Factors influencing medical students' choice of family medicine: effects of rural versus urban background.

OBJECTIVE: To identify factors that influence medical students' choice of family medicine versus another specialty and to analyze influential factors by urban versus rural background of students. DESIGN: Cross-sectional questionnaire survey conducted in 2010. SETTING: University of Alberta in Edmonton. PARTICIPANTS: A total of 118 first-, 120 second-, and 107 third-year medical students. MAIN OUTCOME MEASURES: Twenty-two factors influencing preferred career choice, type of community lived in (rural vs. urban), and student age and sex. RESULTS: Overall, 283 (82.0%) students responded to the survey. Those who preferred family medicine rather than another specialty as a career option were older (≥ 25 years) (69.6% vs. 40.9%, P < .001), female (69.6% vs. 39.3%, P < .001), and had previously lived in rural locations (< 25,000 population) (46.8% vs. 23.9%, P < .001). Four factors were significantly associated with students preferring family medicine compared with any other specialty: emphasis on continuity of care (87.3 vs. 45.3%, P < .001); length of residency (73.4% vs. 25.9%, P < .001); influence of family, friends, or community (67.1% vs. 50.2%, P = .011); and preference for working in a rural community (41.8% vs. 10.9%, P < .001). For students with urban backgrounds, the preference for family medicine was more strongly influenced by the opportunity to deal with a variety of medical problems; current debt load; and family, friends, or community than for those with rural backgrounds. Practice location preferences also differed between students from rural and urban backgrounds. CONCLUSION: Medical students who prefer family medicine as a career choice appear to be influenced by a different set of factors than those who prefer other specialties. Being female; being older; having previously lived in a rural location; placing importance on continuity of care; desire for a shorter residency; and influence of family, friends, or community are associated with medical students preferring family medicine. Some differences in factors influencing career choice exist between medical students from rural versus urban backgrounds. To increase the supply of family physicians, medical schools might consider introducing elements into the admissions process and the medical curriculum that encourage family medicine as a career choice.

Efficacy of journaling in the management of mental illness: a systematic review and meta-analysis.

OBJECTIVES: Journaling is a common non-pharmacological tool in the management of mental illness, however, no clear evidence-based guideline exists informing primary care providers on its use. We seek here to present this synthesis that may begin to inform future research and eventual evidence-based guideline development. DESIGN: Of the 3797 articles retrieved from MEDLINE, EMBASE, PsycINFO, 20 peer-reviewed randomised control trials (31 outcomes) met inclusion criteria. These studies addressed the impact of a journaling intervention on PTSD, other anxiety disorders, depression or a combination of the aforementioned. ELIGIBILITY CRITERIA: Peer reviewed, randomised control trials on the impact of journaling on mental illness were included. INFORMATION SOURCES: MEDLINE, EMBASE and PsycINFO. RESULTS: The data are highly heterogeneous (control arm=I2 of 71.2%, intervention arm=I2 of 83.8%) combined with a B-level Strength of Recommendation Taxonomy recommendation. It was additionally found that there is a significant pre-post psychometric scale difference between control (-0.01, 95% CI -0.03 to 0.00) and intervention arms (-0.06, 95% CI -0.09 to -0.03). This 5% difference between groups indicates that a journaling intervention resulted in a greater reduction in scores on patient health measures. Cohen's d effect size analysis of studies suggests a small to moderate benefit. CONCLUSION: Further studies are needed to better define the outcomes. Our review suggests that while there is some randomised control data to support the benefit of journaling, high degrees of heterogeneity and methodological flaws limit our ability to definitively draw conclusions about the benefit and effect size of journaling in a wide array of mental illnesses. Given the low risk of adverse effects, low resource requirement and emphasis on self-efficacy, primary care providers should consider this as an adjunct therapy to complement current evidence-based management.

Health advocacy training: why are physicians withholding life-saving care?

The societal responsibility of physicians to be health advocates, both at the population and patient level is necessary to positively influence public health and policy. Physicians must commit to learn about policy reform and the legislative process. Several regulatory physician organizations emphasize the importance of health. In addition, the Association of American Medical Colleges' (AAMC) Medical Schools Objectives Project, the Medical Council of Canada Qualifying Examination objectives and several Canadian medical schools outline advocacy as an objective. As a result, several US medical schools have designed and incorporated health advocacy into their curricula. Canadian medical schools, however, have been lagging behind. To address this deficiency, the University of Alberta and the University of Calgary hosted the 1st Annual Alberta Political Action Day (PAD) to engage medical students in advocacy and the policy making process. The two-day time requirement of PAD makes it an efficient model to incorporate health advocacy into the already demanding undergraduate medical curriculum. Canadian medical schools must follow the American example and further integrate initiatives such as PAD to teach health advocacy. The skills developed will enhance student's comprehension of how they can shape health policy and truly advocate for optimal patient care.

Provision of pharmacy services to underserved populations via remote dispensing and two-way videoconferencing.

A telepharmacy program aimed to resolve the dual problem of access to prescription drugs and pharmacists for low-income populations is described. The program was conducted at the Community Health Association of Spokane (CHAS), a federally qualified community health center, and initiated in January 2001. The program, known as Telepharmacy at CHAS, allows for the dispensing of low-cost medications through participation in the federal government's 340B program and use of remote dispensing and counseling via a two-way interactive videoconferencing system to patients at six urban and rural clinics. The regulatory and practical steps necessary to implement and maintain the program are also presented. Consecutive patients whose prescriptions were filled at the base site or remote-sites were invited to complete a pharmacy satisfaction questionnaire during a two-week period in March 2003. Over the two-week period, 93 patients seen at remote sites and 106 seen at the base site completed the questionnaire. Over 75% of patients seen at the remote sites were satisfied with their videoconference interactions with the pharmacist. Of the patients seen at the base site, 66% agreed or strongly agreed that they were satisfied with the time required to obtain medications and counseling. A high percentage of patients at both the base site (94%) and remote sites (63%) strongly agreed or agreed that they would have difficulty affording their medications without this program. Telepharmacy at CHAS has been well received by most of the patients and improved their access to medications and pharmacy services.