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Sample records for academic family physicians

  1. Resource-based relative value units: a primer for academic family physicians.

    PubMed

    Johnson, Sarah E; Newton, Warren P

    2002-03-01

    The Resource-based Relative Value Scale (RBRVS) is the prevailing model used to reimburse physician services today. Based on empirical research, relative value units (RVUs) quantify the relative work, practice expense, and malpractice costs for specific physician services to appropriately establish payment. The fee schedule, implemented by the Health Care Financing Administration in 1992, dramatically affected physician reimbursement, with the goal of correcting disparities across disciplines. In the first 6 years, Medicare payments to family physicians increased by 36%, while payments to specialists decreased by as much as 18%. Recent changes include new practice expense estimates and adjustment of payment based on facility type. The impact of RVUs is even more widespread as many private payers use the fee schedule to set payment rates and as RVUs become the yardstick for physician productivity measures. Despite the initial successes, the ability of RVUs to capture the work done by primary care providers is still limited. Primary care services today are not as easily quantified as surgical procedures, and coding limitations hinder documentation of services. Rapid changes in health care make comparisons to work done 2 decades ago difficult. Understanding the strengths and limitations of RVUs as they apply to family physicians is fundamental to safeguarding the role of primary care.

  2. Family Violence and Family Physicians

    PubMed Central

    Herbert, Carol P.

    1991-01-01

    The acronym IDEALS summarizes family physicians' obligations when violence is suspected: to identify family violence; document injuries; educate families and ensure safety for victims; access resources and coordinate care; co-operate in the legal process; and provide support for families. Failure to respond reflects personal and professional experience and attitudes, fear of legal involvement, and lack of knowledge. Risks of intervention include physician burnout, physician overfunctioning, escalation of violence, and family disruption. PMID:21228987

  3. Family physician clinical compensation in an academic environment: moving away from the relative value unit

    PubMed Central

    Lochner, Jennifer; Trowbridge, Elizabeth; Kamnetz, Sandra; Pandhi, Nancy

    2016-01-01

    Background and Objectives Primary care physician compensation structures have remained largely volume-based, lagging behind changes in reimbursement that increasingly include population approaches such as capitation, bundled payments, and care management fees. We describe a population health-based physician compensation plan developed for two departmental family medicine faculty groups (residency teaching clinic faculty and community clinic faculty) along with outcomes before and after the plan’s implementation. Methods An observational study was conducted. A pre-post email survey assessed satisfaction with the plan, salary, and salary equity. Physician retention, panel size, and relative value unit (RVU) productivity metrics also were assessed before and after the plan’s implementation. Results Before implementation of the new plan, 18% of residency faculty and 33% of community faculty were satisfied or very satisfied with compensation structure. After implementation, those numbers rose to 47% for residency physicians and 74% for community physicians (p<0.01). Satisfaction with the amount of compensation also rose from 33% to 68% for residency faculty and from 26% to 87% for community faculty (p<0.01). For both groups, panel size per clinical full-time equivalent increased and RVUs moved closer to national benchmarks. RVUs decreased for residency faculty and increased for community faculty. Conclusions Aligning a compensation plan with population health delivery by moving rewards away from RVU productivity and towards panel management resulted in improved physician satisfaction and retention, as well as larger panel sizes. RVU changes were less predictable. Physician compensation is an important component of care model redesign that emphasizes population health. PMID:27272423

  4. Family Physicians and Exercise Counseling

    PubMed Central

    Wilson, Douglas M.C.; Ciliska, Donna; Singer, Joel; Williams, Kimberly; Alleyne, Julia; Lindsay, Elizabeth

    1992-01-01

    This trial took 22 volunteer family physicians and randomly exposed some to training intervention and some to no training to study the effect on frequency and quality of exercise prescription to ambulatory adults. During the 6 weeks after training, the trained physicians addressed the issue of exercise with 35.3% of patients. The untrained physicians discussed exercise with only 8.6% of their patients. PMID:21221270

  5. Senior academic physicians and retirement considerations.

    PubMed

    Moss, Arthur J; Greenberg, Henry; Dwyer, Edward M; Klein, Helmut; Ryan, Daniel; Francis, Charles; Marcus, Frank; Eberly, Shirley; Benhorin, Jesaia; Bodenheimer, Monty; Brown, Mary; Case, Robert; Gillespie, John; Goldstein, Robert; Haigney, Mark; Krone, Ronald; Lichstein, Edgar; Locati, Emanuela; Oakes, David; Thomsen, Poul Erik Bloch; Zareba, Wojciech

    2013-01-01

    An increasing number of academic senior physicians are approaching their potential retirement in good health with accumulated clinical and research experience that can be a valuable asset to an academic institution. Considering the need to let the next generation ascend to leadership roles, when and how should a medical career be brought to a close? We explore the roles for academic medical faculty as they move into their senior years and approach various retirement options. The individual and institutional considerations require a frank dialogue among the interested parties to optimize the benefits while minimizing the risks for both. In the United States there is no fixed age for retirement as there is in Europe, but European physicians are initiating changes. What is certain is that careful planning, innovative thinking, and the incorporation of new patterns of medical practice are all part of this complex transition and timing of senior academic physicians into retirement.

  6. Academic family health teams

    PubMed Central

    Carroll, June C.; Talbot, Yves; Permaul, Joanne; Tobin, Anastasia; Moineddin, Rahim; Blaine, Sean; Bloom, Jeff; Butt, Debra; Kay, Kelly; Telner, Deanna

    2016-01-01

    Abstract Objective To explore patients’ perceptions of primary care (PC) in the early development of academic family health teams (aFHTs)—interprofessional PC teams delivering care where family medicine and other health professional learners are trained—focusing on patients’ perceptions of access and patients’ satisfaction with services. Design Self-administered survey. Setting Six aFHTs in Ontario. Participants Adult patients attending appointments and administrators at each of the aFHTs. Main outcome measures Answers to questions about access from the Primary Care Assessment Tool Adult Expanded Version, the Primary Care Assessment Survey, and research team questions. Results The response rate was 47.3% (1026 of 2167). The mean (SD) Primary Care Assessment Tool first-contact accessibility score was 2.28 (0.36) out of 4, with 96.5% of patients rating access less than 3, which was the minimum expected level of care. Two-thirds (66.6%) indicated someone from their aFHTs would definitely or probably see them the same day if they were sick, 56.8% could definitely or probably get advice quickly by telephone, and 14.5% indicated it was definitely or probably difficult to be seen by their primary health care provider (HCP). Additionally, 46.9% indicated they would like to get medical advice by e-mail. For a routine or follow-up visit, 73.4% would be willing to see another aFHT physician if their regular provider were unavailable, while only 48.3% would see a nonphysician HCP. If sick, 88.2% would see another aFHT physician and 55.2% would see a nonphysician HCP. Most (75.3%) were satisfied with access to their regular HCP. Conclusion Although patients are generally satisfied with care, there is room for improvement in access. Strategies are needed to enhance access to care, including addressing appropriate roles and scopes of practice for nonphysician HCPs. The accessibility challenges for aFHTs will likely affect new family physicians and other HCPs training in

  7. Developing physician leaders in academic medical centers.

    PubMed

    Bachrach, D J

    1997-01-01

    While physicians have historically held positions of leadership in academic medical centers, there is an increasing trend that physicians will not only guide the clinical, curriculum and scientific direction of the institution, but its business direction as well. Physicians are assuming a greater role in business decision making and are found at the negotiating table with leaders from business, insurance and other integrated health care delivery systems. Physicians who lead "strategic business units" within the academic medical center are expected to acquire and demonstrate enhanced business acumen. There is an increasing demand for formal and informal training programs for physicians in academic medical centers in order to better prepare them for their evolving roles and responsibilities. These may include the pursuit of a second degree in business or health care management; intramurally conducted courses in leadership skill development, management, business and finance; or involvement in extramurally prepared and delivered training programs specifically geared toward physicians as conducted at major universities, often in their schools of business or public health. While part one of this series, which appeared in Volume 43, No. 6 of Medical Group Management Journal addressed, "The changing role of physician leaders at academic medical centers," part 2 will examine as a case study the faculty leadership development program at the University of Texas M.D. Anderson Cancer Center. These two articles were prepared by the author from his research into, and the presentation of a thesis entitled. "The importance of leadership training and development for physicians in academic medical centers in an increasingly complex health care environment," prepared for the Credentials Committee of the American College of Healthcare Executives in partial fulfillment of the requirements for Fellowship in this College.*

  8. Professional Bankruptcy for the Academic Physician

    PubMed Central

    Thornburg, Loralei L.; Glantz, J. Christopher; Caprio, Thomas V.; Gillespie, Suzanne M.

