Creating a spirituality curriculum for family practice residents

The purpose of this pilot study was to investigate issues related to the creation of a curriculum to teach spirituality to family practice residents; specifically, (1) to determine whether there was support among family practice residents and faculty to include such teaching in the residency curriculum, and (2) to determine specifically what should be taught and how it should be taught. The hypothesis was that residents and faculty would support such a curriculum and that specific educational methodologies could be identified to implement it. This was accomplished by conducting one-on-one interviews and focus groups and by administering a written curriculum needs assessment to family practice residents and faculty, compiling and interpreting the results, and subsequently writing an integrated curriculum.     

A family practice model for clinical psychology.

Contends that the profession of clinical psychology is plagued by problems of role confusion in the public mind, which arises directly from current methods of service delivery. Present psychological service delivery methods are analyzed and found to contain several assumptions that contribute to a poor public image. An alternative model of practice, based on continuous involvement with families over time is described. Adaptive and healthy qualities of consumers of service are stressed. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

The development of leadership skills in clinical practice

Leadership is often seen as the province of the manager. However, as the NHS changes and responsibility is increasingly devolved, practitioners at all levels are expected to lead change and innovation. In this paper the author describes how attending the Leadership in Nursing for the Community (LINC) programme has influenced her practice. As a result of the programme she has an increased awareness of her own leadership role and of the political and professional climate in which she works.     

Using the patient as teacher: A training method for family practice residents in behavioral science.

Since the inception of family medicine as a specialty in allopathy and osteopathy in 1969 and 1973, respectively, there has been a need to develop integrative approaches of teaching behavioral science concepts without violating the scope of practice limitations between the fields. We describe a collaborative training method by which we attempt to achieve this balance. Residents referring patients for mental health services are involved in all phases of the mutual patient's treatment. The intake, recommendation, and feedback sessions are videotaped with both health care providers present. In this method, the necessity of keeping within the limited time constraints of medical schedules is recognized, the application of behavioral science concepts over theory is emphasized, and the role of the behavioral scientist as an equal partner in the team approach to health care is strengthened. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact on patient satisfaction of the introduction of family medicine residents into a model practice facility

This study examines the effects on patient satisfaction of the introduction of family medicine residents into the staff of an ongoing private practice that joined a Department of Family Medicine. Questionnaires were administered to clinic patients during a four-week period four months prior to when residents began seeing patients at the clinic and again five months after residents joined the clinic staff. Satisfaction at both times was high; however, significant declines from Time 1 to Time 2 were noted on most items. Analysis showed that this decline was not related to dissatisfaction within the residents. A questionnaire was also mailed to a sample of patients who had not visited the clinic more than once during the first year of the resident program there. Three fourths of these individuals still viewed themselves as patients of the clinic. Implications of these findings for family medicine residency training programs are discussed.     

Teaching behavioral science to family medicine residents: integrating training into the family practice unit

INTRODUCTION: Physicians need to be well trained in HIV risk assessment interview skills. Little has been written in the literature concerning training methods for this specialized interview. METHODS: One model to teach the HIV risk assessment interview has been developed and has been used to teach third-year medical students. We compared this interactive model, which uses simulated patients to teach HIV Risk Assessment, to a didactic one. Twelve medical residents were taken through either the interactive session or the didactic session. Pre-post changes from questionnaires were calculated to determine any differences in sessions. Also, Objective Structured Clinical Examinations (OSCEs) were used to grade all residents 2 weeks after their sessions. RESULTS: All pre-post changes were calculated and no statistically significant differences were seen (P > 0.50). OSCE interpersonal skills scores and content scores were calculated. The interactive group had statistically significantly higher scores (P < 0.05). CONCLUSION: The data supports the conclusion that an interactive method is more effective to use to train HIV risk assessment interview skills to medical residents when compared to the didactic method.     

A cervical manikin procedure for chiropractic skills development

Spinal injuries resulting from falls out of tree stands are often associated with concomitant neurologic deficit, prolonged hospitalization, and long-term disability. The purpose of this study was to review the types of spinal injuries that resulted from falls from hunting tree stands. We retrospectively reviewed 27 patients who came to our institution for treatment of spine injuries related to tree-stand accidents between 1981 and 1997. Eleven percent of the falls were alcohol related. Mean height of the fall was 19.6 feet (range, 10 to 35 feet). There were 17 burst fractures, 8 wedge compression fractures, 4 fractures involving the posterior elements, and 1 coronal fracture of the sacral body. Significant neurologic injury occurred in 12 patients (44%). Sixteen patients (59%) had associated injuries. Nine patients (33%) had open reduction, internal fixation, and fusion of their spine fractures. One patient was treated with a halo jacket. The remaining patients were treated in rigid, molded, polypropylene thoracolumbar orthoses or lumbosacral corsets. Accidental falls from tree stands may result in significant spinal fractures often associated with concomitant neurologic injury, extended hospitalization, and permanent disability. Many of these injuries may be prevented through aggressive hunter safety education.     

