Promoting improved social support and quality of life with the CenteringPregnancy® group model of prenatal care.

This prospective cohort study compared women participating in CenteringPregnancy® group prenatal care (N = 120) with those in standard individual care (N = 221) to determine if participation in Centering was associated with improvements in perceived social support and quality of life, with concomitant decreases in screens of postpartum depression and improvements in breastfeeding rates. Participants completed surveys at the onset of prenatal care, in the late third trimester and in the postpartum period. Centering participants had higher scores of perceived social support from friends after participating in group care (p < 0.05) with associated improvements in quality of life in the psychological and relational domains (p < 0.05) compared to standard care participants who showed higher scores of perceived support from family (p < 0.05) but did not show concomitant improvements in quality of life. This did not translate to any significant difference in scores on postpartum depression screens but was associated with improvements in breastfeeding continuation rates among Centering participants in the postpartum period. This study indicates that Centering care is associated with improved perceptions of peer social support with associated improvements in quality of life and higher rates of continued breastfeeding.

A 3-Year Study of Resident Reaction to 2011 ACGME Work Hour Rules in a Family Medicine Residency.

INTRODUCTION: 2011 Accreditation Council for Graduate Medical Education (ACGME) work hour rules prompted concerns regarding potential negative impacts on patient care and resident education. We were interested in resident reaction to call restructuring and night oat (NF) in a family medicine residency over 3 years following implementation of the 2011 rules. METHODS: We conducted structured interviews of residents from 2011-2012 through 2013-2014. Interviews were recorded, transcribed, and analyzed for themes. RESULTS: Fifty-eight interviews were conducted, including 18/18 residents in 2011-2012 (100%), 18/20 residents in 2012-2013 (90%), and 22/22 residents in 2013-2014 (100%). Following introduction of the 24-hour work limit, upper year residents reported significantly less fatigue and improved personal lives, patient care, and educational experience. Reactions to NF varied with length and intensity of the NF rotation; most PGY-1 residents reported increased fatigue, more burnout, and worse personal lives on NF. Most residents felt patient care quality on NF did not differ from non-NF rotations because improved inpatient nighttime continuity mitigated effects of fatigue and increased care transitions. Reactions regarding educational experience on NF were initially negative, but improved over time. CONCLUSIONS: Residents' reactions to 2011 ACGME work hour rules suggest the rules improved resident well-being, except on NF. Negative effects of NF may be minimized by limiting NF rotations to 5 nights/week for 2 consecutive weeks, and 1 month total per academic year.

Resident knowledge acquisition during a block conference series.

OBJECTIVE: This study's objective was to determine whether attendance at lectures in a block conference format improves residents' knowledge. METHODS: Seventeen family medicine residents were tested on the content of 27 lectures delivered in a block conference format over a 6-month period. For each lecture, residents completed a pretest, a short-term posttest, and a long-term posttest (1--3 weeks and 1.5--6 months after each lecture, respectively). RESULTS: Mean short-term posttest scores were 10.3 points higher for lecture attendees than nonattendees. Mean long-term posttest scores did not differ significantly for attendees (62.2) versus nonattendees (60.0). CONCLUSIONS: Attendance at didactic lectures in a block conference format did not improve resident knowledge over the long term. These results lead us to question the value of a block conference format and raise the possibility that resident learning might be better served by maximizing clinical experiences and minimizing time in conferences.

Working with impaired residents: trials, tribulations, and successes.

Impairment of physicians' ability to practice medicine safely and effectively is relatively common. Chemical dependency, the leading cause of physician impairment, has a lifetime prevalence of approximately 10%-15% among physicians. Statistics from physician health programs indicate that family physicians are overrepresented among impaired physicians. It is therefore important for family practice residencies to monitor for and deal with physician impairment. Over the past 11 years, we have worked with eight impaired residents: five with chemical dependency, two with cognitive impairment, and one with an affective disorder Seven of the eight residents are currently practicing medicine, six in family practice. Based on our experience and the literature, we have developed an algorithm that includes the recognition, intervention, and aftercare of impaired residents. The long-term success of the majority of impaired residents with whom we have worked suggests that the trials and tribulations of working with this potentially difficult group of residents are well worth the effort.

Can we effectively use the two-item PHQ-2 to screen for postpartum depression?

BACKGROUND AND OBJECTIVES: Postpartum depression screening is widely advocated to identify and treat affected individuals given the significant impact of this disorder on patients and their families. An effective, efficient method is needed to improve compliance with screening, which has led to an increased interest in the use of the two-item Patient Health Questionnaire 2 (PHQ-2). The aim of this study was to determine the sensitivity and specificity of the PHQ-2 in screening for postpartum depression. METHODS: A prospective convenience study was conducted among 200 postpartum women attending their postpartum or 4- and 6-month well-child visits at a multiethnic family medicine residency center. The sensitivity and specificity of the PHQ-2 was determined by using the well validated Edinburgh Postnatal Depression Scale (EPDS) as the gold standard. Positive responses to either scale led to further evaluation and referral. RESULTS: The sensitivity of the PHQ-2 was 100%, and the specificity was 79.3% using the EPDS as the reference standard. In addition, the PHQ-2 identified an additional four/nine women who were subsequently diagnosed with postpartum depression based on follow up of their positive screens. CONCLUSIONS: This study supports previous findings indicating that the PHQ-2 can be an effective tool in screening for postpartum depression.

Increasing timely and available prenatal studies by electronic health records.

BACKGROUND: The government is encouraging the adoption of electronic medical records (EMRs). There is little information about using EMRs in the obstetric literature and none about using them in family medicine residencies. Our purpose was to assess if using an EMR was associated with improvement in the ordering and availability of prenatal tests. METHODS: A retrospective chart review comparing the rate at which prenatal laboratory values were present on the chart, ordered on time, and recorded on a prenatal flow sheet. RESULTS: Comparison of charts before and after implementation of an EMR showed statistically significant improvement in the percent of patients with all first trimester (87.5% vs 96.0%; P=.0025), quadruple screening tests (91.1% vs 98.1%; P=.012), and second trimester screening results (93.5% vs 100%; P=.044) in their charts; first trimester laboratory tests (91.6% vs 99.5%; P=.001) and second trimester ultrasounds (90.9% vs 97.3%; P=.027) being ordered on time; and first trimester results (88.2% vs 95.5%; P=.009), quad screen results (93.1% vs 98.0%; P=.0495), and second trimester ultrasounds (93.5% vs 100%; P=.003) being recorded on the American Congress of Obstetricians and Gynecologists flow sheet. CONCLUSION: Adopting an EMR was associated with an improved rate at which prenatal tests were ordered on time, present on the chart, and recorded on a prenatal flow sheet.