Special Series: Award-winning Research Papers From the American Academy of Family Physicians 1997 Scientific Assembly
(Fam Med 1998;30(4):258-64.)

Recognition of Alzheimer’s Disease:
the 7 Minute Screen™
Paul R. Solomon, PhD; William W. Pendlebury, MD

Background and Objectives: Because Alzheimer’s disease (AD) tends to be underdiagnosed, we developed a brief neurocognitive screening battery to identify AD patients. The 7 Minute Screen™ consists of four individual tests (orientation, memory, clock drawing, verbal fluency). The screen can be rapidly administered and scored and therefore may be appropriate for use in the primary care setting. This study determined the validity and reliability of the 7 Minute Screen in distinguishing patients with AD from healthy controls.

Methods: The 7 Minute Screen was administered to 60 consecutive referrals to a memory disorders clinic who were subsequently diagnosed with probable AD and to 60 community-dwelling individuals. Analysis of the combined scores on the four individual tests was used to determine the probability of dementia in each subject. We also evaluated test-retest and inter-rater reliability, as well as the time required to administer the battery.

Results: When compared with the normal subjects, the patients with AD were significantly more impaired on each of the four tests included in the 7 Minute Screen. When the four tests were combined into a logistic regression model, the battery correctly diagnosed 92% of the patients with AD and 96% of the normal subjects. The battery performed equally well when only patients with mild and very mild AD were included. Mean time for administration and scoring was 7 minutes 42 seconds.

Conclusions: The 7 Minute Screen is a reliable and valid instrument for identifying patients with AD. It appears to be a potentially useful tool for identifying patients with AD in a primary care setting.

Special Series: Award-winning Research Papers From the American Academy of Family Physicians 1997 Scientific Assembly
(Fam Med 1998;30(4)265-71.)

Emergency Department Use by Family Practice Patients in an Academic Health Center
Paul A. Campbell; Raki K. Pai; Daniel J. Derksen, MD; Betty Skipper, PhD

Background and Objectives: With the proliferation of managed care, efforts are being made to reduce emergency department (ED) use after hours and eliminate unnecessary ambulatory visits during office hours. This study characterized the after-hours ED use by a family practice residency patient population and determined differences in appropriate ED use by patients calling ahead versus those arriving at the ED without calling first. American College of Emergency Physicians guidelines were used to define appropriateness of visit.

Methods: A retrospective ED chart and on-call log review were used to obtain data.

Results: A random sampling of family practice patients from January 1993 to December 1994 (n=332) showed that, overall, 62% of patients did not call prior to their ED visit. Calling ahead was not associated with more appropriate ED use. Of those who called ahead, 63% had an appropriate ED visit, compared with 61% of those who did not call ahead. Men were more likely to appropriately use the ED than women. Patients age >64 were more likely to have appropriate ED visits than other age groups.

Conclusions: We found no relationship between calling ahead and appropriate ED use. Possible explanations include that resident physicians are inexperienced and may be uncomfortable with telephone triage due to a lack of formal telephone management training. Patients may misrepresent the severity of their illness. Further, a patient who wants to be seen after hours must be seen for medical legal reasons. Interestingly, privately insured or Medicare recipients were more likely to use the ED appropriately. This association may suggest that fiscal accountability contributes to appropriate utilization, a scenario likely to change as managed care organizes Medicaid and indigent patients.

Special Series: Award-winning Research Papers From the American Academy of Family Physicians 1997 Scientific Assembly
(Fam Med 1998;30(4):272-5.)

Family Practice Residency Program Sites on the World Wide Web
Grant S. Hoekzema, MD; Charles Kodner, MD; James Deckert, MD

Background and Objectives: The World Wide Web is a rapidly expanding entity, and family practice residencies have begun using this technology through the development of Web sites. Our objective was to survey Web sites devoted to family practice residencies.

Methods: We sent a national survey to 451 family practice residency directors.

Results: Of 241 returned surveys, 113 residencies reported an existing Web site. Seventy-four percent of Web sites were created by faculty, but 31% also involved residents in creation. Resident recruitment was the most successful goal of Web sites; 42% of programs reported “moderate” to “very successful” results. However, most programs reported that it was too early to evaluate the goals listed in the survey.

Conclusions: Family practice residencies have an increasingly significant presence on the Web. The development, content, and goals of the sites are similar across programs regardless of creation date, but the evaluation of the success of these goals is at an early stage for most programs.

Educational Research and Methods
(Fam Med 1998;30(4):276-8.)

A Comparison of Family Medicine Clerkship Student Performance Across Multiple Teaching Sites
Michael D. Prislin, MD; Camille F. Fitzpatrick, NP, MSN; Stephen Radecki, PhD

Background and Objectives: Family medicine clerkships are frequently conducted in decentralized settings. Concerns have been raised regarding the educational consistency of such rotations. In this study, we assess learning across multiple training sites, as reflected by measures of student performance.