    2010-01-01

    In modern academic medicine, the amount of academic time is decreasing as the workload and commitments are increasing. As physicians take on so many professional obligations that there is no way to meet all of the demands of the ever-expanding responsibilities, the question becomes: Should academic physicians ever consider filing for their own “professional bankruptcy”? Presented here are 10 steps to successful academic bankruptcy for the overextended junior faculty. Although somewhat fanciful, this method allows faculty to take an honest and critical assessment of their personal and professional goals and to align their career with these goals. With a critical eye to the future, this alignment will allow faculty to decrease their workload while maintaining productivity. PMID:21976103

  9. Colonoscopy: Perspectives for Family Physicians

    PubMed Central

    Cameron, R. D. A.

    1983-01-01

    Fiber-optic endoscopy is an important investigation of the lower gastrointestinal tract, whether or not the radiologist has discovered a lesion. Colonoscopy affords a unique opportunity to visualize the entire colonic mucosa. At the same time, the physician can obtain biopsy specimens, remove polyps, and decompress volvuli. Most experienced endoscopists can reach the cecum in over 90% of patients. If colonoscopy is properly performed, it has a low risk of complications, such as perforation and bleeding. The few absolute contraindications include serious illnesses such as acute myocardial infarction and severe acute inflammatory bowel diseases. Family physicians referring patients for investigations of lower gastrointestinal problems should explain that colonoscopy is an adjunct to, not a replacement for, a barium enema examination. If possible they should find out what preparation the patient will require. PMID:21283399

  10. The availability of fellowship training for foreign family physicians.

    PubMed

    Cohen, M D; Merenstein, J H

    1990-05-01

    The authors surveyed the 49 U.S. fellowship programs in family medicine listed in the 1988 Fellowship Directory published by the Society of Teachers of Family Medicine. The past experience and future intentions of the 47 responding programs toward non-immigrant foreign family physicians coming to the United States to undergo fellowship training in academic family practice were studied. Only a minority of the programs (22%) had ever trained a foreign fellow, and of these only five of 11 were definitely able to do so in the future. Over half (52%) of the programs that had never trained a foreign fellow stated that they were not prepared to train a foreign physician. Although foreign family physicians are encouraged by the American Academy of Family Practice to come to the United States for fellowships, this study shows that it is extremely difficult for these physicians to find programs willing to act as host.

  11. PCBs and the Family Physician

    PubMed Central

    Cappon, I.D.

    1986-01-01

    Pcbs are widespread environmental contaminants present in virtually every mammal on earth. Great controversy and debate has been evoked over the past two decades concerning their potential toxicity. They, along with other organochlorine compounds such as DDT, have been reasonably well studied in field and experimental situations. In general, PCBs are not very toxic, especially in concentrations to which most people are exposed, even those who work in the industrial setting or who eat contaminated fish. In terms of environmental hazards to health, PCBs should be considered as relatively low on the list. The public cannot depend on media information as a source of objective knowledge on controversial compounds like PCBs. The family physician should be able to provide to concerned individuals objective information on the definition, sources and relative toxicity of PCBs. PMID:21267326

  12. Rural Idaho Family Physicians' Scope of Practice

    ERIC Educational Resources Information Center

    Baker, Ed; Schmitz, David; Epperly, Ted; Nukui, Ayaka; Miller, Carissa Moffat

    2010-01-01

    Context: Scope of practice is an important factor in both training and recruiting rural family physicians. Purpose: To assess rural Idaho family physicians' scope of practice and to examine variations in scope of practice across variables such as gender, age and employment status. Methods: A survey instrument was developed based on a literature…

  13. Selection of the Family Physician

    PubMed Central

    Christ, L. W. A. C.; Harris, A. L.; Korchinski, E. D.

    1976-01-01

    This study was conducted to examine the characteristics of ‘initial visits’ by patients, contrasted with ‘average visits’, to discover what is needed to establish a satisfactory patient-physician relationship leading to long term continuous care. In the initial visit, the patient presents with a relatively simple problem which will enable the physician to demonstrate his ability without unduly taxing his skills. This suggests that patients create an opportunity for a thorough face-to-face contact to provide an opportunity for the physician to display his ability so that the patient's desire for a long term relationship can be achieved. The study also suggests that patients' expectations have changed in proportion to changes in the mode of medical practice. PMID:21308071

  14. The Army Wants More Family Physicians.

    DTIC Science & Technology

    1988-03-23

    initiatives required physicians with greater capabilities than those of the current General Medical Officers ( GMOs ). The Family Physician fit the new...and hence AMEDD active duty andstrength by 285, and it would convert a majority of Army GMO authorizations to Family Practice4 (see appendix 1). This...obligation as a GMO . Almost all GMO requirements are in Primary Care, where a broad-based Knowledge is essential. Therefore, when a Categorical Intern

  15. Family Physician Perspectives on Primary Immunodeficiency Diseases

    PubMed Central

    Orange, Jordan S.; Seeborg, Filiz O.; Boyle, Marcia; Scalchunes, Christopher; Hernandez-Trujillo, Vivian

    2016-01-01

    Primary immunodeficiency diseases (PIDs) include over 250 diverse disorders. The current study assessed management of PID by family practice physicians. The American Academy of Allergy, Asthma, and Immunology Primary Immunodeficiency Committee and the Immune Deficiency Foundation conducted an incentivized mail survey of family practice physician members of the American Medical Association and the American Osteopathic Association in direct patient care. Responses were compared with subspecialist immunologist responses from a similar survey. Surveys were returned by 528 (of 4500 surveys mailed) family practice physicians, of whom 44% reported following ≥1 patient with PID. Selective immunoglobulin A deficiency (21%) and chronic granulomatous disease (11%) were most common and were followed by significantly more subspecialist immunologists (P < 0.05). Use of intravenously administered immunoglobulin and live viral vaccinations across PID was significantly different (P < 0.05). Few family practice physicians were aware of professional guidelines for diagnosis and management of PID (4 vs. 79% of subspecialist immunologists, P < 0.05). Family practice physicians will likely encounter patients with PID diagnoses during their career. Differences in how family practice physicians and subspecialist immunologists manage patients with PID underscore areas where improved educational and training initiatives may benefit patient care. PMID:27066486

  16. Physician Impairment: Is It Relevant to Academic Psychiatry?

    ERIC Educational Resources Information Center

    Myers, Michael F.

    2008-01-01

    Objective: This article examines the relevance of physician impairment to the discipline of academic psychiatry. Method: The author reviews the scientific literature, the proceedings of previous International Conferences on Physician Health, and held discussions with experts in the physician health movement, department chairs, program directors,…

  17. Female Physicians and the Work-Family Conflict.

    PubMed

    Treister-Goltzman, Yulia; Peleg, Roni

    2016-05-01

    There has been a dramatic increase in the number of female physicians in all fields and specializations of medicine, but this increase has not resulted in a redistribution of domestic tasks and responsibilities. Reviewing the literature of the last two decades (April 1994 to April 2014) on how female physicians cope with the challenge of balancing their family and professional lives for the duration of their professional careers revealed that they suffer from the work-family conflict more than other professionals and that it has a more negative effect on women than on men. Women physicians consider work-family balance significantly when making career choices. These considerations affect their career success, their productivity as faculty members, their marital life, and parenthood. Having a supportive spouse at home and a facilitating mentor at work are important for a positive work-family balance among female physicians. Special career-supporting measures, such as flexible work schedules and expanded support for childcare over the course of work and when taking part in academic activities, are critical for female physicians.

  18. Mental health activities of family physicians.

    PubMed

    Cassata, D M; Kirkman-Liff, B L

    1981-04-01

    A questionnaire survey of residency trained graduates and nonresidency trained family physicians showed both groups reporting relatively infrequent practice of behavioral medicine. Referrals and counseling sessions/visits produce a combined total of 20 activities per month, or two to four percent of all patient encounters, even though the physicians in the sample reported that 33 percent of their diagnoses were behavioral/psychological. More than 85 percent of the physicians reported access to more than one mental health provider. The six most common health problems encountered in the office were depression, anxiety, obesity, marital discord, alcohol abuse, and sexual problems. Physicians responding to this survey expressed an interest in continuing education programs that emphasize individual, marital, and parenting counseling, and psychopharmacology. There is a major need to improve the mental health component of residency training, which will enable physicians to better manage psychosocial problems in practice settings.

