between food insecurity and diet in these households. Dyads consisting of an adult caregiver and a child (2-5 years old) from the same household in five urban and rural American Indian communities were included. Demographic information was collected, and food insecurity was assessed using two validated items from the USDA Household Food Security Survey. Factors associated with food insecurity were examined using logistic regression. Child and adult diets were assessed using food screeners. Coping strategies were assessed through focus group discussions. These cross-sectional baseline data were collected from 2/2013 through 4/2015 for the Healthy Children, Strong Families 2 randomized controlled trial of a healthy lifestyles intervention for American Indian families. A high prevalence of food insecurity was determined (61%) and was associated with American Indian ethnicity, lower educational level, single adult households, WIC participation, and urban settings (p = 0.05). Food insecure adults had significantly lower intake of vegetables (p insecure children had significantly higher intakes of fried potatoes (p insecurity. The prevalence of food insecurity in American Indian households in our sample is extremely high, and geographic designation may be an important contributing factor. Moreover, food insecurity had a significant negative influence on dietary intake for families. Understanding strategies employed by households may help inform future interventions to address food insecurity. ( NCT01776255 ). Registered: January 16, 2013. Date of enrollment
Full Text Available Family medicine is a new specialty in Botswana and many African countries and its definitionand scope are still evolving. In this region, healthcare is constrained by resource limitation andinefficiencies in resource utilisation. Experiences in countries with good health indicators canhelp inform discussions on the future of family medicine in Africa. Observations made duringa visit to family physicians (FPs in Denmark showed that the training of FPs, the practice offamily medicine and the role of support staff in a family practice were often different andsometimes unimaginable by African standards. Danish family practices were friendly andenmeshed in an egalitarian and efficient health system, which is supported by an effectiveinformation technology network. There was a lot of task shifting and nurses and clerical staffattended to simple or uncomplicated aspects of patient care whilst FPs attended to morecomplicated patient problems. Higher taxation and higher health expenditure seemed toundergird the effective health system. An egalitarian relationship amongst patients andhealthcare workers (HCW may help improve patient care in Botswana. Task shifting shouldbe formalised, and all sectors of primary healthcare should have fast and effective informationtechnology systems. HCW training and roles should be revised. Higher health expenditure isnecessary to achieve good health indicators. Keywords: task shifting, Family Medicine, Family Physician, Denmark, health expenditure, egalitarian
Ogundipe, Radiance M; Mash, Robert
Family Medicine training commenced in Botswana in 2011, and Maun was one of the two sites chosen as a training complex. If it is to be successful there has to be investment in the training programme by all stakeholders in healthcare delivery in the district. The aim of the study was to explore the attitudes of stakeholders to initiation of Family Medicine training and their perspectives on the future roles of family physicians in Ngami district, Botswana. Maun and the surrounding Ngami subdistrict of Botswana. Thirteen in-depth interviews were conducted with purposively selected key stakeholders in the district health services. Data were recorded, transcribed and analysed using the framework method. Participants welcomed the development of Family Medicine training in Maun and expect that this will result in improved quality of primary care. Participants expect the registrars and family physicians to provide holistic health care that is of higher quality and expertise than currently experienced, relevant research into the health needs of the community, and reduced need for referrals. Inadequate personal welfare facilities, erratic ancillary support services and an inadequate complement of mentors and supervisors for the programme were some of the gaps and challenges highlighted by participants. Family Medicine training is welcomed by stakeholders in Ngamiland. With proper planning introduction of the family physician in the district is expected to result in improvement of primary care.
Full Text Available Background & Objective: Health family physician program is a complete system which eliminates the bewilderment of people and increases the satisfaction with health services as its most important results in medical care. The aim of this study was to evaluate the performance of family physicians and their strengths and weaknesses. Material & Methods: In this study, 52 family physicians were chosen via Random Stratified Sampling to participate in the study. A questionnaire titled “Performance of Family Physicians” with 5 domains of management, performance, contract guidelines, community involvement and results was used to collect data. Data were analyzed using SPSS-19 via t-test, ANOVA, Pearson correlation coefficient, and non-parametric tests. Results: Among the 52 studied family physicians, 56.9% were female and 43.1% were male. The lowest and the highest scores were obtained for the community involvement and results, respectively. Based on the results of this study, there were significant relationships among most of the domains. However, there was no significant correlation between the gender and different domains. Conclusion: In order to solve the problems of family physician program and improve the quality of services, more researches should be carried out soon to determine the types and causes of referring to the family physicians. Accordingly, appropriate interventions should be implemented to reduce the burden of visits and improve the quality of health services by guiding the society towards the prevention measures.
Ledford, Christy J W; Cafferty, Lauren A; Seehusen, Dean A
Uncertainty is a central theme in the practice of medicine and particularly primary care. This study explored how family medicine resident physicians react to uncertainty in their practice. This study incorporated a two-phase mixed methods approach, including semi-structured personal interviews (n=21) and longitudinal self-report surveys (n=21) with family medicine residents. Qualitative analysis showed that though residents described uncertainty as an implicit part of their identity, they still developed tactics to minimize or manage uncertainty in their practice. Residents described increasing comfort with uncertainty the longer they practiced and anticipated that growth continuing throughout their careers. Quantitative surveys showed that reactions to uncertainty were more positive over time; however, the difference was not statistically significant. Qualitative and quantitative results show that as family medicine residents practice medicine their perception of uncertainty changes. To reduce uncertainty, residents use relational information-seeking strategies. From a broader view of practice, residents describe uncertainty neutrally, asserting that uncertainty is simply part of the practice of family medicine.
Full Text Available Introduction: Following hip fracture surgery, patients often experience multiple transitions through different care settings, with resultant challenges to the quality and continuity of patient care. Family caregivers can play a key role in these transitions, but are often poorly engaged in the process. We aimed to: (1 examine the characteristics of the family caregivers’ experience of communication and information sharing and (2 identify facilitators and barriers of effective information sharing among patients, family caregivers and health care providers. Methods: Using an ethnographic approach, we followed 11 post-surgical hip fracture patients through subsequent care transitions in rural Ontario; in-depth interviews were conducted with patients, family caregivers (n = 8 and health care providers (n = 24. Results: Priority areas for improved information sharing relate to trust and respect, involvement, and information needs and expectations; facilitators and barriers included prior health care experience, trusting relationships and the rural setting. Conclusion: As with knowledge translation, effective strategies to improve information sharing and care continuity for older patients with chronic illness may be those that involve active facilitation of an on-going partnership that respects the knowledge of all those involved.
Full Text Available Introduction: Following hip fracture surgery, patients often experience multiple transitions through different care settings, with resultant challenges to the quality and continuity of patient care. Family caregivers can play a key role in these transitions, but are often poorly engaged in the process. We aimed to: (1 examine the characteristics of the family caregivers’ experience of communication and information sharing and (2 identify facilitators and barriers of effective information sharing among patients, family caregivers and health care providers.Methods: Using an ethnographic approach, we followed 11 post-surgical hip fracture patients through subsequent care transitions in rural Ontario; in-depth interviews were conducted with patients, family caregivers (n = 8 and health care providers (n = 24.Results: Priority areas for improved information sharing relate to trust and respect, involvement, and information needs and expectations; facilitators and barriers included prior health care experience, trusting relationships and the rural setting.Conclusion: As with knowledge translation, effective strategies to improve information sharing and care continuity for older patients with chronic illness may be those that involve active facilitation of an on-going partnership that respects the knowledge of all those involved.
Folkl, Alex; Chan, Teresa; Blau, Elaine
Free, open access medical education (FOAM) has the potential to revolutionize continuing medical education, particularly for rural physicians who practice emergency medicine (EM) as part of a generalist practice. However, there has been little study of rural physicians' educational needs since the advent of FOAM. We asked how rural physicians in Southwestern Ontario obtained their continuing EM education. We asked them to assess their perceived level of comfort in different areas of EM. To understand how FOAM resources might serve the rural EM community, we compared their responses with urban emergency physicians. Responses were collected via survey and interview. There was no significant difference between groups in reported use of FOAM resources. However, there was a significant difference between rural and urban physicians' perceived level of EM knowledge, with urban physicians reporting a higher degree of confidence for most knowledge categories, particularly those related to critical care and rare procedures. This study provides the first description of EM knowledge and FOAM resource utilization among rural physicians in Southwestern Ontario. It also highlights an area of educational need -- that is, critical care and rare procedures. Future work should address whether rural physicians are using FOAM specifically to improve their critical care and procedural knowledge. As well, because of the generalist nature of rural practice, future work should clarify whether there is an opportunity cost to rural physicians' knowledge of other clinical domains if they chose to focus more time on continuing education in critical care EM.
Full Text Available In China rural area, intergenerational exchange on supporting each other between parents and offspring is uneven. Parents pay much more than the return they’ll get when they’re old, which mainly relates to the utilities of children. In countryside, the utilities of children (especially sons manifest in following aspects: continuing the family line, emotional comfort, laborer and supporting for old age. To some extent, these factors influence the rural intergenerational injustice respectively and together. From the prospective of trend of social and economic development, the caring of the retired will be taken by social insurance system; the intergeneration exchange on supporting each other between parents and offspring will no longer be a social issue, but in the vast rural areas, the influence of traditional culture family lineage is still powerful. The need of caring of the old becomes so weak that emotional effect becomes much more urgent. The weak status of the old generation bring the fathers’ generation in a weak social status, which seriously affect the living conditions of the old generations. Therefore, when focusing the caring issue in the country, besides that we should ensure the old be cared materially, what matters most is keep the balance between the exchanging two sides
Chun, Maria B J; Jackson, David S; Lin, Susan Y; Park, Elyse R
The need for physicians formally trained to deliver care to diverse patient populations has been widely advocated. Utilizing a validated tool, Weissman and Betancourt's Cross-Cultural Care Survey, the aim of this current study was to compare surgery and family medicine residents' perceptions of their preparedness and skillfulness to provide high quality cross-cultural care. Past research has documented differences between the two groups' reported impressions of importance and level of instruction received in cross-cultural care. Twenty surgery and 15 family medicine residents participated in the study. Significant differences were found between surgery and family medicine residents on most ratings of the amount of training they received in cross-cultural skills. Specifically, family medicine residents reported having received more training on: 1) determining how patients want to be addressed, 2) taking a social history, 3) assessing their understanding of the cause of illness, 4) negotiating their treatment plan, 5) assessing whether they are mistrustful of the health care system and÷or doctor, 6) identifying cultural customs, 7) identifying how patients make decisions within the family, and 8) delivering services through a medical interpreter. One unexpected finding was that surgery residents, who reported not receiving much formal cultural training, reported higher mean scores on perceived skillfulness (i.e. ability) than family medicine residents. The disconnect may be linked to the family medicine residents' training in cultural humility - more knowledge and understanding of cross-cultural care can paradoxically lead to perceptions of being less prepared or skillful in this area. Hawaii Medical Journal Copyright 2010.
Klein, Douglas; Allan, G. Michael; Manca, Donna; Sargeant, Joan; Barnett, Carly
Introduction: Considerable time and money are invested in continuing medical education (CME) for family physicians (FPs) but the effectiveness is uncertain. The participation of FPs as coordinators and teachers is not well known. The goal of this project was to describe the role of FPs in organizing and teaching CME events that are accredited for…
Hameed, I.; Hussain, F.; Dastgir, G.
Anatomical studies of the 6 different species of family Polygonaceae viz., Rumex hastatus D. Don, Rumex dentatus Linn, Rumex nepalensis Spreng, Rheum australe D. Don, Polygonum plebejum R. Br and Persicaria maculosa S.F. Gay are presented. The study is based on the presence and absence of epidermis, parenchyma, collenchyma, sclerenchyma, endodermis, pericycle, xylem, phloem, pith, mesophyll cells and stone cells. (author)
Emond, Jennifer A; Bernhardt, Amy M; Gilbert-Diamond, Diane; Li, Zhigang; Sargent, James D
To assess the associations between children's exposure to television (TV) networks that aired child-directed advertisements for children's fast food meals with the collection of fast food meal toy premiums and frequency of family visits to those restaurants. One hundred parents of children 3-7 years old were recruited from a rural pediatrics clinic during 2011; families receiving Medicaid were oversampled. Parents reported the child's TV viewing habits and family visit frequency to the fast food restaurants participating in child-directed TV marketing at the time, and their child's requests for visits to and the collecting of toy premiums from those restaurants. Logistic regression models assessed adjusted associations between a child's TV viewing with more frequent restaurant visits (≥monthly in this population). Structural equation modeling assessed if child requests or toy collecting mediated that association. Thirty-seven percent of parents reported ≥monthly visits to the select fast food restaurants. Among children, 54% requested visits to and 29% collected toys from those restaurants. Greater child commercial TV viewing was significantly associated with more frequent family visits to those fast food restaurants (aOR 2.84 for each 1-unit increase in the child's commercial TV viewing scale, P restaurants. Child desire for toy premiums may be a mediating factor. Copyright © 2016 Elsevier Inc. All rights reserved.
Morra, Dante J; Regehr, Glenn; Ginsburg, Shiphra
Medical students have had a declining interest in family medicine as a career. Some studies have shown a small inverse relationship between debt levels and primary care, but it is unclear how students perceive remuneration in different specialties and how these perceptions might influence career choice. Medical students at one school were surveyed to understand their perceptions of physician remuneration and to gain insight into how these perceptions might affect career selection. Response rate was 72% (560/781 students). Students' estimates of physician income were accurate throughout training, with the overall estimate for family medicine being lower than the actual income by only $10,656. The vast majority of students agreed with the statement that family physicians get paid too little (85%-89% of each class). The importance of payment as a factor in career decision making increased with higher debt and with advancing training. Students are able to accurately predict income by specialty from an early stage of training and have a negative perception of income in family medicine. The perception that family physicians make too little money could be an important driver--or at least a modifier--in the lack of interest in family medicine.
Full Text Available Research Questions: 1. To what extent do rural eligible couples accept the small family norm? 2. What are the factors which influence the adoption of small family norm by these couples? Objectives: 1. To determine the extent of adoption of small norm among family planning service acceptors (2 To identify factors influencing adoption of small family norm. Study Design: Cross sectional Study Setting: 2 villages- a PHC village and one 5 kms away of Block Sonarpur. Participants: 312 eligible couples of these villages. Study Variables: Socio â€" economics status, literacy of the wives, type of family, religion, number of children, type of family planning method. Outcome Variables: Prevalence of contraceptive method use, reasons for not using family planning methods. Statistical Analysis: Proportions Results : The prevalence of contraceptive use was 44.9% but the Effective Couple Protection Rate was only 20.5% and the Crude Birth Rate was still high (35/1000. This was because 40% of the couples had more then 2 children and of them 38% were still exposed to the risk of conception. Muslim couples had a lower contraceptive acceptance rate than Hindu couples. The more literate the wife, the greater the acceptance of the small family norm. Male preference pressure from elders and fear about contraception were the main reasons for non acceptance of family planning methods: The health teams were the main source of information to these couples. Recommendations: There is an urgent need to increase the emphasis on the 2 child family norm. The IEC activities of the health team should be strengthened.
Full Text Available Background: The completion of a thesis is a significant requirement for both a Master′s and a doctorate degree in general practice/family medicine (GP/FM. A postgraduate thesis is a well-planned, time-intensive activity carried out over several years. The quality of the theses can be judged by the proportion of published papers. Objective: This study aimed to describe Master′s and doctoral theses in family medicine and their publications between 1982 and 2014. Materials and Methods: GP/FM degree theses were reviewed at the Faculty of Medicine and central Suez Canal libraries. Several characteristics were extracted from each thesis relating to the main researcher, supervisors, themes, and study methods according to predefined criteria. Publications from the theses were described. Results: Over 33 years, 208 theses were completed by 173 GP/FM researchers. The majority of the theses were for Master′s degrees (84.1%. Regarding the study design, most of the degree theses were cross-sectional studies (76.9%. The adult population was targeted in 33.7% of research theses. Nonprobability sampling was used in 51%. Rural communities were the setting of research in 43.8%, and primary health center (PHC-based studies in 59.1%. The "Patient" category exceeded the other categories (28.4%. Publication from theses started in the second decade of research production. Of the degree theses, 21.6% original articles were published. Only 13.3% of articles from theses were published in PubMed-indexed journals. The researcher was first author in 62.2% of published articles. Conclusion: The production of GP/FM theses and their publications are going to increase. Continuous assessment and planning for GP/FM studies are recommended.
Hiratani, Yuko; Hohashi, Naohiro
Nursing interventions that aim to enhance the family environment are necessary to help single-parent families with children to improve family functioning. The cultural and social factors that are unique to Japan's remote islands should be considered to assess the influence of this unique setting on family functioning. The objectives of this study were to evaluate the family functioning of child-rearing single-parent families living in different environments and to investigate the association between family demographics and family functioning. A self-administered questionnaire, the Japanese version of the Survey of Family Environment, was used to evaluate the sufficiency of family functioning. The participants were families with children enrolled in nurseries and kindergartens who were either living in remote, rural islands or in an urban city on the mainland in Japan. Family functioning was significantly higher for single-parent families living on the islands than for those living in the city in terms of media use, participation in community activities, and the collaboration of family members in child-rearing. Family functioning of single-parent families correlated significantly with household income, the parent's gender, family members' health, and family life cycle. Single-parent families living on Japanese offshore islands maintained family functioning through mutual support and the effective use of information technology. Nevertheless, single-parent families require additional support to improve their healthcare and financial situations.
Emily J. Tomayko
Full Text Available Abstract Background High food insecurity has been demonstrated in rural American Indian households, but little is known about American Indian families in urban settings or the association of food insecurity with diet for these families. The purpose of this study was to examine the prevalence of food insecurity in American Indian households by urban-rural status, correlates of food insecurity in these households, and the relationship between food insecurity and diet in these households. Methods Dyads consisting of an adult caregiver and a child (2–5 years old from the same household in five urban and rural American Indian communities were included. Demographic information was collected, and food insecurity was assessed using two validated items from the USDA Household Food Security Survey. Factors associated with food insecurity were examined using logistic regression. Child and adult diets were assessed using food screeners. Coping strategies were assessed through focus group discussions. These cross-sectional baseline data were collected from 2/2013 through 4/2015 for the Healthy Children, Strong Families 2 randomized controlled trial of a healthy lifestyles intervention for American Indian families. Results A high prevalence of food insecurity was determined (61% and was associated with American Indian ethnicity, lower educational level, single adult households, WIC participation, and urban settings (p = 0.05. Food insecure adults had significantly lower intake of vegetables (p < 0.05 and higher intakes of fruit juice (<0.001, other sugar-sweetened beverages (p < 0.05, and fried potatoes (p < 0.001 than food secure adults. Food insecure children had significantly higher intakes of fried potatoes (p < 0.05, soda (p = 0.01, and sports drinks (p < 0.05. Focus group participants indicated different strategies were used by urban and rural households to address food insecurity. Conclusions The prevalence of food insecurity in
To determine the number of interventions made by pharmacy students at an urban family medicine clinic and the acceptance rate of these recommendations by the healthcare providers. The secondary objective was to investigate the cost avoidance value of the interventions. A prospective, unblinded study was conducted to determine the number and cost avoidance value of clinical interventions made by pharmacy students completing advanced pharmacy practice experiences (APPEs) in an urban family medicine clinic. Eighteen students completed this experience in the 8 months studied. Of the 718 interventions performed, 77% were accepted by physicians, including 58% of the 200 interventions that required immediate action. Projected avoidance was estimated at $61,855. The clinical interventions by pharmacy students were generally well received by healthcare providers and resulted in significant cost savings. Pharmacy students can play an important role in a family medicine clinic.
Oshman, Lauren D; Combs, Gene N
Motivational interviewing is a useful skill to address the common problem of patient ambivalence regarding behavior change by uncovering and strengthening a person's own motivation and commitment to change. The Family Medicine Milestones underline the need for clear teaching and monitoring of skills in communication and behavior change in Family Medicine postgraduate training settings. This article reports the integration of a motivational interviewing curriculum into an existing longitudinal narrative therapy-based curriculum on patient-centered communication. Observed structured clinical examination for six participants indicate that intern physicians are able to demonstrate moderate motivational interviewing skill after a brief 2-h workshop. Participant self-evaluations for 16 participants suggest a brief 2-h curriculum was helpful at increasing importance of learning motivational interviewing by participants, and that participants desire further training opportunities. A brief motivational interviewing curriculum can be integrated into existing communication training in a Family Medicine residency training program. © The Author(s) 2016.
Alizadeh, Mahasti; Jabbari Birami, Hossein; Moradi, Siavash
Introduction: Implementation of rural family physician program in Iran in 2005 has been evaluated and shown that this program has been led to some improvements in health indicators. In this study, some reproductive health (RH) indicators were compared before and after implementation of this program in rural areas of East Azerbaijan, Iran. Methods: In this ecologic- time trend study, the data of 191075 births of rural women of East Azerbaijan from 2001 to 2010 was extracted from vital horoscope (ZIJ) and used for calculation of 20 important RH indicators. The paired t-test and correlation analysis wear used for data analysis. Results: Some indicators such as adolescent marriage rate, adolescent birth and over 35 year olds birth rate were increased after rural family physician program implementation in 2005. Also stillbirth rate and unsafe delivery were decreased during this period. There was a significant correlation between increasing adolescent birth rate and increasing low birth weight deliveries (r= 0.911, P= 0.031) and also between increasing over 35 year olds birth rate and increasing neonatal mortality rate in term of prematurity and congenital malformations (r= 0.912, P= 0.031) after program implementation. Conclusion: Perinatal care and safe delivery even for pregnancies outside the typical child-bearing ages are promoting after implementation of rural family physician program in East Azerbaijan. Also decreasing unsafe delivery and stillbirth rate can be considered as achievements of running this program in this province. PMID:26744731
Full Text Available Introduction: Implementation of rural family physician program in Iran in 2005 has been evaluated and shown that this program has been led to some improvements in health indicators. In this study, some reproductive health (RH indicators were compared before and after implementation of this program in rural areas of East Azerbaijan, Iran. Methods: In this ecologic- time trend study, the data of 191075 births of rural women of East Azerbaijan from 2001 to 2010 was extracted from vital horoscope (ZIJ and used for calculation of 20 important RH indicators. The paired t-test and correlation analysis wear used for data analysis. Results: Some indicators such as adolescent marriage rate, adolescent birth and over 35 year olds birth rate were increased after rural family physician program implementation in 2005. Also stillbirth rate and unsafe delivery were decreased during this period. There was a significant correlation between increasing adolescent birth rate and increasing low birth weight deliveries (r= 0.911, P= 0.031 and also between increasing over 35 year olds birth rate and increasing neonatal mortality rate in term of prematurity and congenital malformations (r= 0.912, P= 0.031 after program implementation. Conclusion: Perinatal care and safe delivery even for pregnancies outside the typical child-bearing ages are promoting after implementation of rural family physician program in East Azerbaijan. Also decreasing unsafe delivery and stillbirth rate can be considered as achievements of running this program in this province.
Full Text Available Abstract Background Numerous not-for-profit pharmacies have been created to improve access to medicines for the poor, but many have failed due to insufficient financial planning and management. These pharmacies are not well described in health services literature despite strong demand from policy makers, implementers, and researchers. Surveys reporting unaffordable medicine prices and high mark-ups have spurred efforts to reduce medicine prices, but price reduction goals are arbitrary in the absence of information on pharmacy costs, revenues, and profit structures. Health services research is needed to develop sustainable and "reasonable" medicine price goals and strategic initiatives to reach them. Methods We utilized cost accounting methods on inventory and financial information obtained from a not-for-profit rural pharmacy network in mountainous Kyrgyzstan to quantify costs, revenues, profits and medicine mark-ups during establishment and maintenance periods (October 2004-December 2007. Results Twelve pharmacies and one warehouse were established in remote Kyrgyzstan with 100%, respectively. Annual mark-ups increased dramatically each year to cover increasing recurrent costs, and by 2007, only 19% and 46% of products revealed mark-ups of 100%. 2007 medicine mark-ups varied substantially across these products, ranging from 32% to 244%. Mark-ups needed to sustain private pharmacies would be even higher in the absence of government subsidies. Conclusion Pharmacy networks can be established in hard-to-reach regions with little funding using public-private partnership, resource-sharing models. Medicine prices and mark-ups must be interpreted with consideration for regional costs of business. Mark-ups vary dramatically across medicines. Some mark-ups appear "excessive" but are likely necessary for pharmacy viability. Pharmacy financial data is available in remote settings and can be used towards determination of "reasonable" medicine price goals
Waning, Brenda; Maddix, Jason; Soucy, Lyne
Numerous not-for-profit pharmacies have been created to improve access to medicines for the poor, but many have failed due to insufficient financial planning and management. These pharmacies are not well described in health services literature despite strong demand from policy makers, implementers, and researchers. Surveys reporting unaffordable medicine prices and high mark-ups have spurred efforts to reduce medicine prices, but price reduction goals are arbitrary in the absence of information on pharmacy costs, revenues, and profit structures. Health services research is needed to develop sustainable and "reasonable" medicine price goals and strategic initiatives to reach them. We utilized cost accounting methods on inventory and financial information obtained from a not-for-profit rural pharmacy network in mountainous Kyrgyzstan to quantify costs, revenues, profits and medicine mark-ups during establishment and maintenance periods (October 2004-December 2007). Twelve pharmacies and one warehouse were established in remote Kyrgyzstan with 100%, respectively. Annual mark-ups increased dramatically each year to cover increasing recurrent costs, and by 2007, only 19% and 46% of products revealed mark-ups of 100%. 2007 medicine mark-ups varied substantially across these products, ranging from 32% to 244%. Mark-ups needed to sustain private pharmacies would be even higher in the absence of government subsidies. Pharmacy networks can be established in hard-to-reach regions with little funding using public-private partnership, resource-sharing models. Medicine prices and mark-ups must be interpreted with consideration for regional costs of business. Mark-ups vary dramatically across medicines. Some mark-ups appear "excessive" but are likely necessary for pharmacy viability. Pharmacy financial data is available in remote settings and can be used towards determination of "reasonable" medicine price goals. Health systems researchers must document the positive and negative
R. P. J. C. Ramanayake; A. H. W. De Silva; D P Perera; R. D. N. Sumanasekara; R Gunasekara; P Chandrasiri
Background: Family Medicine occupies a prominent place in the undergraduate curriculum of the Faculty of Medicine, University of Kelaniya, Sri Lanka. The one month clinical attachment during the fourth year utilizes a variety of teaching methods. This study evaluates teaching learning methods and learning environment of this attachment. Methodology: A descriptive cross sectional study was carried out among consenting students over a period of six months on completion of the clinical attachmen...
