Contributions of US Medical Schools to Primary Care (2003-2014): Determining and Predicting Who Really Goes Into Primary Care.

BACKGROUND AND OBJECTIVES: Schools of medicine in the United States may overstate the placement of their graduates in primary care. The purpose of this project was to determine the magnitude by which primary care output is overestimated by commonly used metrics and identify a more accurate method for predicting actual primary care output. METHODS: We used a retrospective cohort study with a convenience sample of graduates from US medical schools granting the MD degree. We determined the actual practicing specialty of those graduates considered primary care based on the Residency Match Method by using a variety of online sources. Analyses compared the percentage of graduates actually practicing primary care between the Residency Match Method and the Intent to Practice Primary Care Method. RESULTS: The final study population included 17,509 graduates from 20 campuses across 14 university systems widely distributed across the United States and widely varying in published ranking for producing primary care graduates. The commonly used Residency Match Method predicted a 41.2% primary care output rate. The actual primary care output rate was 22.3%. The proposed new method, the Intent to Practice Primary Care Method, predicted a 17.1% primary care output rate, which was closer to the actual primary care rate. CONCLUSIONS: A valid, reliable method of predicting primary care output is essential for workforce training and planning. Medical schools, administrators, policy makers, and popular press should adopt this new, more reliable primary care reporting method.

Community violence and African American male health outcomes: An integrative review of literature.

Community violence exposure is essential when considering African American male adult health outcomes. This integrative review of literature is guided by the research questions: (a) How has community violence been measured in African American male adults? and (b) What impact does community violence have on African America male health outcomes? This study synthesises eight current articles identified by the search terms-community violence, impact, African Americans, care, and men. Of the eight identified articles, there were quantitative (n = 5), qualitative (n = 1) and mixed methods (n = 2). Findings indicate a wide array of screening tools for violent experiences and highlight the potential negative impacts of violence in communities; however, literature regarding strategies for identification and treatment of psychosocial and physical health status of African American male adults experiencing direct and indirect community violence remains limited. Further work in clinical care and community health settings related to violence is warranted.

Validation of a dietary intake tool for african-american dialysis patients with low literacy.

BACKGROUND: This study analysed the validity and reliability of a food frequency questionnaire designed for African-American patients with low literacy. This instrument was designed specifically to meet the need for a tool that was short, easy to understand, and met clinical reliability and validity standards. OBJECTIVES: Assessing patient nutritional status and dietary intake is crucial to the care of patients in end stage kidney disease. The development of a quick and reliable nutritional assessment tool for patients with low literacy could increase nutritional counselling effectiveness and improve patient outcomes. DESIGN: The renal food frequency questionnaire (RFF) and a standard 24-hour recall were administered to a general population of African-American patients undergoing dialysis. Registered Dieticians and statistical analyses were used to validate the content and structural validity and reliability of the RFF to adequately measure dietary intake. PARTICIPANTS: The study sample consisted of 30 African-American patients who received dialysis treatment at a regional teaching hospital facility. RESULTS: The RFF was found to be a simple, easy to understand instrument with low reading complexity (grade level 4.4). Inter-rater reliability was found to be high (.81-1.00), and statistical analysis determined a high level of clinical validity. CONCLUSION: The RFF was found to be a valid dietary recall tool that is appropriate for patients with limited literacy. It was found to have acceptable reliability and validity when compared with a standard 24-hour recall and has potential for use as a dietary intake and monitoring tool in patients undergoing dialysis.

Factors associated with placement of rural primary care physicians in North Carolina.

