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.     

Family practice residency behavioral science training: influence on graduate practice activity

BACKGROUND AND OBJECTIVES: The educational efficacy of family practice residency behavioral science training and how various educational approaches might influence graduate practice activity are poorly understood. In this study, we compare a traditional didactic and clinical block rotation approach to a problem-based learning (PBL) and clinical, experiential behavioral science curriculum. METHODS: Surveys of pre- and post-intervention cohorts were used to assess graduates' perceptions of their understanding of broad behavioral science concepts, their competence to manage specific behavioral conditions, and their behavioral science practice activity. The two cohorts were University of California, Irvine family practice residency program graduates from 1984-1988 (58) and residency graduates from 1993-1995 (27). American Board of Family Practice (ABFP) In-service Training Examination scores were also compared. RESULTS: No significant differences were detected in self-perceived competence and ABFP examination performance. Residency graduates in the post-intervention cohort more often included depression, marital counseling, and eating disorders in their practice and reported more frequent practice activity for situational stress and sexual dysfunction. The post-intervention group reported less involvement with alcohol and substance abuse problems. This group also reported practice activity that exceeded perceived levels of competence for attention deficit disorder, learning disorders, and eating disorders. CONCLUSIONS: Participants in a PBL-clinical experiential curriculum reported higher levels of practice activity for several common behavioral problems. It seems unlikely that these differences were due to curriculum changes. Further investigation of the influence of educational and other factors on residency graduate practice activity is needed.     

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.     

Difficulties in family practice residency training: Recommendations for training health psychologists in primary care settings.

We attempt to pursue a model for health psychologists by developing recommendations for behavioral science input into family practice residencies, gleaned from experiences of several health psychologists specifically trained to be directors of behavioral science programs of such medicine departments. This information is accumulated and based on a 7-year period at one university-based, inner-city program and two community-based hospitals. These recommendations are offered in the hope that health psychology training specialists will anticipate roadblocks associated with family practice residency training programs and will plan accordingly. Specifically, we make recommendations regarding program overview and training background, roadblocks (including medicine as the final authority), theoretical versus practical teaching orientation, resident time constraints, administrative support and priorities, and training effectiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

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.     

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.     

Training in firearm safety counseling in family practice residency programs

We have studied the function of partial orthotopic liver transplantation in the rat by evaluating prothrombin time (PT), liver blood flow, basal and glucose-stimulated insulin secretion and glucose tolerance, and the reticuloendothelial function (RES) in hepatectomized rats subjected to partial liver transplantation. A graft corresponding to 68% of a normal liver was transplanted to totally hepatectomized rats. Comparison was made between control rats and rats subjected to 32% liver resection. PT was not significantly different in the transplanted group compared with liver-resected and control rats. Laser Doppler flowmetry showed that at 28 days after surgery, blood flow had increased in the transplanted livers. Furthermore, on the third day after transplantation, basal plasma insulin was increased and the plasma insulin response to glucose was exaggerated, suggesting reduced insulin action and impaired insulin degradation. Finally, uptake of radioactive-labeled E. coli bacteria, as a measure of RES function, was not compromised in transplanted animals. Based on these results, we conclude that reduced-size liver transplant in out-bred rats results in fast normalization of liver function after surgery although, immediately after surgery, glucose intolerance is seen.     

Increasing clinical prevention efforts in a family practice residency program through CQI methods

BACKGROUND: As primary care physicians develop ongoing relationships with their patients, each contact provides another opportunity for primary, secondary, or tertiary prevention activities. In 1991 an interdisciplinary prevention project team using continuous quality improvement (CQI) principles was established to improve family practice residents' provision of such services. DIAGNOSTIC JOURNEY: For a random sample of 60 patient charts, abstractors looked for documentation of 23 clinical preventive services, including nursing screens, physician on-site and off-site implemented services, lifestyle education (diet, tobacco use), and self-screening education. After the chart review, the physicians, nurses, residents, and clinical staff used a fishbone analysis to identify physician-, clinic system-, and patient-centered factors contributing to the lack of conformance with clinical prevention guidelines. REMADIAL JOURNEY: The residency program began a series of didactic sessions on clinical prevention and instituted a procedures rotation to teach prevention procedure skills such as flexible sigmoidoscopy, stress testing, and colposcopy. On the CQI team's recommendation, a checklist developed by physicians and staff which itemized age- and gender-specific clinical prevention services was placed at the front of all patient charts. Clinic-system and patient factors were also addressed. HOLDING THE GAINS--MONITORING PERFORMANCE: The 1993 postintervention chart review showed significant improvements for 17 (81%) of the 21 targeted services. DISCUSSION: Providing educational sessions on prevention, permitting residents to select the areas of prevention on which to focus, and giving feedback on resident and staff performance through ongoing, nonpunitive monitoring resulted in increased provision of clinical prevention services in a family practice residency training center.     

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)     

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.     

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.     

After-hours telephone calls in a family practice residency: volume, seriousness, and patient satisfaction

BACKGROUND: After-hours calls are common in primary care physicians' practices. Calls may be unnecessary from the physician's perspective, but patients may have a different concept of the importance of reaching their physician immediately. This study's purpose was to compare physician and patient perceptions of the same telephone call episode. METHODS: Family practice residents (n = 19) recorded all patient-initiated after-hours telephone contacts (n = 192) during July 1993. Study personnel then telephoned, within 1 week of their call, the patients who made the calls. Patients were asked about the reason for their call, its seriousness, and their satisfaction with the handling of their problem. RESULTS: During the study month, 1.1 after-hours calls were received for every 10 office visits. A substantial minority of patients (29%) rated their problems in the highest severity category, while physicians assigned only 8% of calls the highest severity rating. The majority of patients (76.7%) were satisfied with how their after-hours calls were handled. CONCLUSIONS: In matched cases, physicians and patients perceive about the same proportion of calls to be routine versus more severe. Although patient satisfaction was high, further research into causes of dissatisfaction is needed.     

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.