Fugh-Berman, Adriane; Brown, Steven R; Trippett, Rachel; Bell, Alicia M; Clark, Paige; Fleg, Anthony; Siwek, Jay
To assess the extent and type of interactions U.S. family medicine residencies permit industry to have with medical students and residents. In 2008, the authors e-mailed a four-question survey to residency directors or coordinators at all 460 accredited U.S. family medicine residencies concerning the types of industry support and interaction permitted. The authors conducted quantitative and qualitative analyses of survey responses and written comments. Residencies that did not permit any industry food, gifts, samples, or support of residency activities were designated "pharma-free." The survey response rate was 62.2% (286/460). Among responding family medicine residencies, 52.1% refused drug samples, 48.6% disallowed industry gifts or food, 68.5% forbade industry-sponsored residency activities, and 44.1% denied industry access to students and residents at the family medicine center. Seventy-five residencies (26.2%) were designated as "pharma-free." Medical-school-based and medical-school-administered residencies were no more likely than community-based residencies to be pharma-free. Among the 211 programs that permitted interaction, 68.7% allowed gifts or food, 61.1% accepted drug samples, 71.1% allowed industry representatives access to trainees in the family medicine center, and 37.9% allowed industry-sponsored residency activities. Respondents commented on challenges inherent to limiting industry interactions. Many programs noted recent changes in plans or practices. Most family medicine residencies limit industry interaction with trainees. Because industry interactions can have adverse effects on rational prescribing, residency programs should assess the benefits and harms of these relationships. Copyright © by the Association of American medical Colleges.
Larson, Paul R; Chege, Patrick; Dahlman, Bruce; Gibson, Christine; Evensen, Ann; Colon-Gonzalez, Maria C; Onguka, Stephanie; Lamptey, Roberta; Cayley, William E; Nguyen, Bich-May; Johnson, Brian; Getnet, Sawra; Hasnain, Memoona
High-quality family medicine education is needed in sub-Saharan Africa to facilitate the future growth of primary care health systems. Current faculty educators recognize the value of dedicated teacher training and ongoing faculty development. However, they are constrained by inadequate faculty development program availability and institutional support. A cross-sectional study design was used to conduct a qualitative needs assessment comprised of 37 in-depth, semi-structured interviews of individual faculty trainers from postgraduate family medicine training programs in eight sub-Saharan African countries. Data were analyzed according to qualitative description. Informants described desired qualities for a family medicine educator in sub-Saharan Africa: (1) pedagogical expertise in topics and perspectives unique to family medicine, (2) engagement in self-directed, lifelong learning, and (3) exemplary character and behavior that inspires others. Informant recommendations to guide the development of faculty development programs include: (1) sustainability, partnership, and responsiveness to the needs of the institution, (2) intentional faculty development must begin early and be supported with high-quality mentorship, (3) presumptions of teaching competence based on clinical training must be overcome, and (4) evaluation and feedback are critical components of faculty development. High-quality faculty development in family medicine is critically important to the primary care workforce in sub-Saharan Africa. Our study describes specific needs and recommendations for family medicine faculty development in sub-Saharan Africa. Next steps include piloting and evaluating innovative models of faculty development that respond to specific institutional or regional needs.
Ouma, S; Turyasima, M; Acca, H; Nabbale, F; Obita, K O; Rama, M; Adong, C C; Openy, A; Beatrice, M O; Odongo-Aginya, E I; Awor, S
Uganda's rapid population growth (3.2%) since 1948 has placed more demands on health sector and lowered living standard of Ugandans resulting into 49% of people living in acute poverty especially in post conflict Northern Uganda. The population rise was due to low use of contraceptive methods (21% in rural areas and 43% in urban areas) and coupled with high unmet need for family planning (41%). This indicated poor access to reproductive health services. Effective use of family planning could reduce the rapid population growth. To determine obstacles to family planning use among rural women in Northern Uganda. A descriptive cross-sectional analytical study. Atiak Health Centre IV, Amuru District, rural Northern Uganda. Four hundred and twenty four females of reproductive ages were selected from both Inpatient and Outpatient Departments of Atiak Health Centre IV. There was high level of awareness 418 (98.6%), positive attitude 333 (78.6%) and fair level of utilisation 230 (54.2%) of family planning. However, significant obstacles to family planning usage included; long distance to Health facility, unavailability of preferred contraceptive methods, absenteeism of family planning providers, high cost of managing side effects, desire for big family size, children dying less than five years old, husbands forbidding women from using family planning and lack of community leaders' involvement in family planning programme. In spites of the high level of awareness, positive attitude, and free family planning services, there were obstacles that hindered family planning usage among these rural women. However, taking services close to people, reducing number of children dying before their fifth birthday, educating men about family planning, making sure family planning providers and methods are available, reducing cost of managing side effects and involving community leaders will improve utilisation of family planning and thus reduce the rapid population growth and poverty.
Ouma, S.; Turyasima, M.; Acca, H.; Nabbale, F.; Obita, K. O.; Rama, M.; Adong, C. C.; Openy, A.; Beatrice, M. O.; Odongo-Aginya, E. I.; Awor, S.
Background Uganda’s rapid population growth (3.2%) since 1948 has placed more demands on health sector and lowered living standard of Ugandans resulting into 49% of people living in acute poverty especially in post conflict Northern Uganda. The population rise was due to low use of contraceptive methods (21% in rural areas and 43% in urban areas) and coupled with high unmet need for family planning (41%). This indicated poor access to reproductive health services. Effective use of family planning could reduce the rapid population growth. Objective To determine obstacles to family planning use among rural women in Northern Uganda. Design A descriptive cross-sectional analytical study. Setting Atiak Health Centre IV, Amuru District, rural Northern Uganda. Subjects Four hundred and twenty four females of reproductive ages were selected from both Inpatient and Outpatient Departments of Atiak Health Centre IV. Results There was high level of awareness 418 (98.6%), positive attitude 333 (78.6%) and fair level of utilisation 230 (54.2%) of family planning. However, significant obstacles to family planning usage included; long distance to Health facility, unavailability of preferred contraceptive methods, absenteeism of family planning providers, high cost of managing side effects, desire for big family size, children dying less than five years old, husbands forbidding women from using family planning and lack of community leaders’ involvement in family planning programme. Conclusions In spites of the high level of awareness, positive attitude, and free family planning services, there were obstacles that hindered family planning usage among these rural women. However, taking services close to people, reducing number of children dying before their fifth birthday, educating men about family planning, making sure family planning providers and methods are available, reducing cost of managing side effects and involving community leaders will improve utilisation of family
Sewani-Rusike, Constance R; Mammen, Marykutty
There is a hierarchical organisation of knowledge in the use of medicinal plants in communities. Medicinal use knowledge starts in the home and is passed on to family members. Next in the hierarchy are neighbours, village elders and finally, traditional healers being the most knowledgeable. For primary health care this hierarchy is actively followed in seeking remedies for ailments. This study was a survey of medicinal plant knowledge from family members of 1(st) year medical students registered at Walter Sisulu University. A total of 206 first year medical students participated in this study in 2010 and 2011. Results revealed 47 species used as home remedies, 32% of which are food plants. Leaves and roots were reported as most commonly used. The top five ailments managed at home were gastrointestinal problems (25 plants), wounds (19 plants), respiratory tract problems (19 plants), infections, including sexually transmitted diseases (19 plants) and pain including headaches (19 plants). Chronic diseases such as hypertension, diabetes, cancer and reproductive ailments also formed a large group of diseases self-managed at home (29 plants). Family members hold knowledge of medicinal plant use. From this study, first year medical students were made aware of the relationship between common ailments and associated home remedies. This study forms a basis for further study of medicinal plants to validate their use as medicinal remedies.
Allan, G Michael; Korownyk, Christina; Tan, Amy; Hindle, Hugh; Kung, Lina; Manca, Donna
There is general consensus in the academic community that evidence-based medicine (EBM) teaching is essential. Unfortunately, many postgraduate programs have significant weakness in their EBM programs. The Family Medicine Residency committee at the University of Alberta felt their EBM curriculum would benefit from critical review and revision. An EBM Curriculum Committee was created to evaluate previous components and develop new strategies as needed. Input from stakeholders including faculty and residents was sought, and evidence regarding the teaching and practical application of EBM was gathered. The committee drafted goals and objectives, the primary of which were to assist residents to (1) become competent self-directed, lifelong learners with skills to effectively and efficiently keep up to date, and 2) develop EBM skills to solve problems encountered in daily practice. New curriculum components, each evidence based, were introduced in 2005 and include a family medicine EBM workshop to establish basic EBM knowledge; a Web-based Family Medicine Desktop promoting easier access to evidence-based Internet resources; a brief evidence-based assessment of the research project enhancing integration of EBM into daily practice; and a journal club to support peer learning and growth of rapid appraisal skills. Issues including time use, costs, and change management are discussed. Ongoing evaluation of the curriculum and its components is a principal factor of the design, allowing critical review and adaptation of the curriculum. The first two years of the curriculum have yielded positive feedback from faculty and statistically significant improvement in multiple areas of residents' opinions of the curriculum and comfort with evidence-based practice.
Jirapongsuwan, Ann; Latt, Kyaw Thu; Siri, Sukhontha; Munsawaengsub, Chokchai
A cross-sectional study was undertaken to investigate family planning (FP) practices and associated factors among reproductive-age married women. Data were collected by interviewing the 300 married women living in a rural area of Myanmar. The questionnaire had reliability coefficients ranging from .8 to .9. Results indicated that 73.3% of women performed FP, and contraceptive injection was the most common method. Significant associations were found with age 21 to 35 years (adjusted odds ratio [adj OR] = 3.748, 95% CI = 2.179-6.445), adequacy of income (adj OR = 2.520, 95% CI = 1.477-4.290), good attitude toward FP (adj OR = 0.386, 95% CI = 0.228-0.656), good support from health care providers (adj OR = 0.129, 95% CI = 0.054-0.313), good support from family (adj OR = 0.304, 95% CI = 0.163-0.565), good support from friends (adj OR = 0.344, 95% CI = 0.193-0.613), and FP practice. It is recommended that designing FP programs with peers and family involvement could increase the practice of FP among rural Myanmar women. © 2016 APJPH.
Larson, Paul R; Chege, Patrick; Dahlman, Bruce; Gibson, Christine; Evensen, Ann; Colon-Gonzalez, Maria C; Onguka, Stephanie; Lamptey, Roberta; Cayley, William E; Nguyen, Bich-May; Johnson, Brian; Getnet, Sawra; Hasnain, Memoona
Reducing the shortage of primary care physicians in sub-Saharan Africa requires expansion of training programs in family medicine. Challenges remain in preparing, recruiting, and retaining faculty qualified to teach in these pioneering programs. Little is known about the unique faculty development needs of family medicine faculty within the sub-Saharan African context. The purpose of this study was to assess the current status and future needs for developing robust family medicine faculty in sub-Saharan Africa. The results are reported in two companion articles. A cross-sectional study design was used to conduct a qualitative needs assessment comprising 37 in-depth, semi-structured interviews of individual faculty trainers from postgraduate family medicine training programs in eight sub-Saharan African countries. Data were analyzed according to qualitative description. While faculty development opportunities in sub-Saharan Africa were identified, current faculty note many barriers to faculty development and limited participation in available programs. Faculty value teaching competency, but institutional structures do not provide adequate support. Sub-Saharan African family physicians and postgraduate trainee physicians value good teachers and recognize that clinical training alone does not provide all of the skills needed by educators. The current status of limited resources of institutions and individuals constrain faculty development efforts. Where faculty development opportunities do exist, they are too infrequent or otherwise inaccessible to provide trainers the necessary skills to help them succeed as educators.
Krztoń-Królewiecka, Anna; Švab, Igor; Oleszczyk, Marek; Seifert, Bohumil; Smithson, W Henry; Windak, Adam
Since the early 1990s former communist countries have been reforming their health care systems, emphasizing the key role of primary care and recognizing family medicine as a specialty and an academic discipline. This study assesses the level of academic development of the discipline characterised by education and research in central and eastern European (CEE) countries. A key informants study, using a questionnaire developed on the basis of a systematic literature review and panel discussions, conducted in 11 central and eastern European countries and Russia. Family medicine in CEE countries is now formally recognized as a medical specialty and successfully introduced into medical training at undergraduate and postgraduate levels. Almost all universities have FM/GP departments, but only a few of them are led by general practitioners. The specialist training programmes in all countries except Russia fulfil the recommendations of the European Parliament. Structured support for research in FM/GP is not always available. However specific scientific organisations function in almost all countries except Russia. Scientific conferences are regularly organised in all the countries, but peer-reviewed journals are published in only half of them. Family medicine has a relatively strong position in medical education in central and eastern Europe, but research in family practice is less developed. Although the position of the discipline at the universities is not very strong, most of the CEE countries can serve as an example of successful academic development for countries southern Europe, where family medicine is still not fully recognised.
Yoon, Saunjoo L; Kim, Jeong-Hee
The aim of this study was to assess the prevalence of complementary and alternative medicines (CAM) use for managing pain and to investigate the factors predictive of current CAM use among rural older women in South Korea. Access to medical care among older adults in rural areas is poorer than in urban areas. A cross-sectional descriptive study with a stratified sample of 139 women aged over 65 with chronic pain residing in rural areas of Jeju Island, South Korea. A self-reported questionnaire was used to collect data. Most subjects reported using at least one type of CAM for relieving pain within the past 12 months. Almost half of them reported currently using CAM. Herbs were the most commonly used CAM. Only 'severity of pain' was presently associated with an increased use of CAM. It is imperative to take socio-geographic-cultural factors into consideration when planning health promotion programs and caring for clients. © 2013.
Mahbubur Rahman AHM; Mahfuza Akter
Taxonomy and traditional medicinal uses on the family Apocynaceae growing throughout the Rajshahi district has been made. A total of 14 species under 12 genera belonging to the family Apocynaceae were collected and identified. Out of the total number of species Allamanda cathartica Linn, Alstonia scholaris (L.) R.Br. Carissa carandas Linn, Catharanthus roseus (L.) G. Don, Ichnocarpus frutescens (L.) R. Br., Nerium oleander Linn., Plumeria alba Linn., Plumeria rubra Linn., Rauvolfia serpentina...
Fisher, Dena M; Brenner, Christopher J; Cheren, Mark; Stange, Kurt C
The American Board of Medical Specialties' Performance in Practice ("Part IV") portion of Maintenance of Certification (MOC) requirement provides an opportunity for practicing physicians to demonstrate quality improvement (QI) competence. However, specialty boards' certification of one physician at a time does not tap into the potential of collective effort. This article shares learning from a project to help family physicians work in groups to meet their Part IV MOC requirement. A year-long implementation and evaluation project was conducted. Initially, 348 members of a regional family physician organization were invited to participate. A second path was established through 3 health care systems and a county-wide learning collaborative. Participants were offered (1) a basic introduction to QI methods, (2) the option of an alternative Part IV MOC module using a patient experience survey to guide QI efforts, (3) practice-level improvement coaching, (4) support for collaboration and co-learning, and (5) provision of QI resources. More physicians participated through group (66) than individual (12) recruitment, for a total of 78 physicians in 20 practices. Participation occurred at 3 levels: individual, intrapractice, and interpractice. Within the 1-year time frame, intrapractice collaboration occurred most frequently. Interpractice and system-level collaboration has begun and continues to evolve. Physicians felt that they benefited from access to a practice coach and group process. Practice-level collaboration, access to a practice coach, flexibility in choosing and focusing improvement projects, tailored support, and involvement with professional affiliations can enhance the Part IV MOC process. Specialty boards are likely to discover productive opportunities from working with practices, professional organizations, and health care systems to support intra- and interpractice collaborative QI work that uses Part IV MOC requirements to motivate practice improvement.
Full Text Available Background: The Cucurbitaceae family comprising about 125 genera and 960 species is a family that is further characterized by commonly having five-angled stems and coiled tendrils and is also known as gourd family of flowering plants. Plant species belonging to this family have a worldwide distribution, but most species can be found in tropical and subtropical countries. A number of the plants belonging to this family have reported important pharmacological activities. Cucurbitaceae family plants are also in use in the folk medicinal system of Bangladesh-a traditional medicinal system, which mainly relies on medicinal plants for treatment of diverse ailments. Aims: Since folk medicinal practitioners form the first tier of primary health care in Bangladesh, the objective of this study was to conduct ethnomedicinal surveys among 75 folk medicinal practitioners (Kavirajes practicing among the mainstream Bengali-speaking population of randomly selected 75 villages in 64 districts of Bangladesh and 8 tribal practitioners (1 each from 8 major indigenous communities or tribes, namely, Bede, Chakma, Garo, Khasia, Marma, Murong, Santal, and Tripura of the country. Materials and Methods: Surveys were carried out with the help of a semi-structured questionnaire and the guided field-walk method. Results: It was observed that the folk and tribal medicinal practitioners use a total of 19 Cucurbitaceae family species for treatment of ailments such as dysentery, diabetes, edema, skin disorders, leukoderma, hypertension, jaundice, typhoid, spleen disorders, respiratory problems, leprosy, rheumatoid arthritis, chicken pox, and cancer. The 19 species of Cucurbitaceae family plants in use were Benincasa hispida, Bryonopsis laciniosa, Citrullus colocynthis, Citrullus lanatu, Coccinia grandis, Cucumis melo, Cucumis sativus, Cucurbita maxima, Cucurbita pepo, Hodgsonia macrocarpa, Lagenaria vulgaris, Luffa acutangula, Luffa cylindrica, Momordica charantia, Momordica
Fauk, Nelsensius Klau; Mwakinyali, Silivano Edson; Putra, Sukma; Mwanri, Lillian
The purpose of this study was to understand the strategies employed by families that adopt Acquired Immune Deficiency Syndrome (AIDS)-orphaned children (Adoptive families) for coping with and mitigating the impact of AIDS in Mbeya Rural District, Tanzania. High numbers of AIDS-orphaned children aged below 18 years in Mbeya Region have led to increasing the burden of families caring for them. Understanding the coping strategies and impact mitigation activities employed by adoptive families is important in order to develop programmes to help them. This study employed a qualitative method for data collection (one-on-one in-depth interviews). The respondents included 12 male and 8 female heads of families that provide essential care for AIDS-orphaned children in Mbeya Rural District in Tanzania. The framework approach was used to analyse the data that were collected from 15 July to 15 August 2010. The study findings revealed that adoptive families faced several challenges including financial constraints due to increased needs for basic essentials such as health care expenses, school fees and food. Further impacts on adoptive families included shortage of work opportunities and limited time to address these challenges. To mitigate these challenges, adoptive families employed a range of coping strategies including selling family assets and renting out parts of cultivable land for extra cash. Task reallocation which involved the AIDS-orphaned children entering the labour force was also employed as a strategy to mitigate challenges and involved de-enrolling of children from schools so they could take part in income-generating activities in order to earn supplementary family income. The creation of additional income-generating activities such as poultry farming were other coping mechanisms employed, and these received support from both non-governmental organisations (NGOs) and governmental organisations, including the Isangati Agricultural Development Organization (local
Xiao, S H
After the Third Meeting of the Eleventh People's Congress, the entire responsibility for agricultural production was transferred to a lower level. Peasants in various areas have adopted the so called production responsibility system, and the phenomenon of an increased population rate has also appeared in some areas. In this article, the author discusses how to solve these problems created by the new situation. The 1st step is try to control population growth through socialist propaganda education, administrative measures, economic incentives and punishments, and family planning work. The 2nd step is to popularize the practice of having only 1 child per household in the rural areas. The 2nd and 3rd child in each family should be controlled and prohibited. This policy formulated by the Central Government should be carried out thoroughly. Families which follow the policy and have only 1 child should be encouraged with economic rewards, and those families which have 2 or more children should be punished economically. The 3rd step is to establish a national work team to be in charge of family planning and birth control. There should be an ideological unity among the nation's leadership. Party members and cadres should establish themselves as good examples for the people so that the population control work may become successful.
To identify the impact of family life on the ways women practice rural medicine and the changes needed to attract women to rural practice. Census of women rural doctors in Victoria in 2000, using a self-completed postal survey. General and specialist practice. Two hundred and seventy-one female general practitioners and 31 female specialists practising in Rural, Remote and Metropolitan Area Classifications 3-7. General practitioners are those doctors with a primary medical degree and without additional specialist qualifications. Interaction of hours and type of work with family responsibilities. Generalist and specialist women rural doctors carry the main responsibility for family care. This is reflected in the number of hours they work in clinical and non-clinical professional practice, availability for on-call and hospital work, and preference for the responsibilities of practice partnership or the flexibility of salaried positions. Most of the doctors had established a satisfactory balance between work and family responsibilities, although a substantial number were overworked in order to provide an income for their families or meet the needs of their communities. Thirty-six percent of female rural general practitioners and 56% of female rural specialists preferred to work fewer hours. Female general practitioners with responsibility for children were more than twice as likely as female general practitioners without children to be in a salaried position and less likely to be a practice partner. The changes needed to attract and retain women in rural practice include a place for everyone in the doctor's family, flexible practice structures, mentoring by women doctors and financial and personal recognition. Women make up less than a quarter of the rural general practice workforce and an even smaller percentage of the specialist rural medical workforce. As a result their experiences are not well articulated in research on rural medical practice and their needs are
Chen, Feinian; Korinek, Kim
This article investigates the effect of family life course transitions on labor allocation strategies in rural Chinese households. We highlight three types of economic activity that involve reallocation of household labor oriented toward a more diversified, nonfarm rural economy: involvement in wage employment, household entrepreneurship, and/or multiple activities that span economic sectors. With the use of data from the China Health and Nutrition Survey (CHNS 1997, 2000, and 2004), our longitudinal analyses of rural household economic activity point to the significance of household demography, life course transitions, and local economic structures as factors facilitating household labor reallocation. First, as expected, a relatively youthful household structure is conducive to innovative economic behavior. Second, household entrances and exits are significant, but their impacts are not equal. Life events such as births, deaths, marriage, or leaving home for school or employment affect household economy in distinctive ways. Finally, the reallocations of household labor undertaken by households are shaped by local economic structures: in particular, the extent of village-level entrepreneurial activity, off-farm employment, and out-migration.
Mutombo, Namuunda; Bakibinga, Pauline; Mukiira, Carol; Kamande, Eva
The last two decades have seen an increase in literature reporting an increase in knowledge and use of contraceptives among individuals and couples in Kenya, as in the rest of Africa, but there is a dearth of information regarding knowledge about benefits of family planning (FP) in Kenya. To assess the factors associated with knowledge about the benefits of FP for women and children, among women in rural Western Kenya. Data are drawn from the Packard Western Kenya Project Baseline Survey, which collected data from rural women (aged 15-49 years). Ordinal regression was used on 923 women to determine levels of knowledge and associated factors regarding benefits of FP. Women in rural Western Kenya have low levels of knowledge about benefits of FP and are more knowledgeable about benefits for the mother rather than for the child. Only age, spousal communication and type of contraceptive method used are significant. Women's level of knowledge about benefits of FP is quite low and may be one of the reasons why fertility is still high in Western Kenya. Therefore, FP programmes need to focus on increasing women's knowledge about the benefits of FP in this region.
Crump, Allison M; Jeter, Karie; Mullins, Samantha; Shadoan, Amber; Ziegler, Craig; Crump, William J
The purpose of our study was to determine what effect a rural-based 8-week surgical clerkship during the third year of medical school in a rural setting has on students' opinions about rural living and practice. Thirty-three third-year medical students completed a rural health opinion survey at the beginning and end of their 8-week rural rotation and a survey measuring their interest in rural practice after the rotation. The setting was a rural hospital with an average acute care census of 100 that is a regional referral center for 5 rural counties. Urban campus-based students had a statistically significant positive change in opinions about rural comfortable living, availability of quality services, community support, and medical resources. The urban campus-based students also showed a significantly increased interest in small town practice after the rotation. Our hypothesis that urban-based students would report an increased level of rural community support at the end of the rotation was confirmed. These urban-based students also reported positive opinions about rural living and practice. The students primarily based at the urban campus also showed a statistically significant more positive attitude toward pursuing a career in a small town after the 8-week experience. This suggests that brief rural immersion experiences may make the larger student pool at an urban campus available to address rural workforce challenges. Future studies at multiple rural sites with a larger sample size are needed to confirm this possibility. © 2017 National Rural Health Association.