  19. Collaboration between family physicians and nurse clinicians

    PubMed Central

    Maheux, Brigitte; Côté, Luc; Sobanjo, Omobola; Authier, Louise; Lajeunesse, Julie; Leclerc, Mylène; Lefort, Louise

    2014-01-01

    Abstract Objective To determine whether graduating family physicians are exposed to collaboration between family physicians and nurse clinicians during their training, as well as their opinions about shared care between doctors and nurse clinicians in the delivery of patient care. Design Anonymous online survey. Setting Two French-Canadian university family medicine residency programs. Participants The 2010 and 2011 graduating family physicians (N = 343) from the University of Montreal and Laval University in Quebec. Main outcome measures The extent to which nurse clinicians in graduating family physicians’ training milieu were involved in preventive and curative patient care activities, and graduates’ opinions about nurse clinicians sharing care with physicians. Results Of 343 graduates, 186 (54.2%) participated in the survey. Although as residents in family medicine their exposure to shared care with nurse clinicians was somewhat limited, respondents indicated that they were generally quite open to the idea of sharing care with nurse clinicians. More than 70% of respondents agreed or strongly agreed that nurse clinicians could adjust, according to protocols of clinical guidelines, the treatment of patients with diabetes, hypertension, and asthma, as well as regulate medication for pain control in terminally ill patients. By contrast, respondents were less favourable to nurse clinicians adjusting the treatment of patients with depression. More than 80% of respondents agreed or strongly agreed that nurse clinicians could initiate treatment via a medical directive for routine hormonal contraception, acne, uncomplicated cystitis, and sexually transmitted infections. Respondents’ opinions on nurse clinicians initiating treatment for pharyngitis and otitis were more divided. Conclusion Graduating family physicians are quite open to collaborating with nurse clinicians. Although they have observed some collaboration between physicians and nurses, there are areas of

  20. The Family Physician's Role During Disasters

    PubMed Central

    Crosby, John

    1986-01-01

    Family physicians can encourage disaster planning and mock disaster exercises in their community. If involved in an actual disaster, the family physician can be helpful as a triage officer in emergency, in initial resuscitation, in minor treatment, in discharging stable patients, and in counselling victims of post-traumatic shock syndrome. The key to effective performance is being prepared beforehand to cope with the stress and confusion of the incident. Use of laboratory and diagnostic imaging must be curtailed until all severely injured patients are treated. ImagesFig. 1Fig. 2Fig. 3Fig. 4 PMID:21267128

  1. Keeping family physicians in rural practice. Solutions favoured by rural physicians and family medicine residents.

    PubMed Central

    Rourke, James T. B.; Incitti, Filomena; Rourke, Leslie L.; Kennard, MaryAnn

    2003-01-01

    OBJECTIVE: To determine how family medicine residents and practising rural physicians rate possible solutions for recruiting and sustaining physicians in rural practice. DESIGN: Cross-sectional mailed survey. SETTING: Rural family practices and family medicine residency programs in Ontario. PARTICIPANTS: Two hundred seventy-six physicians and 210 residents. MAIN OUTCOME MEASURES Ratings of proposed solutions on a 4-point scale from "very unimportant" to "very important". RESULTS: Rural family physicians rated funding for learner-driven continuing medical education (CME) and limiting on-call duty to 1 night in 5 as the most important education and practice solutions, respectively. Residents rated an alternate payment plan to include time off for attending and teaching CME and comprehensive payment plans with a guaranteed income for locums as the most important education and practice solutions, respectively. CONCLUSION: Residents and physicians rated solutions very similarly. A comprehensive package of the highest-rated solutions could help recruit and sustain physicians in rural practice because the solutions were developed by experts on rural practice and rated by family medicine residents and practising rural physicians. PMID:14526866

  2. The changing academic health center. The death of the traditional academic physician.

    PubMed

    Fargason, C A; Fargason, R E

    1996-08-01

    Organizational change is required if academic health centers (AHCs) are to survive the decreased societal commitment to them. The changes will generate significant emotional responses in the physicians employed by such institutions. This article presents an analogy between the reactions of academic physicians to the changes they are experiencing, and the stages of grief that Dr. Kübler Ross described in terminally ill patients. By placing physician responses in this context, emotional responses to organizational changes can be more easily understood and managed, allowing academic physicians to devote more energy to facing the threats to AHCs in an innovative and constructive manner.

  3. High altitude medicine for family physicians.

    PubMed Central

    McMurray, S. J.

    1994-01-01

    High altitude medicine deals with a continuum of diseases ranging from a mild discomfort to serious ailments affecting all organ systems, including the lungs, brain, and eyes. Decreased oxygen tension is the primary cause. The main principles of prevention are staging and graded ascent to allow acclimatization. Adventure travel to high altitude destinations is becoming increasingly popular; family physicians should be informed of the medical problems associated with such travel. Images p712-a p715-a p716-a PMID:8199523

  4. A Family Physician's Guide to Sewage Sludge

    PubMed Central

    Connop, Peter J.

    1983-01-01

    The potential environmental and personal health effects from the agricultural uses of domestic sewage sludge may increasingly require the guidance of the family physician, especially in farming communities. This article summarizes the potential health hazards and outlines the tripartite risk phenomenon—hazard identification, risk assessment, and social evaluation. For the agricultural use of dewatered sewage sludge, strict adherence to regulated procedures should not increase risk beyond that of agriculture generally. Confirmation by prospective epidemiological studies is recommended. PMID:21283298

  5. Stress factors affecting academic physicians at a university hospital.

    PubMed

    Lindfors, Sara; Eintrei, Christina; Alexanderson, Kristina

    2009-01-01

    Research is limited regarding occupational stress in academic physicians; professionals whose work situation includes the three areas of clinical practice, research, and teaching. The aim of this study was to gain knowledge of factors experienced as stressful by academic physicians employed by a university hospital. A questionnaire assessing the frequency and intensity of 36 potentially stressful factors was sent to all 157 academic physicians who were employed at the Linköping University Hospital, Sweden. The response rate was 77%. Both a high frequency and intensity of stress was experienced by 66% of the academic physicians in relation to "time pressure" and by almost 50% in connection with both "find time for research" and having "conflict of interest between different work assignments". Moreover, physicians in the higher age group and those who had attained a higher academic position experienced less stress. The female participants experienced more stress than the males due to gender-related problems and to variables associated with relationships at work. More knowledge is needed to determine the consequences of this finding and to identify coping strategies used for handling such stress.

  6. Family physicians' approach to psychotherapy and counseling. Perceptions and practices.

    PubMed Central

    Swanson, J. G.

    1994-01-01

    To determine how family physicians perceive the support they get for psychotherapy and counseling, we surveyed a random sample of Ontario College of Family Physicians members. Of 100 physicians who had family medicine residency training with psychotherapy experience, 43% indicated that such training was inadequate for their current needs. Because family physicians often provide psychotherapy and counseling, their training should reflect the needs found in practice. PMID:8080505

  7. Burnout among faculty physicians in an academic health science centre

    PubMed Central

    Wright, James Gardner; Khetani, Nicole; Stephens, Derek

    2011-01-01

    BACKGROUND: Burnout experienced by physicians is concerning because it may affect quality of care. OBJECTIVE: To determine the frequency of burnout among physicians at an academic health science centre and to test the hypothesis that work hours are related to burnout. METHODS: All 300 staff physicians, contacted through their personal e-mail, were provided an encrypted link to an anonymous questionnaire. The primary outcome measure, the Copenhagen Burnout Inventory, has three subscales: personal, work related and patient related. RESULTS: The response rate for the questionnaire was 70%. Quantitative demands, insecurity at work and job satisfaction affected all three components of burnout. Of 210 staff physicians, 22% (n=46) had scores indicating personal burnout, 14% (n=30) had scores indicating work-related burnout and 8% (n=16) had scores indicating patient-related burnout. The correlation between total hours worked and total burnout was only 0.10 (P=0.14) DISCUSSION: Up to 22% of academic paediatric physicians had scores consistent with mild to severe burnout. A simple reduction in work hours is unlikely to be successful in reducing burnout and, therefore, quantitative demands, job satisfaction and work insecurity may require attention to address burnout among academic physicians. PMID:22851895

  8. Comparison of prescribing indicators of academic versus non-academic specialist physicians in Urmia, Iran

    PubMed Central

    Sadigh-Rad, Laya; Majdi, Leila; Javaezi, Mehrnush; Delirrad, Mohammad

    2015-01-01

    Objective: As chief prescribers, physicians could have a key role in rational drug use. Core prescribing indicators of all physicians have been evaluated in the Islamic Republic of Iran for several years, but no study has assessed the effects of academic status of doctors on their prescribing behaviors. We aimed to compare prescribing indicators of two groups of academic and non-academic specialist physicians working in Urmia, Iran. Methods: In this cross-sectional study, prescribing indicators of the total number of 37 academic and 104 non-academic specialist physicians in six medical specialties (infectious diseases, psychiatry, otorhinolaryngology, gynecology, pediatrics and general surgery) were studied during 2012 using Rx-analyzer, a dedicated computer application. A set of five quality indicators was used based on the World Health Organization and International Network for Rational Use of Drugs recommendations. Findings: Totally, 709,771 medications in 269,660 prescriptions were studied. For academic and non-academic specialist physicians, the average number of medications per prescription was 2.26 and 2.65, respectively. Similarly, patients’ encounters with injectable pharmaceuticals were 17.37% and 26.76%, respectively. The corresponding figures for antimicrobial agents were 33.12% and 45.46%, respectively. The average costs of every prescription were 6.53 and 3.30 United States Dollar for academic and non-academic specialist physicians, respectively. All the above-mentioned differences were statistically significant. Conclusion: Better prescribing patterns were observed in academic specialist physicians. However, they prescribed medications that were more expensive, while the reason was not investigated in this study. Further studies may reveal the exact causes of these differences. PMID:25984540

  9. Solving Problems: How Does the Family Physician Do It?

    PubMed Central

    Feightner, J. W.; Barrows, H. S.; Neufeld, V. R.; Norman, G. R.

