Extended educational sessions at three family medicine residency programs.

There are few descriptions of graduate medical education curricula in the literature, and the descriptions that have been written have focused more on content than on format. Traditionally, educational presentations in residency programs are offered in one-hour time slots, a format that may be too limited for interactive sessions or hands-on activities. Further, whether these one-hour sessions are offered in the morning, at noon, or in the afternoon, they all present hindrances to residents' attendance. The authors propose that reserving extended blocks of time for educational sessions for residents is one way for programs to ensure both that residents attend the sessions and that they are able to learn what they need to learn during their training to meet the special requirements of the appropriate residency review committee. The authors present the experiences of three family medicine residency programs in developing and implementing extended educational sessions. Each program has multiple training sites, including rural sites. The three programs release residents from their clinical responsibilities to enable them to participate in the half-day to day-long sessions, which cover behavioral issues, procedures training, and other topics. The success of these three programs suggests that extended educational sessions are a viable alternative to the traditional one-hour format.

Effects of training in patient education on attitudes and behaviors of family practice residents.

The attitudes of 24 family practice residents toward patient education and perceptions of their own efficacy as patient educators were measured before and after they underwent a special patient education training program. Their scores were compared to those of 34 family practice residents who did not have access to the program. Study group residents showed positive changes in attitudes, reported behaviors, and problems, while the comparison group showed no changes in any of the categories. The differences were statistically significant for the behaviors and problems but not for the attitudes data.

Tuberous sclerosis in early infancy: a case report.

The diagnosis of tuberous sclerosis in an infant was delayed by 3 months. Failure to take an adequate patient history because of a language barrier between parents and caregivers and to observe the classic stigmata of tuberous sclerosis contributed to the delay. A brief review of the case and the diagnosis of tuberous sclerosis is presented.

The physician as a patient educator. From theory to practice.

Patient nonadherence to therapeutic regimens is a serious issue in the practice of medicine. Empiric studies done by professionals from diverse backgrounds have shown that physicians who use educational strategies can be effective in gaining the cooperation of patients to follow their recommendations. The educational model that currently is most familiar to physicians and the one they use most frequently when educating patients is pedagogy, the theoretic basis for teaching children. Andragogy, a theoretic basis for teaching adults, is now being suggested by medical educators as an alternative model. To illustrate the clinical relevance and application of the andragogic approach, studies focusing on physician behaviors associated with behavioral measures of adherence were reviewed, analyzed, and categorized according to a framework called the "ADULT" model. Physicians in a postgraduate training program who have had exposure to this framework and have incorporated it into their practices report less difficulty functioning as patient educators. The systematic use of this approach can have a positive effect on patient adherence.

The future of family practice training in California.

Although the number of physicians in California has doubled since 1963, the number of family and general practice physicians has declined. The ratio of office-based primary care physicians to population has also decreased. Graduate medical education is funded largely from patient care revenues, but the low rate of reimbursement for ambulatory care makes training in primary care specialties especially dependent on public support. Medicare, the Veterans Administration, and the University of California provide more than $325 million a year in support of graduate medical education in California. Federal and state grant programs provide $5 million a year for family physician training in the state, but appropriations to these programs have been reduced in real terms. California family practice residencies are disproportionately located at county hospitals, where funding shortfalls make them especially vulnerable to cuts in grant programs. Additional resources will be needed if more family physicians are to be trained.