Background: The rapid growth of managed care is posing new challenges for residency education. This study examines the effect of managed care on family practice residency programsÍ abilities to provide an ambulatory continuity experience for resident physicians. This paper also assesses the perceived benefits and problems associated with managed care.

Methods: A survey was mailed in the fall of 1995 to the directors of all US family practice residencies.

Results: Nearly 75% of residencies had experienced a recent increase in managed care volume. Nearly 75% reported associated benefits. Fifty percent reported associated problems for residency training. Only 20% of residencies had a managed care contract that allowed resident physicians to serve as primary care providers. Residencies use a variety of methods to circumvent these restrictions to enable residents to have a continuity practice.

Conclusions: Managed care organizations create opportunities and challenges for the training of primary care physicians.

Background: Family practice residencies lack clear guidelines defining which procedures should be included in their curricula. The American Academy of Family Physicians (AAFP) Task Force on Procedures developed a recommendation (approved by the AAFP Board of Directors) that can be used to create a set of procedures that should be taught in residencies. The task force recommendation is based on procedures taught in most family practice residencies and performed by most practicing family physicians.

Methods: The AAFP Task Force on Procedures surveyed all family practice residency programs and departments to determine which procedures they were teaching. The task force also surveyed a representative sample of practicing family physicians to find out which procedures they were performing.

Results: Residency programs and departments returned 397 surveys (74.1% response), and the sample of 4,400 practicing physicians returned 2,028 surveys (46.1% response). The survey data identified 69 procedures as being taught in most family practice residencies, and 30 of these procedures as being performed by most practicing family physicians.

Conclusions: Many procedures can be identified as being taught in most family practice residencies or performed by most practicing family physicians. Fewer procedures are performed by practicing family physicians than are taught in residencies.

Background and Objectives: The reasons why practicing physicians precept students in their offices, and the rewards they wish to receive for this work, have not been clearly elucidated. This study determined the reasons for precepting and the rewards expected among a network of preceptors in Milwaukee.

Methods: A questionnaire was mailed to 120 community-based physician preceptors in a required, third-year ambulatory care clerkship. Respondents were asked to identify why they volunteered and what they considered appropriate recognition or reward.

Results: The personal satisfaction derived from the student-teacher interaction was, by far, the most important motivator for preceptors (84%). The most preferred rewards for teaching included clinical faculty appointment, CME and bookstore discounts, computer networking, and workshops for improving skills in clinical teaching.

Conclusions: Community-based private physicians who participate in medical student education programs are primarily motivated by the personal satisfaction that they derive from the teaching encounter. An effective preceptor recognition/reward program can be developed using input from the preceptors themselves.

Background and Objectives: Because a shortage of physicians for the rural United States persists, it is important to better understand why individuals from rural areas consider careers in medicine. This study assessed and compared rural and urban high school studentsÍ interest in careers in medicine.

Methods: Students attending presentations given by medical students about health care careers completed a questionnaire given at high schools between 1991-1994. This questionnaire assessed interest in health and medical careers and self-perceived capability to pursue a medical career.

Results: A total of 924 students attended the presentations and returned questionnaires. Approximately 33% of students expressed an interest in some type of health career. Related to choosing such a career were being female, coming from an urban area, and having had a previous talk about a health care career. Among the 13% of students considering becoming a physician, only being from an urban area or having had a previous talk were related to this choice. Rural students who had received previous talks were more likely to consider health care and medicine careers.

Conclusions: Socializing rural high school students to health care and physician careers via structured talks and personal encouragement may increase the number of rural students interested in such careers and help alleviate the shortage of rural health care providers.

Background and Objectives: Clinical prevention is an important component of primary care, but its delivery remains deficient. This study determined the effect of a comprehensive preventive medicine curriculum, in combination with use of a prevention flow sheet, on community and family medicine residentsÍ performance of 16 recommended clinical preventive services.

