Patterns of relating between physicians and medical assistants in small family medicine offices.

PURPOSE: The clinician-colleague relationship is a cornerstone of relationship-centered care (RCC); in small family medicine offices, the clinician-medical assistant (MA) relationship is especially important. We sought to better understand the relationship between MA roles and the clinician-MA relationship within the RCC framework. METHODS: We conducted an ethnographic study of 5 small family medicine offices (having <5 clinicians) in the Cincinnati Area Research and Improvement Group (CARInG) Network using interviews, surveys, and observations. We interviewed 19 MAs and supervisors and 11 clinicians (9 family physicians and 2 nurse practitioners) and observed 15 MAs in practice. Qualitative analysis used the editing style. RESULTS: MAs' roles in small family medicine offices were determined by MA career motivations and clinician-MA relationships. MA career motivations comprised interest in health care, easy training/workload, and customer service orientation. Clinician-MA relationships were influenced by how MAs and clinicians respond to their perceptions of MA clinical competence (illustrated predominantly by comparing MAs with nurses) and organizational structure. We propose a model, trust and verify, to describe the structure of the clinician-MA relationship. This model is informed by clinicians' roles in hiring and managing MAs and the social familiarity of MAs and clinicians. Within the RCC framework, these findings can be seen as previously undefined constraints and freedoms in what is known as the Complex Responsive Process of Relating between clinicians and MAs. CONCLUSIONS: Improved understanding of clinician-MA relationships will allow a better appreciation of how clinicians and MAs function in family medicine teams. Our findings may assist small offices undergoing practice transformation and guide future research to improve the education, training, and use of MAs in the family medicine setting.

Women's understanding of different dosing instructions for a liquid pediatric medication.

INTRODUCTION: Dosing errors by caregivers are common and often are directly attributed to poorly designed instructions. The purpose of this study was to assess whether instruction wording--that is, implicit versus explicit dosage intervals--was associated with participants' ability to describe and correctly measure a dose of a commonly prescribed liquid pediatric prescription medication. METHODS: English-speaking women (N = 193) of child-bearing age were recruited to participate in this study from an outpatient residency clinic in the southeastern United States. Based on a priori randomization, each participant was presented with one of two medication bottles that were identical except for the instructions: (1) "shake liquid well and give (child's name) 6 ML by mouth every 12 hours" ("implicit" dosage interval)," or (2) "shake liquid well and give (child's name) 6 ML by mouth at 7 AM and 7 PM" ("explicit" dosage interval). Participants completed a structured interview to assess sociodemographic characteristics, health literacy skills, ability to describe and demonstrate the dosage of the liquid medication, and preferences for label format. RESULTS: Seventy-two participants (37.3%) were able to correctly describe how they would give the medicine to a child during a 24-hour period, while 145 women (75.1%) were able to correctly demonstrate how they would give one dose of the medication. Approximately one third of participants (32.1%) were able to correctly describe and measure a dose of the medication. Slightly more than half of participants (n = 103, 53.4%) indicated that they would prefer instructions with "explicit" dosage intervals. DISCUSSION: This study suggests that few people can accurately describe how liquid medications are to be administered, while more people can demonstrate the correct dose to be administered.

Building the research culture of family medicine with fellowship training.

BACKGROUND AND OBJECTIVES: The future of family medicine is closely tied to the strength of family medicine research. Physicians with fellowship training have been shown to be more productive researchers than those without fellowship training. This study's objectives are to (1) identify fellowship programs available to family physicians, (2) explore how family medicine fellows are taught research skills, and (3) identify obstacles to enhancing research training in fellowships. METHODS: Fellowship programs available to family physicians were identified by Internet searches and confirmed by telephone or e-mail. Directors of identified fellowships received a 33-item survey exploring research training provided by their program. Descriptive statistics were used to evaluate the quantitative data. Survey comments were analyzed qualitatively to identify themes. RESULTS: We confirmed that 247 of 328 identified research fellowships are available to family physicians. Survey response rate from those 247 fellowships was 65%. Fellowships with and without a research focus are providing research training. They are threatened, however, by weak research infrastructure, inadequate funding, and attitudinal biases against family medicine research. CONCLUSIONS: There are many fellowship and research training opportunities for family physicians. But in many programs, research training is tenuous, and support for researchers is low. We recommend expanding research advocacy efforts within family medicine, Congress, and funding institutions.