Competency-based Education in Family Practice
Hershey S. Bell, MD; Stanley M. Kozakowski, MD; Robin 0. Winter, MD

Background and Objectives: Since their inception, family practice residency programs have been designed on a rotation-based format. It has been assumed that by having residents rotate through a series of educational experiences, they would assimilate the skills necessary to effectively serve as a family physician. An alternative approach is based on the attainment of competency, rather than on the completion of a set of experiences. This method of education is known as competency-based education, mastery learning, or, more recently, outcomes-based assessment. Within family medicine, there is a strong interest in the application of competency-based education to family practice residency training. In response to the growing need to discuss these and other related issues, the Society of Teachers of Family Medicine (STFM) Board created the Task Force on Competency-based Education. Its mission is to disseminate this educational theory to STFM's membership. This article reviews the theory of competency-based education, describes development of a competency-based curriculum model, and discusses the academic issues surrounding adaptation of this form of education to family practice residency programs.

Educational Research and Methods
(Fam Med 1997;29(10):701-4.)

Resident Partnerships: A Tool for Enhancing Ambulatory Training
Patricia Adam, MD, MSPH; Harold A. Williamson Jr, MD, MSPH; Steven C. Zweig, MD, MSPH

Background and Objectives: This study examined resident partnerships and their effect on graduates' practice patterns. Methods: The study authors surveyed graduates from a residency program that used resident partnerships. We also surveyed the graduates' current practice partners, and they served as a comparison group.

Results: The graduates' response rate was 86%, and their current practice partners' response rate was 61%. Graduates from a partnership program rated themselves better trained for outpatient medicine and more comfortable communicating with other physicians and working within a patient care team; they were also slightly less likely to practice inpatient medicine. Reported benefits during residency included enhanced availability for continuity clinics, more emotional and intellectual support, and more flexible work schedules. Conclusions: Graduates valued partnerships during their training and reported being better prepared to work with other physicians in ambulatory settings.

Educational Research and Methods
(Fam Med 1997;29(10):705-8.)

Perceived Characteristics of Successful Family Practice Residency Maternity Care Training Programs
Harry A. Taylor, MD; George H. Hansen, MD

Background and Objectives: This study determined the perceived characteristics of family practice residency training programs that produce a high percentage of graduates who provide maternity care.

Methods: We surveyed a Delphi panel of 28 family practice maternity care experts.

Results: Consensus was reached after the third survey. The characteristics of the family medicine faculty and teaching service were rated as most important. Other essential characteristics were an adequate obstetrical training volume; mutual respect between obstetric and family medicine faculty and residents; support for family practice maternity care from obstetricians, administration, and nursing staff; and family physicians being accepted in the community as maternity care providers.

Conclusions: Family practice residency programs that produce a high percentage of graduates who provide maternity care have a unique, family practice maternity care-friendly environment. Residency programs wishing to increase the percentage of their graduates who provide maternity care should ensure that their faculty support family practice maternity care, are competent in maternity care, and model maternity care in their own practices. They should strive to ensure an adequate volume of obstetrical cases for resident education and work toward educating patients and local obstetricians, nursing staff, and hospital administration regarding family practice maternity care.

Educational Research and Methods
(Fam Med 1997;29(10):709-14.)

Combined Residency Training in Family Practice and Other Specialties
Ron Chapman, MD, MPH; Jim Nuovo, MD

Background and Objectives: The University of California, Davis residencies in family practice and psychiatry are entering the third year of a combined training track. Graduates of the combined program will be eligible for board certification in both specialties. The combined program has created opportunities for collaborative training with other specialties, such as obstetrics and medical informatics. Barriers and challenges to collaborative training include issues of curriculum integration, establishment of an identity for residents and future graduates, resident stress, acceptance of combined programs, counting of generalist physicians, hospital privileges, fulfillment of unmet societal needs, and improved collaboration at academic health centers.

Educational Research and Methods
(Fam Med 1997;29(10):715-8.)

Educational Research and Methods
(Fam Med 1997;29(10):719-23.)

A Hypothetical Model of the Effect of Medical Education on Specialty Choice
Christina S. Randall, PhD; George R. Bergus, MD; Janet A. Schlechte, MD; Gail McGuinness, MD; Charles W. Mueller, PhD

Background and Objectives: Using the Theory of Reasoned Action, we propose a model that diagrams medical school characteristics known or hypothesized to influence the process of specialty choice. The medical school characteristics we consider are administrative support, special programs, primary care funding, number and quality of primary care faculty, faculty influence, primary care residencies, committee representation, primary care environment, required time, and student contact. This model provides explicit hypotheses to be tested in future research on specialty choice.

Educational Research and Methods
(Fam Med 1997;29(10):724-9.)

Factors Associated With Primary Care Residents' Satisfaction With Their Training
Christina S. Randall, PhD; George R. Bergus, MD; Janet A. Schlechte, MD; Gail McGuinness, MD; Charles W. Mueller, PhD

Background and Objectives: Satisfaction is known to impact work performance, learning, recruitment, and retention. This study identifies the factors associated with primary care residents' satisfaction with their training.

Methods: We used a cross-sectional survey based on the Price-Mueller model of job satisfaction. The model included 14 job characteristics, four personal characteristics, and four demographic factors. Data were collected in February and March 1996 from residents in three primary care training programs (family practice, pediatrics, and internal medicine) at a large academic medical center. The same standardized, self-administered questionnaires were used in all three departments.

Results: Seventy-five percent (n=119) of the residents returned questionnaires. Five job characteristics were positively associated with resident satisfaction: continuity of care, autonomy, collegiality, work that encourages professional growth, and work group loyalty. Role conflict, a sixth job characteristic, was negatively associated with satisfaction. The personal characteristic of having an optimistic outlook on life was also positively associated with satisfaction. The model explained 66% of the variation in self-reported satisfaction.

Conclusions: The satisfaction of the residents was significantly associated with six job characteristics and one personal factor. Interventions based on these job characteristics may increase resident satisfaction and may lead to better patient outcomes, better work performance, greater patient satisfaction, and more success in recruiting top students into a residency.

Educational Research and Methods
(Fam Med 1997;29(10):730-5.)

Clinical Research and Methods
(Fam Med 1997;29(10):736-42.)