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ABSTRACTS
Special
Article: 2001 Match Results
Entry
of US Medical School Graduates Into Family Practice
Residencies: 2000-2001 and 3-year Summary
Perry Pugno, MD, MPH, CPE; Gordon T. Schmittling,
MS; Deborah S. McPherson, MD; Norman B. Kahn, Jr, MD
This
is the 20th report prepared by the American Academy
of Family Physicians (AAFP) on the percentage of each
US medical school’s graduates entering family practice
residency programs. Approximately 12.8% of the 15,825
graduates of US medical schools between July 1999 and
June 2000 were first-year family practice residents
in 2000, compared with 13.4% in 1999 and 15.4% in 1998.
Medical school graduates from publicly funded medical
schools were almost twice as likely to be first-year
family practice residents in October 2000 than were
residents from privately funded schools, 15.6% compared
with 8.7%. The West North Central region reported the
highest percentage of medical school graduates who were
first-year residents in family practice programs in
October 2000 at 18.2%; the Middle Atlantic and New England
regions reported the lowest percentages at 8.3% and
6.8%, respectively. Nearly half of the medical school
graduates (47.0%) entering a family practice residency
program as first-year residents in October 2000 entered
a program in the same state where they graduated from
medical school. The percentages for each medical school
have varied substantially from year to year since the
AAFP began reporting this information. This article
reports the average percentage for each medical school
for the last 3 years. Also reported are the number and
percentage of graduates from colleges of osteopathic
medicine who entered Accreditation Council for Graduate
Medical Education-accredited family practice residency
programs, based on estimates provided by the American
Association of Colleges of Osteopathic Medicine.
(Fam Med 2001;33(8):585-93.)
Results
of the 2001 National Resident Matching Program: Family
Practice
Perry Pugno, MD, MPH, CPE; Gordon T. Schmittling,
MS; Deborah S. McPherson, MD; Norman B. Kahn, Jr, MD
The
results of the 2001 National Resident Matching Program
(NRMP) reflect a persistent decline of student interest
in family practice residency training in the United
States. Compared with the 2000 Match, 240 fewer positions
(317 fewer US seniors) were filled in family practice
residency programs through the NRMP in 2001, as well
as 76 fewer (47 fewer US seniors) in primary care internal
medicine, 5 fewer in pediatrics-primary care (7 fewer
US seniors), and 7 fewer (1 fewer US senior) in internal
medicine-pediatric programs. In contrast, 40 more positions
(64 more US seniors) were filled in anesthesiology and
11 more (10 more US seniors) in diagnostic radiology,
two “marker” disciplines that have shown increases over
the past 3 years. Ninety-one fewer positions (2 fewer
US seniors) were also filled in categorical internal
medicine, while 49 more positions (67 more US seniors)
were filled in categorical pediatrics programs, where
trainees perceive options for either practicing as generalists
or entering subspecialty fellowships, depending on the
market. While the needs of the nation, especially rural
and underserved populations, continue to offer a market
for family physicians, family practice experienced a
fourth year of decline though the 2001 NRMP. Current
forces, including student perspectives of specialty
prestige, the turbulence of the health care environment,
media hype, market factors, lifestyle choices, and student
debt, all appear to be influencing many students to
choose subspecialty rather than primary care careers.
(Fam Med 2001;33(8):594-601.)
Residency
Education
Teaching
Evidence-based Medical Care: Description and Evaluation
Roland Grad, MD, MSc; Ann C. Macaulay, MD; Michelle
Warner, MA
Background
and Objectives: This paper describes and evaluates several
years of a seminar series designed to stimulate residents
to seek evidence-based answers to their clinical questions
and incorporate this evidence into practice. Methods:
At the first session, 86 of 89 (97%) residents completed
a baseline needs assessment questionnaire. Post-course
self-assessment questionnaires measured change from
the first to the final seminar session in six domains
of interest and skill, as well as residents’ preferred
sources of information for clinical problem solving
up to 2 years after the course. Results: Before the
seminars, 48% of residents reported that textbooks were
their most important source of information for solving
clinical problems. A total of 58 of 75 (77%) residents
completed the first post-course questionnaire. Residents
reported significant increases in skill at formulating
clinical questions and searching for evidence-based
answers, appraising reviews, and deciding when and how
to incorporate new findings into practice. Use of secondary
sources of information such as “Best Evidence,” moved
up in importance from before the course to after the
course. Conclusions: First-year family practice residents
who completed our seminar series have reported increased
skill at blending consideration of a clinical problem
with the use of secondary sources of information to
access evidence to support their health care decisions.