Hannum, Emily; Kong, Peggy; Zhang, Yuping
In this paper, we investigate the gender gap in education in rural northwest China. We first discuss parental perceptions of abilities and appropriate roles for girls and boys; parental concerns about old-age support; and parental perceptions of different labor market outcomes for girls' and boys' education. We then investigate gender disparities in investments in children, children's performance at school, and children's subsequent attainment. We analyze a survey of 9-12-year-old children and their families conducted in rural Gansu Province in the year 2000, along with follow-up information about subsequent educational attainment collected 7 years later. We complement our main analysis with two illustrative case studies of rural families drawn from 11 months of fieldwork conducted in rural Gansu between 2003 and 2005 by the second author.In 2000, most mothers expressed egalitarian views about girls' and boys' rights and abilities, in the abstract. However, the vast majority of mothers still expected to rely on sons for old-age support, and nearly one in five mothers interviewed agreed with the traditional saying, "Sending girls to school is useless since they will get married and leave home." Compared to boys, girls faced somewhat lower (though still very high) maternal educational expectations and a greater likelihood of being called on for household chores than boys. However, there was little evidence of a gender gap in economic investments in education. Girls rivaled or outperformed boys in academic performance and engagement. Seven years later, boys had attained just about a third of a year more schooling than girls-a quite modest advantage that could not be fully explained by early parental attitudes and investments, or student performance or engagement. Fieldwork confirmed that parents of sons and daughters tended to have high aspirations for their children. Parents sometimes viewed boys as having greater aptitude, but tended to view girls as having more
Yang, Xueyan; Li, Shuzhuo; Feldman, Marcus W.
The objectives of this study are to develop a scale of gender role ideology appropriate for assessing Quality of Care in family planning services for rural China. Literature review, focus-group discussions and in-depth interviews with service providers and clients from two counties in eastern and western China, as well as experts’ assessments, were used to develop a scale for family planning services. Psychometric methodologies were applied to samples of 601 service clients and 541 service providers from a survey in a district in central China to validate its internal consistency, reliability, and construct validity with realistic and strategic dimensions. This scale is found to be reliable and valid, and has prospects for application both academically and practically in the field. PMID:23573222
Flinkenflögel, Maaike; Essuman, Akye; Chege, Patrick; Ayankogbe, Olayinka; De Maeseneer, Jan
Health-care systems based on primary health care (PHC) are more equitable and cost effective. Family medicine trains medical doctors in comprehensive PHC with knowledge and skills that are needed to increase quality of care. Family medicine is a relatively new specialty in sub-Saharan Africa. To explore the extent to which the Primafamed South-South cooperative project contributed to the development of family medicine in sub-Saharan Africa. The Primafamed (Primary Health Care and Family Medicine Education) project worked together with 10 partner universities in sub-Saharan Africa to develop family medicine training programmes over a period of 2.5 years. A SWOT (strengths, weaknesses, opportunities and threats) analysis was done and the training development from 2008 to 2010 in the different partner universities was analysed. During the 2.5 years of the Primafamed project, all partner universities made progress in the development of their family medicine training programmes. The SWOT analysis showed that at both national and international levels, the time is ripe to train medical doctors in family medicine and to integrate the specialty into health-care systems, although many barriers, including little awareness, lack of funding, low support from other specialists and reserved support from policymakers, are still present. Family medicine can play an important role in health-care systems in sub-Saharan Africa; however, developing a new discipline is challenging. Advocacy, local ownership, action research and support from governments are necessary to develop family medicine and increase its impact. The Primafamed project showed that development of sustainable family medicine training programmes is a feasible but slow process. The South-South cooperation between the ten partners and the South African departments of family medicine strengthened confidence at both national and international levels. © The Author 2014. Published by Oxford University Press.
Flinkenflögel, Maaike; Essuman, Akye; Chege, Patrick; Ayankogbe, Olayinka; De Maeseneer, Jan
Background. Health-care systems based on primary health care (PHC) are more equitable and cost effective. Family medicine trains medical doctors in comprehensive PHC with knowledge and skills that are needed to increase quality of care. Family medicine is a relatively new specialty in sub-Saharan Africa. Objective. To explore the extent to which the Primafamed South–South cooperative project contributed to the development of family medicine in sub-Saharan Africa. Methods. The Primafamed (Primary Health Care and Family Medicine Education) project worked together with 10 partner universities in sub-Saharan Africa to develop family medicine training programmes over a period of 2.5 years. A SWOT (strengths, weaknesses, opportunities and threats) analysis was done and the training development from 2008 to 2010 in the different partner universities was analysed. Results. During the 2.5 years of the Primafamed project, all partner universities made progress in the development of their family medicine training programmes. The SWOT analysis showed that at both national and international levels, the time is ripe to train medical doctors in family medicine and to integrate the specialty into health-care systems, although many barriers, including little awareness, lack of funding, low support from other specialists and reserved support from policymakers, are still present. Conclusions. Family medicine can play an important role in health-care systems in sub-Saharan Africa; however, developing a new discipline is challenging. Advocacy, local ownership, action research and support from governments are necessary to develop family medicine and increase its impact. The Primafamed project showed that development of sustainable family medicine training programmes is a feasible but slow process. The South–South cooperation between the ten partners and the South African departments of family medicine strengthened confidence at both national and international levels. PMID:24857843
Schroeder, Steven A
A recurring conference theme was the essential place of social justice within family medicine, especially the need to focus on denominator populations, exalt the personal and caring qualities of doctoring, and address social determinants of health. Many expressed solidarity with "community," but it is not always easy to define community in our large and diverse nation. Exhortations for health advocacy were frequently voiced, but putting these into meaningful action agendas is a challenge. There was general agreement that medicine is in flux and that the many expressions of "commodity-centered consumerism" have altered organization and financing. The increasing demands by "consumers", who want low cost, instant availability, and shared decision-making, and yet change doctors when health plans alter coverage also differentially impact high-volume, low-margin specialties such as family medicine. Additional challenges were the electronic health record and calibrating an appropriate work/life balance. Five action steps are recommended: 1) speak out on the important social and moral issues; 2) be the experts on personal care; 3) make common cause with potential allies; 4) help institutions perceive the value of generalism; and 5) help find ways to enrich generalist disciplines to increase the joy of medicine and decrease the threat of burn out. © Copyright 2016 by the American Board of Family Medicine.
Chen, Jiangsheng; Yang, Hong
Employing data from the China rural-urban mobility survey conducted in 2010, this study investigates the influence of family demographic characteristics on the income, life satisfaction, and potential for rural-urban mobility at the rural household level of two provinces of China: Shaanxi and Henan. A larger labor force in a rural household was found to reduce a family's ability or inclination to move to a city. The findings reveal that family size negatively affects the average income per family member and reduces the marginal income of the labor force and that minor children can improve the life satisfaction of family members. We conclude that a larger family size does not translate to more benefits for a rural household. Family size preference is found to be a reflection of parents' concerns about elderly care and is deemed to be unfavorable for urbanization in P. R. China.
Magee, Susanna R; Eidson-Ton, W Suzanne; Leeman, Larry; Tuggy, Michael; Kim, Thomas O; Nothnagle, Melissa; Breuner, Joseph; Loafman, Mark
Maternity care is an integral part of family medicine, and the quality and cost-effectiveness of maternity care provided by family physicians is well documented. Considering the population health perspective, increasing the number of family physicians competent to provide maternity care is imperative, as is working to overcome the barriers discouraging maternity care practice. A standard that clearly defines maternity care competency and a systematic set of tools to assess competency levels could help overcome these barriers. National discussions between 2012 and 2014 revealed that tools for competency assessment varied widely. These discussions resulted in the formation of a workgroup, culminating in a Family Medicine Maternity Care Summit in October 2014. This summit allowed for expert consensus to describe three scopes of maternity practice, draft procedural and competency assessment tools for each scope, and then revise the tools, guided by the Family Medicine and OB/GYN Milestones documents from the respective residency review committees. The summit group proposed that achievement of a specified number of procedures completed should not determine competency; instead, a standardized competency assessment should take place after a minimum number is performed. The traditionally held required numbers for core procedures were reassessed at the summit, and the resulting consensus opinion is proposed here. Several ways in which these evaluation tools can be disseminated and refined through the creation of a learning collaborative across residency programs is described. The summit group believed that standardization in training will more clearly define the competencies of family medicine maternity care providers and begin to reduce one of the barriers that may discourage family physicians from providing maternity care.
Full Text Available Sahoko H Little,1,2 Sunil S Menawat,1,3 Michael Worzniak,1 Michael D Fetters2 1Oakwood Annapolis Family Medicine Residency, Wayne, Michigan, USA; 2University of Michigan, Department of Family Medicine, Ann Arbor, Michigan, USA; 3Ghent Family Medicine Residency, Eastern Virginia Medical School, Norfolk, Virginia, USA Abstract: Primary care physicians often care for patients with chronic wounds, and they can best serve patients if they have knowledge and proficient skills in chronic wound care, including sharp debridement. The Oakwood Annapolis Family Medicine Residency in Michigan, USA developed a Wound Care Service, incorporating wound care training during the surgical rotation. Effectiveness of the wound care training was evaluated through pre- and posttesting of residents, to assess changes in knowledge and comfort in treating chronic wounds. The results demonstrate significant improvement in residents’ knowledge and comfort in wound care. This innovation demonstrates the feasibility of educating residents in chronic wound care through hands-on experience. Keywords: wound care education, primary care, residency education, surgery rotation, curriculum development
Gaufberg, Elizabeth H.; Joseph, Robert C.; Pels, Richard J.; Wyshak, Grace; Wieman, Dow; Nadelson, Carol C.
Surveyed directors of internal medicine (IM) and family practice (FP) residency programs regarding the format, content, and quantity of psychosocial training in their programs, their opinions on topics related to such training, and program demographics. Found considerable variation in content and time devoted to psychosocial training within and…
AR Yong Rafidah
Full Text Available Doctor-patient communication skills are important in family medicine and can be taught and learned. This paper summarisesthe salient contents and main methods of the teaching and learning of doctor-patient communication, especially thoseapplicable to the discipline.
Objectives. To determine the number of interventions made by pharmacy students at an urban family medicine clinic and the acceptance rate of these recommendations by the healthcare providers. The secondary objective was to investigate the cost avoidance value of the interventions.
Aug 26, 1999 ... aDepartment of Family Medicine, Moi University College of Health, Eldoret, Kenya. bDepartment ... The challenges include the lack of Kenyan teachers of the programme and the introduction ... in the establishment of FM departments in medical schools in .... Kenya Commission for Higher Education (CHE).
Lai, Pauline Siew Mei; Tan, Sing Yee; Liew, Su May
Sociocultural factors have been shown to be important influencers of sexual health and sexuality. Hence, the aim of our study was to explore the views and experiences of family medicine trainees regarding female sexual dysfunction (FSD) with a focus on the barriers and facilitators towards the initiation of conversation on this topic. A qualitative study design involving semi-structured focus group discussions (FGDs) was conducted with 19 family medicine trainees in Malaysia. The conceptual framework used was based on the Theory of Planned Behavior. Thematic approach was used to analyze the data. Participants perceived FSD as being uncommon and unimportant. According to our participants, patients often presented with indirect complaints, and doctors were not proactive in asking about FSD. Three main barriers were identified: doctor factors, perceived patient factors, and system factors. Lack of confidence, knowledge, experience, time, and embarrassment were the key barriers identified at the doctors' level. Lack of awareness, among patients regarding FSD, and local cultural and religious norms were the perceived patient barriers. System barriers were lack of time and privacy. Various facilitators, such as continuous medical education and public forums, were suggested as means to encourage family medicine trainees to initiate discussion on sexual matters during consultations. In conclusion, family medicine trainees found it difficult to initiate conversation on FSD with patients. Interventions to encourage conversation on FSD should target this and other identified barriers.
Czabanowska, Katarzyna; Klemenc-Ketis, Zalika; Potter, Amanda; Rochfort, Andree; Tomasik, Tomasz; Csiszar, Judit; Van den Bussche, Piet
Objective: The aim of this study was to develop a comprehensive framework of quality improvement competencies for use in continuing professional development (CPD) and continuing medical education (CME) for European general practice/family medicine physicians (GPs/FDs). Methods: The study was carried out in three phases: literature review,…
A national survey of family medicine programs and residency training in geriatrics found almost half using home care services as teaching sites. In the program design preferred by residents, the resident followed the patient long-term and discussed management with a multidisciplinary team. An alternative combined rotation is discussed. (Author/MSE)
Mola, Ernesto; De Bonis, Judith A; Giancane, Raffaele
Efforts to improve the quality of healthcare for patients with chronic conditions have resulted in growing evidence supporting the inclusion of patient empowerment as a key ingredient of care. In 2002, WONCA Europe issued the European Definition of General Practice/Family Medicine, which is currently considered the point of reference for European health institutions and general medical practice. Patient empowerment does not appear among the 11 characteristics of the discipline. The aim of this study is to show that many characteristics of general practice are already oriented towards patient empowerment. Therefore, promoting patient empowerment and self-management should be included as a characteristic of the discipline. The following investigation was conducted: analysing the concept and approach to empowerment as applied to healthcare in the literature; examining whether aspects of empowerment are already part of general medical practice; and identifying reasons why the European definition of general practice/family medicine should contain empowerment as a characteristic of the discipline. General practice/family medicine is the most suitable setting for promoting patient empowerment, because many of its characteristics are already oriented towards encouraging it and because its widespread presence can ensure the generalization of empowerment promotion and self-management education to the totality of patients and communities. "Promoting patient empowerment and self-management" should be considered one of the essential characteristics of general practice/family medicine and should be included in its definition.
Sigmon, J Lewis; McPherson, Vanessa; Little, John M
In light of the ongoing consideration for extending the length of residency education in family medicine in the United States, this paper reports the findings from a retrospective, qualitative study of six family physicians that elected to extend their residency training from 3 to 4 years. Each participant completed a written questionnaire and a structured personal interview focusing on various aspects of career development resulting from the additional year of training. The authors independently evaluated these interviews to identify major themes. All the participants were found to have been involved in teaching medicine, valued a more flexible and expanded curriculum, and appreciated their individualized curricula-based on their respective career interests. Given the opportunity, each would opt again for a fourth year of training. There were mixed opinions as to whether the fourth year should be required of all family medicine residents. Other perceived benefits reported were: a better opportunity to find a personally satisfactory practice, additional time for gaining clarity about career plans, and a higher beginning salary as a result of the additional skills and experiences gained. This study of mid-career physicians supports that a fourth-year (PGY4) curriculum in family medicine may enhance subsequent career satisfaction. Further studies of residents in other PGY4 training programs are necessary to assess outcomes comparing our findings as well as guide the discipline's leaders in residency redesign.
Rosenberg, Ellen; Richard, Claude; Lussier, Marie-Thérèse; Abdool, Shelly N
To describe the challenges for immigrant patients and their physicians and their skills in intercultural communication (ICC). We videotaped one clinical encounter for each of 24 psychologically distressed patients visiting their regular family physician. The physician and the patient, each separately, viewed the videotape of their clinical encounter and commented on important moments identified by the participant or the researchers. Patients and/or physicians lacked knowledge of the effects of culture on the doctor-patient relationship and expressions of distress as well as the effects of immigrant-specific stress on health. Most subjects were motivated to have an interpersonal, rather than an intercultural encounter. Physicians and patients demonstrated the skills needed to achieve an interpersonal encounter. Some physicians and their patients achieved intercultural meetings as a result of their interpersonal interactions over a period of years. Lack of formal training partly explains why most participants demonstrated an elementary level of ICC. In addition, Identity Management Theory and Co-cultural Theory explain some of the barriers to ICC. Providing physicians with formal training in intercultural communication and empowerment training for patients is likely to improve the quality of care of immigrants.
Louis S. Jenkins
Conclusion: The training of family physicians across Africa shares many common themes. However, there are also big differences among the various countries and even programmes within countries. The way forward would include exploring the local contextual enablers that influence the learning conversations between trainees and their supervisors. Family medicine training institutions and organisations (such as WONCA Africa and the South African Academy of Family Physicians have a critical role to play in supporting trainees and trainers towards developing local competencies which facilitate learning in the clinical workplace dominated by service delivery pressures.
Nilufar Z. Mamadalieva
Full Text Available Plants of the Lamiaceae family are important ornamental, medicinal, and aromatic plants, many of which produce essential oils that are used in traditional and modern medicine, and in the food, cosmetics, and pharmaceutical industry. Various species of the genera Hyssopus, Leonurus, Mentha, Nepeta, Origanum, Perovskia, Phlomis, Salvia, Scutellaria, and Ziziphora are widespread throughout the world, are the most popular plants in Uzbek traditional remedies, and are often used for the treatment of wounds, gastritis, infections, dermatitis, bronchitis, and inflammation. Extensive studies of the chemical components of these plants have led to the identification of many compounds, as well as essentials oils, with medicinal and other commercial values. The purpose of this review is to provide a critical overview of the literature surrounding the traditional uses, ethnopharmacology, biological activities, and essential oils composition of aromatic plants of the family Lamiaceae, from the Uzbek flora.
Magee, Susanna R; Radlinski, Heidi; Nothnagle, Melissa
The United States has a growing shortage of maternity care providers. Family medicine maternity care fellowships can address this growing problem by training family physicians to manage high-risk pregnancies and perform cesarean deliveries. This paper describes the impact of one such program-the Maternal Child Health (MCH) Fellowship through the Department of Family Medicine at Brown University and the careers of its graduates over 20 years (1991--2011). Fellowship graduates were mailed a survey regarding their training, current practice and teaching roles, and career satisfaction. Seventeen of 23 fellows (74%) responded to the survey. The majority of our fellowship graduates provide maternity care. Half of our respondents are primary surgeons in cesarean sections, and the majority of these work in community hospitals. Nearly all of our graduates maintain academic appointments and teach actively in their respective departments of family medicine. Our maternal child health fellowship provides family physicians with the opportunity to develop advanced skills needed to provide maternity care for underserved communities and teaching skills to train the next generation of maternal child health care providers.
Grant, Kathryn; Burg, Mary Ann; Fraser, Kathryn; Gui, Serena; Kosch, Shae Graham; Nierenberg, Barry; Oyama, Oliver; Pomm, Heidi; Sibille, Kimberly; Spruill, Timothy; Swartz, Virginia
This study explores the beliefs and practices of family medicine physicians regarding the use of nonconventional modalities for menopausal symptom management. Anonymous self-administered questionnaires were distributed to faculty and residents from eight participating family medicine residency programs around Florida, with an overall response rate of 66% (212 respondents). The survey explored what physicians report about patterns of patient inquiries and their responses to patients' inquiries about nonconventional modalities for specific menopausal symptoms and what physicians' report on their advice to patients about using specific herbs and supplements for menopausal symptom relief. Behavioral approaches were encouraged more than herbal therapies, acupuncture, and body therapies for the treatment of most of the menopausal symptoms. However, the most frequent response category was No advice. Resident physicians were significantly more likely than faculty to encourage acupuncture. Faculty physicians were more likely than residents to recommend particular herbal remedies. The majority of the respondents believed there was not sufficient evidence for recommending any of the herbs and supplements listed. These data reveal some important trends about how family medicine physicians respond to nontraditional approaches for menopausal symptom management. Because family medicine physicians typically receive some training in behavioral and psychotherapeutic approaches and there is some evidence for the effectiveness of behavioral strategies in menopausal symptom management, it is not surprising that they are more likely to endorse these approaches. Most family medicine physicians, however, have little or no training in the other nonconventional modalities, and our data show that these modalities received lower levels of endorsement, suggesting that physicians are not clear on their advantages or disadvantages.
Redwood-Campbell, Lynda; Pakes, Barry; Rouleau, Katherine; MacDonald, Colla J; Arya, Neil; Purkey, Eva; Schultz, Karen; Dhatt, Reena; Wilson, Briana; Hadi, Abdullahel; Pottie, Kevin
Recognizing the growing demand from medical students and residents for more comprehensive global health training, and the paucity of explicit curricula on such issues, global health and curriculum experts from the six Ontario Family Medicine Residency Programs worked together to design a framework for global health curricula in family medicine training programs. A working group comprised of global health educators from Ontario's six medical schools conducted a scoping review of global health curricula, competencies, and pedagogical approaches. The working group then hosted a full day meeting, inviting experts in education, clinical care, family medicine and public health, and developed a consensus process and draft framework to design global health curricula. Through a series of weekly teleconferences over the next six months, the framework was revised and used to guide the identification of enabling global health competencies (behaviours, skills and attitudes) for Canadian Family Medicine training. The main outcome was an evidence-informed interactive framework http://globalhealth.ennovativesolution.com/ to provide a shared foundation to guide the design, delivery and evaluation of global health education programs for Ontario's family medicine residency programs. The curriculum framework blended a definition and mission for global health training, core values and principles, global health competencies aligning with the Canadian Medical Education Directives for Specialists (CanMEDS) competencies, and key learning approaches. The framework guided the development of subsequent enabling competencies. The shared curriculum framework can support the design, delivery and evaluation of global health curriculum in Canada and around the world, lay the foundation for research and development, provide consistency across programmes, and support the creation of learning and evaluation tools to align with the framework. The process used to develop this framework can be applied
Full Text Available Abstract Background Recognizing the growing demand from medical students and residents for more comprehensive global health training, and the paucity of explicit curricula on such issues, global health and curriculum experts from the six Ontario Family Medicine Residency Programs worked together to design a framework for global health curricula in family medicine training programs. Methods A working group comprised of global health educators from Ontario's six medical schools conducted a scoping review of global health curricula, competencies, and pedagogical approaches. The working group then hosted a full day meeting, inviting experts in education, clinical care, family medicine and public health, and developed a consensus process and draft framework to design global health curricula. Through a series of weekly teleconferences over the next six months, the framework was revised and used to guide the identification of enabling global health competencies (behaviours, skills and attitudes for Canadian Family Medicine training. Results The main outcome was an evidence-informed interactive framework http://globalhealth.ennovativesolution.com/ to provide a shared foundation to guide the design, delivery and evaluation of global health education programs for Ontario's family medicine residency programs. The curriculum framework blended a definition and mission for global health training, core values and principles, global health competencies aligning with the Canadian Medical Education Directives for Specialists (CanMEDS competencies, and key learning approaches. The framework guided the development of subsequent enabling competencies. Conclusions The shared curriculum framework can support the design, delivery and evaluation of global health curriculum in Canada and around the world, lay the foundation for research and development, provide consistency across programmes, and support the creation of learning and evaluation tools to align with the
Gallagher, Lisa M; Lagman, Ruth; Bates, Debbie; Edsall, Melissa; Eden, Patricia; Janaitis, Jessica; Rybicki, Lisa
Evidence shows that music therapy aids in symptom management and improves quality of life for palliative medicine and hospice patients. The majority of previous studies have addressed patient needs, while only a few addressed the needs of family members. The primary purpose of this study was to understand family members' perceptions of music therapy experienced by a relative in palliative medicine or hospice. Patient self-reported scales and music therapist assessment of change were also investigated. Patients scored their symptoms (pain, anxiety, depression, shortness of breath, and mood) before and after music therapy sessions. One family member present during the session assessed perceived effect on the patient's pain, anxiety, depression, shortness of breath, stress level, restlessness, comfort level, mood, and quality of life. The effect on family member's stress level, quality of life, and mood and helpfulness of the music therapy session for the patient and self were studied. Recommendations about future patient participation in music therapy and qualitative comments were also solicited. Fifty family member/patient dyads participated in the study. Family member perceptions were positive, with 82% of responders indicating improvement for self and patient in stress, mood, and quality of life; 80% rating the session as extremely helpful; and 100% of 49 recommending further music therapy sessions for the patient. Patients reported statistically significant improvement in pain, depression, distress, and mood scores. Family members of patients in palliative medicine and hospice settings reported an immediate positive impact of music therapy on the patient and on themselves. More research needs to be conducted to better understand the benefits of music therapy for family members.
Pellerin, M.A.; Elwyn, G.; Rousseau, M.; Stacey, D.; Robitaille, H.; Legare, F.
PURPOSE: Do residents in family medicine practice share decision making with patients during consultations? This study used a validated scale to score family medicine residents' shared decision-making (SDM) skills in primary care consultations and to determine whether residents' demographic
Full Text Available In the Polish Second Republic, so in the country rebom afiter one hundred twenty three years of captivity, the role of a woman as a woman-mother, was significantly emphasized. Press, literature, researchers have proved that safety and order in the whole country depend on safety and order in individual families. The key notion became: „from education of a mother to education of a child”. While analyzing sources such as newspapers, magazines, diaries, guidebooks, I noticed the following values for which mothers in rural families were held to be responsible: 1 ,value of work connected with obligation in farm and household, so role of mother asahousewife; 2.the value of the family as a community and the mother's role in it. Mother was the first protector, tutor, patron of a child. Mother took care of child and other members in the family, she helped them, she guaranteed the positive atmosphere at home, took care of safety in a wide context. It was significant that mother appealed in the process of socialization to common traditions and experiences; 3.value of education and social consciousness, so the role of the mother in shaping social consciousness; 4.patriotic value, so the role of the mother in shaping patriotic attitude
Birk-Urovitz, Elizabeth; Elisabeth Del Giudice, M; Meaney, Christopher; Grewal, Karan
To assess the use of thyroid-stimulating hormone (TSH) tests for identifying primary hypothyroidism in 2 academic family medicine settings. Descriptive study involving a retrospective electronic chart review of family medicine patients who underwent TSH testing. Two academic family practice sites: one site is within a tertiary hospital in Toronto, Ont, and the other is within a community hospital in Newmarket, Ont. A random sample of 205 adult family medicine patients who had 1 or more TSH tests for identifying potential primary hypothyroidism between July 1, 2009, and September 15, 2013. Exclusion criteria included a previous diagnosis of any thyroid condition or abnormality, as well as pregnancy or recent pregnancy within the year preceding the study period. The proportion of normal TSH test results and the proportion of TSH tests that did not conform to test-ordering guidelines. Of the 205 TSH test results, 200 (97.6%, 95% CI 94.4% to 99.2%) showed TSH levels within the normal range. All 5 patients with abnormal TSH test results had TSH levels above the upper reference limits. Nearly one-quarter (22.4%, 95% CI 16.9% to 28.8%) of tests did not conform to test-ordering guidelines. All TSH tests classified as not conforming to test-ordering guidelines showed TSH levels within normal limits. There was a significant difference ( P hypothyroidism case finding and screening was high, and the overall proportion of TSH tests that did not conform to test-ordering guidelines was relatively high as well. These results highlight a need for more consistent TSH test-ordering guidelines for primary hypothyroidism and perhaps some educational interventions to help curtail the overuse of TSH tests in the family medicine setting. Copyright© the College of Family Physicians of Canada.