    1977-01-01

    Objective evidence exists for a model of clinical problem solving by family physicians. Previous studies have examined the activities of family physicians, but there have been no data indicating the mental process behind these activities. This study, exploring the thought processes of family physicians engaged in clinical problem solving, has lead to the model described in this paper. Its educational and clinical implications are considered. PMID:21304873

  10. Alternative medicine and the family physician.

    PubMed

    Gordon, J S

    1996-11-15

    The seven categories of alternative medicine, as established by the National Institutes of Health Office of Alternative Medicine, are mind-body interventions, bioelectromagnetic therapies, alternative systems of medical practice, manual healing methods, pharmacologic and biologic treatments, herbal medicine, and diet and nutrition. Mind-body approaches have been shown to be effective in a variety of conditions. Acupuncture and homeopathy are alternative systems of medical practice that may be beneficial. Chiropractic manipulation for low back pain and infant message for enhancing growth are two methods of manual healing. While the literature on herbal medicine is vast, most of it focuses on a single approach for a specific condition. Traditional herbalists use a combination of herbs individualized for the specific person. As more and more people turn to alternative therapies, it is important for family physicians to be open to their patients' interest in alternative approaches.

  11. Family Physicians and Teaching Hospitals: A Litany of Woes

    PubMed Central

    Hansen, Niels H.

    1984-01-01

    Retreat of family physicians from caring for their patients in teaching hospitals has been partly imposed and partly passively accepted. Confusion of patient, family doctor and consultant relationships has resulted. Town/gown and family physician/specialist communication problems disrupt a proper model of care. Family physicians need to take individual and group action to initiate change, but little action has been evident. Everyone is the loser. We should reinstitute a model in which family physicians are the closest professionals to their patients, wherever they are in the health care system. Demonstrating the value of family physician coordination of care and continuity of care will positively affect the current financial `loss leader' status of this work. PMID:21279057

  12. Autism: A review for family physicians.

    PubMed

    Karande, Sunil

    2006-05-01

    Autism is a complex neurodevelopmental disorder characterized by qualitative impairments in social interaction and communication, with restricted, repetitive, stereotyped patterns of behavior, interests and activities. These behaviors manifest along a wide spectrum and commence before 36 months of age. Diagnosis of autism is made by ascertaining whether the child's specific behaviors meet the Diagnostic and Statistical Manual of Mental Disorders-IV-Revised criteria. Its etiology is still unclear but recent studies suggest that genetics plays a major role in conferring susceptibility. Recent neuroimaging research studies indicate that autism may be caused by atypical functioning in the central nervous system, particularly in the limbic system: amygdala and hippocampus. In a third of autistic children, loss of language and/or social skills occurs during the second year of life, usually between 15 and 21 months of age. Comorbidity with mental retardation, epilepsy, disruptive behaviors and learning difficulty is not uncommon. Although there is currently no known cure for autism there is evidence to suggest that early intervention therapy can improve functioning of autistic children. Judicious use of psychotropic drugs is necessary to manage associated aggression, hyperactivity, self-mutilation, temper tantrums; but drugs are not a substitute for behavioral and educational interventions. The family physician can play an important role in detecting autism early, coordinating its assessment and treatment, counseling the parents and classroom teacher, and monitoring the child's progress on a long term basis.

  13. Immigration, ethnicity, and accessibility to culturally diverse family physicians.

    PubMed

    Wang, Lu

    2007-09-01

    The study concerns ethnicity, spatial equity, and healthcare access in the context of diversity and integration. The paper first explores how Chinese immigrants in the Toronto Census Metropolitan Area choose between ethnic Chinese family physicians and other family physicians, based on a probability survey. It then applies and modifies gravity-type accessibility measures, of which a special type is the so-called floating catchment area (FCA) method, to evaluate three types of geographical accessibility in family physician utilization. The study suggests a certain degree of spatial inequality among Chinese immigrants in accessing culturally sensitive care. The paper yields important methodological and policy implications.

  14. Cancer Risk Assessment by Rural and Appalachian Family Medicine Physicians

    ERIC Educational Resources Information Center

    Kelly, Kimberly M.; Love, Margaret M.; Pearce, Kevin A.; Porter, Kyle; Barron, Mary A.; Andrykowski, Michael

    2009-01-01

    Context: Challenges to the identification of hereditary cancer in primary care may be more pronounced in rural Appalachia, a medically underserved region. Purpose: To examine primary care physicians' identification of hereditary cancers. Methods: A cross-sectional survey was mailed to family physicians in the midwestern and southeastern United…

  15. What do Victoria family physicians think about housecalls?

    PubMed Central

    Hammett, Tess

    2013-01-01

    Objective To determine the proportion of family physicians doing housecalls, the types of patients they think are appropriate to visit at home, whether physicians are satisfied with the number of housecalls they make, reasons family physicians list for not doing housecalls, and what they consider acceptable remuneration and travel time for housecalls. Design A 12-question paper survey was formulated specifically for this study and piloted by 6 family physicians in British Columbia. It was then mailed with a cover letter to 250 physicians' offices and faxed back anonymously. Setting Family physicians' private offices in Victoria, BC, between December 1 and 19, 2010. Participants A total of 250 randomly selected family physicians from a list of 552 physicians practising in Victoria on the College of Physicians and Surgeons of British Columbia website. Main outcome measures Proportion of physicians doing housecalls, reasons stated for not doing housecalls, and mean acceptable remuneration and travel time for a housecall. Results A total of 73 surveys (29.2%) were returned, 5 of which were not fully completed but were included for the questions that were answered. Sixty-four physicians (87.7%) did at least 1 housecall in the past year, 23 (31.5%) did housecalls at least once a month, and 12 (16.4%) did them at least once a week. Of 71 respondents, 64 physicians (90.1%) listed lack of time as a barrier to performing housecalls, 37 (52.1%) listed unsatisfactory remuneration, and 35 (49.3%) listed lengthy travel times. Most physicians indicated that appropriate remuneration for a housecall was either $142.21 (n = 30, 42.9%) or $108.41 (n = 26, 37.1%). Thirty-seven physicians (52.9%) noted that 20 minutes was an acceptable maximum 1-way travel time for a housecall, while 29 (41.4%) listed 10 minutes. Conclusion Several systemic factors, including lack of time, unsatisfactory remuneration, and large geographic catchment areas, make it difficult for urban family physicians

  16. The academic occupational physician as consultant. A 10-year perspective.

    PubMed

    McCunney, R J

    1994-04-01

    The academic community has long served the private sector in a consultant capacity in engineering and in the sciences. With respect to occupational medicine, physicians, when working for industry, have generally practiced in a health care setting. Within the past 10 years, however, the business sector has placed more attention on the health implications of its operations as a result of regulations, liability, and rising health care costs. These issues, which go beyond traditional clinical responsibilities, have furthered the need for businesses to receive strategic medical advice to effectively operate and to maintain a competitive edge. One particular business sector, the chemical industry, has been challenged seriously because of legitimate as well as perceived health risks associated with the production and use of its products. This paper describes the professional experiences over a 10-year period (1983 to 1993) of an occupational physician working as a consultant to an international chemical company. Services have related to epidemiology, health policy, toxicology, plant oversight as well as serving as a health advisor on matters involving the relation between business and health. An academic affiliation with an occupational medicine residency program has facilitated access to related occupational health professionals to assist in problem solving and research. Opportunities for consulting in occupational medicine will depend upon the nature of the organization as well as the personal and professional characteristics of the physician. Requests for these types of services, however, are likely to expand in the near future, primarily as a result of wider awareness of the implications of work on health, increased litigation, and government regulations.