Packaged impact: A structured communication skills workshop.

Assessed the impact of a structured communications skills workshop of self-referred clients who expressed problems in feeling uncomfortable in their relationships with others. 16 male and 14 female undergraduates were assigned to 1 of 2 experimental groups or a waiting list control group. During a 7-wk treatment period, the 2 experimental groups received the structured workshop. The control group received no treatment. Pre- and posttest results indicated a significant difference between scores on the criterion measures (Concept Specific Anxiety Scale, Interpersonal Relationship Rating Scale, and the Fundamental Interpersonal Relations Orientation-Behavior scale) and favor the workshop group in terms of (a) reduced anxiety in interpersonal situations and (b) reported increase in establishing interpersonal relationships. (15 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Primary care health psychology training: A collaborative model with family practice.

Are you planning a new postdoctoral training program in health psychology? Are your students seeking postdoctoral training in health psychology? Are you looking for a good formal postdoctoral fellowship in health psychology to continue your training? This article describes in detail the philosophy, educational objectives, and learning activities that make up a 13-year-old fellowship approved by the American Psychological Association in clinical health psychology, a model for clinical training in this specialty. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family practice residents and future obstetrics practice

Retinoids and interferon-alpha (IFN-alpha) have been shown to have a synergetic antiproliferative and differentiative effect on many cell lines, and in combination they have already been tested with some success in the treatment of some tumors. We investigated the tolerance and efficacy of high dose 13-cis-retinoic acid (2 mg/kg/day) and IFN-alpha in the treatment of advanced squamous cell carcinoma of the lung and of the head and neck. No partial or complete response was observed in the 10 patients treated. The toxicity was unusual and mild to moderate considering the dose of retinoid given. This observation leads us to suspect that IFN-alpha may alleviate some of the side effects of the retinoid, and is of interest in the design of future clinical trials.     

A family practice education system based on patient care outcomes in family practice settings

The philosophy, goals, objectives, methodology, and results of a family practice faculty development program are described. Developing family practice educators who will create an education system based on patient care outcomes in family practice settings is the central philosophical purpose of this faculty development program. On completion of the program all participants recognized the essential nature of this philosophical goal and were more comfortable and confident in their ability to: (1) determine resident learning needs; (2) organize curriculum units; (3) use different teaching techniques; and (4) understand their own personal teaching needs and interests. The implications of these changes for developing a family practice curriculum based on patient needs are described.     

Medical referrals for hypnotherapy: opinions of physicians, residents, family practice outpatients, and psychiatry outpatients

Previous studies surveying attitudes and education regarding the clinical use of hypnosis have been conducted with patient populations only. The current study was undertaken to assess the attitudes, experiences, training levels, and interest in future education regarding the use of hypnosis by staff physicians, medical resident physicians, family practice outpatients, and psychiatry outpatients. All subjects were drawn from a 400-physician group practice in Central Texas affiliated with a large university health science center. Results indicate that the majority of physicians (79%) and residents (67%) had received no prior training and even fewer had experienced hypnosis. The percentages for personal experience with hypnosis were similar for psychiatric outpatients, physicians, and residents. The need for patient and practitioner education was elucidated by the high rate of endorsement of misconceptions regarding hypnosis by patients (over half) and by some medical practitioners as well. Limited awareness of the appropriate applications of hypnosis was reported. However, 85% of practitioners expressed an interest in hypnosis education. Further research in medical setting demographics is recommended to validate generalizability of results and facilitate construction of medical education programs in hypnosis.     

Training family practice residents in abortion and other reproductive health care: a nationwide survey

The majority of residents responding to a 1995 survey of program directors and chief residents at 244 family medicine residency programs in the United States reported they had no clinical experience in cervical cap fitting, diaphragm fitting or IUD insertion and removal. For all family planning methods except oral contraceptives, no more than 24% of residents had experience with 10 or more patients. Although 29% of programs included first-trimester abortion training as either optional or routine, only 15% of chief residents had clinical experience providing first-trimester abortions. Five percent of residents stated they certainly or probably would provide abortions, while 65% of residents stated they certainly would not provide abortions. A majority (65%) of residents agreed that first-trimester abortion training should be optional within family practice residency programs. Residents were more likely to agree with inclusion of optional abortion training and with the appropriateness of providing abortions in family practice if their program offered the training.