Iglar, Karl; Murdoch, Stuart; Meaney, Christopher; Krueger, Paul
To determine the number of patient visits, patient demographic information, and diagnoses in an urban ambulatory care setting in a family medicine residency program, and assess the correlation between the number of patient visits and residents' in-training examination (ITE) scores. Retrospective analysis of data from resident practice profiles, electronic medical records, and residents' final ITE scores. Family medicine teaching unit in a community hospital in Barrie, Ont. Practice profile data were from family medicine residents enrolled in the program from July 1, 2013, to June 30, 2014, and electronic medical record and ITE data were from those enrolled in the program from July 1, 2010, to June 30, 2015. Number of patient visits, patient characteristics (eg, sex, age), priority topics addressed in clinic, resident characteristics (eg, age, sex, level of residency), and residents' final ITE scores. Between July 1, 2013, and June 30, 2014, there were 11 115 patient visits. First-year residents had a mean of 5.48 patient visits per clinic, and second-year residents had a mean of 5.98 patient visits per clinic. A Pearson correlation coefficient of 0.68 was found to exist between the number of patients seen and the final ITE scores, with a 10.5% difference in mean score between residents who had 1251 or more visits and those who had 1150 or fewer visits. Three diagnoses (ie, epistaxis, meningitis, and neck pain) deemed important for Certification by the College of Family Physicians of Canada were not seen by any of the residents in clinic. There is a moderate correlation between the number of patients seen by residents in ambulatory care and ITE scores in family medicine. It is important to assess patients' demographic information and diagnoses made in resident practices to ensure an adequate clinical experience. Copyright© the College of Family Physicians of Canada.
Higuchi, Michiyo; Okumura, Junko; Aoyama, Atsuko; Suryawati, Sri; Porter, John
The use of medicines and nurses'/midwives' adherence to standard treatment guidelines (STGs) were examined in Timor-Leste during the early stage of the nation's new health system development. A cross-sectional study was conducted as the quantitative element of mixed methods research. Retrospective samples from patient registration books and prospective observations were obtained in 20 randomly selected rural community health centers. The medicines use indicators, in particular the level of injection use, in Timor-Leste did not suggest overprescription. Prescribers with clinical nurse training prescribed significantly fewer antibiotics than those without such training (P < .01). The adjusted odds ratio of prescribing adherence for clinical nurse training, after accounting for confounders and prescriber clustering, was 6.6 (P < .01). STGs for nonphysician health professionals at the primary health care level have potential value in basic health care delivery, including appropriate use of medicines, in resource-limited communities when strategically developed and introduced. © 2012 APJPH.
Background. The curriculum of the Faculty of Medicine at the University of Botswana includes rural community exposure for students throughout their 5 years of training. In addition to community exposure during the first 2 years, students complete 16 weeks of family medicine and 8 weeks of public health medicine. However ...
Alejandra Rodríguez Torres
Full Text Available OBJECTIVE The goal of this study is to compare and interpret the meaning of family support for diabetic patients and their families using social representations according to a structural approach of Abric’s theory. METHODS The study was carried out in a Family Medicine Center of the Chalco Municipality in Mexico State. The population studied comprised ten diabetic patient-family pairs. The first part of the study was a simple word association test that aimed to find terms or statements related to the concept of “family support”, as well as its frequency of appearance and range of association. Once the terms or statements were obtained, they were categorized according to their “support” capabilities. A semi-structured interview for each category was conducted as well as a graphic analysis of Friedman’s meanings. The discourse of diabetic patients was compared to that of the families in order to find similarities and differences. RESULTS Evocation of terms was done in the first part of the study, and it was found that the emotional domain was central to the discourse. However, in the second part of the study, when categorization and analysis of discourse is performed, there are differences in the centrality of terms and statements. The family tends to center in the active domain, whereas the patient centers in the emotional domain. CONCLUSIONS This study brings up the emotional needs of the patient as essential components of support efforts. This promotes reflection about changing strategies in the design of public healthcare programs in that they may include family support from the viewpoint of otherness.
Rodríguez, Alejandra; Camacho, Esteban Jaime; Escoto, María Del Consuelo; Contreras, Georgina; Casas, Donovan
The goal of this study is to compare and interpret the meaning of family support for diabetic patients and their families using social representations according to a structural approach of Abric's theory. The study was carried out in a Family Medicine Center of the Chalco Municipality in Mexico State. The population studied comprised ten diabetic patient-family pairs. The first part of the study was a simple word association test that aimed to find terms or statements related to the concept of "family support", as well as its frequency of appearance and range of association. Once the terms or statements were obtained, they were categorized according to their "support" capabilities. A semi-structured interview for each category was conducted as well as a graphic analysis of Friedman's meanings. The discourse of diabetic patients was compared to that of the families in order to find similarities and differences. Evocation of terms was done in the first part of the study, and it was found that the emotional domain was central to the discourse. However, in the second part of the study, when categorization and analysis of discourse is performed, there are differences in the centrality of terms and statements. The family tends to center in the active domain, whereas the patient centers in the emotional domain. This study brings up the emotional needs of the patient as essential components of support efforts. This promotes reflection about changing strategies in the design of public healthcare programs in that they may include family support from the viewpoint of otherness.
Rushworth, G F; Diack, L; MacRobbie, A; Munoz, S-A; Pfleger, S; Stewart, D
Sparsely populated areas are potentially predisposed to health inequalities due to limited access to services. This study aimed to explore and describe issues of access to medicines and related advice experienced by residents of the Scottish Highlands and Western Isles. Cross-sectional cohort study. Anonymized questionnaires were mailed to a random sample of 6000 residents aged ≥18 years identified from the electoral register. The questionnaire contained items on: access to medicines; interactions with health care services; and perceptions of the services. Results were analysed using descriptive, inferential and spatial statistics. Adjusted response rate was 49.5% (2913/5889). Almost two thirds (63.4%, 1847) were prescribed medicines regularly, 88.5% (1634) of whom considered the source convenient. Pharmacy (73.8%, 1364) or dispensing GP (24.0%, 443) were the most accessed sources. Prescription medicine advice was mainly obtained from the GP (55.7%, 1029). Respondents ≥80 years old were significantly (P 80 years living alone disagreed that they obtained prescribed medicines from a convenient source. The majority of respondents who felt they did not have a convenient medicines source, regardless of urban/rural classification, lived within five miles of a pharmacy or GP practice. Respondents accessed medicines and advice from a variety of sources. While most considered their access to medicines convenient, there were issues for those over 80 years and living alone. Perceived convenience would not appear to be solely based on geographical proximity to supply source. This requires further exploration given that these individuals are likely to have long-term conditions and be prescribed medicines on a chronic basis. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Martin, Shelly D; Bush, Anneke C; Lynch, Julia A
Domestic terrorism is a real threat focusing on a need to engage in effective emergency preparedness planning and training. Front-line physicians are an important component of any emergency preparedness plan. Potential victims of an attack include children who have unique physiologic and psychological vulnerabilities in disasters. Front-line providers need to have adequate training to effectively participate in local planning initiatives and to recognize and treat casualties including children. The goal of the survey was to assess the current state of terrorism preparedness training, including child victims, by emergency medicine, family practice, and pediatric residency programs in the United States and to assess methods of training and barriers to establishing effective training. A survey was e-mailed to a comprehensive list of all US pediatric, family practice, and emergency medicine residency programs 3 times between September 2003 and January 2004. The survey measured the perceived risk of terrorist attack, level of training by type of attack, level of training regarding children, method of training, and barriers to training. Overall, 21% of programs responded (46 of 182 pediatric, 75 of 400 family practice, and 29 of 125 emergency medicine programs). Across all of the event types, emergency medicine programs were more likely to report adequate/comprehensive training. However, terrorism preparedness funding, these data suggest that we are failing to provide adequate training to front-line providers who may care for children in a catastrophic domestic terrorist event.
Doohan, Noemi C; Duane, Marguerite; Harrison, Bridget; Lesko, Sarah; DeVoe, Jennifer E
The Future of Family Medicine (FFM) project has helped shape and direct the evolution of primary care medicine over the past decade. Pisacano Scholars, a group of leaders in family medicine supported by the American Board of Family Medicine, gathered for a 2-day symposium in April 2013 to explore the history of the FFM project and outline a vision for the next phase of this work-FFM version 2.0 (v2.0). After learning about the original FFM project (FFM v1.0), the group held interactive discussions using the World Café approach to conversational leadership. This commentary summarizes the discussions and highlights major themes relevant to FFM v2.0 identified by the group. The group endorsed the FFM v1.0 recommendations as still relevant and marvelled at the progress made toward achieving many of those goals. Most elements of FFM v1.0 have moved forward, and some have been incorporated into policy blueprints for reform. Now is the time to refocus attention on facets of FFM v1.0 not yet realized and to identify key aspects missing from FFM v1.0. The Pisacano Scholars are committed to moving the FFM goals forward and hope that this expression of the group's vision will help to do so.
Morley, Christopher P; Rosas, Scott R; Mishori, Ranit; Jordan, William; Jarris, Yumi Shitama; Competencies Work Group, Family Medicine/Public Health; Prunuske, Jacob
Phenomenon: The integration of public health (PH) competency training into medical education, and further integration of PH and primary care, has been urged by the U.S. Institute of Medicine. However, PH competencies are numerous, and no consensus exists over which competencies are most important for adoption by current trainees. Our objective was to conduct a group concept mapping exercise with stakeholders identifying the most important and feasible PH skills to incorporate in medical and residency curricula. We utilized a group concept mapping technique via the Concept System Global Max ( http://www.conceptsystems.com ), where family medicine educators and PH professionals completed the phrase, "A key Public Health competency for physicians-in-training to learn is …" with 1-10 statements. The statement list was edited for duplication and other issues; stakeholders then sorted the statements and rated them for importance and feasibility of integration. Multidimensional scaling and cluster analysis were used to create a two-dimensional point map of domains of PH training, allowing visual comparison of groupings of related ideas and relative importance of these ideas. There were 116 nonduplicative statements (225 total) suggested by 120 participants. Three metacategories of competencies emerged: Clinic, Community & Culture, Health System Understanding, and Population Health Science & Data. Insights: We identified and organized a set of topics that serve as a foundation for the integration of family medicine and PH education. Incorporating these topics into medical education is viewed as important and feasible by family medicine educators and PH professions.
Coverage of NJFP includes: Family medicine; Primary health care; District health; Rural health; Health promotion Prevention of disease and disability ;Community oriented primary care ;Education and training of professionals and health workers in primary health care and family medicine; Medical informatics and ...
Arnot, Madeleine; Naveed, Arif
Education for all as a global agenda has particular repercussions for those living in rural poverty. By adopting a Bourdieusian framework to analyse interview data collected from fathers, mothers, sons and daughters in 10 rural Punjabi households, we expose the intersections of education, gender, poverty and rurality. The concept of a "rural…
Klemenc-Ketis, Zalika; Kurpas, Donata; Tsiligianni, Ioanna; Petrazzuoli, Ferdinando; Jacquet, Jean-Pierre; Buono, Nicola; Lopez-Abuin, Jose; Lionis, Christos
Research in family medicine is a well-established entity nationally and internationally, covering all aspects of primary care including remote and isolated practices. However, due to limited capacity and resources in rural family medicine, its potential is not fully exploited yet. An idea to foster European rural primary care research by establishing a practice-based research network has been recently put forward by several members of the European Rural and Isolated Practitioners Association (EURIPA) and the European General Practice Research Network (EGPRN). Two workshops on why, and how to design a practice-based research network among rural family practices in Europe were conducted at two international meetings. This paper revisits the definition of practice-based research in family medicine, reflects on the current situation in Europe regarding the research in rural family practice, and discusses a rationale for practice-based research in rural family medicine. A SWOT analysis was used as the main tool to analyse the current situation in Europe regarding the research in rural family practice at both meetings. The key messages gained from these meetings may be employed by the Wonca Working Party on research, the International Federation of Primary Care Research Network and the EGPRN that seek to introduce a practice-based research approach. The cooperation and collaboration between EURIPA and EGPRN creates a fertile ground to discuss further the prospect of a European practice-based rural family medicine research network, and to draw on the joint experience.
Silk, Hugh; Savageau, Judith A; Sullivan, Kate; Sawosik, Gail; Wang, Min
National initiatives have encouraged oral health training for family physicians and other nondental providers for almost 2 decades. Our national survey assesses progress of family medicine residency programs on this important health topic since our last survey in 2011. Family medicine residency program directors (PDs) completed an online survey covering various themes including number of hours of oral health (OH) teaching, topics covered, barriers, evaluation, positive influences, and program demographics. Compared to 2011, more PDs feel OH should be addressed by physicians (86% in 2017 vs 79% in 2011), yet fewer programs are teaching OH (81% vs 96%) with fewer hours overall (31% vs 45% with 4 or more hours). Satisfaction with the competence of graduating residents in OH significantly decreased (17% in 2017 vs 32% in 2011). Program directors who report graduates being well prepared to answer board questions on oral health topics are more likely to have an oral health champion (P<0.001) and report satisfaction with the graduates' level of oral health competency (P<0.001). Programs with an oral health champion, or having a relationship with a state or national oral health coalition, or having routine teaching from a dental professional are significantly more likely to have more hours of oral health curriculum (P<0.001). Family medicine PDs are more aware of the importance of oral health, yet less oral health is being taught in residency programs. Developing more faculty oral health champions and connecting programs to dental faculty and coalitions may help reduce this educational void.
Full Text Available Aim: With the health transformation program in Turkey, the Family Medicine Implementation (FMI was started across the nation in the end of 2010. This study attempted to assess the influence of the FMI on outpatient applications to a third level state hospital.Methods: The number of outpatient applications from 2007 to 2014 was screened through an automation system. Eight clinics were examined including the clinics which Ministry of Health, the Board of Medical Specialties assigned as a part of obligatory rotation within the scope of Family Medicine assistant training, and emergency service. The year 2011 was taken as beginning year of the Family Medicine system. The period from 2007 to 2010 was taken as the pre-FMI period while the term from 2010 to 2014 was taken as the post-FMI period. The outpatient application rates of the selected clinics were compared by periods in correlation with population changes in the Anatolian site of İstanbul. In the analysis of the data, descriptive statistics, mean and standard deviation for continuous variables, Mann Whitney U Test for abnormal distribution comparisons of measured values were used. Significance was assessed at p<0,01 and p<0,05 levels.Results: It was found that no significant increase occurred in the number of patients who applied to the clinics of chest diseases and cardiology in parallel to population growth. In other clinics, the number of applications increased in correlation with population growth.Conclusion: The family medicine implementation made positive effects on the third level hospital in the beginning phase. We are of the opinion that, in order for these positive effects to be improved further, patients should be encouraged to apply to family physicians, and a health referral chain should be implemented with sufficient numbers of primary care personnel.
Graves, Lisa; Lalla, Leonora; Young, Meredith
To examine the relationship between objective assessment of performance and self-rated competence immediately before and after participation in a required summative family medicine clerkship objective structured clinical examination (OSCE). Learners rated their competence (on a 7-point Likert scale) before and after an OSCE along 3 dimensions: general, specific, and professional competencies relevant to family medicine. McGill University in Montreal, Que. All 168 third-year clinical clerks completing their mandatory family medicine rotation in 2010 to 2011 were invited to participate. Self-ratings of competence and objective performance scores were compared, and were examined to determine if OSCEs could be a "corrective" tool for self-rating perceived competence (ie, if the experience of undergoing an assessment might assist learners in recalibrating their understanding of their own performance). A total of 140 (83%) of the third-year clinical clerks participated. Participating in an OSCE decreased learners' ratings of perceived competence (pre-OSCE score = 4.9, post-OSCE score = 4.7; F 1,3192 = 4.2; P competence for all categories of behaviour (before and after) showed no relationship to OSCE performance ( r .08 for all), nor did ratings of station-relevant competence (before and after) ( r .09 for all). Ratings of competence before and after the OSCE were correlated for individual students ( r > 0.40 and P perceived competence had decreased, and these ratings had little relationship to actual performance, regardless of the specificity of the rated competency. Discordance between perceived and actual competence is neither novel nor unique to family medicine. However, this discordance is an important consideration for the development of competency-based curricula. Copyright© the College of Family Physicians of Canada.
Abdulmajeed A Abdulmajeed
Full Text Available Background: Research in family medicine (FM provides an important contribution to its discipline. Family medicine research can contribute to many areas of primary care, ranging from the early diagnosis to equitable health care. Publication productivity is important in academic settings as a marker for career advancement. Objective: To describe the publications by family medicine researcher authors between 1992 and 2013. Materials and Methods: All full text, original articles published by family medicine researcher; author with affiliation to the Suez Canal University were collected using the internet and hand search. The journals that published for family medicine researcher authors were identified. Author characteristics were described. The trend of publications was described. All articles were analyzed for their characteristics, including the themes and study designs according to predefined criteria. Results: Along 22 years, 149 research articles were published by 48 family medicine authors in 39 medical journals. The largest category in publications was related to Family physician/Health service (FP-HS, n = 52 articles, followed by ′Patient′ category (n = 42. All the studies were quantitative; the largest group was represented by cross-sectional studies (76.5%. Conclusions: The publication productivity by family medicine researchers are going to be increased. FP-HS and patient topics were mostly addressed in publications. Cross-sectional studies exceeded any other designs. There is need to put more emphasis on intervention studies. Continuous assessment and improvement of FM research production and publication is recommended.
Abdulmajeed, Abdulmajeed A; Ismail, Mosleh A; Nour-Eldein, Hebatallah
Research in family medicine (FM) provides an important contribution to its discipline. Family medicine research can contribute to many areas of primary care, ranging from the early diagnosis to equitable health care. Publication productivity is important in academic settings as a marker for career advancement. To describe the publications by family medicine researcher authors between 1992 and 2013. All full text, original articles published by family medicine researcher; author with affiliation to the Suez Canal University were collected using the internet and hand search. The journals that published for family medicine researcher authors were identified. Author characteristics were described. The trend of publications was described. All articles were analyzed for their characteristics, including the themes and study designs according to predefined criteria. Along 22 years, 149 research articles were published by 48 family medicine authors in 39 medical journals. The largest category in publications was related to Family physician/Health service (FP-HS, n = 52 articles), followed by 'Patient' category (n = 42). All the studies were quantitative; the largest group was represented by cross-sectional studies (76.5%). The publication productivity by family medicine researchers are going to be increased. FP-HS and patient topics were mostly addressed in publications. Cross-sectional studies exceeded any other designs. There is need to put more emphasis on intervention studies. Continuous assessment and improvement of FM research production and publication is recommended.
Full Text Available Abstract Background During 1982–1992, the Maternal and Child Health Family Planning (MCH-FP Extension Project (Rural of International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B, in partnership with the Ministry of Health and Family Welfare (MoHFW of the Government of Bangladesh (GoB, implemented a series of interventions in Sirajganj Sadar sub-district of Sirajganj district. These interventions were aimed at improving the planning mechanisms and for reviewing the problem-solving processes to build an effective monitoring system of the interventions at the local level of the overall system of the MOHFW, GoB. Methods The interventions included development and testing of innovative solutions in service-delivery, provision of door-step injectables, and strengthening of the management information system (MIS. The impact of an in-built monitoring system on the overall performance was assessed during the period from June 1995 to December 1996, after the withdrawal of the interventions in 1992. Results The results of the assessment showed that Family Welfare Assistants (FWAs increased household-visits within the last two months, and there was a higher use of service-delivery points even after the withdrawal of the interventions. The results of the cluster surveys, conducted in 1996, showed that the selected indicators of health and family-planning services were higher than those reported by the Bangladesh Demographic and Health Survey (BDHS 1996–1997. During June 1995-December, 1996, the contraceptive prevalence rate (CPR increased by 13 percentage points (i.e. from 40% to 53%. Compared to the national CPR (49%, this increase was statistically significant (p Conclusion The in-built monitoring systems, including effective MIS, accompanied by rapid assessments and review of performance by the programme managers, have potentials to improve family planning performance in low-performing areas.
Ivezić-Lalić, Dragica; Bergman Marković, Biserka; Kranjčević, Ksenija; Kern, Josipa; Vrdoljak, Davorka; Vučak, Jasna
This study compared the association between the 3 definitions of metabolic syndrome (MetS) suggested by the World Health Organization (WHO), National Cholesterol Education Programme (NCEP ATP III), and International Diabetes Federation (IDF), and the risk of cardiovascular diseases (CVD) and shows the prevalence and characteristics of persons with MetS in continental vs. coastal regions and rural vs. urban residence in Croatia. A prospective multicenter study was conducted on 3245 participants≥40 years, who visited general practices from May to July 2008 for any reason. This was a cross-sectional study of the Cardiovascular Risk and Intervention Study in Croatia-family medicine project (ISRCTN31857696). All analyzed MetS definitions showed an association with CVD, but the strongest was shown by NCEP ATP III; coronary disease OR 2.48 (95% CI 1.80-3.82), cerebrovascular disease OR 2.14 (1.19-3.86), and peripheral artery disease OR 1.55 (1.04-2.32), especially for age and male sex. According to the NCEP ATP III (IDF), the prevalence was 38.7% (45.9%) [15.9% (18.6%) in men, and 22.7% (27.3%) in women, and 28.4% (33.9%) in the continental region, 10.2% (10.9%) in the coastal region, 26.2% (31.5%) in urban areas, and 12.4% (14.4%) in rural areas. Older age, male sex, and residence in the continental area were positively associated with MetS diagnosis according to NCEP ATP III, and current smoking and Mediterranean diet adherence have protective effects. The NCEP ATP III definition seems to provide the strongest association with CVD and should therefore be preferred for use in this population.
The quantity of the received calories by families is one of the important debates in public and development economic context. This is an attractive subject for government officials and policy makers in different countries. In the current paper, the impacts of households' income shocks, price and food commodity subsidies on the quantity of the received amount of calories in the rural parts of Iran are studied. For this purpose, we used time series data of 1961-2011 in the vector auto-regressive (VAR model. The results indicated that the impact period of the applied shock on the quantity of paid subsidies to agricultural sector is shorter than the period of price and income shocks. Besides, the most sensitivity of calorie demand is related to the income factor. According to the research findings, we can conclude that for creating food security, we should create economic stability in the market and consider the final effect of changes in nutrition pattern when determining the policies regarding market regulation, subsidies and taxation regardless of income growth that affect rural households and will have a serious negative impact on calories.
Adilson R. Paz Stamberg
Full Text Available This paper focuses on understanding the rationality of production management and available resources in agricultural production unit (UPA, identifying its main technical and socioeconomic characteristics in order to make a diagnosis to subsidize the rural manager in decision making.This study was part of the extension project approved in the Institutional Incentive Extension Program of the Farroupilha Federal Institute (Brazil, prioritizing as object of study a family UPA in the municipality of Santo Antônio das Missões/RS/Brazil, being conducted between October-November 2014.As methodological procedure a survey was done with qualitative and quantitative data, such as natural resources, utilized agricultural area, herd, plant, machinery and equipment, availability of labor force and yields of the various cultivation subsystems, breeding and processing. This data was organized in a spreadsheet, which identifies the adopted production system and its main technical and socioeconomic characteristics. As proposed, technical and managerial intervention in the production system, proposed strategically to enhance milk production opposed to the soybean production, considering its high contribution in relation to the value added per unit area.Key Words: Rural Administration - Production management - Systemic approach.
Pedersen, Carsten Bøcker; Mortensen, Preben Bo
Many studies have identified urban-rural differences in schizophrenia risk. Hypothetical underlying cause(s) may include toxic exposures, diet, infections, and selective migration. The authors investigated whether the underlying cause(s) responsible for the urban-rural differences were rooted...... evaluated whether the nearest older sibling's place of birth had an independent effect on schizophrenia risk. If the cause(s) responsible for the urban-rural differences are rooted in individuals only, the nearest older sibling's place of birth should have no independent effect. In this analysis....... Some of the cause(s) responsible for the urban-rural differences in schizophrenia risk are rooted in families, but some might also be rooted in individuals....
Phillips, J F; Hossain, M B; Arends-Kuenning, M
Experimental studies demonstrating the effectiveness of nonclinical distribution of contraceptives are typically conducted in settings where contraceptive use is low and unmet need is extensive. Determining the long-term role of active outreach programs after initial demand is met represents an increasingly important policy issue in Asia, where contraceptive prevalence is high and fixed service points are conveniently available. This article examines the long-term rationale for household family planning in Bangladesh-where growing use of contraceptives, rapid fertility decline, and normative change in reproductive preferences are in progress, bringing into question the rationale for large-scale deployment of paid outreach workers. Longitudinal data are analyzed that record outreach encounters and contraceptive use dynamics in a large rural population. Findings demonstrate that outreach has a continuing impact on program effectiveness, even after a decade of household visitation. The policy implications of this finding are reviewed.
