Challenges to Academic Family Medicine in the Current Health Care Environment
William J. Hueston, MD; Arch G. Mainous III, PhD; Carol Bazell, MD; Margaret Kelsey Connor, MPH

Background: Changes in health care delivery and funding have placed strains on academic medical centers’ ability to meet their multiple missions. To gain insight into how this new academic landscape is affecting academic primary care, this study examined the current status and perceived challenges at nine departments of family medicine at allopathic and osteopathic medical schools.

Methods: Site visits were made to nine academic departments of family medicine where key informant interviews were conducted with several individuals in key leadership positions. Sites were chosen to maximize diversity among departments along a variety of factors, such as location, size, mission, and type of school (private versus public). Interviews were transcribed and analyzed by a three-person multidisciplinary team for key themes.

Results: Analysis of interviews revealed five major challenges for academic departments of family medicine: 1) adjusting to new clinical demands in the academic health center, 2) organizing and administering new initiatives in community-based education, 3) recruiting and retaining faculty, 4) developing and maintaining research capacity, and 5) serving multiple missions (education, clinical care, and academic pursuits) in times of financial restraint.

Conclusions: Significant challenges face academic departments of family medicine. The success or failure of departments of family medicine to meet these challenges could serve as a bellwether for how primary care fits into the future overall scheme of academic health centers.

Special Article
(Fam Med 2000;32(4):240-5.)

Long-term Effects of a Primary Health Care Intervention Program for Women: Lower Blood Pressure and Stable Weight
Cecilia Björkelund, MD, PhD; Lauren Lissner, PhD; Carol Devine, PhD; Anna Karin Lindroos, PhD; Lis Palm, RD; Anna Westerståhl, MD

Background: In Strömstad, with 10,000 inhabitants, a cardiovascular prevention program was launched during 1985–1987 because of high rates of cardiovascular disease. To study long-term effects in women, an 8-year follow-up was conducted.

Methods: Participants (n=114) and nonparticipants (n=269) in the lifestyle intervention program in 1985–1987 (both groups with cardiovascular risk factors) were compared regarding risk factor levels after 8 years. Effects were also compared to another community not exposed to intervention.

Results: After 8 years, intervention participants showed significant reduction of mean systolic blood pressure compared to the control group and had higher intake of dietary fibers and more-positive attitudes to and better knowledge of healthy diets. There was no increase of mean body weight or serum triglyceride levels whatsoever in the intervention group. Compared with another female population not exposed to intervention, body weight and systolic blood pressure changed in a significantly more favorable way.

Conclusions: Results from the prevention program could be discerned after 8 years. Advantages in risk factor changes could also be found when comparing with another female population. Given the high level of stroke in women within the community, the blood pressure advantage in the intervention group is particularly encouraging.

Award-winning Research Papers From the American Academy of Family Physicians 1999 Annual Scientific Assembly
(Fam Med 2000;32(4):246-51.)

Prevalence of the Use of Herbal Products in a Low-income Population
Margaret Planta, MD; Berit Gundersen, PharmD; John C. Petitt, MD

Objectives: This study determined the prevalence of herb/supplement use in a low-income population and determined the providers’ level of knowledge about herbs/supplements.

Methods: Adult English-speaking patients seen at a rural family practice residency clinic were offered an anonymous survey. Another survey was developed for the clinic providers. Data were analyzed using the chi-square test.

Results: Fifty-six percent of a low-income population use herbs/supplements; 41% of all users cited friends or relatives as their main source of information, and 53% of users had not informed their provider. In the provider survey, 69% of the providers indicated that they had received no education about herbs/supplements, yet 71% were asked about them by patients at least twice a month.

Conclusions: Because herb/supplement use occurs across all demographic groups, all patients should be questioned about their use of such substances. Currently, few providers are prepared to guide their patients about herbs/supplements. Efforts should be made to educate health care providers about common herbs/supplements.

Award-winning Research Papers From the American Academy of Family Physicians 1999 Annual Scientific Assembly
(Fam Med 2000;32(4):252-7.)

Recruitment Behavior and Program Directors: How Ethical Are Their Perspectives About the Match Process?
Peter J. Carek, MD, MS; Kimberly D. Anderson, PhD; Amy V. Blue, PhD; Brian E. Mavis, PhD

Objective: This study examined family practice residency directors’ perspectives on the 1999 National Resident Matching Program (NRMP) process and identified directors’ expectations for students’ recruitment behavior.

Methods: Subjects were the family practice residency program directors. A 22-item written questionnaire was mailed to each director. The questions related to the directors’ perceptions of the following issues: applicants interviewing in more than one specialty, communication initiated by programs or applicants, commitments made to applicants and by applicants, ethical dilemmas faced by the program director, and the NRMP process itself. Descriptive statistics were reported.

