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5.
Fam Med ; 51(8): 641-648, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31509215

RESUMO

BACKGROUND AND OBJECTIVES: The optimal length of residency training in family medicine is under debate. This study compared applicant type, number of applicants, match positions filled, matched applicant type, and ranks to fill between 3-year (3YR) and 4-year (4YR) residencies. METHODS: The Length of Training Pilot (LOTP) is a case-control study comparing 3YR (seven residencies) and 4YR (six residencies) training models. We collected applicant and match data from LOTP programs from 2012 to 2018 and compared data between 3YR and 4YR programs. National data provided descriptive comparisons. An annual resident survey captured resident perspectives on training program selection. Summary statistics and corresponding t-tests and χ2 tests of independence were performed to assess differences between groups. We used a linear mixed model to account for repeated measures over time within programs. RESULTS: There were no differences in the mean number of US MD, US DO, and international medical graduate applicants between 3YR and 4YR programs. Both the 3YR and 4YR programs had a substantially higher number of US MD and DO applicants compared to national averages. The percentages of positions filled in the match and positions filled by US MDs, DOs and IMGs were not different between groups. The percentage of residents in 4YR programs who think training in family medicine requires a fourth year varied significantly during the study period, from 35% to 25% (P<.001). The predominant reasons for pursuing training in a 4YR program was a desire for more flexibility in training and a desire to learn additional skills beyond clinical skills. CONCLUSIONS: The applicant pool and match performance of the residencies in the LOTP was not affected by length of training. Questions yet to be addressed include length of training's impact on medical knowledge, scope of practice, and clinical preparedness.


Assuntos
Competência Clínica , Avaliação Educacional/estatística & dados numéricos , Medicina de Família e Comunidade/educação , Internato e Residência , Seleção de Pessoal/estatística & dados numéricos , Adulto , Estudos de Casos e Controles , Educação de Pós-Graduação em Medicina , Feminino , Humanos , Masculino , Estudos Prospectivos , Fatores de Tempo
6.
Fam Med ; 51(8): 649-656, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31509216

RESUMO

BACKGROUND AND OBJECTIVES: Family medicine rural training track (RTT) residency programs produce a higher proportion of graduates who choose rural practice than other programs, yet RTTs face continuing threats to their existence. This study sought to understand threats to RTT sustainability and resilience factors that enable RTTs to thrive. METHODS: In 2014 and 2015, the authors conducted semistructured interviews of 21 RTT leaders representing two closed programs and 22 functioning programs. Interview topics included program strengths providing resilience and sustainability, risk factors for closure or vulnerabilities threatening sustainability, and advice for other RTTs. The authors performed a content analysis, coding pertinent themes in all interview data. RESULTS: From the top three assets, risks, and advice that respondents offered, the following nine themes emerged, in order from most to least mentioned: leadership, faculty and teaching resources, program support, finances, resident recruitment, program attributes, program mission, political and environmental context, and patient-related clinical experiences. Interviewees frequently reported multifactorial causes for RTT sustainability or closure. CONCLUSIONS: Numerous factors identified, such as distance, can operate as positive or negative influences for program resilience, depending on place and context. Resilience depends on multiple forms of social capital, including robust networks among individuals and various communities: the local population and patients, local health care providers, residency faculty, and RTTs in general. The small size and remoteness of RTTs make them vulnerable to multiple challenges in finances, regulations, and accreditation, requiring program adaptability and suggesting the need for flexibility in the policies that govern them.


Assuntos
Medicina de Família e Comunidade/educação , Internato e Residência , Área de Atuação Profissional/tendências , Educação de Pós-Graduação em Medicina , Medicina de Família e Comunidade/tendências , Humanos , Entrevistas como Assunto , Liderança , Fatores de Risco , Serviços de Saúde Rural/tendências
7.
Fam Med ; 51(8): 664-669, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31509217

RESUMO

BACKGROUND AND OBJECTIVES: Facilitation is common in the era of practice transformation. Much of the literature on practice facilitators focuses on the role of external facilitators who come into a practice to aid in practice transformation efforts. Our study sought to better understand the attributes of exemplary facilitators. METHODS: We conducted 10 structured interviews in four family medicine residencies. RESULTS: Program directors easily identified internal staff who serve informally as exemplary facilitators. Despite varying jobs, they possess seven identifiable attributes within three broad domains: task orientation, relational skills, and emotional intelligence. CONCLUSIONS: Given the increasing cost of practice transformation and the finite resources in many clinics, this study can help leaders identify current employees best suited for facilitation.