OBJECTIVES: The objective of this study was to determine what factors influence primary care physicians to choose rural practice locations to better develop the rural workforce in North Carolina. To better recruit and retain physicians, residents, and medical students for rural practice, we must understand what factors positively influence their choice of practice location. METHODS: A survey was sent to all primary care physicians licensed in the state of North Carolina (N = 2829), with 975 usable (return rate 34.5%). Results were analyzed using basic descriptive statistics and χ(2) automatic interaction detection analysis. RESULTS: Findings indicated that solo practice, critical access hospital, community health center, or federally qualified health center sites were strongly associated with rural practice. Pay as a factor in choosing a work site, financial support from a hospital, and medical school loan repayment also was correlated with rural practice. Seventy-two percent of rural physicians reported being raised in a town of ≤11,000, which was found to be highly associated with working in a rural area. This single point is highly indicative of rural practice and by defining this new level it roughly doubles the predictive value previously defined by other researchers. CONCLUSIONS: Incentives such as loan repayment, salary guarantees, and practice assistance for rural physicians currently provided under several federal and state programs should continue to assist in attracting primary care physicians to rural areas. Having been raised in an area of ≤11,000 was highly predictive of future rural medical practice and could be used in the recruitment of physicians and residents to increase the ultimate yield for rural areas. With these new data, North Carolina medical schools and practices serving rural areas may be able to better recruit and retain physicians with a predilection to rural practice.

Perceptions of community health center impact on private primary care physician practice.

CONTEXT: Community health centers (CHCs) were created in the mid-1960s to expand access to care in impoverished and underserved areas. The number of CHC sites has more than tripled in eastern North Carolina from 28 primary care centers in 2000 to 89 in 2010. OBJECTIVE: This study determined the perceptions of physicians on the impact of CHC expansion on the local practice environment. DESIGN: Descriptive statistics and correlations were used to compare responses regarding perceptions and differences between practice characteristics as well as physician ratios by year. Both CHC and private practice physician addresses were mapped using ArcGIS. SETTING AND PARTICIPANTS: Surveys were sent to 1422 (461 returns/32.5% response rate) primary care physicians residing in 43 predominantly rural eastern North Carolina counties. RESULTS: A large percentage of the respondents (82.7%) affirmed that they felt neutral or did not view CHCs to be competitors, whereas a minority (17%) did view them to be difficult to compete against. Forty-two percent of private practice respondents disagreed that CHCs offer a wider range of services despite significantly more CHC physicians than private practice respondents indicating that their facility provided basic services. CONCLUSION: The CHCs were perceived to offer a wider range of services, employ more staff, and have more practice locations than private practices. However, private practice physicians did not perceive CHCs to have a competitive advantage or to unfairly impact their practices, possibly due to inconsistent population growth in relation to the physician retention during the last 10 years.

The effect of primary care fellowship training on career satisfaction, happiness and perceived stress.

PURPOSE: This study was designed to measure the impact of primary care fellowship training on the subsequent happiness, career satisfaction and perceived stress levels of fellowship-trained physicians as compared to a general population of Family Medicine physicians in North Carolina. METHODS: A written survey instrument was completed by fellowship graduates of the Brody School of Medicine (n=53) and general population of Family Medicine physicians in North Carolina (n=203) in 2011. The survey included general demographic and practice variables, and validated psychological scales on subjective happiness, satisfaction with life, and perceived stress. RESULTS: Fellowship graduates (n=50), and non-fellowship graduates (n=203), exhibited similar levels of satisfaction with life (fellows=27.36 SD 5.45, FM physicians=26.91, SD 5.99 on a 5-35 scale), statistically higher levels of perceived stress (fellows=5.92, SD 3.03, FM physicians=4.98, SD 2.70 on a 0-16 scale), and significantly higher levels of subjective happiness (fellows=5.61SD 83, FM physician=4.75 SD 1.00 on a 1-7 scale). Female fellow response was significantly higher on the Satisfaction with Life and Subjective Happiness Scores, and lower on the Perceived Stress Scale. Male fellowship graduates presented with a reverse relationship, with higher perceived stress and lower satisfaction with life and subjective happiness. CONCLUSIONS: Fellowship training exhibited a positive psychological effect on the graduate respondents versus the general physician population. Scores on various well-being scales were higher than the general Family Medicine physician population as a whole, although stress levels were also higher. Female physicians seem to garner a much larger gain in satisfaction than male fellowship graduates, who score slightly worse than the general family medicine population on the satisfaction with life and Perceived Stress Scales.

ACE inhibitors and potassium foods--nurses' knowledge.

