Family practice physicians' firearm safety counseling beliefs and behaviors

The purpose of this study was to identify family physicians' firearm safety counseling beliefs and behaviors. A survey was mailed to a random sample of 600 members of the American Academy of Family Physicians. A three wave mailing technique was used to maximize the response rate and yielded 271 usable surveys (55% response rate). Outcome measures included training experience in firearm safety counseling, the prevalence of firearm safety counseling by family physicians, and their perceptions regarding such counseling. The majority (78%) of family physicians lacked formal training on how to counsel patients about firearm safety and 49% believed more time should be spent in residency programs on firearm safety counseling. The majority (84%) of respondents never or rarely counseled patients on firearm safety and 50% believed firearm safety counseling should be a low priority in their delivery of primary care. The majority of respondents did not regularly counsel patients about firearm safety, did not believe firearm safety counseling should be a priority, and did not believe firearm safety counseling would be effective in reducing firearm-related trauma.     

Physical therapy education in family practice residency programs

BACKGROUND: This study investigated the role and extent of physical therapy education in family practice residency programs. Physical therapy is not specifically included in graduate curricula guidelines, and the literature contains little information on its involvement in programs. METHODS: A questionnaire was developed to determine how physical therapy education is taught in family practice residencies. The questionnaire was mailed to all (391) directors of US-accredited family practice residency programs. RESULTS: A total of 256 directors (65.5%) responded. The majority of directors (67%) stated that there was a significant need for the physical therapy component. Only 52% (133/256), however, included physical therapy in their curricula. Physical therapy education was most frequently (67.6%, 92/136) included in required rotations (eg, orthopedics) and taught mostly by hospital-based physical therapists (77.0%, 104/135) or subspecialists (55.6%, 75/135). CONCLUSION: This study shows that physical therapy education offers a potentially relevant and important element of family practice residency training, but it has been underemphasized.     

Exercise stress test training in family practice residency programs

EST is a commonly indicated procedure in primary care medicine and as such is well suited for use by family physicians. At present there are few family physicians performing this procedure in their offices. Our survey of US family practice residency directors has shown an interest well above what would be expected for the level of current practice in the community; however, there remains an ambivalence on the need to provide EST training in the curriculum.     

Why first-year family practice residents choose their residency programs

We report two cases of polychondritis associated with mesenteric panniculitis. Case 1. In February 1989, a woman born in 1949 presented with 40 degrees C fever accompanied by pain in the abdomen and pelvis. Eight days later, nodular skin lesions appeared on her lower limbs. The abdomen was swollen with gas and undepressible. An abdominal CT scan revealed partitioned peritoneal collections, and a guided needle aspiration produced a chylous fluid. Direct and indirect bacteriological examinations gave negative results. Histology showed intense inflammatory reaction with giant cells and lipophages, thereby confirming the presence of mesenteric panniculitis. Six months later, the development of chondritic lesions on the nose and the helix of the ear clinched the diagnosis of polychondritis. The patient was put on corticosteroid therapy for a few months, and in January this year (1993) she is durably asymptomatic. Case 2. In October 1977, a woman born in 1937 presented with polychondritis with prolonged fever, inflammatory syndrome and chondritic lesions of the nose, larynx and helix of the ear. In December 1978, she developed signs of abdominal obstruction. Laparotomy revealed infiltration by multiple nodular formations of the entire posterior line of attachment of the mesentery. Biopsies withdrew a puriform fluid. Histology showed a partly necrotic adipose tissue with giant cells and lipophages. High-dose corticosteroid therapy partially controlled the chondritic and abdominal manifestations. The occurrence of abdominal pain in patients with polychondritis may result from several disorders, such as iatrogenic complications, digestive tract vasculitis or ulcerative colitis, but also associated mesenteric panniculitis.     

Hospital privileges for graduates of family practice residency programs

In 1979 the American Academy of Family Physicians, as the first phase of a long-range study of family practice residency outcomes, surveyed graduates for the years 1970 through 1978 who were diplomates of the American Board of Family Practice. This report is limited to an overview analysis of the hospital admission and practice privileges of the 3,021 respondents actively practicing family medicine in the United States. A higher percentage of respondents in census regions west of the Mississippi River were more likely to have privileges in obstetrics and surgery than were respondents in eastern regions. Respondents in nonmetropolitan areas were more likely to have hospital privileges than were respondents in metropolitan areas.     

Alternative medicine instruction in medical schools and family practice residency programs

Mutations in the gene encoding neural cell adhesion molecule L1 (L1CAM) are involved in X-linked hydrocephalus (HSAS, hydrocephalus due to stenosis of the aqueduct of Sylvius), MASA syndrome (mental retardation, aphasia, shuffling gait, and adducted thumbs), and spastic paraplegia type 1. We examined the L1CAM mutation in a Japanese family with HSAS for the purpose of DNA-based genetic counseling. The proband was a 9-year-old boy who had a 1-bp deletion in exon 22 of the L1CAM gene. This resulted in a shift of the reading frame, and introduction of a premature stop codon. Translation of this mRNA will create a truncated protein without the transmembrane domain, which cannot be expressed on the cell surface. Magnetic resonance images (MRI) revealed markedly enlarged lateral ventricles, hypoplastic white matter, thin cortical mantle, agenesis of the corpus callosum and septum pellucidum, and a fused thalamus. These findings represented impaired L1CAM function during development of the nervous system with resultant adhesion between neurons, neurites outgrowth and fasciculation, and neural cell migration. Screening by Apa I digestion of polymerase chain reaction (PCR) products identified the mother and the younger sister as heterozygous carriers. The carriers were asymptomatic. The father and the other sister did not have the mutation. The identification of L1CAM mutation in families with HSAS will give them the opportunity for DNA-based counseling and prenatal diagnosis.     

