Special Articles: 1998 Match Results
(Fam Med 1998;30(8):554-63.)

Results of the 1998 National Resident Matching Program: Family Practice
Norman B. Kahn, Jr, MD; Julea G. Garner, MD; Gordon T. Schmittling, MS; Daniel J. Ostergaard, MD; Robert Graham, MD

The 1998 National Resident Matching Program (NRMP) results reflect a change in the perceptions and choices of physicians entering graduate medical education in the United States. Ninety-one fewer positions were filled in family practice residency programs in 1998, as well as 21 fewer in primary care internal medicine, 12 fewer in primary care pediatrics, and 13 fewer in internal medicine-pediatric programs. In contrast, 49 more positions were filled in anesthesiology, and 12 more US seniors chose diagnostic radiology, two “marker” disciplines that have recently been market sensitive. Thirty-four more positions were also filled in each of categorical internal medicine and pediatrics programs, where trainees are “pluripotential” with perceived options for practicing as generalists or entering subspecialty fellowships, depending on the market. While the demands of managed care and the needs of rural and underserved populations continue to offer a market for family physicians, family practice may have experienced a “primary care backlash” though the 1998 NRMP.

Special Articles: 1998 Match Results
(Fam Med 1998;30(8):564-70.)

Family Practice Night-call Frequency: 1981–1997
Dana E. King, MD; Lars Larsen, MD; Amy M. Shende, MA

Background: Night call has both service and educational value. This study examined trends in night-call frequency from 1981–1997. Our hypothesis was that night-call frequency is decreasing in family practice residency programs.

Methods: We reviewed the Directory of Family Practice Residency Programs from 1981, 1989, and 1997 and entered into a database information about call frequency from all of the programs in each year. In-house night-call frequency and frequency of home call requiring other trips to the hospital were combined to determine total calls per year.

Results: The mean number of total calls for PGY-1 residents was 190, 124, and 104 for each cohort year, respectively (1981, 1989, 1997). PGY-2 total calls were 160, 96, and 74. PGY-3 total calls were 151, 73, and 57. For all years of residency, total calls in 1997 were fewer than for 1981 and 1989.

Conclusions: Family practice residents have less night call now than in 1981 or 1989. The educational consequences of decreasing night call should be evaluated.

Educational Research and Methods
(Fam Med 1998;30(8):571-3.)

Family Practice in the New South Africa
Robert L. Williams, MD, MPH; Stephen J. Reid, MBChB, MFamMed

Remarkable changes are taking place in the new South Africa. Planned changes in the health care arena present the new, relatively small discipline of family practice with great opportunity for development and growth. With established generalist roots and recent formal recognition in South Africa, family practice should be well suited for a lead role in the government’s efforts to extend health care access to those denied it under apartheid. Whether family practice moves into that role will depend on whether as a discipline it can project a vision of how it can meet the country’s health care needs. Close examination of family practice in South Africa shows how the field reflects many of the societal problems of the past and the challenges of the future. With a clear vision of its role in the new South Africa, family practice could overcome these challenges, as well as answer a broader question about the place of family practice outside of the first world setting.

International Family Medicine
(Fam Med 1998;30(7):574-8.)

Graphical Methods for Detecting Bias
in Meta-analysis
Robert L. Ferrer, MD, MPH

The trustworthiness of meta-analysis, a set of techniques used to quantitatively combine results from different studies, has recently been questioned. Problems with meta-analysis stem from bias in selecting studies to include in a meta-analysis and from combining study results when it is inappropriate to do so. Simple graphical techniques address these problems but are infrequently applied. Funnel plots display the relationship of effect size versus sample size and help determine whether there is likely to have been selection bias in including studies in the meta-analysis. The L’Abbé plot displays the outcomes in both the treatment and control groups of included studies and helps to decide whether the studies are too heterogeneous to appropriately combine into a single measure of effect.

Research Series
(Fam Med 1998;30(8):579-83.)

A Closer Look at Confounding
Jeffrey Sonis, MD, MPH

Background and Objectives: Confounding is one of the most common and important biases in primary care research. This article explains the genesis and effects of two common misconceptions of confounding: 1) Confounding can be assessed with a statistical test. 2) All covariates should be included in a multivariate model to control confounding. Assessment of confounding by testing the statistical significance of baseline differences or the significance of a potential confounding factor in a multivariate model can produce underestimates or overestimates of the true association between an exposure and an outcome. Inclusion of all covariates in a multivariate model may lead to controlling for variables that are not, in fact, confounders. This may produce underestimates or overestimates of the effect in question, as well as artificially widened confidence intervals. Both of these misconceptions can lead to profound misinterpretation of research results. To prevent problems resulting from these misunderstandings, researchers should consider drawing causal models prior to conducting the research and use the change-in-estimate criterion, rather than a statistical test, to detect confounding.

Research Series
(Fam Med 1998;30(8):584-8.)

The Family Physician: What Sort of Person?
Howard Brody, MD, PhD

Background: Character and virtue are as important as knowledge and skills in describing the ideal family physician. Sir Luke Fildes’ The Doctor, a widely reproduced painting, provides a visual icon that helps focus attention on important aspects of the character of a “healing sort of person.” By stressing rules and principles to the detriment of a good life as a biographical or narrative whole, modern teaching of medical ethics may fail to sufficiently address this aspect of humanism in medicine. Three virtues or character traits that seem necessary for the ideal family physician are humility, compassion, and forgiveness. Such evidence as now exists supports the idea that these physician attributes might be linked to superior health outcomes.

Commentary
(Fam Med 1998;30(8):589-93.)