Background and Objectives: Conducted by a task force of the Association of Departments of Family Medicine, this study defines current issues in the clinical practice of academic departments of family medicine in US medical schools.

Methods: A survey instrument on departmental demographics, funding, teaching, and governance in regard to clinical practice was sent to 130 family medicine department chairs or other key contacts in US medical schools. A total of 106 usable responses were obtained, for an 81.5% response rate.

Results: Results indicate that, in response to a need to increase clinical practice income, academic medical centers (AMCs) and departments are increasingly hiring physician faculty for positions that mainly involve patient care, although at salaries less than the community level. In spite of increasing departmental responsibilities in predoctoral and resident education and clinical practice, much teaching is done by community physicians. There is significant purchasing of community practices and growing involvement of the AMCs in the practice activities of departments. Two thirds of clinical chairs reported "pretty good" to "great" satisfaction on a five-point scale.

Background: This study assessed the clinical learning experiences provided to third-year medical students during a 2-week, required, community-based family medicine preceptorship.

Methods: After completing the preceptorship, students classified their level of performance on 80 clinical activities. During 3 academic years, 486 third-year students completed the preceptorship.

Results: Delivery of well-child care was the only prevention skill in which a high percentage of students (more than 67%) received experience; students received moderate experience (34%-67% of students) with another seven prevention skills. Students received a high level of active experience with four clinical problems: upper respiratory tract infection, acute otitis media, sinusitis, and strep throat, and a moderate level of active experience on another 17 clinical problems. There were no procedural skills on which students received a high level of experience, but students received a moderate level of experience with 10 procedural skills.

Background: A new licensing examination for family physicians was introduced in the Province of Quebec, Canada, in 1990. It contains a newly developed, standardized, patient-based objective structured clinical examination (OSCE) used in complementarity with two other instruments (Short Answers Management Problems [SAMPs] and Simulated Office Orals [SOOs]) that have been used for many years by the College of Family Physicians of Canada (CFPC) for certification purposes. This research studied the criterion validity of the OSCE using the last instruments as criteria.

Methods: The results of the 172 spring 1994 candidates were analyzed. Cronbach alpha reliability coefficients were computed. Pearson's correlation coefficients and regression analysis measured the extent to which scores on the new Quebec OSCE correlated with the scores on the CFPC instruments.

Results: Correlation coefficients were significant between the Quebec OSCE scores and the CFPC examination total scores (.700), the SAMPs scores (.634), and the SOOs scores (.514). Multiple regression analysis confirmed that scores on the Quebec OSCE explained a significant but still limited proportion of the variation in scores of the CFPC examination.

Background and Objectives: The culture of family practice training programs does little to convince residents that research is a worthwhile and important activity. The traditional dichotomy between research and clinical medicine persists today, despite an identified clinical mission for research.

Methods: As part of an effort to build the research capacity of family practice training programs, a telephone survey was administered in August 1995 to the program directors of all residency programs listed in the American Academy of Family Physicians 1995 Directory of Family Practice Residency Programs. The directors were asked about their program's research environment, features designed to promote research activity, and the level of resident research productivity.

Results: More than half (53.6%) of the program directors felt that their training program actively promotes research. Three out of four indicated that involving residents in research is a goal of their program. However, only four of 10 (40.8%) programs provide specific time for research, and family practice residents appear to be relatively inactive by conventional measures of research productivity.

Conclusions: Research appears to be developing a limited role in family practice training programs. Resident research productivity remains relatively low and may be a result of residency programs not providing specific time for participating in research. However, the program directors' supportive attitudes may contribute to research and scholarly activity becoming an integral part of a family physicianÍs training.
Educational Research and Methods
(Fam Med 1997;29(1):33-7.)

Background and Objectives: Management of upper respiratory infection (URI) was examined in a family practice clinic to determine evidence-based practices, specifically for medication choice. Scientific evidence supports the use of decongestants and perhaps decongestant/antihistamine combinations in adolescents and adults and antipyretics in all age groups. The use of cold preparations for children younger than age 5 is not evidence based.

Methods: Data on demographics, medications prescribed, and over-the-counter medications recommended were collected from patient charts for 293 URI visits over a 6-month period. The cost of evidence-based URI treatment was compared with the cost of nonevidence-based treatment.

Results: Thirty-three percent of patients younger than age 5 were given a prescription; 96% of the prescription cost in this age group was nonevidence based. Twenty-six percent of all patients seen were given unnecessary and potentially harmful medication. These unnecessary medications accounted for almost 60% of the total prescription cost. Various combinations of antihistamines, decongestants, and antitussives were most commonly prescribed.

Conclusions: Few medications have been shown to effectively alleviate the symptoms of the generally self-limited, benign common cold. Medications are often overprescribed, escalating health care costs and, in some cases, exposing the patient to dangerous side effects. Family physicians and educators are encouraged to reexamine their treatment and teaching practices for the common cold.
Clinical Research and Methods
(Fam Med 1997;29(1):38-6.)

Background and Objectives: Determining authorship for publications is often a difficult process, even more so when individuals from several disciplines collaborate with community organizations to conduct projects. Although multidisciplinary and community-academic partnerships provide fertile ground for publication efforts, disputes about authorship and ownership of data may hinder efforts to disseminate information. This article describes a process for dealing with authorship in multi-professional collaborations. It provides an authorship scale, similar to a neonatal Apgar scale, to determine order of authorship in multi-professional projects. Key components or activities in the process of authorship are identified, and points are assigned to each component in proportion to an investigator's level of activity in each component/activity. Scores are summed and can range from 1 to 35 for each author. The order of authorship is then determined by the relative score of each participant.
Faculty Development
(Fam Med 1997;29(1):42-4.)

Background: This research explored the relationship between collegial networking and faculty "vitality" among graduates of the family medicine faculty development fellowship at the University of North Carolina at Chapel Hill. Faculty vitality was defined by retention in full-time teaching, job satisfaction, academic activity, and contributions to the discipline.

Methods: A questionnaire was mailed to 170 family physician graduates of the 1980-1992 fellowship classes. After a mail and telephone follow-up, the response rate was 85%. Data were collected on career history, professional interests, professional relationships, assessment of fellowship, and professional activities.

Results: Respondents with collegial networks were more likely to participate in several academic activities and were more likely to remain in full-time teaching. No association was found between collegial networks and satisfaction or contributions to the discipline. There were only small differences in effect between intra-departmental and extra-departmental collegial networks. Stratification by program type and gender revealed no evidence of effect modification or confounding.

Conclusions: Collegial networks influence some aspects of faculty vitality, particularly retention in full-time teaching. Further research is needed to fully understand its impact.
Faculty Development
(Fam Med 1997;29(1):45-9.)