Wen, Ming; Lin, Danhua
Using recent cross-sectional data of rural children aged from 8 to 18 in Hunan Province of China, this article examines psychological, behavioral, and educational outcomes and the psychosocial contexts of these outcomes among children left behind by one or both of their rural-to-urban migrant parents compared to those living in nonmigrant families. The results showed that left-behind children were disadvantaged in health behavior and school engagement but not in perceived satisfaction. The child's psychosocial environment, captured by family socioeconomic status, socializing processes, peer and school support, and psychological traits, were associated with, to varying extent, child developmental outcomes in rural China. These influences largely remain constant for the sampled children regardless of their parents' migrant status. © 2011 The Authors. Child Development © 2011 Society for Research in Child Development, Inc.
Flávio Sacco dos Anjos
Full Text Available The article is based on qualitative research carried out in the southern extreme of the Rio Grande do Sul state and explores the transformations on the practices of self-consumption production in the context of familiar agriculture, essentially, under the impacts of the process of commoditization of agriculture and the rural life. The self-consumption practices present a cultural matrix among rural families, in spite of the symbolic value attributed to products generated within the very rural establishment, as compared to the ones which are acquired externally in usual commerce or from other units of production. The field-work was performed within thirty family agricultural establishments whose main commercial activity lies on the milk, peach and tobacco production. The authors discuss the impacts of the commoditization of agriculture on the practical of self-consumption production.
Ammar R Abu Zuhairah
Full Text Available Aims: The aim was to compare Eastern, Makkah, and Asir regions in term of residents′ perception of the achievement of training objectives, and to assess various rotations based on residents′ perception. Settings and Design: This cross-sectional study was done among family medicine residents in the Eastern, Makkah, and Asir regions. Methodology: A questionnaire was developed by the investigator and validated by two experts. All residents, except R1 residents, were included. All data were collected by the investigator by direct contact with the residents. Statistical Analysis Used: Cronbach′s alpha, analysis of variance, t-test, and univariate regression model as appropriate, were used. Results: Reliability of the questionnaire was found to be 75.4%. One hundred and seven (response rate: 83.6% residents completed the questionnaire. There were 51 (47.7%, 27 (25.2%, and 29 (27.1% residents in the program in the Eastern region, Makkah, and Asir, respectively. The mean age was 29.1 ± 2.5 years; half of the residents were male, most of (83.2% were married, and more than half (54.2% of had worked in primary health care before joining the program. Overall, 45% of the residents perceived that they had achieved the training objectives. The highest rotations as perceived by the residents were psychiatry and otolaryngology while the lowest were orthopedics and ophthalmology. There were significant differences among the study regions with regard to the rotations in family medicine, internal medicine, orthopedics, general surgery, and emergency medicine. Conclusions: Overall, a good percentage of the residents perceived that they had achieved the training objectives. The rotations differed in the studied regions. Psychiatry and otolaryngology had the highest percentage of family medicine residents who perceived that they had achieved the training objectives while lowest was in internal medicine and obstetrics and gynecology. The highest rotations as
Cunningham, Amy T; Delgado, David J; Jackson, Joseph D; Crawford, Albert G; Jabbour, Serge; Lieberthal, Robert D; Diaz, Victor; LaNoue, Marianna
Group medical visits (GMVs), which combine 1-on-1 clinical consultations and group self-management education, have emerged as a promising vehicle for supporting type 2 diabetes management in primary care. However, few evaluations exist of ongoing diabetes GMVs embedded in medical practices. This study used a quasi-experimental design to evaluate diabetes GMV at a large family medicine practice. We examined program attendance and attrition, used propensity score matching to create a matched comparison group, and compared participants and the matched group on clinical, process of care, and utilization outcomes. GMV participants (n = 230) attended an average of 1 session. Participants did not differ significantly from the matched comparison group (n = 230) on clinical, process of care or utilization outcomes. The diabetes GMV was not associated with improvements in outcomes. Further studies should examine diabetes GMV implementation challenges to enhance their effectiveness in everyday practice. © Copyright 2018 by the American Board of Family Medicine.
Ezquerra Lezcano, Matilde; Bundo Vidiella, Magda; Descarrega Queralt, Ramón; Martín Zurro, Amando; Fores García, Dolores; Fornells Vallès, Josep Maria
The purpose of this article is to report on the experience in formative evaluation that was carried out in the Catalonian family and community medicine teaching units during the years 2001-2007. This formative evaluation project included the use of several evaluation tools such as, self-listening, video-recording, structured observation of clinical practice, cases by computer and simulated patients. Different resident intakes have participated in the development of the project, as well as their teaching unit tutors and coordinators. This accumulated experience has allowed it to progress into the field of formative evaluation, and to adapt and integrate the activities that were being carried out in a resident portfolio, which in our opinion is the best tool for the formative evaluation of the family medicine resident. Copyright 2009 Elsevier España, S.L. All rights reserved.
Okafor Henrietta U
Full Text Available Abstract Background Malaria remains a major cause of mortality among under five children in Nigeria. Most of the early treatments for fever and malaria occur through self-medication with antimalarial drugs bought from medicine sellers. These have led to increasing calls for interventions to improve treatment obtained in these outlets. However, information about the current practices of these medicine sellers is needed before such interventions. This study aims to determine the medicine sellers' perspectives on malaria and the determinants that underlie their dispensing patterns of antimalarial drugs. Methods The study was conducted in Ugwugo-Nike, a rural community in south-east Nigeria. It involved in-depth interviews with 13 patent medicine sellers. Results A majority of the medicine sellers were not trained health professionals and malaria is recognized as a major health problem by them. There is poor knowledge and poor dispensing behaviour in relation to childhood malaria episodes. Although referral of severe malaria is common, there are those who will not refer. Verbal advice is rarely given to the care-givers. Conclusion More action research and interventions to improve prescription and referral practices and giving verbal advice to care-givers is recommended. Ways to integrate the drug sellers in the health system are also recommended.
Peabody, Michael R; O'Neill, Thomas R; Eden, Aimee R; Puffer, James C
Due to the Accreditation Council for Graduate Medical Education (ACGME)/American Osteopathic Association (AOA) single-accreditation model, the specialty of family medicine may see as many as 150 programs and 500 trainees in AOA-accredited programs seek ACGME accreditation. This analysis serves to better understand the composition of physicians completing family medicine residency training and their subsequent certification by the American Board of Family Medicine. We identified residents who completed an ACGME-accredited or dual-accredited family medicine residency program between 2006 and 2016 and cross-tabulated the data by graduation year and by educational background (US Medical Graduate-MD [USMG-MD], USMG-DO, or International Medical Graduate-MD [IMG-MD]) to examine the cohort composition trend over time. The number and proportion of osteopaths completing family medicine residency training continues to rise concurrent with a decline in the number and proportion of IMGs. Take Rates for USMG-MDs and USMG-IMGs seem stable; however, the Take Rate for the USMG-DOs has generally been rising since 2011. There is a clear change in the composition of graduating trainees entering the family medicine workforce. As the transition to a single accreditation system for graduate medical education progresses, further shifts in the composition of this workforce should be expected. © Copyright 2017 by the American Board of Family Medicine.
Stacciarini, Jeanne-Marie R; Smith, Rebekah; Garvan, Cynthia Wilson; Wiens, Brenda; Cottler, Linda B
Upon immigration to the rural areas in the US, Latino families may experience cultural, geographic, linguistic and social isolation, which can detrimentally affect their wellbeing by acting as chronic stressors. Using a community engagement approach, this is a pilot mixed-method study with an embedded design using concurrent qualitative and quantitative data. The purpose of this study is to evaluate family and social environments in terms of protective factors and modifiable risks associated with mental well-being in Latino immigrants living in rural areas of Florida. Latino immigrant mother and adolescent dyads were interviewed by using in-depth ethnographic semistructured interviews and subsequent quantitative assessments, including a demographic questionnaire and three structured instruments: the Family Environment Scale Real Form, the SF-12v2™ Health Survey and the short version (eight items) of PROMIS Health Organization Social Isolation. This mixed-method pilot study highlighted how family, rural, and social environments can protect or impair wellbeing in rural Latino immigrant mother and adolescent dyads.
Schiamberg, Lawrence B.; Chin, Chong-Hee
Focusing on the family as a context for the development of life plans by youth, this report summarizes findings of a 14-year longitudinal study on the educational and occupational life plans and achievement of youth in rural low-income areas in six southeastern states. Specific attention is given to (1) how parental educational and occupational…
Sano, Yoshie; Richards, Leslie N.; Zvonkovic, Anisa M.
Guided by symbolic interactionism, this qualitative study based on interviews with 83 rural mothers investigated mothers' perceptions of nonresident fathers' involvement in low-income families. Contrary to some fathers' claims that mothers "gatekeep" their access to children, the majority of mothers in our study wanted increased father…
Pauwels, Judith; Weidner, Amanda
Numerous organizations are calling for the expansion of graduate medical education (GME) positions nationally. Developing new residency programs and expanding existing programs can only happen if financial resources are available to pay for the expenses of training beyond what can be generated in direct clinical income by the residents and faculty in the program. The goal of this study was to evaluate trended data regarding the finances of family medicine residency programs to identify what financial resources are needed to sustain graduate medical education programs. A group of family medicine residency programs have shared their financial data since 2002 through a biennial survey of program revenues, expenses, and staffing. Data sets over 12 years were collected and analyzed, and results compared to analyze trends. Overall expenses increased 70.4% during this period. Centers for Medicare and Medicaid Services (CMS) GME revenue per resident increased by 15.7% for those programs receiving these monies. Overall, total revenue per resident, including clinical revenues, state funding, and any other revenue stream, increased 44.5% from 2006 to 2016. The median cost per resident among these programs, excluding federal GME funds, is currently $179,353; this amount has increased over the 12 years by 93.7%. For this study group of family medicine programs, data suggests a cost per resident per year, excluding federal and state GME funding streams, of about $180,000. This excess expense compared to revenue must be met by other agencies, whether from CMS, the Health Resources and Services Administration (HRSA), state expenditures or other sources, through stable long-term commitments to these funding mechanisms to ensure program viability for these essential family medicine programs in the future.
Manson, Helen M; Satin, David; Nelson, Valerie; Vadiveloo, Thenmalar
Although professional organizations endorse ethics education in family medicine training, there is little published evidence that ethics teaching occurs. This survey collated data on the aims, content, pedagogical methods, assessment, and barriers relating to formal ethics education in family medicine residency programs in the United States. A questionnaire surveyed all 445 family medicine residency programs in the United States. Forty percent of programs responded (178/445). Of these, 95% formally teach at least one ethics topic, 68.2% teach six or more topics, and 7.1% teach all 13 core topics specified in the questionnaire. Programs show variation, providing between zero to 100 hours' ethics education over the 3 years of residency training. Of the responding programs, 3.5% specify well-defined aims for ethics teaching, 25.9% designate overall responsibility for the ethics curriculum to one individual, and 33.5% formally assess ethics competencies. The most frequent barriers to ethics education are finding time in residents' schedules (59.4%) and educator expertise (21.8%). Considerable variation in ethics education is apparent in both curricular content and delivery among family medicine residency programs in the United States. Additional findings included a lack of specification of explicit curricular aims for ethics teaching allied to ACGME or AAFP competencies, a tendency not to designate one faculty member with lead responsibility for ethics teaching in the residency program, and a lack of formal assessment of ethics competencies. This has occurred in the context of an absence of robust assessment of ethics competencies at board certification level.
Ikram, A.; Zahra, N.B.
The use of herbs for therapeutic purpose is as old as human history. In Pakistan a major part of population is dependent on the traditional medicine derived from plants for primary health care system. The interest in the use of traditional system of medicine has gained popularity globally. The developed countries are shifting their focus to further research based on the indigenous knowledge collected from aboriginal people. The present study reviews the ethno-medicinal uses of family Apiaceae reported from Pakistan. Out of 167 species reported from Pakistan, 66 are found to be used medicinally. Most commonly treated disorders by use of Apiaceae herbal flora are gastrointestinal tract and liver disorders (28%) followed by cough, cold and respiratory tract problems (11%). The plant parts frequently used are roots (22%) followed by whole plant material (19%), leaf material (18%), fruit (13%), seed (12%), stem, flower, aerial parts (5%) and sap (1%). It is suggested to carry out similar studies for other families to explore the indigenous knowledge for the development of commercial products and to collectively document the scattered existing knowledge. (author)
Cristina M. Uritu
Full Text Available Recently, numerous side effects of synthetic drugs have lead to using medicinal plants as a reliable source of new therapy. Pain is a global public health problem with a high impact on life quality and a huge economic implication, becoming one of the most important enemies in modern medicine. The medicinal use of plants as analgesic or antinociceptive drugs in traditional therapy is estimated to be about 80% of the world population. The Lamiaceae family, one of the most important herbal families, incorporates a wide variety of plants with biological and medical applications. In this study, the analgesic activity, possible active compounds of Lamiaceae genus, and also the possible mechanism of actions of these plants are presented. The data highlighted in this review paper provide valuable scientific information for the specific implications of Lamiaceae plants in pain modulation that might be used for isolation of potentially active compounds from some of these medicinal plants in future and formulation of commercial therapeutic agents.
Jacqueline R. Halladay
Full Text Available As part of the Heart Healthy Lenoir Project, we developed a practice level intervention to improve blood pressure control. The goal of this study was: (i to determine if single nucleotide polymorphisms (SNPs that associate with blood pressure variation, identified in large studies, are applicable to blood pressure control in subjects from a rural population; (ii to measure the association of these SNPs with subjects’ responsiveness to the hypertension intervention; and (iii to identify other SNPs that may help understand patient-specific responses to an intervention. We used a combination of candidate SNPs and genome-wide analyses to test associations with either baseline systolic blood pressure (SBP or change in systolic blood pressure one year after the intervention in two genetically defined ancestral groups: African Americans (AA and Caucasian Americans (CAU. Of the 48 candidate SNPs, 13 SNPs associated with baseline SBP in our study; however, one candidate SNP, rs592582, also associated with a change in SBP after one year. Using our study data, we identified 4 and 15 additional loci that associated with a change in SBP in the AA and CAU groups, respectively. Our analysis of gene-age interactions identified genotypes associated with SBP improvement within different age groups of our populations. Moreover, our integrative analysis identified AQP4-AS1 and PADI2 as genes whose expression levels may contribute to the pleiotropy of complex traits involved in cardiovascular health and blood pressure regulation in response to an intervention targeting hypertension. In conclusion, the identification of SNPs associated with the success of a hypertension treatment intervention suggests that genetic factors in combination with age may contribute to an individual’s success in lowering SBP. If these findings prove to be applicable to other populations, the use of this genetic variation in making patient-specific interventions may help providers with
Vafaee-Najar, Ali; Nejatzadegan, Zohreh; Pourtaleb, Arefeh; Kaffashi, Shahnaz; Vejdani, Marjan; Molavi-Taleghani, Yasamin; Ebrahimipour, Hosein
Following the implementation of family physician plan in rural areas, the quantity of provided services has been increased, but what leads on the next topic is the improvement in expected quality of service, as well. The present study aims at determining the gap between patients' expectation and perception from the quality of services provided by family physicians during the spring and summer of 2012. This was a cross-sectional study in which 480 patients who referred to family physician centers were selected with clustering and simple randomized method. Data were collected through SERVQUAL standard questionnaire and were analyzed with descriptive statistics, using statistical T-test, Kruskal-Wallis, and Wilcoxon signed-rank tests by SPSS 16 at a significance level of 0.05. The difference between the mean scores of expectation and perception was about -0.93, which is considered as statistically significant difference (P≤ 0.05). Also, the differences in five dimensions of quality were as follows: tangible -1.10, reliability -0.87, responsiveness -1.06, assurance -0.83, and empathy -0.82. Findings showed that there was a significant difference between expectation and perception in five concepts of the provided services (P≤ 0.05). There was a gap between the ideal situation and the current situation of family physician quality of services. Our suggestion is maintaining a strong focus on patients, creating a medical practice that would exceed patients' expectations, providing high-quality healthcare services, and realizing the continuous improvement of all processes. In both tangible and responsive, the gap was greater than the other dimensions. It is recommended that more attention should be paid to the physical appearance of the health center environment and the availability of staff and employees.
Huang, William Y; Rogers, John C; Nelson, Elizabeth A; Wright, Crystal C; Teal, Cayla R
Reflection after patient encounters is an important aspect of clinical learning. After our medical school instituted a reflection paper assignment for all clerkships, we wanted to learn about the types of encounters that students found meaningful on a family medicine clerkship and how they impacted students' learning. Family and Community Medicine Clerkship students completed a reflection paper after the clerkship, based on guidelines that were used for all clerkship reflection papers at our medical school. Two reviewers independently organized student responses into themes and then jointly prioritized common themes and negotiated any initial differences into other themes. A total of 272 reflection papers describing an actual learning moment in patient care were submitted during the study period of January 2011--December 2012. In describing actions performed, students most frequently wrote about aspects of patient-centered care such as listening to the patient, carefully assessing the patient's condition, or giving a detailed explanation to the patient. In describing effects of those actions, students wrote about what they learned about the patient-physician interaction, the trust that patients demonstrated in them, the approval they gained from their preceptors, and the benefits they saw from their actions. An important contribution of a family medicine clerkship is the opportunity for students to further their skills in patient-centered care and realize the outcomes of providing that type of care.
Full Text Available Background. Zambia is a nation of nine million people, and has too few physicians to meet the country’s health needs. Following the strategy of other sub-Saharan countries, Zambia has developed a training programme in family medicine to help improve the medical competencies of its physician workforce. A needs assessment was undertaken to better understand the landscape into which Zambian family medicine is being placed. Methods. In 2014, a nine-question survey in Likert-scale format was developed, validated, and then delivered to four stakeholder groups: (i practicing clinical physicians, (ii the general public, (iii the University of Zambia’s School of Medicine’s academic faculty and (iv medical students. The needs assessment was delivered through several different mechanisms: via web-based service, to respondents’ email addresses; in paper form, to population samples of convenience; and verbally, through face-to-face encounters. Results. The number of stakeholders from each group who responded to the needs assessment were: clinical physicians, 27; general public, 15; academic faculty, 14; and medical students, 31. Five of the nine survey statements achieved super-majority consensus, with >66% of stakeholders in each group agreeing. Two additional statements achieved a simple-majority consensus with >50% agreement within each stakeholder group. Conclusion. This survey suggests that there is a broad-based a priori understanding of family medicine in Zambia, and general agreement that its presence would be valuable to Zambia’s healthcare system.
Schmacke, Norbert; Müller, Veronika; Stamer, Maren
Homeopathy is one of the most frequently used areas of complementary and alternative medicine (CAM). Previous research has focused in particular on the pharmacological effectiveness of homeopathy. There is intense discussion among German family medical practitioners as to whether family medicine should adopt elements of homeopathy because of the popularity of this treatment method. For the first time in Germany, patients with chronic conditions were asked about their views on the medical care provided by homeopathic medical practitioners. The survey used questionnaire-based, semi-structured expert interviews, the contents of which were then analysed and summarised. A total of 21 women and five men aged from 29 to 75 years were surveyed. The 'fit' between therapist and patient proved to be particularly important. Both the initial homeopathic consultation and the process of searching for the appropriate medication were seen by patients as confidence-inspiring confirmations of the validity of homeopathic therapy which they considered desirable in this personalised form. The possible adoption by family medicine of elements of homeopathy may be seen as controversial, but this study again indicates the vital importance of successful communication to ensure a sustainable doctor-patient relationship. Advances in this sector not only require continuous efforts in the areas of medical training and professional development, but also touch on basic questions relating to the development of effective medical care, such as those currently being discussed in the context of the 'patient-centred medical home'.
Wu, Justine P; Bennett, Ian; Levine, Jeffrey P; Aguirre, Abigail Calkins; Bellamy, Scarlett; Fleischman, Joan
We aimed to assess the effect of an educational intervention on the interest in and support for abortion training among family medicine residents. We conducted a cross-sectional survey before and after an educational lecture on medical and surgical abortion in primary care among 89 residents in 10 New Jersey family medicine programs. Before the lecture, there was more interest in medical abortion training than surgical abortion. Resident interest in surgical abortion and overall support for abortion training increased after the educational intervention (p<.01). Efforts to develop educational programs on early abortion care may facilitate the integration of abortion training in family medicine.
Vernon-Feagans, Lynne; Cox, Martha
About 20% of children in the United States have been reported to live in rural communities, with child poverty rates higher and geographic isolation from resources greater than in urban communities. There have been surprisingly few studies of children living in rural communities, especially poor rural communities. The Family Life Project helped fill this gap by using an epidemiological design to recruit and study a representative sample of every baby born to a mother who resided in one of six poor rural counties over a 1-year period, oversampling for poverty and African American. 1,292 children were followed from birth to 36 months of age. This monograph described these children and used a cumulative risk model to examine the relation between social risk and children's executive functioning, language development, and behavioral competence at 36 months. Using both the Family Process Model of development and the Family Investment Model of development, observed parenting was examined over time in relation to child functioning at 36 months. Different aspects of observed parenting were examined as mediators/moderators of risk in predicting child outcomes. Results suggested that cumulative risk was important in predicting all three major domains of child outcomes and that positive and negative parenting and maternal language complexity were mediators of these relations. Maternal positive parenting was found to be a buffer for the most risky families in predicting behavioral competence. In a final model using both family process and investment measures, there was evidence of mediation but with little evidence of the specificity of parenting for particular outcomes. Discussion focused on the importance of cumulative risk and parenting in understanding child competence in rural poverty and the implications for possible intervention strategies that might be effective in maximizing the early development of these children.
Flávia dos Santos Silva
Full Text Available Human beings have accumulated rich experience with natural resources over time, but such knowledge can be strongly influenced by several factors, such as age, sex and occupation. This study focuses on the influence of these factors on knowledge of medicinal plants in a rural community in northeastern Brazil. Data were collected through semi-structured interviews with 102 people, with the number of plants and uses cited studied for quantitative analysis. Through this research, it was possible to show that the social variables studied (age, sex and informants occupation have contributed to the formation of different patterns of knowledge regarding medicinal resources. The results indicate that awareness of this dynamic is necessary for the proper implementation of projects where the goal is the sustainable use of natural resources (because it indicates the different levels of knowledge within a community, for studies intended to discover new drugs (because it indicates the peculiarities of certain groups, and for biodiversity conservation strategies.
Full Text Available Abstract Background Smoking rates among the general population in Bosnia and Herzegovina are extremely high, and national campaigns to lower smoking rates have not yet begun. As part of future activities of the Queen's University Family Medicine Development Program in the Balkans Region, technical assistance may be provided to Bosnia and Herzegovina to develop of national tobacco control strategies. This assistance may focus on training doctors and nurses on smoking cessation strategies with a view to helping their patients to stop smoking. Given this important role that health professionals have, data is needed on smoking rates as well as on smoking behaviour among doctors and nurses in Bosnia and Herzegovina. This study therefore seeks to determine the smoking rates and behaviour of family medicine physicians and nurses in Bosnia and Herzegovina and to determine how well prepared they feel with respect to counselling their patients on smoking cessation strategies. Methods The WHO Global Health Professional Survey, a self-administered questionnaire, was distributed to physicians and nurses in 19 Family Medicine Teaching Centres in Bosnia and Herzegovina in June 2002. Smoking rates and behaviour, as well as information on knowledge and attitudes regarding smoking were determined for both physicians and nurses. Results Of the 273 physicians and nurses currently working in Family Medicine Teaching Centres, 209 (77% completed the questionnaire. Approximately 45% of those surveyed currently smoke, where 51% of nurses smoked, compared to 40% of physicians. With respect to knowledge and attitudes, all respondents agreed that smoking is harmful to one's health. However, "ever" smokers, compared to "never" smokers, were less likely to agree that health professionals who smoke were less likely to advise patients to quit smoking than non-smoking health professionals. Less than half of physicians and nurses had received formal training in smoking
Hodgetts, Geoffrey; Broers, Teresa; Godwin, Marshall
Smoking rates among the general population in Bosnia and Herzegovina are extremely high, and national campaigns to lower smoking rates have not yet begun. As part of future activities of the Queen's University Family Medicine Development Program in the Balkans Region, technical assistance may be provided to Bosnia and Herzegovina to develop of national tobacco control strategies. This assistance may focus on training doctors and nurses on smoking cessation strategies with a view to helping their patients to stop smoking. Given this important role that health professionals have, data is needed on smoking rates as well as on smoking behaviour among doctors and nurses in Bosnia and Herzegovina. This study therefore seeks to determine the smoking rates and behaviour of family medicine physicians and nurses in Bosnia and Herzegovina and to determine how well prepared they feel with respect to counselling their patients on smoking cessation strategies. The WHO Global Health Professional Survey, a self-administered questionnaire, was distributed to physicians and nurses in 19 Family Medicine Teaching Centres in Bosnia and Herzegovina in June 2002. Smoking rates and behaviour, as well as information on knowledge and attitudes regarding smoking were determined for both physicians and nurses. Of the 273 physicians and nurses currently working in Family Medicine Teaching Centres, 209 (77%) completed the questionnaire. Approximately 45% of those surveyed currently smoke, where 51% of nurses smoked, compared to 40% of physicians. With respect to knowledge and attitudes, all respondents agreed that smoking is harmful to one's health. However, "ever" smokers, compared to "never" smokers, were less likely to agree that health professionals who smoke were less likely to advise patients to quit smoking than non-smoking health professionals. Less than half of physicians and nurses had received formal training in smoking cessations strategies, but about two thirds of health
Medicines can treat diseases and improve your health. If you are like most people, you need to take medicine at some point in your life. You may need to take medicine every day, or you may only need to ...
