Caring for the underserved: using patient and physician focus groups to inform curriculum development.

BACKGROUND: Training pediatric residents to care for the underserved is a recognized curricular need. A literature review revealed that curricula specific to caring for the underserved tend to focus on specific medical diagnoses rather than physician or patient behaviors. OBJECTIVE: To collect and evaluate information essential for developing a curriculum to teach care for the underserved. METHODS: Focus groups were conducted to identify themes responsive to the question, "What does a physician need to know to care for the underserved?" Each of 3 focus groups met twice. The physician group included 5 pediatricians and 3 family practitioners. There were 2 patient groups: one Spanish-speaking (N = 13) and one English-speaking (N = 8). Content analysis was used to identify themes from each of the focus groups. RESULTS: Prevailing themes from the 3 groups were communication/respect, cultural issues, and frustration with systems, such as health insurance, transportation, and health delivery systems. Patients expressed an almost universal wish for physicians to listen to them and to attempt to "understand my life." Physicians expressed concerns with lacking the time to establish quality patient relationships and the need to serve multiple roles. The groups did not discuss issues related to specific medical conditions. CONCLUSIONS: Physicians and underserved patients identified communication/respect, cultural issues, and frustration with systems, such as health insurance, transportation, and health delivery systems, as important factors in caring for the underserved. Curricula to teach care of the underserved should include these themes.

How well does the continuity experience prepare residents for practice?

BACKGROUND: The goal of the continuity experience (CE) is to prepare graduates for pediatric practice. OBJECTIVE: To determine graduates' perceptions of how well CE prepared them for practice; to measure their satisfaction with CE; and to identify associations between patient and preceptor characteristics and the outcomes of satisfaction and preparation. DESIGN AND METHODS: Questionnaire mailed to pediatricians (N = 130) who had completed pediatric residency at the University of Utah between 1985 and 1996. Information was collected regarding current practice data and information regarding their CE site, the number and types of patients seen at that site, their evaluation of their preceptor, their satisfaction with their CE, and their opinion regarding how well their CE prepared them for practice. RESULTS: Of the 130 surveys, 58% were returned. Respondents reported degrees of preparedness as follows: 26% rated themselves "very well" prepared, and 56% rated themselves "pretty well" prepared. Satisfaction with CE was 32% "very satisfied" and 57% "satisfied." Graduates whose CE had been at a private practice (PP) reported higher degrees of preparedness than those whose CE had been at a university hospital clinic (UH) or a public health clinic (PH) (% reporting feeling "very well prepared": PP = 53%, UH = 16%, PH = 19%). Seeing more patients per half day was associated with a higher rate of feeling well prepared. PP graduates reported seeing more patients than those at the other sites. CONCLUSION: Though some differences were reported regarding the content of CE, the majority of graduates felt that their CE had prepared them well for practice.