The Comfort of Family Practice Residents With Health Care of Patients of the Opposite Gender
Scott A. Paluska, MD; Frank J. D’Amico, PhD

Background and Objectives: Studies have shown that female and male residents see disproportionately few patients of the opposite gender. Such an imbalance may be detrimental to the quality of residency training. This study examined residents’ levels of comfort in caring for patients of the same and opposite genders and their assessments of the adequacy of the number of same- and opposite-gender patients they saw during residency training.

Methods: Data were collected from four family practice residency programs in the Midwest. All current family practice residents at the four sites surveyed were given a questionnaire asking them to rate their perceptions of the gender distributions of their patient panels and comfort with several areas of health care, some gender specific. The questionnaire used a five-point Likert scale.

Results: Ninety-four surveys (83% response rate) were collected. Ninety-three percent of female residents reported seeing enough female patients, but only 54% reported seeing enough male patients. Seventy-six percent of male residents reported seeing enough male patients, but only 31% reported seeing enough female patients. More females than males (88% versus 48%) felt comfortable with women’s health, but more males than females (70% versus 31%) felt comfortable with men’s health. Male residents were significantly more comfortable than female residents in performing or managing prostate exams, testicular exams, and prostatitis. Female residents were significantly more comfortable with clinical breast exams and breast disease.

Conclusions: Male and female residents perceive disproportionate experiences in their exposure to patients of the opposite gender. Significant differences between male and female residents were also apparent regarding their relative comfort in managing some gender-specific health care topics. These results have implications for residency education.

(Fam Med 2000;32(9):612-7.)

Differences in Ambulatory Teaching and Learning by Gender Match of Preceptors and Students
Patricia A. Carney, PhD; Allen J. Dietrich, MD; Scottie Eliassen, MS; Catherine Pipas, MD; Dennis Donahue, MS

Background and Objectives: Important differences exist in traditional medical education by gender of the teachers and learners. Much less is known about how gender influences educational experiences in community-based ambulatory settings. In this study, we explored how community-based teaching and learning varies by gender of the students and preceptors.

Methods: This prospective study used both paper- and computer-based documentation systems to collect information on student-patient-preceptor encounters. A consecutive sample of third-year medical students contributed data on one full clinical day each week as they rotated through a required 8-week family medicine clerkship. The main measures of interest included patient age and gender, health care visit type (acute, acute exacerbation of chronic, chronic, and health maintenance), method of learning in history taking and physical examinations (observing preceptor, being observed by preceptor, performing unobserved, or working jointly with preceptor), content of physical examinations, amount of preceptor feedback, preceptor teaching content, and gender of the students and their preceptors.

Results: Ninety-three students contributed data on 5,017 patient encounters. The distribution of encounters by student-preceptor dyad included: 1,926 (38%) female students with male preceptors, 1,716 (34%) male students with male preceptors, 841 (17%) female students with female preceptors, and 534 (11%) male students with female preceptors. We found that female preceptors conduct more complete physical exams with students than do male preceptors (28% versus 23%). Female students with male preceptors devoted more encounters to observation only than any other dyad (20% versus 12%), and female preceptors are more likely than male preceptors to allow students to perform unobserved (70% versus 59%). Patient gender played little if any role in how students and their preceptors worked together.

Conclusions: Differences of potential importance were found in teaching and learning by gender of the student-preceptor dyad. This factor can and should be considered when determining how students can best meet educational objectives in community-based ambulatory settings.

(Fam Med 2000;32(9):618-23.)

Dialogues in the Exam Room: Medical Interviewing by Resident Family Physicians
Kim Marvel, PhD; Gregory Major, MD; Kathleen Jones, MA; Carol Pfaffly, PhD

Background: Limited information exists about the application of the biopsychosocial model in medical practice. This study expanded our knowledge about the extent to which psychosocial content is included in medical interviews conducted by resident family physicians.

Methods: Interviews of 180 patients conducted by six second-year family practice residents were audiotaped and transcribed. Physician statements were analyzed and coded as social talk, physician-centered statements, patient-centered statements, and discussion of patient affect, family, health promotion, and patient education.

Results: The proportion of interviews in which specific physician interactions occurred were physician-centered statements: 100%, patient-centered statements: 66%, dealing with patient affect: 18%, information about family: 61%, initiation of health promotion: 33%, and initiation of patient education: 46%. Discussions of patient opinion/perception, patient affect, family information, and health promotion occurred most commonly during well-care visits and with female patients.

Conclusions: In this sample of residents, providers extended the interview beyond a purely biomedical focus. However, the psychosocial focus often was brief and applied inconsistently across patients.

(Fam Med 2000;32(9):628-32.)

Alcohol-free Instant Hand Sanitizer Reduces Elementary School Illness Absenteeism
David L. Dyer, PhD; Arnold Shinder, DO; Fay Shinder, RN

Background and Hypotheses: A substantial percentage of school absenteeism among children is related to transmissible infection. Rates of transmission can be reduced by hand washing with soap and water, but such washing occurs infrequently. This study tested whether an alcohol-free instant hand sanitizer (CleanHands®) could reduce illness absenteeism in school-age children.

Methods: A 10-week, open-label, crossover study was performed on 420 elementary school-age children (ages 5–12). Students were given a brief orientation immediately prior to the start of the study on the relationship of germs, illness, and hand washing. Each student in the treatment group then received the test product in individual bottles, with instructions to apply one to two sprays to the hands after coming into the classroom, before eating, and after using the restroom, in addition to their normal hand washing with soap and water. The control group was instructed to continue hand washing as normal with non-medicated soap. After 4 weeks of treatment and a 2-week wash-out period, the control and experimental groups were reversed. Data gathered on absenteeism were classified as gastrointestinal or respiratory related and normalized for non-illness-related absenteeism and school holidays.

Results: Compared to the hand washing-only control group, students using CleanHands® were found to have 41.9% fewer illness-related absence days, representing a 28.9% and a 49.7% drop in gastrointestinal- and respiratory-related illnesses, respectively. Likewise, absence incidence decreased by 31.7%, consisting of a 44.2% and 50.2% decrease in incidence of gastrointestinal- and respiratory-related illnesses, respectively. No adverse events were reported during the study.

Conclusions: Daily use of the instant hand sanitizer was associated with significantly lower rates of illness-related absenteeism.

(Fam Med 2000;32(9):633-8.)

Association of Attending Physician Specialty With the Cesarean Delivery Rate in the Same Patient Population
Andrew S. Coco, MD; Thomas J. Gates, MD; Mary E. Gallagher; Michael A. Horst, MS

Background and Objectives: In the context of a dramatic increase in US cesarean delivery rates over the past 30 years and explicit national goals to decrease the cesarean rate, previous retrospective studies have shown that pregnant women cared for by family physicians may be less likely to undergo cesarean delivery, compared with patients cared for by obstetricians.

Methods: We conducted a retrospective chart review of 3,560 deliveries from the family practice service of a community-based family practice residency from 1986–1995, focusing primarily on cesarean delivery rates during two periods of time. During period 1 (n=1,063), all attendings were private practice obstetricians. After a transition period, all births were attended by family medicine faculty (period 2, n=1,346). Results: The total cesarean delivery rate declined from 16.7% in period 1 to 11.1% in period 2. Repeat cesareans declined from 8.5% to 2.9%.

Conclusions: In this community-based residency, a change in the specialty of the attending physician was associated with a 34% decline in the cesarean delivery rate. The observed decline in the cesarean rate could not be accounted for by any change in patient demographics or secular trends in cesarean delivery rates.

(Fam Med 2000;32(9):639-44.)