Methods: A retrospective study was done to document preventive services based on chart reviews of 240 clinic patients for the year prior to intervention initiation and the first year following the intervention.

Results: Chi-square analysis revealed a significant increase in the delivery of 12 out of 15 recommended clinical preventive services after the intervention.

Conclusions: Implementation of comprehensive preventive medicine curricula, in combination with use of a clinical prevention flow sheet, is associated with an increase in preventive care offered to patients by community and family medicine residents.

Background and Objectives: Much of rural Colorado has been designated a shortage area for primary care health personnel. The stateÍs only medical school and its family practice residency programs are expected to address this long-standing problem. This study identified predictors of rural practice location and contrasted the service profiles of rural versus urban family physicians and general practitioners.

Methods: The Colorado Board of Medical Examiners mailed a questionnaire to all licensed Colorado physicians. Logistic regression analyses were conducted using variables determined to be significantly related to practice location (rural versus urban) by univariate statistical tests. Information from the 986 family physician and general practitioner respondents identified personal and educational variables strongly associated with choice of rural practice location and differentiated between practice tendencies of rural versus urban physicians.

Results: Having been raised in rural Colorado was the most powerful predictor of rural practice location in the state. Family physicians and general practitioners serving rural populations spent much more time weekly providing direct patient care and more often cared for Medicaid patients.

Conclusions: Personal characteristics and background may be useful considerations in selecting among applicants for medical schools and family practice residency programs committed to reducing the severe shortage of health care service in rural areas.

Background and Objectives: A community-based family practice residency program initiated a cervical screening project to provide free Pap smears to women who had not had one in 3 years. The research identified reasons why patients had not been screened within the past 3 years.

Methods: A total of 214 consecutive participants in the free Pap smear clinic completed questionnaires. The questionnaire asked about reasons why screening had not occurred over the last 3 years.

Results: Altogether, 65.4% of the study group reported cost-related factors as barriers to participation; 37.9% cited either scheduling concerns, fear, or embarrassment; and 36% cited misinformation issues about either screening recommendations, effectiveness of treatment, or disease presentation.

Conclusions: Strategies to increase participation in Pap smear screening clinics may include increasing availability of free or low-cost screening examinations, increasing time efficiency and scheduling flexibility of examinations, and making efforts to mitigate the fear and embarrassment associated with the exam.

Background and Objectives: Presentations at the annual meetings of the Society of Teachers of Family Medicine were analyzed to determine trends in the content of the work and the types of work represented.

Methods: All program presentations from 1979, 1986, and 1993-1995 were analyzed. Content classifications were based on historic analyses of family medicine literature. Classifications of types of scholarship came from a 1990 Carnegie Foundation report, Scholarship Reconsidered: Priorities of the Professoriate.

Results: Results showed that a wide variety of scholarly activities were presented, but application of educational work was predominant. Many presentations crossed interdisciplinary boundaries, including behavioral science, faculty development, and health services.

Conclusions: Contributions of family medicine scholarship may be applicable to other medical fields. The variety of family medicine scholarship may warrant a redefinition of reward systems for faculty.

The issue of selection bias is often raised in the critical appraisal of medical studies, but it is often poorly defined and misunderstood. This paper describes three common patterns of use of the term selection bias and their effects on study results. The three ways in which selection bias is used are related to 1) selection of representative subjects, 2) selection of subjects to exposures, and 3) selection of subjects at outcome.

Avoidance of bias in the first of these issues, selection of representative subjects, enhances the ability to generalize a studyÍs results. The other two uses of selection bias relate to the internal validity of studies. The selection of subjects to exposures without randomization in observational studies can distort results because of confounding variables. The selection of study subjects at outcome in case-control and cross-sectional studies can distort study findings if selection into the study is distorted according to exposure status.

Readers of medical studies should understand the different implications of these uses to improve their critical evaluation of studies. Writers and discussants should be aware of these differences and provide clarifying details when they use the term.