Assuntos
Comportamento Cooperativo , Medicina de Família e Comunidade/educação , Medicina de Família e Comunidade/organização & administração , Ciência da Implementação , Internato e Residência , Inovação Organizacional , Inteligência Emocional , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa , Melhoria de Qualidade
8.
Fam Med ; 51(8): 682-686, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31509219

RESUMO

BACKGROUND AND OBJECTIVES: An adequate family medicine workforce is needed to improve health and health care outcomes in the United States, yet few medical students in the US become family physicians. Indicators of family medicine interest upon medical school matriculation exist. Family medicine interest groups (FMIGs) may influence student choice. This study examines the association of FMIG participation with various matriculation interest indicators to predict which students go on to become family physicians. METHODS: The American Medical Association Masterfile was used to identify the practice specialty of 601 graduates of the University of Washington School of Medicine who matriculated between 2003 and 2007. Graduates' scores on the Family Medicine Interest Survey (FMIS) and whether a student listed family medicine as their top choice upon matriculation along with FMIG participation and demographic characteristics were used in a binary logistic regression model to predict eventual practice. The model output was used to calculate odds ratios and predicted probabilities of family medicine practice given initial family medicine interest and FMIG participation. RESULTS: FMIG participation was associated with higher odds ratios and increased predicted probability of becoming a family physician regardless of initial interest although the magnitude of the difference varied. FMIG participants who listed family medicine as their top specialty had a 68% predicted probability of entering family medicine compared to 8% probability if they did not list family medicine first and did not participate in FMIG. FMIG participation was associated with odds ratios between 3.27-4.19 for entering family medicine regardless of FMIS score. CONCLUSIONS: Among University of Washington students with family medicine as their top specialty choice upon matriculation, FMIG participation was associated with higher odds of entering the specialty. The same was true, although to a lesser degree, for students who had a high score on the FMIS.


Assuntos
Escolha da Profissão , Medicina de Família e Comunidade/educação , Medicina de Família e Comunidade/estatística & dados numéricos , Internato e Residência , Médicos de Família/estatística & dados numéricos , Educação Médica , Feminino , Humanos , Masculino , Opinião Pública , Estudantes de Medicina , Inquéritos e Questionários , Estados Unidos
11.
Aten. prim. (Barc., Ed. impr.) ; 51(7): 435-441, ago.-sept. 2019. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-185731

RESUMO

Objetivo: Valorar si un programa formativo ofrecido por médicos de familia en el currículum oficial de medicina sobre principios y estrategias para ayudar a los pacientes a cambiar conductas de riesgo (APCCR) produce cambios en sus percepciones, opiniones y actitudes con relación a este tipo de intervenciones. Diseño: Estudio cuasiexperimental antes-después. Emplazamiento: Una facultad de medicina. Participantes: Todos los alumnos de 4.o curso de medicina (n = 110). Intervenciones: Formación experiencial sobre estrategias comunicativas para APCCR. Mediciones: Opiniones y percepciones evaluadas antes y después del curso mediante cuestionario ad hoc. Resultados: Tras el curso, los estudiantes (n = 103) cambiaron sus ideas sobre la motivación como factor «interno» (15, 13%) a "interno-externo" (71, 61%) (p = 0,003), reforzando sus opiniones sobre la capacidad del médico para APCCR (alta: 72, 62%; baja: 10, 12%; p = 0,008). Los alumnos se consideraron más capaces de respetar la autonomía de los pacientes cuando estos toman decisiones o siguen conductas consideradas perjudiciales (fácil: 58, 50%; difícil: 28, 24%; p = 0,001) e incrementaron su percepción sobre su capacidad para afrontar este tipo de entrevistas (83, 72% vs. 1, 1%; p < 0,001). Conclusiones: Esta formación parece contribuir a crear en estudiantes percepciones y actitudes positivas relacionadas con aspectos claves a la hora de afrontar una entrevista para APCCR, lo cual supone un aspecto preliminar clave para implementar este tipo de estrategias


Objective: To evaluate whether a training program offered by family physicians in the official medical curriculum on principles and strategies to help patients change risk behaviours (HPCRB), produces changes in perceptions, opinions, and attitudes regarding this type of intervention. Design: Quasi-experimental before-after study. Setting: A School of Medicine. Participants: All students in their 4th year (n = 110). Interventions: Experiential training course on communicative strategies for HPCRB. Measurements: Opinions and perceptions were evaluated before and after the course using an ad hoc survey. Results: After the course, students (n = 103) changed their ideas about motivation as an "internal" (15, 13%) to ‘internal-external’ factor (71, 61%) (P = .003), reinforcing their opinions about the clinician's ability for HPCRB (high: 72, 62%; low: 10, 12%; P = .008). They considered themselves more capable to respect patient autonomy when they make decisions or follow harmful behaviours (easy: 58, 50%; difficult: 28, 24%; P = .001), and increased their perception of their ability to cope with this type of interview (83, 72% vs. 1, 1%; P < .001). Conclusions: This training course seems to contribute to creating positive perceptions and attitudes in students, as regards key aspects when conducting an interview for HPCRB. This is a key preliminary aspect to implement this type of strategy