Evidence of discrimination against international medical graduates applying to family practice residency programs

BACKGROUND AND OBJECTIVES: The purpose of the study was to test the hypothesis that discrimination exists against international medical graduates (IMGs) applying to US family practice residency programs. METHODS: Two sets of letters were sent to 146 family practice residency programs randomly selected from the Directory of Graduate Medical Education Programs. The letters requested information and an application. All letters were identical except that the author of the first set was described as "a foreign medical graduate." The author of the second set was described as "a fourth-year medical student at the University of Nebraska Medical Center." Replies were monitored for 6 weeks after the second mailing. Response rates to each "candidate" were measured. In addition, responses were evaluated for the presence of a brochure describing the residency program, an application, cover letter, invitation for interview, eligibility criteria, and other material. RESULTS: A total of 113 programs (79%) responded. Of these, 102 responded to the fourth-year medical student and 57 responded to the IMG. Of the 46 programs replying to both candidates, only 20 provided identical mailings. Nine of the 46 programs required IMGs to meet standards that exceeded requirements set by the Educational Commission for Foreign Medical Graduates for residency training in the United States. CONCLUSIONS: A pattern of dissimilarity exists in the way family practice residency programs respond to requests for application materials, and the differences appear to depend on whether the candidate is a US medical graduate or an IMG. These results raise questions about the fairness of current methods of resident selection.     

Research in the family practice residency program

Research activity in family practice is becoming increasingly important as the specialty matures past its initial organizational and developmental phase. Family practice residency programs are directly involved in the definition and implementation of modern concepts in family medicine and frequently have available the necessary tools and resources for substantive research of various types. These programs therefore have both the opportunity and responsibility to become actively involved in research. Significant contributions have already been made in this area by faculty and residents in a number of family practice residency programs. This paper provides an overview of research areas in family practice, presents some examples of research to date, and suggests some practical approaches to facilitate further research efforts in family practice residency programs.     

The service-education linkage: implications for family practice residency programs and community and migrant health centers

INTRODUCTION: Access to quality primary health care for our country's underserved populations is a challenge for both the government and physicians. The Division of Medicine, through funding priorities and other initiatives, is encouraging family practice educators to train residents and students for work in community and migrant health centers (C/MHCs) in underserved areas. The objective of this research was to study linkages between family practice residency programs and C/MHCs and determine the reasons for affiliation, disadvantages and advantages, predictors of successful linkages, and common errors in the linkage agreement. METHODS: We conducted in-depth telephone interviews with the directors of 13 of the 19 family practice residency programs identified as having linkages with C/MHCs. RESULTS: All interviewees at residency programs indicated that their programs had a mission to serve underserved patients. The most commonly cited constraining factor cited by both residency programs and C/MHCs was financial support for residents, on-site faculty, and support staff. Many programs reported that residents training at the C/MHC were able to gain a community health perspective and practice community-oriented primary care. Finally, financing the relationship involved many different approaches, ranging from the residency paying all of the salaries, to a sharing of salaries by the residency, state, and/or hospital, to C/MHC paying the salaries either through its own funds or through grant support. DISCUSSION: These data provide an assessment of the current issues that family practice residencies must address to implement service-education linkages. They provide an empirical basis to outline the steps involved in forming a linkage between a residency and a C/MHC.     

Lafayette's family practice residency program: practice patterns of graduates

The Lafayette Family Practice Residency Program graduated 25 physicians prior to 1995. This project was undertaken to support our assumption that graduates establish their practices in communities near their residency programs. Further we surveyed the graduates to determine graduate satisfaction and practice characteristics. The vast majority (88%) of these physicians were practicing in Louisiana at the time of this survey. Over half the graduates were practicing in Acadiana. The results suggest that these physicians are indeed satisfied in their careers as family physicians.     

Behavioral science training in family practice residency education: a first evaluation

Although behavioral science training is an essential component of family practice residency education, there have been few evaluations of its effects. In this study, selected behaviors of senior residents and their patients in two different family practice residency programs were compared. One program emphasized behavioral science, the other did not. Residents in the more behaviorally oriented program had more positive attitudes toward both social factors in illness and the importance of a warm physician-patient relationship. In addition, these residents claimed to know more about non-pharmacologic treatments for depression and anxiety and felt more confident in their ability to handle them than their less behaviorally trained counterparts. In regard to patient care, patients of residents in the program which emphasized behavioral science were more likely to receive a psychosocial diagnosis and resident counseling or mental health referral than patients of residents in the program which did not. On a patient satisfaction questionnaire, patients of the two programs differed on only one subscale which concerned convenience of care. Although these early results are encouraging, behavioral science training needs continuing clarification and evaluation of its goals and accomplishments.