(Fam Med 2001;33(7):602-6.)
Predictors
of Psychosocial Teaching Styles in a Family Practice
Residency Program
Johanna Shapiro, PhD; Michael Prislin, MD; Chris
Hanks; Patricia Lenahan, LCSW
Background
and Objectives: Although physician clinical precepting
has been extensively studied, little information exists
about the teaching styles of behavioral science faculty.
This study investigated group characteristics associated
with two styles of teaching—authoritative and collaborative—used
by behavioral science faculty in a family practice residency
training program. Methods: A 6-year retrospective study
was conducted with 89 family practice residents and
1,228 patients. Unstructured written comments about
direct observation of resident-patient encounters in
a family practice clinic were coded using a combination
of qualitative and quantitative approaches, then analyzed
in relationship to variables such as gender, perceived
resident ability and level of training, ethnicity of
patient, and severity of patient diagnosis. Results:
Overall, behavioral scientists used twice as many collaborative
as authoritative teaching comments. Male behavioral
scientists used more authoritative comments than did
female behavioral scientists. First-year residents and
female residents received more teaching generally than
did their more- experienced and male counterparts. Perceived
global performance of resident and severity of patient
diagnosis were also related to teaching style. Conclusions:
Behavioral science faculty should consider that group
characteristics of teachers, residents, and patients
may influence teaching style.
(Fam Med 2001;33(8):607-13.)
Clinical
Research and Methods
Infant
Sleep: Resident Recommendations and SES Differences
in Patient Practices
Sandra K. Morgan, PhD; C. Merle Johnson, PhD
Background:
Although much research has focused on parental report
of infant sleep position since the 1992 American Academy
of Pediatrics (AAP) recommendation for non-prone placement,
few studies have examined physician recommendations
regarding infant sleep. This study examined differences
between resident recommendations for infant sleep position
and cosleeping (bed sharing) and parental report of
practice. We also assessed socioeconomic differences
in parent practice, awareness, and acceptability of
AAP guidelines. Methods: We conducted a telephone survey
of parents of 2-, 4-, 8-, and 12-month-old infants from
two family practice centers. All 27 residents at both
centers completed a paper and pencil survey. Results:
Resident recommendations and parental practices differed
significantly for both sleep positioning and cosleeping.
Parents of 165 infants participated, revealing that
higher socioeconomic families were more aware of, compliant
with, and more accepting of AAP recommendations for
supine positioning. Conclusions: Parents consistently
report that their physician or nurse is the primary
source of information for infant sleep. Results of this
study, however, indicate significant differences between
physician recommendation and parental practice and acceptability
of AAP guidelines. Physicians need to continue to discuss
this information past the newborn period.
(Fam Med 2001;33(7):614-20.)
Disease
Management for Diabetes Among Family Physicians and
General Internists: Opportunism or Planned Care?
Sandra K. Morgan, PhD; Arch G. Mainous III,
PhD
Background
and Objectives: Diabetes requires substantial ongoing
medical management and use of monitoring tests. However,
physicians’ performance of these tests is often suboptimal.
This study explored primary care physicians’ management
of diabetes in the context of both planned diabetes
visits and acute visits for conditions unrelated to
diabetes. Methods: Semi-structured depth interviews
were conducted with 12 primary care physicians in 9
family practice and internal medicine practices distributed
throughout the state of South Carolina. All interviews
were tape recorded and transcribed. Themes, divergences,
and trends were identified and discussed by the investigators.
Results: Although all participants reported a preference
toward planned diabetes management, because most patients
fail to adhere to scheduled care, opportunistic disease
management tended to be the default mode of diabetes
care. Participants reported performing appropriate tests
during scheduled visits but acknowledged that when confined
to acute visits, diabetes care was difficult to perform.
Reasons included time constraints and patient agenda.
Participants reported that inadequate tracking of completion
of diabetes standards of care influenced their adherence
to guidelines. Conclusions: The current system of delivering
diabetes care opportunistically in the context of non-diabetes
acute visits may need to be more closely examined in
an effort to improve the delivery of services.
(Fam
Med 2001;33(8):621-5.)
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