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Ann Fam Med ; 16(5): 436-439, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30201640


POEMs (patient-oriented evidence that matters) are studies that address a relevant clinical question, demonstrate improved patient-oriented outcomes, and have the potential to change practice. For 20 years the authors of this article have reviewed more than 100 English language clinical journals monthly to identify POEMs in the medical literature relevant to primary care practice. This article identifies the POEMs in each of the last 20 years that were highest ranked for having recommended a major and persistent change in practice that year. They include POEMs that recommend a novel, effective intervention, a second group that recommends abandoning an ineffective practice, and a third group that recommends abandoning a potentially harmful practice. The top POEMs of the past 20 years illustrate the breadth of practice change in primary care and the need for family physicians to have a systematic approach to keeping up with the medical literature, such as that in POEMs, especially because many of these important articles did not appear in the primary care literature.

Pesquisa Biomédica/tendências , Medicina Baseada em Evidências/tendências , Medicina de Família e Comunidade/tendências , Médicos de Família/tendências , Atenção Primária à Saúde/tendências , Pesquisa Biomédica/história , Medicina Baseada em Evidências/história , Medicina de Família e Comunidade/história , História do Século XX , História do Século XXI , Humanos , Médicos de Família/história , Atenção Primária à Saúde/história
Fam Med ; 49(4): 275-281, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28414406


BACKGROUND: Residency programs have been integral to the development, expansion and progression of family medicine as a discipline. Three reports formed the foundation for graduate medical education in family medicine: Meeting the Challenge of Family Practice, The Graduate Education of Physicians, and Health is a Community Affair. In addition, the original core concepts of comprehensiveness, coordination, continuity, and patient centeredness continue to serve as the foundation for residency training in family medicine. While the Residency Review Committee for Family Medicine of the Accreditation Council for Graduate Medical Education has provided the requirements for training throughout the years, key organizations including the Society of Teachers of Family Medicine, the American Academy of Family Physicians, the Association of Family Medicine Residency Directors, and the American Board of Family Medicine have provided resources for and supported innovation in programs. Residency Program Solutions, National Institute for Program Director Development, and Family Medicine Residency Curriculum Resource are several of the resources developed by these organizations. The future of family medicine residency training should continue the emphasis on innovation and development of resources to enhance the training of residents. Areas for further development include leadership and health care systems training that allows residents to assume leadership of multidisciplinary health care teams and increase focus on the family medicine practice population as the main unit for resident education.

Medicina de Família e Comunidade/educação , Medicina de Família e Comunidade/história , Internato e Residência/história , Acreditação/história , Currículo/normas , Educação de Pós-Graduação em Medicina , História do Século XX , História do Século XXI , Humanos , Liderança , Assistência Centrada no Paciente , Médicos/normas , Desenvolvimento de Programas/métodos
Fam Med ; 49(4): 282-288, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28414407


BACKGROUND: Family medicine (FM) undergraduate medical educators have had two distinct missions, to increase the knowledge, skills, and attitudes of all students while also striving to attract students to the field of family medicine. A five decade literature search was conducted gathering FM curricular innovations and the parallel trends in FM medical student interest. Student interest in FM had a rapid first-decade rise to 14%, a second 1990's surge, followed by a drop to the current plateau of 8-9%. This falls far short of the 30-50% generalist benchmark needed to fill the country's health care needs. Curricular innovations fall into three periods: Charismatic Leaders & Clinical Exposures (1965-1978), Creation of Clerkships of FM (1979-1998) and Curricular Innovations (1998-present). There is good evidence that having a required third-year clerkship positively impacts student interest in the field, however there is little research regarding the recruitment impact of specific clerkship curricula. Other tools associated with student interest include programming geared towards primary care or rural training and extracurricular opportunities such as FM Interest Groups. Strategic plans to improve the primary care work force should focus funding and legislative efforts on effective methods such as: establishing and maintaining FM clerkships, admitting students with rural and underserved backgrounds or primary care interest, developing longitudinal primary care tracks, and supporting extracurricular FM activities. Rigorous research is needed to assess how best to utilize limited educational resources to ensure that all students graduate with a core set of FM competence as well as an increased FM matriculation.