Assuntos
Humanos , Masculino , Feminino , Adulto , Promoção da Saúde , Estudantes de Medicina/estatística & dados numéricos , Educação Médica , Atenção Primária à Saúde/organização & administração , Medicina de Família e Comunidade/educação , Inquéritos e Questionários , Percepção
12.
J Grad Med Educ ; 11(4 Suppl): 34-46, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31428258

RESUMO

Background: Investments in training physician specialists through postgraduate medical education (PGME) are critical for Sub-Saharan Africa, given the increasing burden of non-communicable diseases. Objectives: The objectives of this scoping review were to (1) understand the breadth of publications on PGME from Sub-Saharan Africa, and (2) conduct a thematic analysis of lessons learned by specific training programs. Methods: We conducted a literature search of 7 databases for PGME literature published between January 1991 and December 2016. Two reviewers independently reviewed titles and abstracts for inclusion. Full-text articles were then reviewed, and bibliometric data were extracted to create a profile of PGME-related publications. Two authors coded the manuscripts to identify articles written about specific PGME programs. These were analyzed for lessons learned. Results: We identified 813 publications that reported on postgraduate medical education in Sub-Saharan Africa. Most articles were published between 2005 and 2016. Nations leading in publication were South Africa and Nigeria, followed by Ethiopia, Uganda, Kenya, Ghana, and Malawi. The largest number of articles related to general surgery training, followed by family medicine, emergency medicine, and anesthesiology. Thematic analysis revealed advantages of training programs for health facilities, challenges related to teaching, resourcing, and standardizing of training, and lessons learned related to international partnerships, faculty engagement, and research support for trainees. Conclusions: PGME in Sub-Saharan Africa has evolved over the past 26 years. Future growth will require strategic support to scale programs, support new specialties, trainees, and teachers, and leverage best practice models to sustain PGME programs.


Assuntos
Educação de Pós-Graduação em Medicina , Internato e Residência , Ensino , África ao Sul do Saara , Medicina de Emergência/educação , Medicina de Família e Comunidade/educação , Cirurgia Geral/educação , Humanos
14.
BMC Med Educ ; 19(1): 258, 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31296217

RESUMO

BACKGROUND: Community-based education (CBE) is strategically important to provide contextual learning for medical students. CBE is a priority for countries striving for better primary health care. However, the CBE literature provides little curriculum guidance to enhance undergraduate medical education with the primary health care context. We aim to develop a CBE framework for undergraduate medical education (from macro, meso, and micro curriculum levels) to engage students and teachers with better, more meaningful learning, within primary health care settings. METHODS: We used a grounded theory methodology by interviewing eight medical educationalists and ten CBE teachers, followed with the coding process by sensitizing the concepts of 'medical education' and 'primary care', to explore any new concepts. The primary data originated from a developing country where the paradigm of high-quality primary health care is mostly unfamiliar. Three senior researchers from international associations of general practices from different countries provided validation to the results. RESULTS: We identified a new framework for a community-based educational program. The micro-curriculum should offer opportunities for small group activities, ranging from simple to complex learning, emphasizing clinical skills, leadership, and teamwork to improve self-directed and collaborative practice. Sufficient role models and constructive feedback within primary care contexts are robust facilitators. For the meso-curriculum, comprehensive coordination on teacher-training and CBE program is needed. To ensure the sustainability of the program, faculty leaders and managers should include the macro-curriculum with a national postgraduate general practice curriculum and provide strong commitment. CONCLUSIONS: We designed a 'CBE-tree' model for the undergraduate medical curriculum. By using the CBE framework developed in this study, students and teachers may better comprehend the essential of primary health care.


