Major depression and the self-criticism and dependency personality dimensions.

The Depressive Experiences Questionnaire was used to assess the personality dimensions of dependency and self-criticism in 52 depressed patients before and after treatment and in 22 healthy family practice patients. Neither personality dimension was significantly influenced by change in depressed mood, and the recovered depressed patients had higher levels of dependency and self-criticism than the comparison subjects.

A process for evaluation of residency rotations.

An evaluation tool for measuring the experiences of family practice residents as they rotate through various services was developed and tested. The tool is described and the effect on the program is discussed. The ease of administration has led to acceptance in not only the family practice program but also in other departments.

Traditional vs. flexible programmes: training in family and community medicine.

The aims of this study were to gain an understanding of the concerns of those in control in Canadian Family Medicine, and to gain an understanding of the experiences of trainees in the traditional postgraduate year 2 (PGY-2) and in a flexible PGY-2 at the University of Toronto (U of T) Department of Family and Community Medicine (DFCM) in 1994. Qualitative methodology was used in the study to find out the feelings and experiences of these groups. It was found that national and departmental bodies in Family Medicine are concerned with competency and are open to trying different processes. Trainees in the flexible programme had a strong sense of control according to the study. They identified their educational needs, had confidence in their assessments, and spoke the language of continuous learning. Residency programmes need to be flexible and trainee-centred.

Solitary penile ulcer associated with infections mononucleosis.

Determining the cause of genital ulcers requires extensive laboratory investigation, particularly if there is no history of sexually transmitted disease. In a patient with a solitary penile erosion who was tired, weak, sweaty and febrile, hematologic and serologic tests suggested infectious mononucleosis, and bacteriologic and serologic studies, along with attempts at virus culture, ruled out syphilis and herpes simplex. The erosion healed soon after the other signs and symptoms resolved. It therefore appears that solitary penile erosions may be a presenting feature of infectious mononucleosis.

Endometrial carcinoma: feasibility of case-finding in a family physician's office.

To study the feasibility of endometrial sampling in a family physician's office we examined 42 asymptomatic women 50 years of age or older with the use of a Milan-Markley helix to obtain cytopathologic material. Nine procedures could not be completed because of stenosis of the introitus or cervix. The procedure took less than 3 minutes to complete for 30 women, and there was no technical difficulty for 27. Adequate amounts of tissue for diagnosis were obtained from 32 women. One or more risk factors for endometrial carcinoma were present in 34 women. Nine samples showed atypical hyperplasia. Although 37 women experienced discomfort and 19 experienced spotting, 35 were willing to have the procedure repeated annually or as indicated by their physician.

Potentially undesirable prescribing and drug use among the elderly. Measurable and remediable.

Forty-seven patients older than 65 years were randomly selected for structured chart review of all long-term medications documented during the prior year and the number of instances of potentially undesirable prescribing for each patient. A trained nurse subsequently made home visits to assess all long-term medications used regularly during the same period. Forty-five percent of elderly patients had one or more instances of potentially undesirable drug use, all of which appeared to be readily remediable. Commercial drug interaction software identified less than half of the potentially undesirable instances.

Measuring community-oriented attitudes towards medical practice.

BACKGROUND: The measurement of attitude and attitudinal changes regarding community-oriented primary care (COPC) and the community-oriented principles of family medicine from the College of Family Physicians of Canada was a key component of this study involving family medicine residents. The Department of Family and Community Medicine at the Toronto Hospital initiated a new COPC curriculum in July 1997 for its first-year residents which was designed to teach the principles of family medicine which are community oriented. OBJECTIVE: This study was developed to provide an analysis and summary of the attitude and attitudinal changes of residents exposed to the programme and those of two cohort groups who were not exposed. METHODS: A quasi-experimental design was used. A 20-item questionnaire was administered pre- and post-intervention. Qualitative data were also collected from focus group sessions with the residents exposed to the programme. RESULTS: The questionnaire was found to have good reliability, with an alpha coefficient of 0.8. No significant differences were observed between the study and control groups pre- and post-intervention. Within the study group, two items from the questionnaire yielded significant differences (P < 0.05). These items dealt with lack of funding and impracticality issues of applying COPC in medical practice. They were also the prevalent themes generated from the focus group session analysis. CONCLUSIONS: The qualitative data corroborated the findings of the survey. These findings have helped in the evolution of the curriculum. Longitudinal studies to measure attitudes and the practice of COPC and community-oriented principles of family medicine after residency are recommended.

Rewarding medical teaching excellence in a major Canadian teaching hospital.

A major Canadian teaching hospital has developed a program to recognize and reward excellence in medical education. The program includes a system to collect and evaluate feedback from trainees and administrators--with an annual celebration event where awards are presented. Three categories of hospital-wide awards are presented: educational administration, program development, and extraordinary contribution. There are departmental awards for best undergraduate and postgraduate physicians, allied health professional, and house staff/fellow. This program functioned well to evaluate teachers across departments and for all levels of trainees in the hospital and will expand to become part of the ongoing evaluation of teachers in the institution.

Patient consent to observation. Responses to requests for written consent in an academic family practice unit.

OBJECTIVE: To examine patient rates of consent to observation and response to being asked for written consent. DESIGN: Patients were asked to provide written consent for a supervising physician to observe a resident performing a physical examination, or for both direct observation and videotaping of the visit. After the visit, all patients were interviewed, and patients who had given written consent completed a questionnaire. SETTING: The family practice unit at a teaching hospital affiliated with the University of Toronto. PARTICIPANTS: A representative sample of new and returning patients. MAIN OUTCOME MEASURES: Patient consent to observation or videotaping. RESULTS: Most patients (92.2%) agreed to be observed. Of those asked only for consent to observe, 97.3% agreed. Of those asked for consent to observe and videotape, 85.2% agreed. When specifically asked, 22% of patients who agreed to observation expressed concerns. CONCLUSION: We must devise clear policies and procedures for obtaining patient consent that are both sensitive to patients' concerns and administratively effective.