Characteristics of and issues faced by rural female family physicians.

The purpose of this study was to identify characteristics of and issues faced by female family physicians practicing in rural areas. A 37-item survey was designed to obtain demographic information about the background, community and practice of rural female physicians. An open-ended question regarding the issues and problems faced by female physicians in rural communities was included. Study subjects were identified from the membership of the American Academy of Family Physicians (AAFP). The questionnaire was mailed to all 850 active female AAFP members practicing in communities with less than 50,000 inhabitants during the winter of 1999. Completed and usable surveys were received from 587 (69.9 percent). The average age of respondents was 45. The majority were married (81.1 percent) and had children (80.1 percent). Half of the women had grown up in communities of 25,000 or less population. Twenty-seven percent of the respondents had no rural exposure in medical school; 39 percent had no rural exposure in residency; and 16 percent had no rural exposure in medical school or residency. The majority of respondents (62 percent) practiced in communities of less than 10,000. A large majority (70 percent) of these women planned to stay in the community for 10 years or more, with 58.6 percent responding that they plan to stay indefinitely. Assumptions regarding rural physicians, especially women, must be updated to accurately assist communities in recruiting rural physicians and to assist medical schools and residencies in adequately preparing graduates for rural practice.

Promoting medical student involvement in primary care research.

BACKGROUND AND OBJECTIVES: As the growth of primary care continues, the need for strengthening the scientific foundations of practice becomes more pressing. Although there is general agreement on the importance of promoting primary care research by medical students, little has been reported on how this can be accomplished. The goal of the program described is to involve medical students in primary care research. METHODS: Over the last 7 years, the Department of Family Medicine at the University of Colorado has promoted the involvement of medical students in primary care research through a program consisting of five elements: 1) a student development program (the Family Medicine Scholars Program), 2) financial support for student research, 3) a core of faculty mentors, 4) a strong coordinating effort by the predoctoral education office, and 5) research agendas geared to student schedules. RESULTS: The number of students involved in primary care research, presentations, and publication of papers by students has increased since we initiated our medical student research program 7 years ago. CONCLUSIONS: The elements discussed have proven successful at increasing student participation in primary care research.

Personalized remedial intensive training of one medical student in communication and interview skills.

BACKGROUND: Medical students found to be deficient in communication and interview skills pose a difficult remediation challenge. There is no standard way to address such deficiencies. The authors describe the development and implementation of an intensive remedial curriculum. DESCRIPTION: A 2nd-year student found deficient in communication skills was held back for a year and paired with a clinical preceptor for intensive skills training, including a weekly precepted clinic, structured readings, standardized patient (SP) exercises, communications workshops, and end-of-year standardized clinical evaluations. EVALUATION: The student's self-assessment and the preceptor's assessments of communication skill gradually improved over the year. The student improved through a progression of SP exercises focusing on specific communication skills. The student passed a final evaluation exercise with an excellent rating from the SP and the preceptor. CONCLUSIONS: This multistrategy approach to improve communication skills can be applied to other students and in other institutions. Based on the Bayer Institute communication workshops and integrated coaching techniques, the material forms a framework to help deficient students to become proficient in communication and interviewing skills.

How representative of typical practice are practice-based research networks? A report from the Ambulatory Sentinel Practice Network Inc (ASPN)

OBJECTIVE: To evaluate the patients and practices of family physicians in a national practice-based research network to understand whether results from practice-based research networks are likely to be relevant to other practicing clinicians. STUDY DESIGN: Survey focused on family physicians that replicated the National Ambulatory Medical Care Survey (NAMCS). SETTING: The Ambulatory Sentinel Practice Network Inc (ASPN), a practice-based research network, consisting of volunteer primary care practices that serve approximately 350,000 patients. OUTCOME MEASURES: Comparison of visits reported in ASPN with the visits reported in the 1990 NAMCS in terms of patient demographics, reasons for visit, diagnostic and therapeutic services, diagnoses, disposition, and amount of time spent with patients. RESULTS: Overall, the two samples differed with respect to demographic characteristics of patients, while problems, diagnoses, services, disposition, and time spent with patients were similar. Specific pair-wise comparisons identified areas of difference. CONCLUSION: The ASPN and possibly other similar practice-based research networks are sufficiently representative of family practice to serve as useful laboratories in which family practice and primary care can be explored.

Student perspectives on primary care preceptorships: enhancing the medical student preceptorship learning environment.

BACKGROUND: Medical students participate in a longitudinal (3-year) primary care preceptorship to assist them in developing skills in interviewing and examining patients in an ambulatory care setting. PURPOSE: To identify from a student's perspective important context and process issues in a longitudinal preceptorship. METHODS: The investigators used an "editing" style of analysis to identify significant themes across 24 medical student focus groups held between October 1995 and December 1997. RESULTS: Significant themes emerged from the data analysis that describe important features of what makes the preceptorship work for students. The main themes are active teaching, active learning, a trusting relationship, sufficient time, and a shared understanding of preceptorship objectives. The potential benefits to students in an enhanced learning environment are comfort, confidence, responsibility, skills, knowledge, reinforcement, learning opportunities, teaching opportunities, and models for practice. CONCLUSIONS: We offer recommendations for enhancing longitudinal preceptorships for preceptors, students, and leaders in medical education.