Kopčavar Guček, Nena; Petek, Davorina; Švab, Igor; Selič, Polona
In 1996 the World Health Organization declared intimate partner violence (IPV) the most important public health problem. Meta-analyses in 2013 showed every third female globally had been a victim of violence. Experts find screening controversial; family medicine is the preferred environment for identifying victims of violence, but barriers on both sides prevent patients from discussing it with doctors. In July 2014, a qualitative study was performed through semi-structured interviews with ten family doctors of different ages and gender, working in rural or urban environments. Sound recordings of the interviews were transcribed, and the record verified. The data were interpreted using content analysis. A coding scheme was developed and later verified and analysed by two independent researchers. The text of the interviews was analysed according to the coding scheme. Two coding schemes were developed: one for screening, and the other for the active detection of IPV. The main themes emerging as barriers to screening were lack of time, staff turnover, inadequate finance, ignorance of a clear definition, poor commitment to screening, obligatory follow-up, risk of deterioration of the doctor-patient relationship, and insincerity on the part of the patient. Additionally, cultural aspects of violence, uncertainty/ helplessness, fear, lack of competence and qualifications, autonomy/negative experience, and passive role/stigma/ fear on the part of the patients were barriers to active detection. All the participating doctors had had previous experience with active detection of IPV and were aware of its importance. Due to several barriers to screening for violence they preferred active detection.
KOPČAVAR GUČEK, Nena; PETEK, Davorina; ŠVAB, Igor; SELIČ, Polona
Introduction In 1996 the World Health Organization declared intimate partner violence (IPV) the most important public health problem. Meta-analyses in 2013 showed every third female globally had been a victim of violence. Experts find screening controversial; family medicine is the preferred environment for identifying victims of violence, but barriers on both sides prevent patients from discussing it with doctors. Methods In July 2014, a qualitative study was performed through semi-structured interviews with ten family doctors of different ages and gender, working in rural or urban environments. Sound recordings of the interviews were transcribed, and the record verified. The data were interpreted using content analysis. A coding scheme was developed and later verified and analysed by two independent researchers. The text of the interviews was analysed according to the coding scheme. Results Two coding schemes were developed: one for screening, and the other for the active detection of IPV. The main themes emerging as barriers to screening were lack of time, staff turnover, inadequate finance, ignorance of a clear definition, poor commitment to screening, obligatory follow-up, risk of deterioration of the doctor-patient relationship, and insincerity on the part of the patient. Additionally, cultural aspects of violence, uncertainty/ helplessness, fear, lack of competence and qualifications, autonomy/negative experience, and passive role/stigma/ fear on the part of the patients were barriers to active detection. Conclusion All the participating doctors had had previous experience with active detection of IPV and were aware of its importance. Due to several barriers to screening for violence they preferred active detection. PMID:27647084
Sano, Yoshie; Manoogian, Margaret M.; Ontai, Lenna L.
This qualitative study examined the nature of partnerships among 28 rural low-income mothers who experienced partnership transitions across three waves of annual interviews. Guided by "lens of uncertainty" and "boundary ambiguity theory," the authors specifically explored (a) how low-income mothers in rural communities experience partnership…
T S Anish
Full Text Available Background: The world is experiencing a pandemic of chikungunya which has swept across Indian Ocean and the Indian subcontinent. Kerala the southernmost state of India was affected by the chikungunya epidemic twice, first in 2006 and then in 2007. Kerala has got geography and climate which are highly favorable for the breeding of Aedes albopictus, the suspected vector. Aim: The aim of the study was to highlight the various domestic and environmental factors of the families affected by chikungunya in 2007 in Thiruvananthapuram district (rural of Kerala. Settings and design: This is a cross-sectional survey conducted in Thiruvananthapuram (rural district during November 2007. Materials and Methods : Samples were selected from field area under three Primary Health Centers. These areas represent the three terrains of the district namely the highland, midland, and lowland. The sample size was estimated to be 134 houses from each study area. The field area of health workers was selected as clusters and six subcenters from each primary health center were randomly selected (lot method. Results and Conclusions: The proportion of population affected by chikungunya fever is 39.9% (38.9-40.9%. The investigators observed water holding containers in the peri-domestic area of 95.6% of the houses. According to regression (binary logistic analysis, the area of residence [adjusted odds ratio (OR = 8.01 (6.06-14.60], residing in a non-remote area [adjusted OR=0.25 (0.16-0.38], perceived mosquito menace [adjusted OR=3.07 (2.31-4.64], and containers/tires outside the house [adjusted OR=5.61 (2.74-27.58] were the independent predictors of the occurrence of chikungunya in households.
Full Text Available To quantify the impact of service provider characteristics on young people's choice of family planning (FP service provider in rural Malawi in order to identify strategies for increasing access and uptake of FP among youth.A discrete choice experiment was developed to assess the relative impact of service characteristics on preferences for FP service providers among young people (aged 15-24. Four alternative providers were included (government facility, private facility, outreach and community based distribution of FP and described by six attributes (the distance between participants' home and the service delivery point, frequency of service delivery, waiting time at the facility, service providers' attitude, availability of FP commodities and price. A random parameters logit model was used to estimate preferences for service providers and the likely uptake of services following the expansion of outreach and community based distribution (CBDA services. In the choice experiment young people were twice as likely to choose a friendly provider (government service odds ratio [OR] = 2.45, p<0.01; private service OR = 1.99, p<0.01; CBDA OR = 1.88, p<0.01 and more than two to three times more likely to choose a provider with an adequate supply of FP commodities (government service OR = 2.48, p<0.01; private service OR = 2.33, p<0.01; CBDA = 3.85, p<0.01. Uptake of community based services was greater than facility based services across a variety of simulated service scenarios indicating that such services may be an effective means of expanding access for youth in rural areas and an important tool for increasing service uptake among youth.Ensuring that services are acceptable to young people may require additional training for service providers in order to ensure that all providers are friendly and non-judgemental when dealing with younger clients and to ensure that supplies are consistently available.
Diana Milena Soler Fonseca
Full Text Available In the rural municipality of Paipa, Boyaca many families rely on cattle breeding to obtain from this activity, suficient income and resources to meet their basic needs, however little is known about the true role of this species in the nourishment safety of rural families in the municipality of Paipa in Boyacá, for that reason, this study aimed to analyze the importance of general breeding cattle in the nourishment safety of thirty peasant families in the municipality of Paipa, Boyacá and get to know the social and cultural roles that are generated by this livestock activity. The obtained result was that the cale are raised as a second choice in the pursuit of economic resources, after the birds. In cattle production an average of five animals per farm are raised, the widely used breeds are the Normando, Holstein and crosses between them; milk production dominates with an average yield of 150 liters/week per family; income and costs production depend on the number of cattle raised, the gained income is used to purchase food for home, but savings are not encouraged; the consumption of dairy products is very low and beef cattle is not consumed within the household; animals management is in charge of all family members (both genders. In general, cattle farming make interesting economic contributions to the countryside families, but these revenues are used to purchase food of high nutritional value, also a2ecting the nourishment safety of the studied families.
Larson, Nicole; Wang, Qi; Berge, Jerica M; Shanafelt, Amy; Nanney, Marilyn S
Although existing evidence links breakfast frequency to better dietary quality, little is known specifically in regard to the benefits associated with eating breakfast together with one's family. The present study describes the prevalence and experience of having family meals at breakfast among rural families and examines associations between meal frequency and adolescent diet quality. Data were drawn from Project BreakFAST, a group-randomized trial aimed at increasing school breakfast participation in rural Minnesota high schools, USA. Linear mixed models were used to examine associations between student reports of family breakfast frequency and Healthy Eating Index 2010 (HEI-2010) scores while accounting for clustering within schools, demographics and household food security. Adolescent students from sixteen schools completed online surveys, height and weight measurements, and dietary recalls at baseline in 2012-2014. The sample included 827 adolescents (55·1 % girls) in grades 9-10 who reported eating breakfast on at most three days per school week. On average, adolescents reported eating breakfast with their family 1·3 (sd 1·9) times in the past week. Family breakfast meals occurred most frequently in the homes of adolescents who reported a race other than white (P=0·002) or Hispanic ethnicity (P=0·02). Family breakfast frequency was directly associated with adolescent involvement in preparing breakfast meals (Pfood patterns at breakfast. Additional research is needed to better inform and evaluate strategies.
Lima, Crislaine Alves Barcellos de; Lima, Ângela Roberta Alves; Mendonça, Cledenir Vergara; Lopes, Caroline Vasconcellos; Heck, Rita Maria
To understand the use of medicinal plants and the role of faith in the family care system. The adopted methodology is qualitative research, conducted in April and July 2015, in a municipality of Rio Grande do Sul, Brazil, Brazil, with three informants who have knowledge of the healthcare practices. The data were interpreted using interpretive anthropology. Data interpretation led to two categories: Medicinal plants in health care and Care with the use of plants in the blessing ritual. It was identified that the use of plants and faith healing is a particular form of self-care in that given community. The purpose of this practice is to cure people from a biological and comprehensive perspective, involving the body, soul, spirit, and environment. The research revealed that medicinal plants go beyond the merely biological relationship in the family care system. Use of these plants is not based on the principle of buying and selling, but rather on the act of exchanging, giving, receiving, and reciprocating.
Predictors of patient satisfaction for Brooke Army Medical Center Family Medicine Service primary care clinics was performed. Data was obtained from...Factors Affecting Patient Satisfaction in Family Medicine Service Clinics at Brooke Army Medical Center Presented to MAJ Eric Schmacker, Ph.D. In...study. All patients ’ medical information was protected at all times and under no circumstances will be discussed or released to any outside agency
Lacasse, Miriam; Ratnapalan, Savithiri
To review the literature on teaching-skills training programs for family medicine residents and to identify formats and content of these programs and their effects. Ovid MEDLINE (1950 to mid-July 2008) and the Education Resources Information Center database (pre-1966 to mid-July 2008) were searched using and combining the MeSH terms teaching, internship and residency, and family practice; and teaching, graduate medical education, and family practice. The initial MEDLINE and Education Resources Information Center database searches identified 362 and 33 references, respectively. Titles and abstracts were reviewed and studies were included if they described the format or content of a teaching-skills program or if they were primary studies of the effects of a teaching-skills program for family medicine residents or family medicine and other specialty trainees. The bibliographies of those articles were reviewed for unidentified studies. A total of 8 articles were identified for systematic review. Selection was limited to articles published in English. Teaching-skills training programs for family medicine residents vary from half-day curricula to a few months of training. Their content includes leadership skills, effective clinical teaching skills, technical teaching skills, as well as feedback and evaluation skills. Evaluations mainly assessed the programs' effects on teaching behaviour, which was generally found to improve following participation in the programs. Evaluations of learner reactions and learning outcomes also suggested that the programs have positive effects. Family medicine residency training programs differ from all other residency training programs in their shorter duration, usually 2 years, and the broader scope of learning within those 2 years. Few studies on teaching-skills training, however, were designed specifically for family medicine residents. Further studies assessing the effects of teaching-skills training in family medicine residents are
Moosa, Shabir; Mash, Bob; Derese, Anselme; Peersman, Wim
Integrated team-based primary care is an international imperative. This is required more so in Africa, where fragmented verticalised care dominates. South Africa is trying to address this with health reforms, including Primary Health Care Re-engineering. Family physicians are already contributing to primary care despite family medicine being only fully registered as a full specialty in South Africa in 2008. However the views of leaders on family medicine and the role of family physicians is not clear, especially with recent health reforms. The aim of this study was to understand the views of key government and academic leaders in South Africa on family medicine, roles of family physicians and human resource issues. This was a qualitative study with academic and government leaders across South Africa. In-depth interviews were conducted with sixteen purposively selected leaders using an interview guide. Thematic content analysis was based on the framework method. Whilst family physicians were seen as critical to the district health system there was ambivalence on their leadership role and 'specialist' status. National health reforms were creating both threats and opportunities for family medicine. Three key roles for family physicians emerged: supporting referrals; clinical governance/quality improvement; and providing support to community-oriented care. Respondents' urged family physicians to consolidate the development and training of family physicians, and shape human resource policy to include family physicians. Family physicians were seen as critical to the district health system in South Africa despite difficulties around their precise role. Whilst their role was dominated by filling gaps at district hospitals to reduce referrals it extended to clinical governance and developing community-oriented primary care - a tall order, requiring strong teamwork. Innovative team-based service delivery is possible despite human resource challenges, but requires family
Unverzagt, Mark; Wallerstein, Nina; Benson, Jeffrey A; Tomedi, Angelo; Palley, Toby B
A population health curriculum using methodologies from community-oriented primary care (COPC) was developed in 1994 as part of a required third-year family medicine clerkship at the University of New Mexico. The curriculum integrates population health/community medicine projects and problem-based tutorials into a community-based, ambulatory clinical experience. By combining a required population health experience with relevant clinical training, student careers have the opportunity to be influenced during the critical third year. Results over a 7-year period describe a three-phase evolution of the curriculum, within the context of changes in medical education and in health care delivery systems in that same period of time. Early evaluation revealed that students viewed the curricular experience as time consuming and peripheral to their training. Later comments on the revised curriculum showed a higher regard for the experience that was described as important for student learning.
Malatskey, Lilach; Bar Zeev, Yael; Tzuk-Onn, Adva; Polak, Rani
The WHO estimates that by 2020 two-thirds of the diseases worldwide will be the result of unhealthy lifestyle habits. Less than half of primary care physician graduates feel prepared to give lifestyle behaviour counselling. Our objective was to evaluate the impact of lifestyle medicine (LM) course on self-reported knowledge, attitudes, self-efficacy and health behaviour of family medicine residents. Based on the Israeli syllabus for the study of LM, we delivered five face to face 20 H courses. Pre/post data were collected by knowledge, attitudes, self-efficacy and personal health survey: RESULTS: A total of 112 family medicine residents participated in one of the five courses, of which 91 (81.3%) filled both pre and post surveys. Participates showed an improvement in self-reported knowledge and capacity to manage patients in regard to smoking, weight management and physical activity. An improvement was noted in personal health behaviour of overweight participant's in regard to self-reported physical activity. A comprehensive LM syllabus based course has a positive impact on family medicine residents LM counselling abilities. We suggest that LM course should be considered as a potential permanent addition to the family medicine residency programme. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Akl, Elie A; Gunukula, Sameer; Mustafa, Reem; Wilson, Mark C; Symons, Andrew; Moheet, Amir; Schünemann, Holger J
The evidence supporting the effectiveness of educational games in graduate medical education is limited. Anecdotal reports suggest their popularity in that setting. The objective of this study was to explore the support for and the different aspects of use of educational games in family medicine and internal medicine residency programs in the United States. We conducted a survey of family medicine and internal medicine residency program directors in the United States. The questionnaire asked the program directors whether they supported the use of educational games, their actual use of games, and the type of games being used and the purpose of that use. Of 434 responding program directors (52% response rate), 92% were in support of the use of games as an educational strategy, and 80% reported already using them in their programs. Jeopardy like games were the most frequently used games (78%). The use of games was equally popular in family medicine and internal medicine residency programs and popularity was inversely associated with more than 75% of residents in the program being International Medical Graduates. The percentage of program directors who reported using educational games as teaching tools, review tools, and evaluation tools were 62%, 47%, and 4% respectively. Given a widespread use of educational games in the training of medical residents, in spite of limited evidence for efficacy, further evaluation of the best approaches to education games should be explored.
Wilson Mark C
Full Text Available Abstract Background The evidence supporting the effectiveness of educational games in graduate medical education is limited. Anecdotal reports suggest their popularity in that setting. The objective of this study was to explore the support for and the different aspects of use of educational games in family medicine and internal medicine residency programs in the United States. Methods We conducted a survey of family medicine and internal medicine residency program directors in the United States. The questionnaire asked the program directors whether they supported the use of educational games, their actual use of games, and the type of games being used and the purpose of that use. Results Of 434 responding program directors (52% response rate, 92% were in support of the use of games as an educational strategy, and 80% reported already using them in their programs. Jeopardy like games were the most frequently used games (78%. The use of games was equally popular in family medicine and internal medicine residency programs and popularity was inversely associated with more than 75% of residents in the program being International Medical Graduates. The percentage of program directors who reported using educational games as teaching tools, review tools, and evaluation tools were 62%, 47%, and 4% respectively. Conclusions Given a widespread use of educational games in the training of medical residents, in spite of limited evidence for efficacy, further evaluation of the best approaches to education games should be explored.
Blusi, Madeleine; Asplund, Kenneth; Jong, Mats
The aim of this intervention study was to illuminate the meaning of ICT-based caregiver support as experienced by older family carers living in vast rural areas, caring for a spouse at home. In order to access, the support service participants were provided with a computer and high speed Internet in their homes. Semi structured webcam-interviews were carried out with 31 family carers. A strategy for webcam interviewing was developed to ensure quality and create a comfortable interview situation for the family carers. Interviews were analysed using content analyses, resulting in the themes: Adopting new technology with help from others and Regaining social inclusion . The results indicate that ICT-based support can be valuable for older family carers in rural areas as it contributes to improve quality in daily life in a number of ways. In order to fully experience the benefits, family carers need to be frequent users of the provided support. Adequate training and encouragement from others were essential in motivating family carers to use the support service. Access to Internet and webcamera contributed to reducing loneliness and isolation, strengthening relationships with relatives living far away and enabled access to services no longer available in the area. Use of the ICT-service had a positive influence on the relationship between the older carer and adult grandchildren. It also contributed to carer competence and promote feelings of regaining independence and a societal role.
Sy, Alice; Wong, Eric; Boisvert, Leslie
To determine family medicine residents' learning behaviour and preferences outside of clinical settings in order to help guide the development of an effective academic program that can maximize their learning. Retrospective descriptive analysis of academic learning logs submitted by residents as part of their academic training requirements between 2008 and 2011. London, Ont. All family medicine residents at Western University who had completed their academic program requirements (N = 72) by submitting 300 or more credits (1 credit = 1 hour). Amount of time spent on various learning modalities, location where the learning took place, resources used for self-study, and the objective of the learning activity. A total of 72 residents completed their academic requirements during the study period and logged a total of 25 068 hours of academic learning. Residents chose to spend most of their academic time engaging in self-study (44%), attending staff physicians' teaching sessions (20%),and participating in conferences, courses, or workshops (12%) and in postgraduate medical education sessions (12%). Textbooks (26%), medical journals (20%), and point-of-care resources (12%) were the 3 most common resources used for self-study. The hospital (32%), residents' homes (32%),and family medicine clinics (14%) were the most frequently cited locations where academic learning occurred. While all physicians used a variety of educational activities, most residents (67%) chose self-study as their primary method of learning. The topic for academic learning appeared to have some influence on the learning modalities used by residents. Residents used a variety of learning modalities and chose self-study over other more traditional modalities (eg, lectures) for most of their academic learning. A successful academic program must take into account residents' various learning preferences and habits while providing guidance and training in the use of more effective learning methods and
Cawse-Lucas, Jeanne; Evans, David V; Ruiz, David R; Allcut, Elizabeth A; Andrilla, C Holly A; Thompson, Matthew; Norris, Thomas E
The Medicare Primary Care Exception (PCE) allows residents to see and bill for less-complex patients independently in the primary care setting, requiring attending physicians only to see patients for higher-level visits and complete physical exams in order to bill for them as such. Primary care residencies apply the PCE in various ways. We investigated the impact of the PCE on resident coding practices. Family medicine residency directors in a five-state region completed a survey regarding interpretation and application of the PCE, including the number of established patient evaluation and management codes entered by residents and attending faculty at their institution. The percentage of high-level codes was compared between residencies using chi-square tests. We analyzed coding data for 125,016 visits from 337 residents and 172 faculty physicians in 15 of 18 eligible family medicine residencies. Among programs applying the PCE criteria to all patients, residents billed 86.7% low-mid complexity and 13.3% high-complexity visits. In programs that only applied the PCE to Medicare patients, residents billed 74.9% low-mid complexity visits and 25.2% high-complexity visits. Attending physicians coded more high-complexity visits at both types of programs. The estimated revenue loss over the 1,650 RRC-required outpatient visits was $2,558.66 per resident and $57,569.85 per year for the average residency in our sample. Residents at family medicine programs that apply the PCE to all patients bill significantly fewer high-complexity visits. This finding leads to compliance and regulatory concerns and suggests significant revenue loss. Further study is required to determine whether this discrepancy also reflects inaccuracy in coding.
Broughton, Edward Ivor; Hameed, Waqas; Gul, Xaher; Sarfraz, Shabnum; Baig, Imam Yar; Villanueva, Monica
This study reports on the effectiveness and efficiency from the program funder's perspective of the Suraj Social Franchise (SSF) voucher program in which private health-care providers in remote rural areas were identified, trained, upgraded, and certified to deliver family planning services to underserved women of reproductive age in 29 districts of Sindh and 3 districts of Punjab province, Pakistan between October 2013 and June 2016. A decision tree compared the cost of implementing SSF to the program funder and its effects of providing additional couple years of protection (CYPs) to targeted women, compared to business-as-usual. Costs included vouchers given to women to receive a free contraceptive method of their choice from the SSF provider. The vouchers were then reimbursed to the SSF provider by the program. A total of 168,206 married women of reproductive age (MWRA) received SSF vouchers between October 2013 and June 2016, costing $3,278,000 ($19.50/recipient). The average effectiveness of the program per voucher recipient was an additional 1.66 CYPs, giving an incremental cost-effectiveness of the program of $4.28 per CYP compared to not having the program (95% CI: $3.62-5.31). The result compares favorably to other interventions with similar objectives and appears affordable for the Pakistan national health-care system. It is therefore recommended to help address the unmet need for contraception among MWRA in these areas of Pakistan and is worthy of trial implementation in the country more widely.
Baraka, Jitihada; Rusibamayila, Asinath; Kalolella, Admirabilis; Baynes, Colin
Provider perspectives have been overlooked in efforts to address the challenges of unmet need for family planning (FP). This qualitative study was undertaken in Tanzania, using 22 key informant interviews and 4 focus group discussions. The research documents perceptions of healthcare managers and providers in a rural district on the barriers to meeting latent demand for contraception. Social-ecological theory is used to interpret the findings, illustrating how service capability is determined by the social, structural and organizational environment. Providers' efforts to address unmet need for FP services are constrained by unstable reproductive preferences, low educational attainment, and misconceptions about contraceptive side effects. Societal and organizational factors--such as gender dynamics, economic conditions, religious and cultural norms, and supply chain bottlenecks, respectively--also contribute to an adverse environment for meeting needs for care. Challenges that healthcare providers face interact and produce an effect which hinders efforts to address unmet need. Interventions to address this are not sufficient unless the supply of services is combined with systems strengthening and social engagement strategies in a way that reflects the multi-layered, social institutional problems.
Grant, Monica J; Yeatman, Sara
Despite the frequency of divorce and remarriage across much of sub-Saharan Africa, little is known about what these events mean for the living arrangements of children. We use longitudinal data from rural Malawi to examine the effects of family transitions on the prevalence and incidence of child fostering, or children residing apart from their living parents. We find that between 7 % and 15 % of children aged 3-14 are out-fostered over the two-year intersurvey period. Although divorce appears to be a significant driver of child fostering in the cross-sectional analysis, it is not significantly associated with the incidence of out-fostering. In contrast, maternal remarriage has both a lagged and an immediate effect on the incidence of out-fostering. Furthermore, the likelihood of out-fostering is even higher among children whose mother remarried and had a new child during the intersurvey period. Using longitudinal data collected from living mothers rather than from children's current foster homes offers new insights into the reasons children are sent to live with others besides their parents.
Weel, C. van; Rosser, W.W.
An invitational conference led by the World Organization of Family Doctors (Wonca) involving selected delegates from 34 countries was held in Kingston, Ontario, Canada, March 8 to12, 2003. The conference theme was "Improving Health Globally: The Necessity of Family Medicine Research." Guiding
Cohidon, Christine; Senn, Nicolas
During the last two decades in Europe, the scope of activities regarding chronic diseases management in family medicine has increased while technical activities and preventative care have decreased. A new literature review and meta-analysis confirms that the use of electronic health records improves the quality of care. In the field of interprofessionnality, the task delegation in chronic care management to nurses or medical assistants is a source of satisfaction for these professionals. At the same time, this could improve patients' quality of life. Finally, a systematic literature review reports the major assets according to the family physicians regarding their occupation i.e. freedom to organize and manage their own work, good balance between workload and income and high intellectual stimulation.
Madsen, Mia; Andersen, Per Kragh; Gerster, Mette
OBJECTIVES: Although well established, the association between socioeconomic position and health and health behaviour is not clearly understood, and it has been speculated that familial factors, for example, dispositional factors or exposures in the rearing environment, may be underlying the asso......OBJECTIVES: Although well established, the association between socioeconomic position and health and health behaviour is not clearly understood, and it has been speculated that familial factors, for example, dispositional factors or exposures in the rearing environment, may be underlying...... and the Danish Registry of Medicinal Product statistics. A total of 8582 monozygotic (MZ) and 15 788 dizygotic same sex (DZSS) twins were included. OUTCOME MEASURES: Number of prescription fillings during follow-up (1995-2005) was analysed according to education and income. Results of unpaired and intrapair...