  17. Indiana family physician attitudes and practices concerning smoking cessation.

    PubMed

    Saywell, R M; Jay, S J; Lukas, P J; Casebeer, L L; Mybeck, K C; Parchman, M L; Haley, A J

    1996-01-01

    Most physicians are aware of the health benefits of smoking cessation and agree they have a responsibility to help smokers quit. Many physicians, however, do not regularly address smoking cessation with their patients. Questionnaires were sent to 2,095 family practice physicians in Indiana. Information obtained included: demographic data; office-based smoking cessation practices; counseling; and physicians' perceptions of intervention outcomes. Most physicians (86%) asked new patients if they smoked, and 23% questioned patients about their exposure to passive smoke. Younger physicians, female physicians and urban physicians were more likely to ask new patients if they smoked. A formal smoking cessation program was used by 28% of the responding physicians. Among those not using a program, 7% reported plans to implement one in the coming year, 40% were not planning to implement one, and 53% were unsure. Physician and practice characteristics were not correlated with the use of smoking cessation programs. Only 11% of physicians considered their smoking cessation counseling skills to be excellent; 27% indicated the need for improvement in skills. One-half (52%) believed their counseling efforts were effective; almost half (45%) believed that current reimbursement policies limited their involvement in smoking cessation interventions. Most respondents have not instituted smoking cessation programs in their practices. It is likely that a combination of strategies, including both undergraduate, graduate and continuing medical education programs and reform in reimbursement practices for cessation programs, will be required to achieve significant increases in long-term smoking abstinence rates.

  18. Office Management of Chemical Dependency by Family Physicians

    PubMed Central

    Baker, Ray

    1991-01-01

    Family physicians are in an ideal position to identify, intervene with, and treat substance use disorders. If family physicians position themselves to reflect objective evidence of consequences of substance use and offer suggestions for change while leaving responsibility for recovery with the patient, patients often choose to recover. Because the disease is characterized by exacerbations, remissions, and relapses, continued involvement with the recovering patient ensures the greatest chance of recovery. PMID:21228969

  19. Female family physicians in obstetrics: achieving personal balance.

    PubMed Central

    Carroll, J C; Brown, J B; Reid, A J

    1995-01-01

    OBJECTIVE: To describe the experiences of female family physicians who practise obstetrics in balancing professional obligations with personal and family needs, given the unique challenges that such practice poses for these physicians. DESIGN: Qualitative study. SETTING: Ontario. PARTICIPANTS: A purposefully selected sample of nine female family physicians who met the criteria of being married, having children and currently practising obstetrics. OUTCOME MEASURES: Experiences of female family physicians and their strategies in their personal, family and professional lives that enable them to continue practising obstetrics. RESULTS: All participants continued to practise obstetrics because of the pleasure they derived from it, despite the challenges of balancing the unpredictable demands of obstetrics with their personal and family needs. To continue in obstetrics, they needed to make changes in their lives, either through a gradual, evolutionary process or in response to a critical event. Alterations to work and family arrangements permitted them to meet the challenges and led to increased satisfaction. Changes included making supportive call-group arrangements, limiting work hours and the number of births attended and securing help with household duties. CONCLUSIONS: An in-depth examination, through the use of qualitative methods, showed the reasons why some female family physicians continue to practise obstetrics despite the stressful aspects of doing so. This knowledge may be useful for women who are residents or experienced clinicians and who are considering including obstetrics in their practice. PMID:7497390

  20. A new, but old business model for family physicians: cash.

    PubMed

    Weber, J Michael

    2013-01-01

    The following study is an exploratory investigation into the opportunity identification, opportunity analysis, and strategic implications of implementing a cash-only family physician practice. The current market dynamics (i.e., increasing insurance premiums, decreasing benefits, more regulations and paperwork, and cuts in federal and state programs) suggest that there is sufficient motivation for these practitioners to change their current business model. In-depth interviews were conducted with office managers and physicians of family physician practices. The results highlighted a variety of issues, including barriers to change, strategy issues, and opportunities/benefits. The implications include theory applications, strategic marketing applications, and managerial decision-making.

  1. Fundamentals of financial statement analysis for academic physician managers.

    PubMed

    Danzi, J T; Boom, M L

    1998-04-01

    Academic medical centers (i.e., teaching hospitals) and academic medical practices are under pressure to control costs to compete with for-profit health care institutions. The authors explain how academic physician managers who want to control costs wisely must first understand the cost structure of the medical center or practice and compare that structure with those of for-profit institutions. Doing this requires a firm understanding of how to use a valuable tool, financial statement analysis, to assess an institution's health and performance. Such analysis consists of calculating a variety of financial ratios (e.g., operating income divided by revenues; net income divided by total assets) and then comparing them with the corresponding ratios that are considered industry norms. Three types of financial statements (defined in detail) lend themselves to this approach: the balance sheet, income statement, and statement of cash flows. The authors define standard financial ratios, point out their uses and limitations, and emphasize that a ratio's meaning derives from comparing it with the corresponding benchmark ratio in the industry as a whole. Ratios should be used not as the end point of assessing financial status, but as ways to identify possible problems that require further investigation. Analysis of trends of ratios over time within an institution is a complementary approach. The authors then discuss the use of ratios in three standard types of institutional evaluation: of performance, of liquidity and leverage, and of strategic planning. In addition, they present the financial statement of a fictitious academic medical center as an example of how to use ratios for financial statement analysis. The authors emphasize that the key to using the ratios they discuss and hundreds of others is first to decide what question needs answering and then to choose the relevant ratios to provide a basis for finding the answer.

  2. The Family Physician in the Witness Box

    PubMed Central

    Emson, H. E.

    1983-01-01

    The doctor appearing in court must learn a new language and be prepared to deal with the legal profession, which is quite different from his own. Adequate preparation for a court case can make it less confusing; this article gives guidelines for doctors occasionally called to give evidence, or who are accused of malpractice. Doctors called as witnesses must consult with lawyers early, to determine exactly what information the court wants and the form a report should take. Physicians should carefully study and summarize all their evidence in non-technical language before a court appearance. By learning some legal language, they can also understand and adequately answer lawyers' questions. A physician accused of negligence must make no admissions before the case and have no contact with the plaintiff other than to formally acknowledge the charge. The Canadian Medical Protective Association should be contacted as soon as possible. PMID:21283283

  3. Do people with disabilities have difficulty finding a family physician?

    PubMed

    McColl, Mary Ann; Aiken, Alice; Schaub, Michael

    2015-04-28

    Primary care has been ideally characterized as the medical home for all citizens, and yet recent data shows that approximately 6% do not have a family physician, and only 17.5% of family practices are open to new patients. Given acknowledged shortages of family physicians, this research asks the question: Do people with disabilities have particular difficulty finding a family physician? Health Care Connect (HCC) is a government-funded agency in Ontario Canada, designed to "help Ontarians who are without a family health care provider to find one". Using data from HCC, supplemented by interviews with HCC staff, the study explores the average wait time for patients with disabilities to be linked with a primary care physician, and the challenges faced by agency staff in doing so. The study found that disabled registrants with the program are only slightly disadvantaged in terms of wait times to find a family physician, and success rates are ultimately comparable; however, agency staff report that there are a number of significant challenges associated with placing disabled patients.

  4. The Family Physician and the Ophthalmologist: Defining Areas of Work

    PubMed Central

    Hørven, Ivar; Elle, Egil

    1975-01-01

    In our April issue, Dr. Bentsen described the educational objectives for training family physicians which are being established by the Norwegian College of General Practitioners. One activity of that College has been to define clinical management and boundaries of family medicine in relation to the various specialties. This article describes those boundaries in relation to ophthalmology. PMID:20469202

  5. Role of family physicians in an urban hospital

    PubMed Central

    Neimanis, Ieva; Woods, Anne; Zizzo, Angelo; Dickson, Robert; Levy, Richard; Goebel, Cindy; Corsini, John; Burns, Sheri; Gaebel, Kathryn

    2017-01-01

    Abstract Objective To investigate changes in family doctors’ attitudes about and participation in hospital activities and inpatient care in an urban hospital family medicine department from 1977 to 1997 and 2014. Design Cross-sectional survey design. Setting The Department of Family Medicine at St Joseph’s Healthcare Hamilton in Ontario. Participants Family physicians affiliated with the Department of Family Medicine at St Joseph’s Healthcare Hamilton were surveyed in 2014. Data were compared with findings from similar surveys administered at this institution in 1977 and 1997. Main outcome measures Family physicians’ roles in hospital activities, attitudes toward the role of the family physician in the hospital setting, and the barriers to and facilitators of maintaining this role. Results A total of 93 physicians returned completed surveys (37.3% response rate). In 2014, half of the respondents provided some inpatient care. This patient care was largely supportive and newborn care (71.7% and 67.4%, respectively). In 2014, 47.3% believed the quality of care would suffer (compared with 92.1% in 1977 and 87.5% in 1997) if they were not involved in patient care in the hospital. There was also a considerable shift away from the 1977 and 1997 perception that the family physician had a role as patient advocate: 92.0% and 95.3%, respectively, compared with only 49.5% in the 2014 survey. Conclusion Family physicians’ hospital activities and attitudes continued to change from 1977 to 1997 and 2014 in this urban hospital setting. Most of the respondents had stopped providing direct inpatient care, with a few continuing to provide supportive care. Despite this, most respondents still see a role for the Department of Family Medicine within the hospital as a focus for identifying with their family physician community, a place to interact with other specialist colleagues, and a source of some continuing medical education. PMID:28292802

  6. "Why Give up Something That Works so Well?": Retirement Expectations among Academic Physicians

    ERIC Educational Resources Information Center

    Silver, Michelle Pannor; Pang, N. Celeste; Williams, Sarah A.