Assuntos
Redes Comunitárias/organização & administração , Currículo , Educação de Graduação em Medicina/organização & administração , Medicina de Família e Comunidade/educação , Feminino , Teoria Fundamentada , Humanos , Masculino , Modelos Educacionais , Atenção Primária à Saúde , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Estudantes de Medicina/estatística & dados numéricos , Reino Unido
18.
BMC Med Educ ; 19(1): 251, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31286945

RESUMO

BACKGROUND: In South Africa it is compulsory to submit a satisfactory portfolio of learning to gain entrance to the national exit examination of the College of Family Physicians and to qualify as a family physician. A paper-based portfolio has been implemented thus far and the need for an electronic portfolio (e-portfolio) was identified. The aim of the study was to describe and evaluate the implementation of an e-portfolio for the training of family medicine registrars in the Western Cape province of South Africa. METHODS: Mixed methods were used. A quasi-experimental study evaluated paper- and e-portfolios from the same 28 registrars in 2015 compared to 2016. Semi-structured interviews were conducted with 11 registrars or supervisors to explore their experiences of using the e-portfolio. Quantitative data was analysed in the Statistical Package for Social Sciences and qualitative data in Atlas.ti. RESULTS: Most respondents found the e-portfolio easier to use and more accessible. It made progress easier to monitor and provided sufficient evidence of learning. Feedback was made easier and more explicit. There were concerns regarding face-to-face feedback being negatively affected. It was suggested to have a feedback template to further improve feedback. Several aspects were significantly better in the e-portfolio such as feedback on the registrar's general behaviour, alignment with learning outcomes, less feedback based on hearsay and acknowledgement of the feedback by the registrar. Although not statistically significant, there was an increase in the usage of the e-portfolio, compared to the paper portfolio. CONCLUSION: In general, the e-portfolio is an improvement on the paper-based portfolio. It is easier to access, more user-friendly and less cumbersome. It makes feedback and monitoring of progress and development of registrars easier and more visible and provides sufficient evidence of learning. Its implementation throughout South Africa is recommended.


Assuntos
Competência Clínica/normas , Documentação/métodos , Educação de Pós-Graduação em Medicina , Medicina de Família e Comunidade/educação , Médicos de Família/educação , Atitude do Pessoal de Saúde , Computação em Nuvem , Documentação/tendências , Avaliação Educacional , Estudos de Avaliação como Assunto , Retroalimentação , Humanos , Internet , Aprendizagem , Desenvolvimento de Programas , África do Sul
19.
Fam Med ; 51(7): 555-558, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31287900

RESUMO

After 3 decades in private practice, I joined the faculty of a nearby residency program. Like most family medicine residencies, it follows a curriculum that my physician father would have recognized: heavy emphasis on inpatient medicine; short shrift to continuity care. Despite a changing marketplace, there is still a disconnect between how we train graduates (for full spectrum care) and where they end up (in ambulatory practices). Is our identity disappearing? I contend that the primary and indispensable duty of a residency program is to model professional values and prepare residents to live and work in sustainable communities. Though the scope of practice will vary, family physicians still pride themselves in putting the needs of their patients at its center.


Assuntos
Docentes de Medicina/psicologia , Medicina de Família e Comunidade/educação , Internato e Residência , Currículo/normas , Educação de Pós-Graduação em Medicina , Humanos , Médicos de Família/normas , Inquéritos e Questionários
20.
Fam Med ; 51(7): 587-592, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31287903

RESUMO

BACKGROUND AND OBJECTIVES: Canadian residents' breastfeeding experiences have only been reported in studies that broadly explored pregnancy and parenthood. We sought to fully explore Canadian family medicine resident mothers' breastfeeding experiences, and identify strategies to support workplace breastfeeding for future trainees. METHODS: Using an online survey, University of Toronto family medicine residents who gave birth from 2010 through 2016 were queried about their exclusive and overall breastfeeding duration, barriers, and facilitators to workplace breastfeeding, and strategies to improve the breastfeeding experience for future resident mothers. Data were downloaded from Qualtrics software and descriptive statistical analyses were conducted using IBM SPSS Statistics v.24.0. Subjective comments were examined and linked to quantitative findings. RESULTS: Fifty-six of 179 eligible residents completed the survey (31% response rate). More than three-quarters of residents were on maternity leave for 7 to 12 months. All initiated breastfeeding, and 54% breastfed exclusively for 6 months. The median breastfeeding duration was 10 to 12 months. Almost two-thirds of residents were breastfeeding upon return to work, and all experienced barriers to workplace breastfeeding including lack of time, private space, and refrigeration for expressed milk. Lack of a workplace breastfeeding policy and inadequate support from supervisors or program directors were additional barriers. Peer mentorship and more breastfeeding education were identified as strategies to support future residents' breastfeeding goals. CONCLUSIONS: Addressing long-standing barriers to workplace breastfeeding, and providing peer and educational supports were identified as strategies that could inform program policies to support future trainees' breastfeeding goals and experiences.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Medicina de Família e Comunidade/educação , Internato e Residência , Mães/estatística & dados numéricos , Local de Trabalho/psicologia , Adulto , Aleitamento Materno/psicologia , Canadá , Estudos Transversais , Feminino , Humanos , Internet , Mães/psicologia , Gravidez , Inquéritos e Questionários , Fatores de Tempo
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