Results: Only a few of the residency program directors (9.1%) felt that it was ethically wrong for an applicant to interview in more than one specialty. However, most program directors (83%) indicated that the knowledge of an applicant interviewing in more than one specialty had a “significant” negative or “some” negative effect on the applicant’s rank order. Ninety-five percent of program directors indicated that they engage in follow-up communication with applicants following the formal interview. Almost all program directors (98%) reported that at least some applicants contact them following the formal interview to inform them that the program was a “high” or No. 1 rank-order choice. The majority of program directors (94%) felt that the NRMP process placed their program in the position of having to be dishonest with applicants to match their top choices.

Conclusions: The results of the study indicate that the actions of many program directors and applicants may not be consistent with the written policies of the NRMP.

Residency Education
(Fam Med 2000;32(4):258-60.)

A Comparison of Resident and Faculty Attitudes Toward Physician-assisted Suicide and Active Voluntary Euthanasia
Bruce Bushwick, MD; David Emrhein, MEd; Kristi Peters, MS

Purpose: Assisted death practices such as physician-assisted suicide (PAS) and active voluntary euthanasia (AVE) are becoming more acceptable to the public and the medical profession. This study compared the attitudes and practices of resident house staff physicians with the medical staff physicians responsible for teaching them regarding PAS and AVE.

Methods: A convenience sample of 372 medical staff and 105 resident house staff from a multi-residency community teaching hospital were anonymously surveyed. The overall response rate was 47%. The questionnaire consisted of 10 questions that examined the subjects’ professional and legal values, willingness to participate in assisted death practices, and personal preferences for assisted death practices.

Results: The resident house staff differed significantly from the medical staff in attitudes toward assisted death practices. The resident house staff was less likely to support the traditional prohibitions against PAS and AVE. The resident house staff was also more likely to offer assisted death practices if they were legal. There was no significant difference, however, in the participation of assisted death practices between the groups respectively for PAS and AVE. The residents were more likely to request PAS or AVE for themselves or family members.

Conclusions: There are significant differences in attitudes and practices between resident physicians and medical staff physicians concerning PAS and AVE. These differences could lead to professional conflicts when setting clinical goals for end-of-life care and could compromise patient care.

Residency Education
(Fam Med 2000;32(4):261-6.)

Applied Medical Informatics and Computing Skills of Students, Residents, and Faculty
Anthony F. Jerant, MD; Andree J. Lloyd, PhD

Background and Objectives: Little is known regarding the applied medical informatics and computing skills of family practice residents and faculty, yet such information is critical when planning a medical informatics curriculum. We conducted a survey at our institution to collect this information.

Methods: An applied medical informatics and computing skills survey was administered to 93 first-year medical students, 42 family practice residents, and 14 family medicine faculty. Responses were compared between groups before and after stratification by age and gender.

Results: A total of 92% of students, 100% of residents, and 79% of faculty responded. Faculty had the highest rate of computer ownership (91%), followed by students (86%) and family practice residents (79%). Students and interns had the highest overall confidence using computers, followed by faculty and then senior residents. Faculty, students, and junior residents were significantly more confident than senior residents in their ability to perform several specific tasks, such as conducting a MEDLINE search. Residents perceived lack of money and time as barriers to improving their skills.

Conclusions: Current senior residents may require remedial training to graduate with the computer skills specified in curricular guidelines. While upcoming medical students and interns will demand more advanced training, faculty may not have the skills to provide it.

Medical Informatics
(Fam Med 2000;32(4):267-72.)

Core Curriculum Guidelines: Minimum Standards, Practical Goals, or Lofty Ideals?
William M. Chop, Jr, MD

Background: Increasing numbers of immigrants from the former Soviet Union (FSU) are coming to the United States. Educated and resilient, this population has many ethnic origins, but all have shared a common experience under the Soviet system and the deterioration of health care since the collapse of the Soviet Union. An ethnomedical approach was used to review published work and integrate material obtained in interviews with physicians in the FSU. Information is organized into concepts of causality, therapists, and forms of therapy. FSU medicine incorporates many Western treatments but also uses natural and spa remedies. Mainstream FSU physicians make diagnoses and use therapies that are unknown in the West. In addition, the active traditions of folk medicine and magical curing persist. US health care practitioners need to go to extra lengths to understand the perspectives and experiences of these patients and must explain basic concepts of health care in this country that will be new. An open approach to the patients’ non-Western beliefs and remedies will support a successful patient-practitioner interaction.

Essays and Commentaries
(Fam Med 2000;32(4):273-4.)