    2015-01-01

    For individuals with strong work identities, the decision to retire can be particularly challenging. For academic physicians, retirement is an important personal decision that also has far-reaching implications for the healthcare system. This is because academic physicians are responsible for producing the research from which key medical decisions…

  7. Patient Satisfaction with the Family Physician Program in Sabzevar, Iran

    PubMed Central

    Ghorbani, Alireza; Raeissi, Pouran; Saffari, Ehsan; Reissi, Nahid

    2016-01-01

    Background and Objectives: Patient satisfaction with the family physician program is an important factor for more favorable treatment results. Evaluation of patient satisfaction improves the services and approximates them to patient’s preferences. The family physician program has been executed since late March, 2005 in Iran. This study aimed to measure patient satisfaction with family physician services and determines factors affecting the level of satisfaction in order to propose appropriate suggestions for providing medical services based on patients’ expectations. Methods: Forty-one centers provide healthcare services in rural and urban areas. The participants in this study comprised 1263 people. The data were collected by an inventory with 11 items about demographic specifications, waiting time and the importance of physician’s sex and 40 items for assessing the level of patient satisfaction. Results: A total of 1199 patients participated in the current study, 72.1% of them were female and 19.6% waited 10-20 minutes for receiving services. About 55.72% of the participants chose high and very high for the items of the inventory. Total satisfaction with the family physician program decreased with age (p-value= 0.029).Moreover, total satisfaction did not show any significant differences in different groups in terms of sex, place of residence, education level and marital status. Also family physicians’ sex did not affect patient satisfaction significantly. Based on results of regression model, an increase in patients’ age by one year decreased their satisfaction by 0.12 and level of satisfaction in rural patients was lower than that in urban patients by 7.93. Conclusions: The level of patient satisfaction with family physician services was moderate, which mostly arose from the components of the family physician program and services such as the waiting time, costs, welfare facilities, accessibility and the service-providing team rather than patients

  8. Prevalence of abusive encounters in the workplace of family physicians

    PubMed Central

    Miedema, Baukje; Hamilton, Ryan; Lambert-Lanning, Anita; Tatemichi, Sue R.; Lemire, Francine; Manca, Donna; Ramsden, Vivian R.

    2010-01-01

    ABSTRACT OBJECTIVE To examine the career prevalence of abusive encounters for family physicians in Canada. DESIGN A 7-page cross-sectional mailed survey in English and French. SETTING Canada. PARTICIPANTS A total of 3802 randomly selected practising family physicians who were members of the College of Family Physicians of Canada. MAIN OUTCOME MEASURES Demographic characteristics of survey participants, career prevalence of abusive encounters, and perpetrators of abuse. MAIN FINDINGS Twenty percent (20.4%) of the surveys (n = 774) were returned. Of the respondents, 44% were men and 56% were women. Most were in private practice in urban settings. The average number of years in practice was 15. The career prevalence of abusive encounters was divided into “minor,” “major,” and “severe” incidents. Of all the respondents, 98% had experienced at least 1 incident of minor abuse, 75% had experienced at least 1 incident of major abuse, and 39% had experienced at least 1 incident of severe abuse. Using χ2 analysis, a number of demographic variables were found to be significantly associated with abuse including the physician’s race and sex. Patients were the most common perpetrators of abuse. Ninety percent of family physicians surveyed reported that they had been abused by patients, while 70% reported that they had been abused by family members of patients. CONCLUSION Approximately 2 in 5 family physicians surveyed were subjected to a considerable amount of severe abuse during practice. Abuse in the office setting might have grave consequences for the health and well-being of the victimized physicians and might hinder service retention where the risk of abuse is greatest. PMID:20228289

  9. Tension Headaches: A Challenge to the Family Physician

    PubMed Central

    Cohen, May

    1978-01-01

    Tension headache is a frequently encountered symptom. The skills of the family physician make him or her ideally suited to assess and manage the patient with this problem. Diagnosis depends on a thorough understanding of the nature and ‘life-history’ of the headache as well as knowledge of the patient as an individual and as part of his or her family and social environment. Management requires a holistic ongoing approach, employing a judicious combination of medication and physical therapy. Above all, the physician must help the patient develop different ways of dealing with anxiety and conflict. PMID:21301541

  10. Family-physician interactions in the intensive care unit.

    PubMed

    Azoulay, Elie; Sprung, Charles L

    2004-11-01

    Surrogate designation has the potential to represent the patient's wishes and promote successful family involvement in decision making when options exist as to the patient's medical management. In recent years, intensive care unit physicians and nurses have promoted family-centered care on the basis that adequate and effective communication with family members is the key to substitute decision making, thereby protecting patient autonomy. The two-step model for the family-physician relationship in the intensive care unit including early and effective provision of information to the family followed by family input into decision making is described as well as specific needs of the family members of dying patients. A research agenda is outlined for further investigating the family-physician relationship in the intensive care unit. This agenda includes a) improvement of communication skills for health care workers; b) research in the area of information and communication; c) interventions in non-intensive care unit areas to promote programs for teaching communication skills to all members of the medical profession; d) research on potential conflict between medical best interest and the ethics of autonomy; and e) publicity to enhance society's interest in advance care planning and surrogate designation amplified by debate in the media and other sounding boards. These studies should focus both on families and on intensive care unit workers. Assessments of postintervention outcomes in family members would provide insights into how well family-centered care matches family expectations and protects families from distress, not only during the intensive care unit stay but also during the ensuing weeks and months.

  11. Email communication in a developing country: different family physician and patient perspectives

    PubMed Central

    Makarem, Nisrine N.; Antoun, Jumana

    2016-01-01

    Background Email communication between physicians and patients could improve access to and delivery of health care. Most of the literature studies about email communication between physicians and patients have been conducted in developing countries. Therefore, this study aims to analyze the practices, attitudes, and barriers of both physicians’ and patients’ use of email within the same health care setting of a developing country. Methods A cross-sectional paper-based survey was conducted among 39 physicians and 500 patients at the Family Medicine clinics of the American University of Beirut, a tertiary academic medical center. Results Most of the surveyed patients and physicians reported that they would like to communicate through email and agreed that it is useful. However, only 19% of the patients have ever communicated with their physicians via email, and only 5.1% of physicians have often communicated with their patients via email. Almost half of the patients surveyed were unaware of the possibility of this form of communication, and only 17% reported that their physician offered them his or her email address. In addition, physicians and patients did not agree on the services to be provided by email communication. For instance, almost half of the patients indicated consultation for an urgent medical matter as suitable for email communication. Conclusion The use of email communication in health care is still scarce. Patients and physicians have different perspectives of its use and importance. Further rigorous research is needed to clarify the advantages and disadvantages of this form of communication, especially in the developing world. Interested physicians are encouraged to establish appropriate personal policies for email communication with adequate announcement and patient education plans. PMID:27855773

  12. The Irritable Colon: The Family Physician's Most Common Gastroenterological Dilemma

    PubMed Central

    Rosser, W.W.

    1988-01-01

    The irritable colon syndrome presents the family physician with a diagnostic dilemma that tests both diagnostic and physician-patient relationship skills. Although the syndrome is common, it has no pathology, and the pathophysiology does not explain fully its signs and symptoms, which are not distinct, but are similar to those of a number of serious organic conditions. Careful history taking, simple investigations, and the addition of 20g of wheat germ fibre to the patient's daily diet will usually control the symptoms. Regulation or reduction of aggravating factors such as anxiety, depression, dietary intolerance or food allergies, antibiotic use, GI infections, and laxative abuse will also control the symptoms. The family physician who is able to tailor the diagnosis and management of the problem to the individual patient demonstrates the benefits of having an on-going relationship with the patient. PMID:21253150

  13. The Irritable Colon: The Family Physician's Most Common Gastroenterological Dilemma.

    PubMed

    Rosser, W W

    1988-03-01

    The irritable colon syndrome presents the family physician with a diagnostic dilemma that tests both diagnostic and physician-patient relationship skills. Although the syndrome is common, it has no pathology, and the pathophysiology does not explain fully its signs and symptoms, which are not distinct, but are similar to those of a number of serious organic conditions. Careful history taking, simple investigations, and the addition of 20g of wheat germ fibre to the patient's daily diet will usually control the symptoms. Regulation or reduction of aggravating factors such as anxiety, depression, dietary intolerance or food allergies, antibiotic use, GI infections, and laxative abuse will also control the symptoms. The family physician who is able to tailor the diagnosis and management of the problem to the individual patient demonstrates the benefits of having an on-going relationship with the patient.