Vaona, Alberto; Del Zotti, Franco; Girotto, Sandro; Marafetti, Claudio; Rigon, Giulio; Marcon, Alessandro
Studies on data collection and quality of care in Italian family medicine are lacking. The aim of this study was to assess the completeness of data collection of patients with diabetes in a large sample of family physicians in the province of Verona, Veneto region, a benchmark for the Italian National Health System. We extracted the data on all the patients with diabetes from the electronic health records of 270 family physicians in 2006 and 2009. We reported the percentage of patients with data recorded for 12 indicators of performance derived from the National Institute for Clinical Excellence diabetes guidelines. Secondarily, we assessed quality of care using the Q-score (the lower the score, the greater the risk of cardiovascular events). Patients with diabetes were 18,507 in 2006 and 20,744 in 2009, and the percentage of patients registered as having diabetes was 4.9% and 5.4% of the total population, respectively (p Data collection improved for all the indicators between 2006 and 2009 but the performance was still low at the end of the study period: patients with no data recorded were 42% in 2006 and 32% in 2009, while patients with data recorded for ≥5 indicators were 9% in 2006 and 17% in 2009. The Q-score improved (mean ± SD, 20.7 ± 3.0 in 2006 vs 21.3 ± 3.6 in 2009, p data collection and quality of care for patients with diabetes during the study period. Nonetheless, data collection was still unsatisfactory in comparison with international benchmarks in 2009. Structural interventions in the organization of family medicine, which have not been implemented since the study period, should be prioritised in Italy.
Lou, Vivian W Q; Lu, Nan; Xu, Ling; Chi, Iris
This study tested the relationship between grandparent-grandchild family capital and self-rated health of older rural Chinese adults and the mediating role of the grandparent-parent relationship in terms of grandparent-grandchild family capital and self-rated health. Data were derived from a random sample of 1,027 adults aged 60 and older who were interviewed in the rural Chaohu region in 2009. Structural equation modeling was used to examine the direct effect of grandparent-grandchild family capital in terms of relations with the first child's family on self-rated health among respondents, as well as the mediating effect of the grandparent-parent relationship. The results showed the direct effect of grandparent-grandchild family capital on self-rated health of older rural Chinese adults. The grandparent-parent relationship had a partial mediation effect on the relationship between grandparent-grandchild family capital and self-rated health of respondents. Grandparent-grandchild family capital had a unique direct effect on the self-rated health of older rural Chinese adults, enriching our theoretical understanding of sources of family capital and their impacts in a collectivist cultural context that emphasizes intergenerational interaction and exchange. The findings also highlighted the mediation effects of grandparent-parent relationships on the relationship between grandparent-grandchild family capital and self-rated health of older rural Chinese adults, supporting the "grandchild-as-linkage" hypothesis in understanding the social determination of self-rated health in China.
Barr, Wendy B; Tong, Sebastian T; LeFevre, Nicholas M
Group prenatal care has been shown to improve both maternal and neonatal outcomes. With increasing adaption of group prenatal care by family medicine residencies, this model may serve as a potential method to increase exposure to and interest in maternity care among trainees. This study aims to describe the penetration, regional and program variations, and potential impacts on future maternity care practice of group prenatal care in US family medicine residencies. The CAFM Educational Research Alliance (CERA) conducted a survey of all US family medicine residency program directors in 2013 containing questions about maternity care training. A secondary data analysis was completed to examine relevant data on group prenatal care in US family medicine residencies and maternity care practice patterns. 23.1% of family medicine residency programs report provision of group prenatal care. Programs with group prenatal care reported increased number of vaginal deliveries per resident. Controlling for average number of vaginal deliveries per resident, programs with group prenatal care had a 2.35 higher odds of having more than 10% of graduates practice obstetrics and a 2.93 higher odds of having at least one graduate in the past 5 years enter an obstetrics fellowship. Residency programs with group prenatal care models report more graduates entering OB fellowships and practicing maternity care. Implementing group prenatal care in residency training can be one method in a multifaceted approach to increasing maternity care practice among US family physicians.
Sururu, Cherifa; Mash, Robert
Strengthening primary health care (PHC) is a priority for all effective health systems, and family physicians are seen as a key member of the PHC team. Zimbabwe has joined a number of African countries that are seriously considering the introduction of postgraduate family medicine training. Implementation of training, however, has not yet happened. To explore the views of key stakeholders on the introduction of postgraduate family medicine training. Key academic, governmental and professional stakeholders in Zimbabwean health and higher education systems. Twelve semi-structured interviews were conducted with purposively selected key stakeholders. Data were recorded, transcribed and analysed using the framework method. Anticipated benefits: More effective functioning of PHC and district health services with reduced referrals, improved access to more comprehensive services and improved clinical outcomes. Opportunities: International trend towards family medicine training, government support, availability of a small group of local trainers, need to revise PHC policy. Anticipated barriers: Family medicine is unattractive as a career choice because it is largely unknown to newly qualified doctors and may not be recognised in private sector. There is concern that advocacy is mainly coming from the private sector. Threats: Economic conditions, poor remuneration, lack of funding for resources and new initiatives, resistance from other specialists in private sector. Stakeholders anticipated significant benefits from the introduction of family medicine training and identified a number of opportunities that support this, but also recognised the existence of major barriers and threats to successful implementation.
Yao, Qiang; Liu, Chaojie; Ferrier, J Adamm; Liu, Zhiyong; Sun, Ju
To assess the impact of the National Essential Medicines Scheme (NEMS) with respect to urban-rural inequalities regarding drug prescriptions in primary care facilities. A stratified two-stage random sampling strategy was used to sample 23,040 prescriptions from 192 primary care facilities from 2009 to 2010. Difference-in-Difference (DID) analyses were performed to test the association between NEMS and urban-rural gaps in prescription patterns. Between-Group Variance and Theil Index were calculated to measure urban-rural absolute and relative disparities in drug prescriptions. The use of the Essential Medicines List (EML) achieved a compliance rate of up to 90% in both urban and rural facilities. An overall reduction of average prescription cost improved economic access to drugs for patients in both areas. However, we observed an increased urban-rural disparity in average expenditure per prescription. The rate of antibiotics and glucocorticoids prescription remained high, despite a reduced disparity between urban and rural facilities. The average incidence of antibiotic prescription increased slightly in urban facilities (62 to 63%) and reduced in rural facilities (67% to 66%). The urban-rural disparity in the use of parenteral administration (injections and infusions) increased, albeit at a high level in both areas (44%-52%). NEMS interventions are effective in reducing the overall average prescription costs. Despite the increased use of the EML, indicator performances with respect to rational drug prescribing and use remain poor and exceed the WHO/INRUD recommended cutoff values and worldwide benchmarks. There is an increased gap between urban and rural areas in the use of parenteral administration and expenditure per prescription.
Buck-McFadyen, Ellen V
More than 1 in 10 Canadians experience food insecurity, and a growing number of families rely on food banks each month. This ethnographic study aimed to give voice to rural families about their experiences with food insecurity while situating the findings within the broader social, political and economic context. Semi-structured interviews were conducted with women who had children living at home, and interviewer observations within the food bank were recorded as field notes. Content analysis was combined with the constant comparison method of data analysis to identify common themes regarding the experience of living with food insecurity and the influence of public policy. Seven female participants described the emotional toll that food insecurity had on their well-being and relationships, with stress and depression common to many women. Strategies used to stretch resources included cooking from scratch, growing produce, stocking up on sale items, hunting and fishing, and paying half-bills. Many participants described going without food so that their children could eat first, and three participants went without prescription medications. Rurality and social programs were identified as both supports and barriers to overcoming food insecurity. Participants in this study were highly skilled in attempting to feed their families with limited resources, although this proved inadequate to overcome their food insecurity. This highlights the need for policy initiatives to address the root causes of food insecurity and health inequities, including access to rural employment and high-quality child care, drug benefits and guaranteed annual income programs.
Al-Taee Waleed G
Full Text Available Abstract Background The inclusion of family medicine in medical school curricula is essential for producing competent general practitioners. The aim of this study is to evaluate a task-based, community oriented teaching model of family medicine for undergraduate students in Iraqi medical schools. Methods An innovative training model in family medicine was developed based upon tasks regularly performed by family physicians providing health care services at the Primary Health Care Centre (PHCC in Mosul, Iraq. Participants were medical students enrolled in their final clinical year. Students were assigned to one of two groups. The implementation group (28 students was exposed to the experimental model and the control group (56 students received the standard teaching curriculum. The study took place at the Mosul College of Medicine and at the Al-Hadba PHCC in Mosul, Iraq, during the academic year 1999–2000. Pre- and post-exposure evaluations comparing the intervention group with the control group were conducted using a variety of assessment tools. Results The primary endpoints were improvement in knowledge of family medicine and development of essential performance skills. Results showed that the implementation group experienced a significant increase in knowledge and performance skills after exposure to the model and in comparison with the control group. Assessment of the model by participating students revealed a high degree of satisfaction with the planning, organization, and implementation of the intervention activities. Students also highly rated the relevancy of the intervention for future work. Conclusion A model on PHCC training in family medicine is essential for all Iraqi medical schools. The model is to be implemented by various relevant departments until Departments of Family medicine are established.
Anderson Gregory J
Full Text Available Abstract Background. Prevention of pre-hypertension is an important goal for primary care patients. Obesity is a risk factor for hypertension, but has not been addressed for pre-hypertension in primary care populations. The objective of this study was to assess the degree to which obesity independently is associated with risk for pre-hypertension in family medicine patients. Methods. This study was a retrospective analysis of information abstracted from medical records of 707 adult patients. Multivariable logistic regression was used to test the relationship between body mass index (BMI and pre-hypertension, after adjustment for comorbidity and demographic characteristics. Pre-hypertension was defined as systolic pressure between 120 and 139 mm Hg or diastolic pressure between 80 and 89 mm Hg. Results. In our sample, 42.9% of patients were pre-hypertensive. Logistic regression analysis revealed that, in comparison to patients with normal body mass, patients with BMI > 35 had higher adjusted odds of being pre-hypertensive (OR = 4.5, CI 2.55–8.11, p Conclusion. In our sample of family medicine patients, elevated BMI is a risk factor for pre-hypertension, especially BMI > 35. This relationship appears to be independent of age, gender, marital status and comorbidity. Weight loss intervention for obese patients, including patient education or referral to weight loss programs, might be effective for prevention of pre-hypertension and thus should be considered as a potential quality indicator.
Elder, Nancy C; Tobias, Barbara; Lucero-Criswell, Amber; Goldenhar, Linda
Compared to verbal communication, teaching the skill of observation is often shortchanged in medical education. Through a family medicine-art museum collaboration, we developed an elective course for second-year medical students titled the "Art of Observation" (AOO). To evaluate the course's effect on clinical skills, we performed a qualitative evaluation of former students during their clinical rotations. In the spring of 2005, all students who had completed the AOO course in 2003 or 2004 were invited to take part in an online evaluation consisting of eight journaling survey questions. Students were instructed to answer the survey questions with specific examples. Question areas included the most memorable experience, the course's influence on the doctor-patient relationship, usefulness during clinical years of medical school, and skills unique to AOO. The anonymous data were analyzed qualitatively, coding the responses to categories derived from the data, leading to the formation of themes. Of the 19 students eligible, 17 participated. We found three important themes: (1) the AOO positively influenced clinical skills, (2) both art museum exercises and a clinical preceptorship were necessary to achieve those skills, and (3) the AOO led to a sense of personal development as a physician. In addition, students told us that the training in observation and description skills they learned were unique to the AOO. This collaboration between a department of family medicine and an art museum produced a course that facilitated observational skills used in successful doctor-patient relationships.
Runyan, Christine; Savageau, Judith A; Potts, Stacy; Weinreb, Linda
Up to 60% of practicing physicians report symptoms of burnout, which often peak during residency. Residency is also a relevant time for habits of self-care and resiliency to be emphasized. A growing literature underscores the importance of this; however, evidence about effective burnout prevention curriculum during residency remains limited. The purpose of this project is to evaluate the impact of a new, 1-month wellness curriculum for 12 second-year family medicine residents on burnout, empathy, stress, and self-compassion. The pilot program, introduced during a new rotation emphasizing competencies around leadership, focused on teaching skills to cultivate mindfulness and self-compassion in order to enhance empathy and reduce stress. Pre-assessments and 3-month follow-up assessments on measures of burnout, empathy, self-compassion, and perceived stress were collected to evaluate the impact of the curriculum. It was hypothesized that this curriculum would enhance empathy and self-compassion as well as reduce stress and burnout among family medicine residents. Descriptive statistics revealed positive trends on the mean scores of all the measures, particularly the Mindfulness Scale of the Self-Compassion Inventory and the Jefferson Empathy Scale. However, the small sample size and lack of sufficient power to detect meaningful differences limited the use of inferential statistics. This feasibility study demonstrates how a residency wellness curriculum can be developed, implemented, and evaluated with promising results, including high participant satisfaction.
Falcone, John L; Middleton, Donald B
The Accreditation Council for Graduate Medical Education (ACGME) sets residency performance standards for the American Board of Family Medicine Certification Examination. This study aims are to describe the compliance of residency programs with ACGME standards and to determine whether residency pass rates depend on program size and location. In this retrospective cohort study, residency performance from 2007 to 2011 was compared with the ACGME performance standards. Simple linear regression was performed to see whether program pass rates were dependent on program size. Regional differences in performance were compared with χ(2) tests, using an α level of 0.05. Of 429 total residency programs, there were 205 (47.8%) that violate ACGME performance standards. Linear regression showed that program pass rates were positively correlated and dependent on program size (P family medicine training programs do not meet the ACGME examination performance standards. Pass rates are associated with residency program size, and regional variation occurs. These findings have the potential to affect ACGME policy and residency program application patterns.
Rodríguez-Cogollo, R; Paredes-Alvarado, I R; Galicia-Flores, T; Barrasa-Villar, J I; Castán-Ruiz, S
having an appropriate patient safety culture is the first recommendation to improve it. The aim of this article is to determine the safety culture in family medicine residents and then to identify improvement strategies. an online cross-sectional survey of residents in family medicine teaching units of Aragon using the translated, validated and adapted to Spanish, Medical Office Survey on Patient Safety Culture (MOSPS) questionnaire. The results were grouped in 12-dimensional responses for analysis, and the mean value of each dimension was calculated. Perceptions were described by Percentages of Positive (PRP) and Negative Responses (PRN) to each dimension. positive results were seen in «the Patient Care Tracking/Follow-up». There were significant differences in the «Information Exchange With Other Settings», «Staff Training» and «Overall Perceptions of Patient Safety and Quality». Study participants viewed «Work Pressure and Pace» negatively. the institutions providing health services, as well as their staff, are increasingly aware of the importance of improving Patient Safety, and the results of this study allowed us to present information that helps identify weaknesses, and to design initiatives and strategies to improve care practices. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.
Full Text Available Background: Up to 60% of practicing physicians report symptoms of burnout, which often peak during residency. Residency is also a relevant time for habits of self-care and resiliency to be emphasized. A growing literature underscores the importance of this; however, evidence about effective burnout prevention curriculum during residency remains limited. Objectives: The purpose of this project is to evaluate the impact of a new, 1-month wellness curriculum for 12 second-year family medicine residents on burnout, empathy, stress, and self-compassion. Methods: The pilot program, introduced during a new rotation emphasizing competencies around leadership, focused on teaching skills to cultivate mindfulness and self-compassion in order to enhance empathy and reduce stress. Pre-assessments and 3-month follow-up assessments on measures of burnout, empathy, self-compassion, and perceived stress were collected to evaluate the impact of the curriculum. It was hypothesized that this curriculum would enhance empathy and self-compassion as well as reduce stress and burnout among family medicine residents. Results: Descriptive statistics revealed positive trends on the mean scores of all the measures, particularly the Mindfulness Scale of the Self-Compassion Inventory and the Jefferson Empathy Scale. However, the small sample size and lack of sufficient power to detect meaningful differences limited the use of inferential statistics. Conclusions: This feasibility study demonstrates how a residency wellness curriculum can be developed, implemented, and evaluated with promising results, including high participant satisfaction.
Ashkin, Evan A; Newton, Warren P; Toomey, Brian; Lingley, Ronald; Page, Cristen P
Expanding residency training programs to address shortages in the primary care workforce is challenged by the present graduate medical education (GME) environment. The Medicare funding cap on new GME positions and reductions in the Health Resources and Services Administration (HRSA) Teaching Health Center (THC) GME program require innovative solutions to support primary care residency expansion. Sparse literature exists to assist in predicting the actual cost of incremental expansion of a family medicine residency program without federal or state GME support. In 2011 a collaboration to develop a community health center (CHC) academic medical partnership (CHAMP), was formed and created a THC as a training site for expansion of an existing family medicine residency program. The cost of expansion was a critical factor as no Federal GME funding or HRSA THC GME program support was available. Initial start-up costs were supported by a federal grant and local foundations. Careful financial analysis of the expansion has provided actual costs per resident of the incremental expansion of the residencyRESULTS: The CHAMP created a new THC and expanded the residency from eight to ten residents per year. The cost of expansion was approximately $72,000 per resident per year. The cost of incremental expansion of our residency program in the CHAMP model was more than 50% less than that of the recently reported cost of training in the HRSA THC GME program.
Growing evidence supports the inclusion of patient empowerment as a key ingredient of care for patients with chronic conditions. In recent years, several studies based on patient empowerment, have been carried out in different European countries in the context of general practice and primary care to improve management of chronic diseases. These studies have shown good results of the care model, increasing patient and health professionals' satisfaction, adherence to guidelines and to treatment, and improving clinical outcomes. In 2011, the Wonca European Council included as the twelfth characteristic of the European definitions of general practice/family medicine: 'promote patient empowerment'. The aim of this paper is to clarify the meaning of 'patient empowerment' and to explain why family medicine should be considered the most suitable setting to promote it. The inclusion of patient empowerment as one of the essential characteristics of general practice fills a conceptual gap and clearly suggests to the European health care systems a tested model to face chronic diseases: involving and empowering patients in managing their own conditions to improve health and well-being.
King, Richard V; Murphy-Cullen, Cassie L; Mayo, Helen G; Marcee, Alice K; Schneider, Gregory W
Computers, personal digital assistants (PDA), and the Internet are widely used as resources in medical education and clinical care. Educators who intend to incorporate these resources effectively into residency education programmes can benefit from understanding how residents currently use these tools, their skills, and their preferences. The researchers sent questionnaires to 306 US family medicine residency programmes for all of their residents to complete. Respondents were 1177 residents from 125 (41%) programmes. Access to a computer was reported by 95% of respondents. Of these, 97% of desktop and 89% of laptop computers could access the Internet. Residents accessed various educational and clinical resources. Half felt they had 'intermediate' skills at Web searches, 23% had 'some skills,' and 27% were 'quite skilled.' Those under 30 years of age reported higher skill levels. Those who experienced a Web-based curriculum in medical school reported higher search skills and greater success in finding clinical information. Respondents preferred to use technology to supplement the didactic sessions offered in resident teaching conferences. Favourable conditions exist in family medicine residency programmes to implement a blend of traditional and technology-based learning experiences. These conditions include residents' experience, skills, and preferences.
Cole McGrew, Martha; Wayne, Sharon; Solan, Brian; Snyder, Tiffany; Ferguson, Cheryl; Kalishman, Summers
Learners in medical education are often inadequately prepared to address the underlying social determinants of health and disease. The objective of this article is to describe the development, implementation, and evaluation of a Health Policy and Advocacy curriculum incorporated into our family medicine clerkship. We developed a Health Policy and Advocacy course for medical students within our family medicine clerkship. We evaluated the curriculum using a survey of our own design administered to students before and after their clerkship year. We created a mean score for each subscale that measured (1) physician's role, (2) knowledge, and (3) confidence in ability and calculated differences between the pre-survey and the post-survey scores for four medical school classes. We also conducted a focus group to get student input on the new curriculum. Mean scores on the pre- and post-surveys were highest for the subscale regarding attitudes about a physician's role in health policy and advocacy and did not change over time. Scores for self-reported knowledge and confidence in abilities increased significantly from the beginning to the end of the clerkship year. Students were generally positive about the curriculum but had some concerns about finding time for advocacy in their future practices. Training in health care policy and advocacy can be successfully implemented into a medical school curriculum with positive outcomes in students' self-reported knowledge and confidence in their abilities. Work remains on providing advocacy role models for students.
Márquez-Godínez, S A; Zonana-Nacach, A; Anzaldo-Campos, M C; Muñoz-Martínez, J A
To determine the risk of diabetic foot in patients with type II diabetes mellitus (DM) seen in a Family Medicine Unit. The study included type II DM patients with a disease duration ≥ 5 years seen in a Family Medicine Unit, Tijuana, Mexico, during September-December 2011. Neuropathy was assessed with the Diabetic Neuropathy Symptom questionnaire, and pressure sensation using a 10-g Semmes-Weinstein monofilament. A patient had a high risk of diabetic foot if there was sensitivity loss, foot deformities, and non-palpable pedal pulses. We studied 205 patients with an average (± SD) age and DM duration of 59 ± 10 years and 10.7 ± 6.7 years, respectively. Ninety one patients (44%) had a high risk of developing diabetic foot, and it was associated with; an education of less than 6 years (OR 2.3; 95%CI: 1-1-4.1), DM disease duration ≥ 10 years (OR 5.1; 95%CI: 2.8-9.4), female gender (OR 2.0; 95%CI: 1.1-3.6), monthly familiar income diabetic neuropathy, since they have a high risk of diabetic foot. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.
McGrew, M C; Skipper, B; Palley, T; Kaufman, A
The value of problem-based learning (PBL) in the preclinical years of medical school has been described widely in the literature. This study evaluates student and faculty perceptions of PBL during the clinical years of medical school, on a family medicine clerkship. Students used a 4-point scale to rate clerkship educational components on how well learning was facilitated. Faculty narratives of their perceptions of PBL were reviewed. Educational components that involved active learning by students--clinical activity, independent learning, and PBL tutorials--were ranked highest by students. Faculty perceived that PBL on the clerkship simulated "real-life" learning, included more behavioral and population issues, and provided substantial blocks of student contact time for improved student evaluation. Students and faculty in a family medicine clerkship ranked PBL sessions higher than any other nonclinical component of the clerkship. In addition to providing students with opportunities for self-directed learning, the PBL sessions provide faculty with more contact time with students, thereby enhancing the assessment of students' learning and progress.
Mainous, Arch G; Fang, Bo; Peterson, Lars E
The Family Medicine (FM) Milestones are competency-based assessments of residents in key dimensions relevant to practice in the specialty. Residency programs use the milestones in semiannual reviews of resident performance from the time of entry into the program to graduation. Using a national sample, we investigated the relationship of FM competency-based assessments to resident progress and the complementarity of milestones with knowledge-based assessments in FM residencies. We used midyear and end-of-year milestone ratings for all FM residents in Accreditation Council for Graduate Medical Education-accredited programs during academic years 2014-2015 and 2015-2016. The milestones contain 22 items across 6 competencies. We created a summative index across the milestones. The American Board of Family Medicine database provided resident demographics and in-training examination (ITE) scores. We linked information to the milestone data. The sample encompassed 6630 FM residents. The summative milestone index increased, on average, for each cohort (postgraduate year 1 [PGY-1] to PGY-2 and PGY-2 to PGY-3) at each assessment. The correlation between the milestone index that excluded the medical knowledge milestone and ITE scores was r = .195 ( P ITE scores and composite milestone assessments were higher for residents who advanced than for those who did not. Competency-based assessment using the milestones for FM residents seems to be a viable multidimensional tool to assess the successful progression of residents.
Akoojee, Yusuf; Mash, Robert
Family physicians play a significant role in the district health system and need to be equipped with a broad range of clinical skills in order to meet the needs and expectations of the communities they serve. A previous study in 2007 reached national consensus on the clinical skills that should be taught in postgraduate family medicine training prior to the introduction of the new speciality. Since then, family physicians have been trained, employed and have gained experience of working in the district health services. The national Education and Training Committee of the South African Academy of Family Physicians, therefore, requested a review of the national consensus on clinical skills for family medicine training. A Delphi technique was used to reach national consensus in a panel of 17 experts: family physicians responsible for training, experienced family physicians in practice and managers responsible for employing family physicians. Consensus was reached on 242 skills from which the panel decided on 211 core skills, 28 elective skills and 3 skills to be deleted from the previous list. The panel was unable to reach consensus on 11 skills. The findings will guide training programmes on the skills to be addressed and ensure consistency across training programmes nationally. The consensus will also guide formative assessment as documented in the national portfolio of learning and summative assessment in the national exit examination. The consensus will be of interest to other countries in the region where training programmes in family medicine are developing.
Winkler, Andrea Sylvia; Mayer, Michael; Ombay, Michael; Mathias, Bartholomayo; Schmutzhard, Erich; Jilek-Aall, Louise
Most people with epilepsy (PWE) live in developing countries with limited access to health care facilities. In sub-Saharan Africa with approximately 12 million PWE, 90% do not receive adequate medical treatment. In this context, traditional medicine, being easily accessible, plays an important role. However, in sub- Saharan Africa, studies on the attitude of people (both affected and not affected by epilepsy) towards traditional medicine for treatment of epilepsy are scarce. In this study, 167 people (59 PWE, 62 relatives, 46 villagers) were interviewed at the hospital and in the community with a semi-structured validated questionnaire regarding the prevailing attitude towards traditional medicine for treatment of epilepsy in a rural area of northern Tanzania. Various traditional healing methods (THM) could be ascertained, i.e. traditional herbal medicine, spiritual healing, scarifications and spitting. 44.3% (n=74/167) of the interviewed people were convinced that epilepsy could be treated successfully with THM. Interestingly, 34.1% (n=57/167) thought that Christian prayers could cure the cause and/or treat symptoms of epilepsy. Significantly more PWE and their relatives were in favour of THM compared to villagers not knowing about epilepsy or not being immediately affected by epilepsy (χ(2)-test, p=0.004). Further factors influencing people's attitudes towards THM were gender, tribe, religion and urbanity of people's dwellings. Our study demonstrates that not only THM but also prayers in the Christian sense seem to play an important role in people's beliefs regarding successful treatment of epilepsy. Factors influencing this belief system have been identified and are discussed.
