Residency
Education
Family
Practice Graduate Preparedness in the Six ACGME Competency Areas: Prequel
Deirdre C. Lynch, RhD; Perry Pugno, MD, MPH, CPE; Diane K. Beebe,
MD; Samuel W. Cullison, MD; John J. Lin, MA
Background and Objectives: Since July 2002, family practice residency program
accreditation requires evidence of teaching and assessing residents in six
competency areas. This study was conducted to obtain baseline information about
family practice graduates’ perceptions
of the importance of specific competencies and the extent to which residency
training prepared them to perform skills representative of the six competency
areas. Methods: A national, cross-sectional survey was conducted
of family physicians who had graduated from residency programs from 1998 to
2000. Results:The response rate was 54% (n=1,228). Graduates reported the most
preparation in patient care skills, followed by interpersonal and communication
skills and then professionalism. The least preparation was reported for skills
pertinent to practice-based learning and improvement, systems-based practice,
and some areas of professionalism. Conclusions: Areas of residency education
that
appear to warrant improvement include education about system aspects of care,
practice-based learning and improvement, and selected professionalism issues.
(Fam Med 2003;35(5):324-9.)
Benchmarking the Costs
of Residency Training in Family Practice
Judith Pauwels, MD; Andrew Oliveira, MD, MHA; Nancy Stevens, MD, MPH
Financial and operational benchmarking data for family practice residency
programs within the University of Washington Network were established
for the year 2000. Data were systematically collected by standardized
questionnaire, evaluated for quality and verified, and then analyzed.
Revenues, expenses, faculty structures, productivity, and family practice
center staffing models are reported, using program averages and ranges
or standard deviations for individual data elements. Variations and data
problems
included data line definitions, difficulties obtaining data from sponsoring
institutions, indirect program costs, and widely differing program
structures. Limited conclusions can be made regarding “best practices,” but
the results contribute to the establishment of normative data for budgeting
and operational evaluation of family practice programs.
(Fam
Med 2003;35(5):330-6.)
Medical
Student Education
Task-oriented Processes
in Care (TOPIC): A Proven Model for Teaching Ambulatory Care
John Rogers, MD, MPH; Jane Corboy, MD; Joyce Dains, DrPH; William Huang,
MD; Warren Holleman, PhD; James Bray, PhD; Marconi Monteiro, EdD
Background and Objectives: The TOPIC model conceptualizes the work
of family physicians as five prototypical visits (new problem, checkup, chronic
illness, psychosocial problem,
and behavioral change) and four major processes (physician information processing,
patient-physician relationship development, integration of information and relationship,
and lifelong learning). This paper describes methods
for teaching this model to clerkship students and reports 4 years of outcome
data. Methods: The instruction included seminars at the beginning of the
rotation, a laminated pocket card as a reminder in clinical sites, a clerkship “passport” with
examples of TOPIC verbal presentations, and student selfstudy for the end-of-rotation
Clinical Performance Examination (CPX). Evaluation outcomes include student
perceptions of the seminars and student performance on the CPX. Results:
Students rated the usefulness of the seminars favorably. The CPX scores showed
that
students performed most of the tasks expected for each prototypical visit.
Conclusions: Students learned the tasks
presented in the seminars and demonstrated them during the CPX. The model
is robust since students learned the material despite
some changes in teaching methods. (Fam Med 2003;35(5):337-42.)
Methods for Teaching Physical Examination Skills to Medical Students
Pamela Dull, MD; Danell J. Haines, PhD
Background and Objectives: Teaching
physical examination (PE) skills is a fundamental component of medical education.
However, there is little information available
about how medical school faculty teach PE skills. This study surveyed PE course
directors to determine how they presently teach PE skills, the methods that
are perceived to be the best, and how standardized patients (SPs) are recruited
and paid. Methods: A written survey was mailed to PE course directors at US
allopathic and osteopathic medical schools. Results: PE course directors at
83 (58%) schools responded. Results indicate that the top three methods presently
used for teaching (demonstration on an SP, practice on an SP, and practice
on patients) and those perceived to be the best methods are the same but in
different rank order. A significant difference was observed in the overall
mean scores of the present methods versus the best methods in 8 of the 10 teaching
methods; thus, instructors are not always using the best methods to teach PE.
There were also differences in methods used to teach “sensitive areas” (ie,
genital or breast exam). Conclusions: The highest-ranked methods for teaching
PE are demonstrations and practice with SPs and practice on real patients.
However, PE instructors are not always using the teaching methods they deem
best.
(Fam Med 2003;35(5):343-8.)