  14. What Is So Special About a Family Physician?

    PubMed Central

    Deisher, Joseph B.

    1974-01-01

    Around a core of common, acute and chronic, recurrent health problems, a family physician must marshall the traditional episodic management for both inpatient and outpatient illness. He must also be especially adept at recently emerging routines of prevention and early detection. He provides individual and familial psychologic support and counselling, for both its therapeutic and preventive values. In addition, he must relate the individual care of his patient and the patient's family to the community as a whole. In doing this he will use not only his own skills but those of lay health volunteers, trained allied health care professionals and skilled subspecialists in the limited medical disciplines. The proper preparation of family physicians for this complicated role has far-reaching implications for change in both medical education and medical practice. PMID:4439902

  15. The Family Physician's Role in Managing Chronic Leukemia

    PubMed Central

    Galbraith, Peter R.

    1988-01-01

    This article provides a brief update on the clinical approach to chronic myelogenous leukemia and chronic lymphocytic leukemia, based on advances in pathbiology and the effect of new concepts on treatment policies. These disorders were selected because family physicians take most responsibility for the day-to-day management of these most common forms of chronic leukemias. PMID:21253119

  16. Work Values and Job Satisfaction of Family Physicians

    ERIC Educational Resources Information Center

    Bouwkamp-Memmer, Jennifer C.; Whiston, Susan C.; Hartung, Paul J.

    2013-01-01

    Theory and prior research suggest linkages between work values and job satisfaction. The present study examined such linkages in a group of workers in a professional occupation. Family physicians (134 women, 206 men, 88% Caucasian) responded to context-specific measures of work values and job satisfaction. ANOVA results indicated a work values…

  17. Exercise-induced asthma. What family physicians should do.

    PubMed Central

    D'Urzo, A.

    1995-01-01

    Exercise-induced asthma is described as a transitory increase in airway resistance during or after vigorous exercise. Nearly 90% of patients with chronic asthma and 40% of allergic nonasthmatic patients have the condition. Family physicians should try to educate patients about their asthma and, barring contraindications, encourage them to participate in regular physical activity. PMID:8563507

  18. Celiac disease. CME update for family physicians.

    PubMed Central

    Devlin, Shane M.; Andrews, Christopher N.; Beck, Paul L.

    2004-01-01

    OBJECTIVE: To review current understanding of the epidemiology, pathophysiology, diagnosis, and management of celiac disease. QUALITY OF EVIDENCE: Few recent randomized controlled trials (level I evidence) have studied treatments for celiac disease. There are recent comparative studies (level II evidence) and there is well established consensus (level III evidence) on diagnosis and treatment of celiac disease. MAIN MESSAGE: Celiac disease is an immune-mediated small bowel enteropathy caused by exposure to wheat gluten protein. The disease can be insidious and often presents with only subtle extraintestinal manifestations in a variety of organ systems. Recent epidemiologic surveys suggest celiac disease is much more common in North America than previously thought. Advances in immunology and screening have made diagnosis more reliable than in the past. Removing gluten from the diet is effective in most cases. CONCLUSION: Celiac disease manifests subtly and is an easy diagnosis to miss. Good laboratory screening tests and effective treatment are available. Family practitioners should consider celiac disease in patients who present with confounding symptoms. PMID:15171674

  19. Factors influencing palliative care. Qualitative study of family physicians' practices.

    PubMed Central

    Brown, J. B.; Sangster, M.; Swift, J.

    1998-01-01

    OBJECTIVE: To examine factors that influence family physicians' decisions to practise palliative care. DESIGN: Qualitative method of in-depth interviews. SETTING: Southwestern Ontario. PARTICIPANTS: Family physicians who practise palliative care on a full-time basis, who practise on a part-time basis, or who have retired from active involvement in palliative care. METHOD: Eleven in-depth interviews were conducted to explore factors that influence family physicians' decisions to practise palliative care and factors that sustain their interest in palliative care. All interviews were audiotaped and transcribed verbatim. The analysis strategy used a phenomenological approach and occurred concurrently rather than sequentially. All interview transcriptions were read independently by the researchers, who then compared and combined their analyses. Final analysis involved examining all interviews collectively, thus permitting relationships between and among central themes to emerge. MAIN OUTCOME FINDINGS: The overriding theme was a common philosophy of palliative care focusing on acceptance of death, whole person care, compassion, communication, and teamwork. Participants' philosophies were shaped by their education and by professional and personal experiences. In addition, participants articulated personal and systemic factors currently affecting their practice of palliative care. CONCLUSIONS: Participants observed that primary care physicians should be responsible for their patients' palliative care within the context of interdisciplinary teams. For medical students to be knowledgeable and sensitive to the needs of dying patients, palliative care should be given higher priority in the curriculum. Finally, participants argued compellingly for transferring the philosophy of palliative care to the overall practice of medicine. PMID:9612588

  20. Pod people. Response of family physicians and family practice nurses to Kosovar refugees in Greenwood, NS.

    PubMed Central

    Twohig, P. L.; Burge, F.; MacLachlan, R.

    2000-01-01

    OBJECTIVE: To explore roles of family physicians and family practice nurses who provided care to Kosovar refugees at Greenwood, NS. DESIGN: Qualitative study based on individual interviews with family physicians and family practice nurses. SETTING: Family practices in Halifax, NS. PARTICIPANTS: Six family practice nurses, four physician faculty members, four community-based family physicians, and two family medicine residents were interviewed. Participants were purposefully chosen from the roster of service providers. METHOD: All interviews were conducted by one of the researchers and were semistructured. Interviews lasted approximately 30 minutes and were immediately transcribed. Key words and phrases were identified and compared with subsequent interviews until saturation was achieved. MAIN FINDINGS: Data yielded four analytical categories: the clinical encounter, expectation and experience, role and team functioning, and response. Participants reported how providing care in the context of a refugee camp was both similar to and different from their daily activities in family practice, as were their working relationships with other health care professionals. CONCLUSION: Primary care for refugees during complex health emergencies is often underreported in the literature. Yet family practice physicians and nurses recounted that they had the requisite skills to provide care in such a context. Images Figure 1 Figure 2 PMID:11143581

  1. Academic characteristics of orthopedic team physicians affiliated with high school, collegiate, and professional teams.

    PubMed

    Makhni, Eric C; Buza, John A; Byram, Ian; Ahmad, Christopher S

    2015-11-01

    We conducted a study to determine the academic involvement and research productivity of orthopedic team physicians at high school, college, and professional levels of sport. Through Internet and telephone queries, we identified 1054 team physicians from 362 institutions, including 120 randomly selected high schools and colleges and 122 professional teams (baseball, basketball, football, hockey). For all physicians included in the study, we performed a comprehensive search of the Internet and of a citation database to determine academic affiliations, number of publications, and h-index values. Of the 1054 physicians, 678 (64%) were orthopedic surgeons. Percentage of orthopedic team physicians affiliated with an academic medical center was highest in professional sports (64%; 173/270) followed by collegiate sports (36%; 98/275) and high school sports (20%; 27/133). Median number of publications per orthopedic team physician was significantly higher in professional sports (30.6) than in collegiate sports (10.7) or high school sports (6). Median number of publications by orthopedic physicians also varied by sport, with the highest number in Major League Baseball (37.9; range, 0-225) followed by the National Basketball Association (32.0; range, 0-227) and the National Football League (30.4; range, 0-460), with the lowest number within the National Hockey League (20.7; range, 0-144). Academic affiliation and research productivity of orthopedic team physicians vary by competition level and professional sporting league.

  2. Modeling spatial accessibility of immigrants to culturally diverse family physicians.

    PubMed

    Wanga, Lu; Roisman, Deborah

    2011-01-01

    This article uses accessibility as an analytical tool to examine health care access among immigrants in a multicultural urban setting. It applies and improves on two widely used accessibility models—the gravity model and the two-step floating catchment area model—in measuring spatial accessibility by Mainland Chinese immigrants in the Toronto Census Metropolitan Area. Empirical data on physician-seeking behaviors are collected through two rounds of questionnaire surveys. Attention is focused on journey to physician location and utilization of linguistically matched family physicians. Based on the survey data, a two-zone accessibility model is developed by relaxing the travel threshold and distance impedance parameters that are traditionally treated as a constant in the accessibility models. General linear models are used to identify relationships among spatial accessibility, geography, and socioeconomic characteristics of Mainland Chinese immigrants. The results suggest a spatial mismatch in the supply of and demand for culturally sensitive care, and residential location is the primary factor that determines spatial accessibility to family physicians. The article yields important policy implications.