Gupta, Noopur; Vashist, Praveen; Tandon, Radhika; Gupta, Sanjeev K; Kalaivani, Mani; Dwivedi, S N
To determine the type and nature of traditional eye medicine (TEM), their sources and use and practices related to self-medication for ophthalmic diseases in a rural Indian population. A population-based, cross-sectional study was conducted in 25 randomly selected clusters of Rural Gurgaon, Haryana, India as part of CORE (Cornea Opacity Rural Epidemiological) study. In addition to comprehensive ophthalmic examination, health-seeking behavior and use of self-medication and TEM was assessed in the adult population using a semi-structured questionnaire. Physical verification of available ophthalmic medications in the enumerated households was conducted by the study team. Descriptive statistics were computed along with multivariable logistic regression analysis to determine associated factors for use of self-medication and TEM. Of the 2160 participants interviewed, 396 (18.2%) reported using ophthalmic medications without consulting an ophthalmologist, mainly for symptoms like watering (37.1%), redness (27.7%), itching (19.2%) and infection (13.6%). On physical verification of available eye drops that were being used without prescription, 26.4% participants were practicing self-medication. Steroid, expired/unlabeled and indigenous eye drops were being used by 151(26.5%), 120(21.1%) and 75 (13.2%) participants respectively. Additionally, 25.7% (529) participants resorted to home remedies like 'kajal'(61.4%), honey (31.4%), ghee (11.7%) and rose water (9.1%). Use of TEM is prevalent in this population. The rampant use of steroid eye drops without prescription along with use of expired or unlabelled eye drops warrants greater emphasis on safe eye care practices in this population. Public awareness and regulatory legislations must be implemented to decrease harmful effects arising due to such practices.
Ganasegeran, Kurubaran; Rajendran, Anantha Kumar; Al-Dubai, Sami Abdo Radman
The use of complementary and alternative medicine (CAM) as a source of cure has gained much spectrum worldwide, despite skeptics and advocates of evidence-based practice conceptualized such therapies as human nostrum. This study aimed to explore the factors affecting CAM use among rural communities in Malaysia. A cross-sectional study was carried out on 288 occupants across four rural villages within the District of Selama, Perak, Malaysia. A survey that consisted of socio-economic characteristics, history of CAM use and the validated Holistic Complementary and Alternative Medicine Questionnaire (HCAMQ) were used. The prevalence of self-reported CAM use over the past one year was 53.1%. Multiple logistic regression analyses yielded three significant predictors of CAM use: monthly household income of less than MYR 2500, higher education level, and positive attitude towards CAM. Psycho-socioeconomic factors were significantly associated with CAM use among rural communities in Malaysia.
R. P. J. C. Ramanayake
Full Text Available Background: Family Medicine occupies a prominent place in the undergraduate curriculum of the Faculty of Medicine, University of Kelaniya, Sri Lanka. The one month clinical attachment during the fourth year utilizes a variety of teaching methods. This study evaluates teaching learning methods and learning environment of this attachment. Methodology: A descriptive cross sectional study was carried out among consenting students over a period of six months on completion of the clinical attachment using a pretested self administered questionnaire. Results: Completed questionnaires were returned by 114(99% students. 90.2% were satisfied with the teaching methods in general while direct observation and feed back from teachers was the most popular(95.1% followed by learning from patients(91.2%, debate(87.6%, seminar(87.5% and small group discussions(71.9%. They were highly satisfied with the opportunity they had to develop communication skills (95.5% and presentation skills (92.9%. Lesser learning opportunity was experienced for history taking (89.9%, problem solving (78.8% and clinical examination (59.8% skills. Student satisfaction regarding space within consultation rooms was 80% while space for history taking and examination (62% and availability of clinical equipment (53% were less. 90% thought the programme was well organized and adequate understanding on family medicine concepts and practice organization gained by 94% and 95% of the students respectively. Conclusions: Overall student satisfaction was high. Students prefer learning methods which actively involve them. It is important to provide adequate infra structure facilities for student activities to make it a positive learning experience for them.
Ramanayake, R P J C; De Silva, A H W; Perera, D P; Sumanasekara, R D N; Gunasekara, R; Chandrasiri, P
Family Medicine occupies a prominent place in the undergraduate curriculum of the Faculty of Medicine, University of Kelaniya, Sri Lanka. The one month clinical attachment during the fourth year utilizes a variety of teaching methods. This study evaluates teaching learning methods and learning environment of this attachment. A descriptive cross sectional study was carried out among consenting students over a period of six months on completion of the clinical attachment using a pretested self administered questionnaire. Completed questionnaires were returned by 114(99%) students. 90.2% were satisfied with the teaching methods in general while direct observation and feed back from teachers was the most popular(95.1%) followed by learning from patients(91.2%), debate(87.6%), seminar(87.5%) and small group discussions(71.9%). They were highly satisfied with the opportunity they had to develop communication skills (95.5%) and presentation skills (92.9%). Lesser learning opportunity was experienced for history taking (89.9%), problem solving (78.8%) and clinical examination (59.8%) skills. Student satisfaction regarding space within consultation rooms was 80% while space for history taking and examination (62%) and availability of clinical equipment (53%) were less. 90% thought the programme was well organized and adequate understanding on family medicine concepts and practice organization gained by 94% and 95% of the students respectively. Overall student satisfaction was high. Students prefer learning methods which actively involve them. It is important to provide adequate infra structure facilities for student activities to make it a positive learning experience for them.
Randall, Ellen; Crooks, Valorie A; Goldsmith, Laurie J
Most Canadians receive basic health services from a family physician and these physicians are particularly critical in the management of chronic disease. Canada, however, has an endemic shortage of family physicians. Physician shortages and turnover are particularly acute in rural regions, leaving their residents at risk of needing to transition between family physicians. The knowledge base about how patients manage transitioning in a climate of scarcity remains nascent. The purpose of this study is to explore the experience of transitioning for chronically ill, rurally situated Canadian women to provide insight into if and how the system supports transitioning patients and to identify opportunities for enhancing that support. Chronically ill women managing rheumatic diseases residing in two rural counties in the province of Ontario were recruited to participate in face-to-face, semi-structured interviews. Interview transcripts were analysed thematically to identify emergent themes associated with the transitioning experience. Seventeen women participated in this study. Ten had experienced transitioning and four with long-standing family physicians anticipated doing so soon. The remaining three expressed concerns about transitioning. Thematic analysis revealed the presence of a transitioning trajectory with three phases. The detachment phase focused on activities related to the termination of a physician-patient relationship, including haphazard notification tactics and the absence of referrals to replacement physicians. For those unable to immediately find a new doctor, there was a phase of unattachment during which patients had to improvise ways to receive care from alternative providers or walk-in clinics. The final phase, attachment, was characterized by acceptance into the practice of a new family physician. Participants often found transitioning challenging, largely due to perceived gaps in support from the health care system. Barriers to a smooth transition
Full Text Available Crime in the family constitutes one of the major concerns of recent years in Albania. Violence in Albanian families remains unnoticed and is not declared by the majority of those affected. The worst is that there are deep rural areas where violence is accepted as normal within a family. Many studies have come to the conclusion that women who have higher education tend to be better prepared to cope with domestic disputes and solve the problems with communication, so are less likely to be victims of physical violence. The economic, cultural, emotional and social factors are sources that generate violence or crime within the family. The transition from a totalitarian to a democratic society brought not only functional changes, but also differences in their implementation. This was accompanied by misunderstandings of the individual crisis and human rights. This misunderstanding is often associated with deviant behavior or by criminal acts. Poverty, unemployment, jealousy, alcohol and drugs are some of the main reasons that cause domestic violence. Albania has long been considered a patriarchal society where men have more rights than women. This difference has led to a situation where husbands continue to see themselves as more superior, and tend to violate their women or children. In recent years poverty has even increased bringing domestic violence to alarming levels. But besides the major problem of growing violence within the family, the biggest problem is the failure of declaration, because of the mentality, shame, lack of trust in government bodies etc. This problem is even greater in rural areas, where there is a lack of police structures, while NGOs cannot cover the whole country. This study was concentrated in the city of Durres, where 600 surveys were undertaken to people of different ages. This paper is focused in the way of how domestic violence is seen by citizens of the city of Durres and those coming from rural areas.
Full Text Available Abstract Background The objectives of this study were: a to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM in primary care; b to investigate the influence of patient preferences on clinical decision-making; and c to explore the role of intuition in family practice. Method Qualitative analysis of semi-structured interviews of 15 family physicians purposively selected from respondents to a national survey on EBM mailed to a random sample of Canadian family physicians. Results Participants mainly welcomed the promotion of EBM in the primary care setting. A significant number of barriers and limitations to the implementation of EBM were identified. EBM is perceived by some physicians as a devaluation of the 'art of medicine' and a threat to their professional/clinical autonomy. Issues regarding the trustworthiness and credibility of evidence were of great concern, especially with respect to the influence of the pharmaceutical industry. Attempts to become more evidence-based often result in the experience of conflicts. Patient factors exert a powerful influence on clinical decision-making and can serve as trumps to research evidence. A widespread belief that intuition plays a vital role in primary care reinforced views that research evidence must be considered alongside other factors such as patient preferences and the clinical judgement and experience of the physician. Discussion Primary care physicians are increasingly keen to consider research evidence in clinical decision-making, but there are significant concerns about the current model of EBM. Our findings support the proposed revisions to EBM wherein greater emphasis is placed on clinical expertise and patient preferences, both of which remain powerful influences on physician behaviour.
Tracy, C Shawn; Dantas, Guilherme Coelho; Upshur, Ross E G
The objectives of this study were: a) to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM) in primary care; b) to investigate the influence of patient preferences on clinical decision-making; and c) to explore the role of intuition in family practice. Qualitative analysis of semi-structured interviews of 15 family physicians purposively selected from respondents to a national survey on EBM mailed to a random sample of Canadian family physicians. Participants mainly welcomed the promotion of EBM in the primary care setting. A significant number of barriers and limitations to the implementation of EBM were identified. EBM is perceived by some physicians as a devaluation of the 'art of medicine' and a threat to their professional/clinical autonomy. Issues regarding the trustworthiness and credibility of evidence were of great concern, especially with respect to the influence of the pharmaceutical industry. Attempts to become more evidence-based often result in the experience of conflicts. Patient factors exert a powerful influence on clinical decision-making and can serve as trumps to research evidence. A widespread belief that intuition plays a vital role in primary care reinforced views that research evidence must be considered alongside other factors such as patient preferences and the clinical judgement and experience of the physician. Primary care physicians are increasingly keen to consider research evidence in clinical decision-making, but there are significant concerns about the current model of EBM. Our findings support the proposed revisions to EBM wherein greater emphasis is placed on clinical expertise and patient preferences, both of which remain powerful influences on physician behaviour.
Bishop, Lisa; Young, Stephanie; Twells, Laurie; Dillon, Carla; Hawboldt, John
A pharmacist managed anticoagulation service was initiated in a multi-physician family medicine clinic in December 2006. In order to determine the patient and physician satisfaction with the service, a study was designed to describe the patients' satisfaction with the warfarin education and management they received from the pharmacist, and to describe the physicians' satisfaction with the level of care provided by the pharmacist for patients taking warfarin. A self-administered survey was completed by both eligible patients receiving warfarin and physicians prescribing warfarin between December 2006 and May 2008. The patient survey collected information on patient demographics, satisfaction with warfarin education and daily warfarin management. The physician survey collected data about the satisfaction with patient education and daily anticoagulation management by the pharmacist. Seventy-six of 94 (81%) patients completed the survey. Fifty-nine percent were male with a mean age of 65 years (range 24-90). Ninety-six percent agreed/strongly agreed the pharmacist did a good job teaching the importance of warfarin adherence, the necessity of INR testing and the risks of bleeding. Eighty-five percent agreed/strongly agreed the risk of blood clots was well explained, 79% felt the pharmacist did a good job teaching about dietary considerations and 77% agreed/strongly agreed the pharmacist explained when to see a doctor. All patients felt the pharmacist gave clear instructions on warfarin dosing and INR testing. Four of nine physicians (44%) completed the survey. All agreed/strongly agreed the pharmacist was competent in the care provided, were confident in the care their patients received, would like the pharmacist to continue the service, and would recommend this program to other clinics. Patients and family physicians were satisfied with the pharmacist managed anticoagulation program and recommended continuation of the program. These results support the role of the
Esterhuizen, Tonya; Gathiram, Prem
ABSTRACT Background Family physicians are trained to treat a wide range of diseases, treatment being centred on the patient, family and community irrespective of age, gender, or ethnic or racial background. To deal with inequalities in health care, the South African government introduced the concept of a district health system in 1997. It was only in August 2007, however, that family medicine was legislated as a speciality. This study was undertaken prior to the enactment of this legislation. Method A descriptive quantitative study using a self-administered questionnaire was undertaken. A convenience sampling technique was used (N = 60) to assess the reactions of medical practitioners towards the impending legislation. Results Overall, 60% of the sample was in favour of the legislation. There were no significant differences between those working in the private and public sectors or between generalists and specialists. With regard to those not in favour of the legislation compared to those in favour of the legislation, a significantly increased number answered the following statements in the affirmative: (i) ‘I already carry out the functions of a family physician’ (p = 0.001), (ii) ‘They [specialist family physicians] will not be as qualified as specialists in other categories’ (p = 0.005), (iii) ‘It will have a negative impact on general practice’ (p competitiveness’ (p = 0.021), (v) ‘It will not have any effect on patient care’ (p = 0.010) and (vi) ‘There is no need for such a speciality’ (p = 0.001). Conclusion We concluded that the majority were in favour of the legislation being implemented.
Full Text Available Medicinal plants are the basic source of health care in the Pearl Valley District Poonch, Azad Jammu, and Kashmir. The basic aim of present study was to record information about the use of plants in herbal preparation and quantification of recorded data.The research was conducted with the null hypothesis that there was no differential distribution of knowledge among the communities between genders and among different age groups in the study area and across cultural medicinal uses of the plants are similar. To check these hypotheses information about medicinal plants was collected from 46 laypeople and 18 herbalists by using an open ended and semistructured questionnaire. Different ethnobotanical indices were calculated in order to quantify the knowledge on the medicinal plants reported in the study.Our study recorded 136 species of medicinal plants belonging to 45 families with Asteraceae (14 species as the dominant family of the area. Decoction (26 species, juice and powder (24 species each were most common methods of preparation. Spearman's correlation analysis showed that age and gender had the significant effect on both numbers of mentioned species and different uses. A number of known medicinal plants and the number of different uses (H: 38.51; p < 0.001 differ significantly as indicated by Kruskal-Wallis tests. These results showed that the knowledge about the plant varies among different age groups, which were the first hypothesis of the present study. The highest use values (UVs were reported for Berberis lyceum and Ajuga bracteosa (1.13 each followed by Abies pindrow (1.03. Highest informant consensus factor (ICF values were recorded for digestive system diseases (ICF = 0.90 and muscular and skeletal system diseases (ICF = 0.89. The value of Jaccarad index ranged from 6.11 to 32.97 with an average value of 19.84, percentage of similarity was highest between study area and Pir Lasura National Park (34.62%.High similarity might be due to
Postiglione, Gerard A.; Ailei, Xie; Jung, Jisun; Yanbi, Hong
New preferential policies in China promise to increase the number of rural students entering top-tier universities, where there is a wider path to a higher social status. While a substantial body of literature has investigated rural students' trajectories to university, there is a dearth of systematic empirical studies on the academic success of…
Rural Poverty is one of the greatest social problems confronting the world today. The problem is more pronounced in the developing countries. Ghana is no exception to this global problem of rural poverty. Ghana as a nation has adopted a lot of measures to address poverty. From the early 1980's to 2002, the country has ...
Gibson, Christine; Ladak, Farah; Shrestha, Ashis; Yadav, Bharat; Thu, Kyaw; Aye, Tin
Family medicine is an integral part of primary care within health systems. Globally, training programmes exhibit a great degree of variability in content and skill acquisition. While this may in part reflect the needs of a given setting, there exists standard criteria that all family medicine programmes should consider core activities. WONCA has provided an open-access list of standards that their expert community considers essential for family medicine (GP) post-graduate training. Evaluation of developing or existing training programmes using these standards can provide insight into the degree of variability, gaps within programmes and equally as important, gaps within recommendations. In collaboration with the host institution, two family medicine programmes in Nepal and Myanmar were evaluated based on WONCA global standards. The results of the evaluation demonstrated that such a process can allow for critical review of curriculum in various stages of development and evaluation. The implications of reviewing training programmes according to WONCA standards can lead to enhanced training world-wide and standardisation of training for post-graduate family medicine.
Ian J. Nelligan
Full Text Available Background and objectives: Family medicine postgraduate programmes in Kenya are examining the benefits of Community-Oriented Primary Care (COPC curriculum, as a method to train residents in population-based approaches to health care delivery. Whilst COPC is an established part of family medicine training in the United States, little is known about its application in Kenya. We sought to conduct a qualitative study to explore the development and implementation of COPC curriculum in the first two family medicine postgraduate programmes in Kenya. Method: Semi-structured interviews of COPC educators, practitioners, and academic stakeholders and focus groups of postgraduate students were conducted with COPC educators, practitioners and academic stakeholders in two family medicine postgraduate programmes in Kenya. Discussions were transcribed, inductively coded and thematically analysed. Results: Two focus groups with eight family medicine postgraduate students and interviews with five faculty members at two universities were conducted. Two broad themes emerged from the analysis: expected learning outcomes and important community-based enablers. Three learning outcomes were (1 making a community diagnosis, (2 understanding social determinants of health and (3 training in participatory research. Three community-based enablers for sustainability of COPC were (1 partnerships with community health workers, (2 community empowerment and engagement and (3 institutional financial support. Conclusions: Our findings illustrate the expected learning outcomes and important communitybased enablers associated with the successful implementation of COPC projects in Kenya and will help to inform future curriculum development in Kenya.
Edward Ivor Broughton
Full Text Available IntroductionThis study reports on the effectiveness and efficiency from the program funder’s perspective of the Suraj Social Franchise (SSF voucher program in which private health-care providers in remote rural areas were identified, trained, upgraded, and certified to deliver family planning services to underserved women of reproductive age in 29 districts of Sindh and 3 districts of Punjab province, Pakistan between October 2013 and June 2016.MethodA decision tree compared the cost of implementing SSF to the program funder and its effects of providing additional couple years of protection (CYPs to targeted women, compared to business-as-usual. Costs included vouchers given to women to receive a free contraceptive method of their choice from the SSF provider. The vouchers were then reimbursed to the SSF provider by the program.ResultsA total of 168,206 married women of reproductive age (MWRA received SSF vouchers between October 2013 and June 2016, costing $3,278,000 ($19.50/recipient. The average effectiveness of the program per voucher recipient was an additional 1.66 CYPs, giving an incremental cost-effectiveness of the program of $4.28 per CYP compared to not having the program (95% CI: $3.62–5.31.ConclusionThe result compares favorably to other interventions with similar objectives and appears affordable for the Pakistan national health-care system. It is therefore recommended to help address the unmet need for contraception among MWRA in these areas of Pakistan and is worthy of trial implementation in the country more widely.
Eliason, Sebastian; Baiden, Frank; Quansah-Asare, Gloria; Graham-Hayfron, Yvonne; Bonsu, Derek; Phillips, James; Awusabo-Asare, Kofi
Uptake of postpartum family planning (PPFP) remains low in sub-Saharan Africa and very little is known about how pregnant women arrive at their decisions to adopt PPFP. This information is needed to guide the development of interventions to promote PPFP. We conducted a survey among pregnant women attending antenatal clinics in a rural district in Ghana. We used univariate and multivariate logistic regression analysis to explore how knowledge of various family planning (FP) methods, past experience with their use and the acceptability of PPFP to male partners and close relations influenced the intention of pregnant women to adopt PPFP. We interviewed 1914 pregnant women in four health facilities. About 84% considered PPFP acceptable, and 70% intended to adopt a method. The most preferred methods were injectables (31.5%), exclusive breastfeeding (16.7%), and oral contraceptive pills (14.8%). Women whose first choice of PPFP method were injectables were more likely to be women who had had past experience with its use (O.R = 2.07, 95% C.I. 1.50-2.87). Acceptability of PPFP by the pregnant woman (O.R. = 3.21, 1.64-6.26), perception of partner acceptability (O.R. = 3.20, 1.94-5.48), having had prior experience with the use of injectables (O.R. = 3.72, 2.61-5.30) were the strongest predictors of the intention to adopt PPFP. Conversely women who knew about the diaphragm (O.R. = 0.59, 0.38-0.93) and those who had past experience with IUD use (O.R. = 0.13, 0.05-0.38) were less likely to want to adopt PPFP. Acceptability of PPFP to the pregnant woman, male partner approval, and past experience with the use of injectables are important factors in the PPFP decisions of women in this population. Antenatal and early postnatal care need to be adapted to take these factors into consideration.
Jammeh, Sulayman S S; Liu, Chieh-Yu; Cheng, Su-Fen; Lee-Hsieh, Jane
Family planning services have been free of charge and available in all the health facilities in the Gambia since 1975 yet contraceptive prevalence is only 17.5% and even 6% in some areas. Since the last census in 2003, there existed no available data on married couples' contraception status. To explore married couples' family planning knowledge, attitudes, and practices in rural and urban Gambia and to analyze what factors may affect such knowledge, attitudes and practices. Quantitative cross-sectional study design was used. Through convenience sampling, 176 men and 235 women representing a total of 176 couples participated. A structured questionnaire was used for data collection. The mean scores of the married couples family planning knowledge, attitudes, and practices were 19.00 ± 6.11(ranging from 0 to 64), 6.90 ± 3.08 (0 to 14) and 4.69 ± 3.3 (0 to 19) respectively. Urban residents had higher scores on family planning practice than rural residents (pfamily planning knowledge, attitude and practice in Gambia", as well as suggesting broader health intervention programs in health education and promotion.
Hossain, Mian B
With a population of over 131 million and a fertility rate of 29.9 per 1000, population growth constitutes a primary threat to continued economic growth and development in Bangladesh. One strategy that has been used to cease further increases in fertility in Bangladesh involves using family planning outreach workers who travel throughout rural and urban areas educating women regarding contraceptive alternatives. This study uses a longitudinal database to assess the impact of family planning outreach workers' contact upon contraceptive switching and upon the risk of an unintended pregnancy. Using longitudinal data on contraceptive use from the Operations Research Project (ORP) of the International Centre for Diarrhoeal Disease Research (ICDDR,B) in Bangladesh, multiple decrement life table analysis and multilevel, discrete-time competing risk hazards models were used to estimate the cumulative probabilities of switching to an alternative form of contraceptive use after a woman engaged in a discussion with an outreach worker. After controlling for the effects of socio-demographic and economic characteristics, the analysis revealed that family planning outreach workers' contact with women significantly decreases the risk of transitioning to the non-use of contraceptives. This contact also reduces the risk of an unintended pregnancy. Family planning workers' contact with women is associated with the increased risk of a woman switching from one modern method to another modern method. The study results indicate that side-effects and other method-related reasons are the two primary reasons for contraceptive discontinuation in rural Bangladesh.
Thorsen, Rikke Stamp; Pouliot, Mariève
Traditional medicine is commonly assumed to be a crucial health care option for poor households in developing countries. However, little research has been done in Asia to quantify the reliance on traditional medicine and its determinants. This research contributes to filling in this knowledge gap using household survey data collected from 571 households in three rural and peri-urban sites in Nepal in 2012. Questions encompassed household socioeconomic characteristics, illness characteristics, and treatment-seeking behaviour. Treatment choice was investigated through bivariate analyses. Results show that traditional medicine, and especially self-treatment with medicinal plants, prevail as treatment options in both rural and peri-urban populations. Contrarily to what is commonly assumed, high income is an important determinant of use of traditional medicine. Likewise, knowledge of medicinal plants, age, education, gender and illness chronicity were also significant determinants. The importance of self-treatment with medicinal plants should inform the development of health policy tailored to people’s treatment-seeking behaviour. PMID:26130610
Full Text Available Adae O Amoako,1 Agyenim B Amoako,2 George GA Pujalte3 1Department of Family and Community Medicine, Penn State Hershey Medical Center, Hershey, PA, USA; 2Department of Family Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA; 3Sports Medicine, Divisions of Primary Care, and Orthopedics, Mayo Clinic Health System, Waycross, GA, USA Background and objective: Family physicians are expected to be comfortable in treating common sports injuries. Evidence shows a limited level of comfort in treating these injuries in pediatric and internal medicine residents. Studies are lacking, however, in family medicine residents. The purpose of this study is to assess the comfort level of family medicine residents in treating common sports injuries in adults and children based on their perceived level of knowledge and attitudes. Methods: This is a cross-sectional study of family medicine residents in the United Sates. A written survey of 25 questions related to sports injury knowledge and factors affecting comfort level were collected. A chi-square test was implemented in calculating P-values. Results: Five hundred and fifty-seven residents responded to the survey. A higher percentage of doctors of osteopathy (86.6%, 82.5%, 69.6%, and 68.7% compared to doctors of medicine (78.5%, 71.6%, 53.4%, and 52.8% respectively identified ankle sprain, concussion, plantar fasciitis, and lateral epicondylitis as common injuries, and felt comfortable in treating them (P-values =0.015, 0.004, 0.0001, and 0.0002, respectively. Residents with high interest in sports medicine correctly identified the injuries as common and felt comfortable treating them as well (knowledge, P=0.027, 0.0029, <0.0001, and 0.0001, respectively; comfort level, P=0.0016, <0.0001, 0.0897, and 0.0010, respectively. Conclusion: Medical education background, factors that affect training, and an interest in sports medicine contribute to residents' knowledge and comfort