Methods: The study population was 77 students assigned to six clusters of family medicine clerkship training sites during the 1993–1994 academic year. Learning, as measured by faculty evaluations, objective structured clinical examination (OSCE) performance, and Society of Teachers of Family Medicine (STFM) predoctoral examination performance, was compared for student cohorts assigned to each of the teaching site clusters using analysis of variance.

Results: No differences in OSCE or STFM examination performance were found across the teaching site clusters. Greater variation in faculty evaluation across sites was apparent, and when the academic and private practice teaching sites were compared with the HMO and community clinics teaching sites, this variation achieved statistical significance.

Conclusions: As measured by OSCE and STFM examination performance, student learning did not vary across multiple training sites. However, greater variability was found in faculty evaluations of student performance. Sources of this variation might include differing levels of student-faculty interactions across sites or subjectivity inherent to the faculty evaluation process.

Educational Research and Methods
(Fam Med 1998;30(4):279-82.)

Survey of Curriculum on Homosexuality/Bisexuality in Departments of Family Medicine
Catherine M. Tesar, PhD; Susan L.D. Rovi, PhD

Background and Objectives: This study assesses what US departments of family medicine are doing to teach undergraduate medical students about homosexuality/bisexuality and the care of gay, lesbian, and bisexual patients.

Methods: A two-page, 14-item, self-administered questionnaire was sent to predoctoral directors at all US medical schools with departments of family medicine (n=116). The questionnaire asked about teaching methods and curriculum hours, whether other departments address the topic, and if there is a gay/lesbian/bisexual student group at the medical school.

Results: Of the 116 predoctoral directors surveyed, 95 (82%) responded. The mean number of departmental curriculum hours devoted to this topic was 2.5 hours for all 4 years of undergraduate medical school. About half (50.6%) of respondents reported that their department spent zero hours teaching about homosexuality/bisexuality. There were no differences in time spent by geographic region, size of school, or between public and private institutions. The most frequently cited teaching method was lectures in medical ethics, followed closely by lectures in human sexuality.

Conclusions: About half of the responding family medicine departments did not include this topic in their curricula. Homosexuality/bisexuality should be included in family medicine’s curriculum to ensure that future primary care physicians can properly care for all of their patients. Recommendations for curriculum modifications are provided.

Educational Research and Methods
(Fam Med 1998;30(4):283-7.)

Family Practice Residency Programs and the Graduation of Rural Family Physicians
Robert C. Bowman, MD; Joan D. Penrod, PhD

Background and Objectives: Family practice residency programs graduate about 600 rural physicians each year. Increases in resident positions have not increased the numbers who choose rural practice. This study examines the relationship between program characteristics and the graduation rate of rural physicians.

Methods: From 1994–1996, we sent an annual survey to the directors of all nonmilitary family practice residency programs; 353 programs (96% response rate) returned questionnaires. Weighted least-squares regression was used to analyze the relationship between program factors and the percentage of graduates who chose practices in 1992, 1993, and 1994 in towns of less than 25,000 not adjacent to a larger metropolitan area.

Results: Family practice residency programs that graduated more rural physicians had more required rural and obstetrical training months, had a full or partial rural mission, were located in more rural states, had the program director as the rural contact, had a procedural emphasis, had fewer residents who were minorities or female, and used fewer types of other major graduate programs for rotations.

Conclusions: This study outlines the important contribution of rural emphasis and training in family practice residency programs. Future studies should explore rural, procedural, and obstetrical training interventions and examine gender, minority, and program location issues.

Educational Research and Methods
(Fam Med 1998;30(4):288-92.)

Management of Spontaneous Abortion in Family Practices and Hospitals
Ellen Wiebe, MD; Patricia Janssen, MPH

Background and Objectives: We performed two retrospective chart surveys, the first of 200 consecutive hospital emergency visits for spontaneous abortion and the second in 33 family physicians’ offices examining 245 patients with spontaneous abortions. This study determined the rate of surgical management of spontaneous abortions within family practices and hospitals, as well as the rate of referrals and complications.

Methods: In the retrospective chart surveys, the information collected included the number of spontaneous abortions, dilation and curettages (D&Cs), referrals, and complications.

Results: Of the women presenting to the hospitals, 92.5% had D&Cs, while 51% of the women presenting to family physicians had D&Cs. Of the women presenting to the hospitals, 99.5% were referred to gynecologists, compared with 41% of the family practice patients. Hemorrhage occurred in 4.6% of the hospital patients and 2% of the family practice patients. Infection occurred in 6% of the hospital patients and .8% of the family practice patients.

Conclusions: Patients with spontaneous abortions who saw their family physicians were more likely to be managed conservatively than those seen in the hospitals. There was no increase in complications in the conservatively managed patients.

Clinical Research and Methods
(Fam Med 1998;30(4):293-6.)