Background and Objectives: Using activities of daily living (ADLs) and instrumental activities of daily living (IADLs) as a focus, faculty at Eastern Virginia Medical School provide an aging simulation exercise for a mandatory fourth-year clerkship in geriatrics. The specific aims of the simulation are to 1) experience the physical frailties of aging, 2) develop creative problem-solving techniques, 3) identify feelings regarding the experience of functional loss, and 4) develop proactive clinical approaches to the care of the elderly.

Methods: Students are assigned one of four diagnoses (Parkinson’s disease, rheumatoid arthritis, advanced diabetes, or stroke) and are then impaired to simulate the frailties of the condition, using a variety of clothes, bindings, and other devices. In their “impaired states,” they perform ADLs and IADLs, such as paying bills, organizing their pills, shopping, toileting, dressing, and eating.

Results: Evaluation results show the aging simulation to be the highest rated program in the clerkship. A pre- and post-course survey on attitudes toward the elderly showed a statistically significant improvement in students’ attitudes toward the elderly following the course.

Conclusions: Simulation exercises in aging are useful activities for helping students better understand the feelings and needs of the elderly.

Educational Research and Methods
(Fam Med 1998;30(1):15-8.)

Counting the Cost of an NRSA Primary Care Research Fellowship Program
Peter Curtis, MD; Virginia D. Shaffer, MS; Adam O. Goldstein, MD; Laura Seufert

Background and Objectives: Concerns are often raised about the potential financial and logistical burdens that fellows (even those who receive federal funding) add to departmental budgets.

Methods: We collected data on patient care income, financial values of teaching, on-call and attending duties, and departmental costs for patient care overhead, administration, and supervision over a 1-year period for six fellows in the National Research Service Award (NRSA) Primary Care Research Fellowship Program at the University of North Carolina at Chapel Hill.

Results: Net receipts for clinical services ranged from $4,023 to $15,742, which, when adjusted for overhead costs, led to financial loss. However, assuming an academic dollar value of $15/hour, teaching, precepting, and on-call coverage were worth from $3,330 to $9,780 to a department, depending on level and specialty of the fellow. Overall, NRSA fellows imposed a financial burden consisting of practice-related costs and uncompensated faculty supervision and administration. Three factors can modify the estimate of this burden, including the calculation of patient care overhead, the estimated value of academic work, and whether fellows provide “replacement” or “additive” clinical functions to their departments.

Conclusions: The NRSA Fellowship Training Program can be a cost-neutral but valuable resource for developing highly trained primary care researchers and new faculty. Increased administrative funding for these programs would be a low-cost strategy to compensate faculty time and program management in generalist departments.

Educational Research and Methods
(Fam Med 1998;30(1):19-23.)

Orientation to Community in a Family Practice Residency Program
Robert Thompson, MD; David Haber, PhD; Charles Chambers, MPH; Leah Fanuiel, MSW; Katherine Krohn, MSW; Alan J. Smith, PhD

Background and Objectives: Family practice residencies are expected to include opportunities for trainees to learn about population-based approaches to health care delivery.

Methods: To prepare them for community projects later in training, first-year residents were introduced to a community-oriented primary care (COPC) curriculum by an interdisciplinary team with representatives from public health and academic family medicine. During their mid-year orientation month, the residents spent three afternoons in community settings, each year focusing on a different public health issue. The residents spent the first afternoon discussing principles of community medicine, the COPC model, and planning community interviews. The second afternoon, they interviewed in the community. The residents reported and evaluated on the third afternoon.

Results: During the 3 years described, most residents participated with enthusiasm, later reporting increased awareness and use of community resources. However, months after the third experience, a comparison of clinic records before and after the orientation showed no difference in the residents’ inclusion of the health issue studied in managing their patients, although social workers and other non-physician faculty team members reported that residents consulted them more frequently following the community orientation.

Conclusions: It is important to provide residents with an efficiently designed and attractive community orientation early in training. An interdisciplinary team should plan and coordinate their experiences, but all faculty should role model good community behavior. Although the 1996 residents described behavioral changes following this brief orientation, this was not documented by a chart review.

Educational Research and Methods
(Fam Med 1998;30(1):24-8.)

International Health Training in Family Practice Residency Programs
Stephen H. Schultz, MD; Sally Rousseau, MSW

Background and Objectives: This survey determined the extent of involvement in and support of international health training by family practice residency programs.

Methods: We mailed a 17-item survey about four areas of international health training (curriculum, faculty, financial support, and international health sites) to the 192 family practice residency programs that answered affirmatively to the American Academy of Family Physicians (AAFP) 1996 survey question, “Does your program offer or encourage an elective in an international setting?”

Results: Of the surveyed programs, 75% (144/192) responded. Fifty-four percent of programs offered some form of international health curriculum, and 15.3% (22/144) provided significant support for resident involvement in international health, defined as having 1) an international health curriculum, 2) funding support (other than paid salary while away), and 3) at least one faculty member who had done health care work in a developing country in the past 2 years. Of the responding programs, 24.3% (35/144) had none of the three criteria. The number of residents who worked in developing countries most strongly correlated with the number of faculty who have done such work in the past 2 years. Logistic regression suggested that the factors associated with a program having residents who have worked in developing countries in the past 2 years included the number of faculty who worked in developing countries in the past 2 years, the number of months of salary paid while on an international health elective, the length of time a program had offered an international health experience, and paid living expenses while at the international site.

Conclusions: A wide range of support is offered for international health education by programs that are self-identified as offering or encouraging international health rotations. This survey begins to clarify the specific factors associated with placing residents in international training opportunities.

Educational Research and Methods
(Fam Med 1998;30(1):29-33.)

The Effect of Physician Characteristics on Compliance With Adult Preventive Care Guidelines
John W. Ely, MD, MSPH; Christopher J. Goerdt, MD, MPH; George R. Bergus, MD; Colin P. West, MS; Jeffrey D. Dawson, ScD; Bradley N. Doebbeling, MD, MS

Background and Objectives: This study identified physician characteristics and attitudes related to self-reported compliance with adult prevention guidelines.

Methods: A questionnaire was mailed to family practice and internal medicine residents and faculty at the University of Iowa (n=209). The questionnaire’s 78 items fell into seven categories, including physician demographics, history-taking practices, counseling practices, self-perceived effectiveness in changing patient behavior, beliefs about preventive care, knowledge about preventive care, and perceived barriers to the delivery of preventive care.

Results: Compliance with history-taking recommendations was independently associated with high knowledge scores, female physician gender, and high self-perceived effectiveness in changing patient behavior. The only factor that was independently associated with counseling efforts was self-perceived effectiveness in changing patient behavior.

Conclusions: Factors that were independently associated with self-reported preventive care efforts include female physician gender, knowledge about preventive care guidelines, and perceived effectiveness in changing patient behavior. After controlling for these factors, other variables such as lack of time, lack of reminder systems, attitudes about preventive care, and amount of formal preventive care education were not related to self-reported compliance with counseling and history-taking recommendations.