Skin Infections and Outpatient Burn Management: Fungal and Viral Skin Infections.

Fungal and viral skin infections are common and typically are managed by family physicians. The fungal skin infections commonly seen in family practice include the various forms of tinea: tinea corporis, tinea gladiatorum, tinea cruris, tinea pedis, tinea capitis, and tinea unguium (eg, onychomycosis). Common viral skin infections include herpes simplex virus infection, herpes zoster, cutaneous and genital warts, and molluscum contagiosum. Many fungal and viral skin infections have a classic appearance but variations and atypical manifestations can make patients with these conditions difficult to diagnose definitively. Confirmatory testing often is not required. In complex cases with atypical features, microscopy, culture, or blood tests can help in making a diagnosis. For some infections, treatment may be initiated before confirmatory test results are received. Most fungal skin infections can be managed effectively with topical antifungals. Tinea capitis and onychomycosis should be managed with oral drugs. Oral antiviral drugs are used to manage most viral skin infections but dosages vary based on the condition and phase of the infectious process. Cutaneous warts typically are managed with salicylic acid and/or cryotherapy.

Examining an Evidence-Based Medicine Culture in Residency Education.

BACKGROUND AND OBJECTIVES: Reports of innovations in evidence-based medicine (EBM) training have focused on curriculum design and knowledge gained. Little is known about the educational culture and environment for EBM training and the extent to which those environments exist in family medicine residencies in the United States. METHODS: A literature review on this topic identified a validated EBM environment scale intended for learner use. This scale was adapted for completion by family medicine residency program directors (PDs) and administered through an omnibus survey. Responses to this scale were analyzed descriptively with program and PD demographics. An EBM culture score was calculated for each program and the results were regressed with the correlated demographics. RESULTS: In our adapted survey, family medicine PDs generally rated their residencies high on the EBM culture scale, but admitted to challenges with faculty feedback to residents about EBM skills, ability to protect time for EBM instruction, and clinician skepticism about EBM. In linear regression analysis, the mean summary score on the EBM scale was lower for female PDs and in programs with a higher proportion of international medical school graduates. CONCLUSIONS: To improve the culture for EBM teaching, family medicine residency programs should focus on faculty engagement and support and the allocation of sufficient time for EBM education.

A Pilot Study to Address Tolerance of Uncertainty Among Family Medicine Residents.

BACKGROUND AND OBJECTIVES: Because patients often present to their family physicians with undifferentiated medical problems, uncertainty is common. Family medicine residents must manage both the ambiguity inherent in the field as well as the very real uncertainty of learning to become a skilled physician with little experience to serve as a guide. The purpose of this analysis was to assess the impact of a new curriculum on family medicine residents' tolerance of ambiguity. METHODS: We conducted an exploratory quasi-experimental study to assess the impact of a novel curriculum designed to improve family medicine residents' tolerance of ambiguity. Four different surveys were administered to 25 family medicine residents at different stages in their training prior to and immediately and 6 months after the new curriculum. RESULTS: Although many constructs remained unchanged with the intervention, one important construct, namely perceived threats of ambiguity, showed significant and sustained improvement relative to before undertaking this curriculum (score of 26.2 prior to the intervention, 22.1 immediately after, and 22.0 6 months after the intervention). CONCLUSIONS: A new curriculum designed to improve tolerance to ambiguity appears to reduce the perceived threats of ambiguity in this small exploratory study.