Escolha da Profissão , Estágio Clínico/história , Medicina de Família e Comunidade/educação , Conhecimentos, Atitudes e Prática em Saúde , Estudantes de Medicina , Competência Clínica , Currículo , Educação de Graduação em Medicina , Medicina de Família e Comunidade/economia , Medicina de Família e Comunidade/história , História do Século XX , História do Século XXI , Humanos , Atenção Primária à Saúde
Fam Med ; 49(4): 289-295, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28414408


BACKGROUND: When the new field of family medicine research began a half century ago, multiple individuals and organizations emphasized that research was a key mission. Since the field's inception, there have been notable research successes for which family medicine organizations, researchers, and leaders-assisted by federal and state governments and private foundations-can take credit. Research is a requirement for family medicine residency programs but not individual residents, and multiple family medicine departments offer research training in various forms for learners at all levels, including research fellowships. Family physicians have developed practice-based research networks (PBRNs) to conduct investigations and generate new knowledge. The field of family medicine has seen the creation of new journals to support the publication of research relevant to practicing family physicians. Nonetheless, in spite of much growth and many successes, family physicians and their research have been underrepresented in research funding. Clinical presentations in family medicine are often complex, poorly-differentiated, and exist as one of several patient complaints and diagnoses, and are not well-covered by the narrow basic-science and specialty research that defines most of the biomedical research enterprise. Overall health in the United States would benefit from a more robust research participation and greater support for family medicine research.

Pesquisa Biomédica/história , Medicina de Família e Comunidade/educação , Medicina de Família e Comunidade/história , Alocação de Recursos , Pesquisa Biomédica/normas , História do Século XX , História do Século XXI , Humanos , Internato e Residência , Assistência Centrada no Paciente , Médicos de Família , Estados Unidos
Fam Med ; 49(4): 304-310, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28414410


BACKGROUND: Family physicians have been involved in the care of rural and urban underserved populations since the founding of the specialty. In the early 1970s family medicine training programs specifically focused on training residents to work with the underserved were established in both urban and rural settings. Key to the success of these programs has been a specific focus on improving access to care, understanding and eliminating health disparities, cultural competency and behavioral science training that recognizes the challenges often faced by patients and families living in poor rural and urban areas of the country. In keeping with a focus on the underserved, several urban underserved residencies also became national models for the provision of primary care to patients and families affected by HIV/AIDS. Family medicine training programs focused on the underserved have resulted in the development of a cohort of family physicians who care for those most in need in the United States. Despite these achievements, persistent challenges remain in providing adequate access to care for many living in rural and inner city settings. New strategies will need to be developed by family medicine programs and others to better meet these challenges.

Medicina de Família e Comunidade/história , Área Carente de Assistência Médica , Médicos de Família/psicologia , Populações Vulneráveis/psicologia , Competência Cultural , Medicina de Família e Comunidade/educação , História do Século XX , História do Século XXI , Humanos , Internato e Residência , Médicos de Família/história , Atenção Primária à Saúde , Estados Unidos
Rev. clín. med. fam ; 10(1): 39-40, feb. 2017. ilus
Artigo em Espanhol | IBECS | ID: ibc-162532


Estas historias de la LIBRETA DE VIAJE DEL MÉDICO DE FAMILIA, que forman una biblioteca del médico caminante o viajero emocional, son hojas sueltas en las que se escribe sobre paisajes y emociones; son un atlas de geografía emocional. La evocación de un paisaje ante la asistencia a un paciente –montañas, ríos, valles, playas, mares, desiertos, mesetas, islas, pantanos, cascadas, dunas, bosques, salinas, lagos, etc.-, con las sensaciones sentidas por el médico, de calor, frescor, humedad, dificultad, agobio, serenidad, inmensidad, soledad, etc. No es un diario, sólo una libreta de apuntes con las vivencias del médico sobre los patrones y procesos de la consulta en un cierto caso clínico, que a su vez, puede ilustrar un prototipo de esa clase de casos (AU)

These stories of the THE FAMILY PHYSICIAN’S TRAVEL NOTEBOOK, which form a library of the walking doctor or emotional traveler, are loose-leaf pages with writings about landscapes and emotions; they are an atlas of emotional geography. The evocation of a landscape before attending a patient –mountains, rivers, valleys, beaches, seas, deserts, plateaus, islands, swamps, waterfalls, dunes, forests, salt marshes, lakes, etc.-, with the sensations felt by the doctor -heat, coolness, humidity, hardship, stress, serenity, vastness, loneliness, etc. It is not a diary, only a notebook with the doctor's experiences about the patterns and processes of consultation in a clinical case, which in turn may illustrate a prototype for this type of cases (AU)

Humanos , Feminino , Narrativas Pessoais como Assunto , Viagem/tendências , Viagem/história , Doença da Altitude/epidemiologia , Medicina de Família e Comunidade/história , Medicina de Família e Comunidade/normas , Clima de Montanha