PURPOSE: According to Joint Commission standards, patients should be educated about drug-nutrient interactions. Because nurses are well-suited to educating patients, this paper aims to assess their knowledge of ACE inhibitor drugs, nutrient interactions and high- and low-potassium foods. DESIGN/METHODOLOGY/APPROACH: Licensed nurses from a teaching hospital in the US south eastern Atlantic region completed a self-administered questionnaire (n = 83). Means, standard deviations and 95 percent confidence intervals were calculated for continuous data and frequency and percentage distribution for discrete data. Student's t-test was used to evaluate responses by ACE inhibitor patient load and nursing education. FINDINGS: Mean nurse knowledge of ACE inhibitors and potassium was 62 +/- 16 percent and identifying high- and low-potassium foods was 32 +/- 23 percent. Most identified five from 12 high-potassium foods and did not know the designation of six, one from 14 low-potassium foods and did not know the designation of 11. Knowledge scores and identifying high- and low-potassium foods were similar regardless of ACE inhibitor patient load and nursing education. PRACTICAL IMPLICATIONS: ACE inhibitors are the fourth most commonly used drug class in the USA. Nurses are well positioned to recognize potential drug-nutrient interactions owing to changing or adding a drug, dose delivery method, dietary change or a patient's physical or clinical status that may indicate nutrient deficiency. The findings suggest that the nurses surveyed were proficient in identifying ACE inhibitors pharmacology, but that most were unable to identify foods that increase drug-nutrient interaction risk, and thus this is an area in which additional training might be beneficial. ORIGINALITY/VALUE: Case menus were used to portray real-life scenarios in which healthcare practitioners can provide patient education about ACE inhibitor drug and dietary potassium interactions.

Using food as a tool to teach science to 3 grade students in Appalachian Ohio.

The Food, Math, and Science Teaching Enhancement Resource (FoodMASTER) Initiative is a compilation of programs aimed at using food as a tool to teach mathematics and science. In 2007-2008, a foods curriculum developed by professionals in nutrition and education was implemented in 10 3(rd)-grade classrooms in Appalachian Ohio; teachers in these classrooms implemented 45 hands-on foods activities that covered 10 food topics. Subjects included measurement; food safety; vegetables; fruits; milk and cheese; meat, poultry, and fish; eggs; fats; grains; and meal management. Students in four other classrooms served as the control group. Mainstream 3(rd)-grade students were targeted because of their receptiveness to the subject matter, science standards for upper elementary grades, and testing that the students would undergo in 4(th) grade. Teachers and students alike reported that the hands-on FoodMASTER curriculum experience was worthwhile and enjoyable. Our initial classroom observation indicated that the majority of students, girls and boys included, were very excited about the activities, became increasingly interested in the subject matter of food, and were able to conduct scientific observations.

Creating a New Paradigm for Premedical Undergraduate Studies: Physicians' Perceptions of Subjects and Skills Critical for Success in Medical School and Practice.

BACKGROUND/PURPOSE: The purpose of this study is to determine subjects and skills that are perceived by practicing physicians as essential for success in medical training and practice. Previous studies suggest that better premedical preparation for a future career as a physician may reduce the need for expanded study of non-clinical subjects and skills in the graduate medical curriculum. METHODS: The study was performed with a random sample of licensed physicians in Ohio (n=2,100), who were queried utilizing a survey instrument of 54 questions including demographics and perceptions on eight subjects and sixteen skills essential for success in medical school and practice. Completed surveys (n=356) were found to be representative of the national demographics of practicing physicians, including similar age, education, gender, type of practice, and specialty. RESULTS: Respondents indicated that the subjects of business, communications, and technology were rated as most important for physician success, while communications, natural sciences and technology were most important for students. Skills identified as most essential to both training and practice included the ability to utilize technology, being honest and truthful, ability to explore, self-educate and research, and ability to communicate orally. CONCLUSIONS: The findings of the study support previous research and indicate that some students entering medical school may not have the breadth of study that practitioners identify as best preparing them for success as a student and practitioner.