Clinical
Research and Methods
Predictors of Screening for Breast and Colorectal Cancer Among Middle-aged Women
Lorraine Silver Wallace, PhD; Rajeev Gupta, MD
Background and Objectives: Rates of breast and colorectal cancer screenings
among women in the United States fall below current guidelines set forth
by the American Cancer Society and Healthy People 2010. This study
examined predictors
of breast and colorectal cancer screening behaviors among women patients
(ages 50–75) at a university-based family practice clinic. Methods:
A random sample of 600 women
patients were sent a comprehensive written questionnaire assessing demographic
characteristics and breast and colorectal cancer screening behaviors and beliefs
via the US Postal Service. Results: Rates of clinical breast examinations,
mammography, fecal occult blood testing, and sigmoidoscopy/colonoscopy exceeded
national and state trends. A greater proportion of women reported
receiving breast cancer
information as compared to colorectal cancer information. Receiving information
from one’s physician was significantly related to having had a
clinical breast examination, a fecal occult blood test, and sigmoidoscopy/colonoscopy.
Significant predictors of fecal occult blood testing included lower perceived
barriers, married, receiving information from physician, and greater
perceived
benefits.Significant predictors of sigmoidoscopy/ colonoscopy included
receiving information from physician, lower perceived barriers, and advanced
age. Conclusions:
The family physician can play an instrumental role in encouraging patients
to adhere to current breast and colorectal cancer screening guidelines.
(Fam Med 2003;35(5):349-54.)
Practice
Management Sources of Error in Delayed Payment of Physician Claims
Jessica M. Lundeen; Wiley W. Souba, MD, ScD, MBA; Christopher S. Hollenbeak,
PhD
Background and Objectives: Our objectives were to determine the distribution
of errors and estimate the magnitude of the burden of delayed payments in
a large physician group practice. Methods: A 25% random sample (n=775) was
taken from all billed records of a physician group practice in the Pacific
Northwest that were delayed 6 months or more as of June 30, 2001. The source
and specific reasons for payment
delays, as well as the amount of each unpaid invoice, were determined by
electronic documentation or telephone calls to the payor. Analysis of variance
was used to determine
whether the amount of the invoice was associated with the source and reason
of error. Results: The source of delayed payments due to provider, payor,
patient, and technical error were 36.1%, 28.1%, 14.5%, and 21.3%, respectively.
The
most-frequent reasons for delayed payment were that the provider incorrectly
set up the account (15.2%), the provider did not follow up on denial (12.9%),
and the payor incorrectly processed the invoice (11.6%). Analysis of variance
suggested that the invoice amount was not significantly associated with the
source but was significantly different across reasons for delayed payment.
The potential financial impact of
earlier recovery of payment was $262,270. Conclusions: In these data, provider
and payor errors accounted for almost two thirds of delayed payments. The
most promising avenue for providers to reduce delayed payments is by reducing
their own errors. Eliminating the two most common errors would result in a
more timely recovery of nearly $70,000 in revenues.
(Fam Med 2003;35(5):355-9.)
Commentary
Evidence-based Medicine Meets Goal-directed Health Care
James W. Mold, MD, MPH; Robert Hamm, PhD; Dewey Scheid, MD, MPH
Evidence-based medicine and goal-directed, patient-centered health
care seem, at times, like parallel universes, though, at a conceptual
level, they are perfectly compatible. Part of the problem is that many
of the kinds of information required for decision making in primary
care
are often unavailable or difficult to find. Several case examples are
used to illustrate this problem, and reasons and solutions are suggested.
The goal-directed health care model could be helpful for directing
the search for evidence that is relevant to the decisions that patients
and their primary care physicians must make on a regular basis.
(Fam Med 2003;35(5):360-4.)
Innovations
in Family Medicine Education
The BELIEF
Instrument: A Preclinical Teaching Tool To Elicit Patients’ Health
Beliefs
Alison E. Dobbie, MD; Martha Medrano, MD; James Tysinger, PhD; Cynthia
Olney, PhD
Purpose: The BELIEF Instrument is a cultural interviewing tool for
preclinical medical students that does not require diagnostic or therapeutic
skills. Methods: An expert panel developed and taught the instrument
to 200 first-year medical students in (1) a didactic session, (2) standardized
patient interviews, and (3) clinical correlation sessions with community
physicians
and third-year medical students. Standardized patients evaluated students
on the BELIEF questions in a graded interview. Results: A total of
93.5% (range 86% to 97%) of 197 students elicited information on each
of the BELIEF items. Conclusions: The BELIEF instrument works
as a cultural interviewing
tool. It is unknown if students’ interviewing behavior generalizes
to real patients in clinical settings.
(Fam Med 2003;35(5):316-9.)
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