Illinois RMED: A Comprehensive Program to Improve the Supply of Rural Family Physicians
Jeffrey A. Stearns, MD; Marjorie A. Stearns, MA; Michael Glasser, PhD; Rich A. Londo, MD

Background: Rural areas of the United States are perennially medically underserved, and the state of Illinois is no exception. A recent survey showed that 75 of Illinois’ 84 rural counties are primary care physician shortage areas. In response to this chronic physician shortage, the Illinois Rural Medical Education (RMED) Program was developed by the University of Illinois College of Medicine at Rockford. The RMED program is a comprehensive, multifaceted program that combines recruitment, admissions, curriculum, support, and evaluation components and is longitudinal across all 4 years of the medical school experience. The admissions process seeks to select students who possess traits indicative of success in eventual rural family practice. These traits are fostered and developed by the 4-year rural curriculum, which emphasizes family medicine, community-oriented primary care, the physician functioning in the context of community, relevant aspects of the “hidden” curriculum, and service learning. After 6 years, RMED has graduated 39 physicians; 69% have gone into family practice, and a total of 82% have selected primary care residencies.

Special Article
(Fam Med 2000;32(1):17-21.)

An Evaluation of Statewide Strategies to Reduce Antibiotic Overuse
Arch G. Mainous III, PhD; William J. Hueston, MD; Margaret M. Love, PhD; Martin E. Evans, MD; Reginald Finger, MD, MPH

Background: The rapid increase of antibiotic resistance poses a significant threat to human health. Overuse of antibiotics has been linked to rates of antibiotic resistance. This study assessed the utility of two common interventions—1) practice profiling and feedback and 2) patient education materials—implemented to decrease antibiotic prescribing for pediatric upper respiratory infections (URIs).

Methods: Based on Medicaid regions in Kentucky, primary care physicians managing pediatric respiratory infections in Medicaid were randomized into four groups. Groups received either 1) performance feedback only, 2) patient education materials only, 3) both feedback and education materials, or 4) no intervention. Participating physicians had their antibiotic prescribing assessed for the period of July 1, 1996, to November 30, 1997, with an intervention in June 1997. The study included 216 physicians and 124,092 episodes of care.

Results: All groups increased in proportion of episodes with antibiotics between the pre-intervention and post-intervention periods. Prescribing in the patient education group and the patient education and feedback group increased at a significantly lower rate than in the control group. Physicians did not change their coding of illness to justify antibiotics after the intervention, and there was no significant generalization of effect of the pediatric intervention on prescribing for adult URIs.

Conclusions: These interventions demonstrate little if any impact on promoting appropriate antibiotic prescribing. Antibiotic prescribing for viral respiratory infections continues to increase, suggesting concomitant increases in antibiotic resistance.

Special Article
(Fam Med 2000;32(1):22-9.)

Suggested Curriculum Guidelines on Complementary and Alternative Medicine: Recommendations of the Society of Teachers of Family Medicine Group on Alternative Medicine
Benjamin Kligler, MD, MPH; Andrea Gordon, MD; Marian Stuart, PhD; Victor Sierpina, MD

Background and Objectives: The widespread use of alternative and complementary therapies by the public provides a new challenge to medical education. No standardized curriculum is available for medical educators in this field. Providing an adequate background on these therapies and reliable, useful information to our learners was a task addressed by the Society of Teachers of Family Medicine (STFM) Group on Alternative Medicine over the past 2 years.

Methods: The group met at conferences and communicated via e-mail to develop a consensus of recommended knowledge, skills, and attitudes in complementary and alternative medicine for incorporation into the family practice residency training curriculum.

Conclusion: This article suggests guidelines as developed by this STFM group to assist programs wishing to include formal training in complementary and alternative medicine in residency training.

Residency Education
(Fam Med 1999;31(10):30-3.)

Why Geriatrics? Academic Geriatricians’ Perceptions of the Positive, Attractive Aspects of Geriatrics
David D. Cravens, MD, MSPH; James D. Campbell, PhD; David R. Mehr, MD, MS

Background: Recruitment of geriatrics trainees has been poor, and the current shortage of academic geriatricians is expected to worsen. Although barriers to entering geriatrics practice have been identified, a review of the literature found few studies about why people choose to enter geriatrics.

Methods: We used qualitative methods to investigate the positive, attractive aspects of geriatrics. Long interviews with six academic geriatricians were taped and transcribed. Transcripts were entered into a textual database computer program and reviewed independently by two investigators.

Results: Six themes emerged: 1) traditional learning experiences, 2) value on personal relationships, 3) a perception of distinctive differences, 4) a desire to feel needed personally and societally, 5) prefer democracy versus autocracy, and 6) desire intellectual challenges. Academic geriatrics, therefore, is particularly attractive to people who value enduring relationships, see challenges in complexity, practice social responsibility, prefer working within a multidisciplinary team, and derive satisfaction from making seemingly small but nonetheless important changes in peoples’ lives.

Conclusions: If further studies validate these findings, they could promote geriatrics as a career, by, for example, identifying students and family practice and internal medicine residents who share these values, beliefs, and attitudes and encouraging them to consider this important field.

Medical Student Education
(Fam Med 2000;32(1):34-41.)