  3. Monthly Incidence Rates of Abusive Encounters for Canadian Family Physicians by Patients and Their Families

    PubMed Central

    Miedema, Baukje (Bo); Hamilton, Ryan; Tatemichi, Sue; Lambert-Lanning, Anita; Lemire, Francine; Manca, Donna; Ramsden, Vivian R.

    2010-01-01

    Objective. The goal of this study was to examine the monthly incidence rates of abusive encounters for family physicians in Canada. Methods. A 7-page cross-sectional survey. Results. Of the entire study sample (N = 720), 29% of the physicians reported having experienced an abusive event in the last month by a patient or patient family member. Abusive incidents were classified as minor, major, or severe. Of the physician participants who reported having been abused, all reported having experienced a minor event, 26% a major, and 8% a severe event. Of the physicians who experienced an abusive event, 55% were not aware of any policies to protect them, 76% did not seek help, and 64% did not report the abusive event. Conclusion. Family physicians are subjected to significant amounts of abuse in their day-to-day practices. Few physicians are aware of workplace policies that could protect them, and fewer report abusive encounters. Physicians would benefit from increased awareness of institutional policies that can protect them against abusive patients and their families and from the development of a national policy. PMID:22332007

  4. Assessment of Family Physicians' Knowledge of Social and Community Services

    PubMed Central

    Craven, Marilyn A.; Kates, N.; Raso, P.

    1990-01-01

    A survey of 255 family physicians and general practitioners in the Hamilton-Wentworth area, revealed that knowledge of social services and community treatment programs was often poor: 65% of 122 respondents did not know about one or more points of access to social services information, and 26% reported that they knew of appropriate social services for less than half of 13 psychosocial problems commonly encountered in family practice. Although 43% indicated that they preferred to treat patients themselves, 47% agreed that lack of information precluded referral, and 75% agreed that opportunities to increase their knowledge of community services would be helpful. PMID:21234060

  5. Developing physician leaders in academic medical centers. Part 1: Their changing role.

    PubMed

    Bachrach, D J

    1996-01-01

    While physicians have historically held positions of leadership in academic medical centers, there is an increasing trend that physicians will not only guide the clinical, curriculum and scientific direction of the institution, but its business direction as well. Physicians are assuming a greater role in business decision making and are found at the negotiating table with leaders from business, insurance and other integrated health care delivery systems. Physicians who lead "strategic business units" within the academic medical center are expected to acquire and demonstrate enhanced business acumen. There is an increasing demand for formal and informal training programs for physicians in academic medical centers in order to better prepare them for their evolving roles and responsibilities. These may include the pursuit of a second degree in business or health care management, intramurally conducted courses in leadership skill development; management, business and finance; or involvement in extramurally prepared and delivered training programs specifically geared toward physicians as conducted at major universities, often in their schools of business or public health. This article article was prepared by the author from research into and presentation of a thesis entitled. "The Importance of Leadership Training And Development For Physicians In Academic Medical Centers In An Increasingly Complex Healthcare Environment, " prepared for the Credentials Committee of the American College of Healthcare Executives in partial fulfillment of the requirements for Fellowship in the College (ACHE). Part 2 will appear in the next issue of the Journal.

  6. Abuse of family physicians by patients seeking controlled substances

    PubMed Central

    Saveland, Christine; Hawker, Leisha; Miedema, Baukje; MacDougall, Peter

    2014-01-01

    Abstract Objective To examine family physicians’ career prevalence and monthly incidence of workplace abuse by controlled substance prescription seekers. Design A 4-page cross-sectional survey. Setting A family medicine continuing medical education event in Halifax, NS. Participants The survey was distributed to 316 family physicians attending the continuing medical education event. Main outcome measures Career prevalence and monthly incidence of workplace abuse related to the act of prescribing controlled substances. Results Fifty-six percent (n = 178) of the 316 surveys were returned completed. Half the study participants were men (49%). Most study participants were in private practice and lived in Nova Scotia, and approximately half (51%) practised in urban settings. On average, the study participants had 20 years of practice experience. The career prevalence of abusive encounters related to controlled substance prescribing was divided into “minor,” “major,” and “severe” incidents. Overall, 95% of study participants reported having experienced at least 1 incident of minor abuse; 48% had experienced at least 1 incident of major abuse; and 17% had experienced at least 1 incident of severe abuse during their careers. Further, 30% reported having been abused in the past month; among those, the average number of abusive encounters was 3. Most (82%) of the abusers were male with a history of addiction (85%) and mental illness (39%). Opioids were the most frequently sought controlled substance. Conclusion Abuse of family physicians by patients seeking controlled substances is substantial. Family physicians who prescribe controlled substances are at risk of being subjected to minor, major, or even severe abuse. Opioids were the most often sought controlled substance. A national discussion to deal with this issue is needed. PMID:24522691

  7. Family physicians’ attitude and interest toward participation in urban family physician program and related factors

    PubMed Central

    Sadeghi, Masoumeh; Dehghani, Mohsen; Aghaee, Monavar Afzal

    2016-01-01

    Introduction: Every family physician has a key role in achieving the goals of the family physician program (FPP). Low satisfaction of physicians in certain areas of Iran and their low maintenance level in the program is quite challenging. The aims of the present study were; (1) to assess the attitude of rural/rural-urban family physicians about FPP and (2) to investigate their interest toward participation in urban FPP and (3) to explore the influencing factors. Methods: This cross-sectional study was performed on 137 family physicians who were working in rural/rural-urban FPP in Mashhad University of Medical Sciences (Iran). A self-designed valid and reliable questionnaire including demographic data and thirty questions on the participants’ attitudes toward the FPP in Likert scale were used. Data were analyzed by multiple logistic regression models using SPSS software. Results: 49.3% of physicians were interested in continuing their cooperation in the urban-FPP. The mean total attitude score was 62.18 out of 100. The highest agreement and positive attitude of physicians were related to achievements of the program goals dimension. Multiple analyses showed that gender (odds ratio [OR] =5.5; male vs. female) and employment status (OR = 16.7 and 10.9 for permanent employment and by contract compared to legal obligation, respectively) were significantly associated with physicians’ willingness toward participation in the urban-FPP. Conclusion: About half of the studied physicians were interested toward participation in the urban-FPP; Male physicians more than females and permanent employees more than others were willing and interested to participate in the urban-FPP. PMID:28349002

  8. Interconception Care for Mothers During Well-Child Visits With Family Physicians: An IMPLICIT Network Study

    PubMed Central

    Rosener, Stephanie E.; Barr, Wendy B.; Frayne, Daniel J.; Barash, Joshua H.; Gross, Megan E.; Bennett, Ian M.

    2016-01-01

    PURPOSE Interconception care (ICC) is recommended to improve birth outcomes by targeting maternal risk factors, but little is known about its implementation. We evaluated the frequency and nature of ICC delivered to mothers at well-child visits and maternal receptivity to these practices. METHODS We surveyed a convenience sample of mothers accompanying their child to well-child visits at family medicine academic practices in the IMPLICIT (Interventions to Minimize Preterm and Low Birth Weight Infants Through Continuous Improvement Techniques) Network. Health history, behaviors, and the frequency of the child’s physician addressing maternal depression, tobacco use, family planning, and folic acid supplementation were assessed, along with maternal receptivity to advice. RESULTS Three-quarters of the 658 respondents shared a medical home with their child. Overall, 17% of respondents reported a previous preterm birth, 19% reported a history of depression, 25% were smoking, 26% were not using contraception, and 58% were not taking folic acid. Regarding advice, 80% of mothers who smoked were counseled to quit, 59% reported depression screening, 71% discussed contraception, and 44% discussed folic acid. Screening for depression and family planning was more likely when the mother and child shared a medical home (P <.05). Most mothers, nearly 95%, were willing to accept health advice from their child’s physician regardless of whether a medical home was shared (P >.05). CONCLUSIONS Family physicians provide key elements of ICC at well-child visits, and mothers are highly receptive to advice from their child’s physician even if they receive primary care elsewhere. Routine integration of ICC at these visits may provide an opportunity to reduce maternal risk factors for adverse subsequent birth outcomes. PMID:27401423

  9. Physician Dismissal of Families Who Refuse Vaccination: An Ethical Assessment.

    PubMed

    Diekema, Douglas S

    2015-01-01

    Thousands of U.S. parents choose to refuse or delay the administration of selected vaccines to their children each year, and some choose not to vaccinate their children at all. While most physicians continue to provide care to these families over time, using each visit as an opportunity to educate and encourage vaccination, an increasing number of physicians are choosing to dismiss these families from their practice unless they agree to vaccinate their children. This paper will examine this emerging trend along with the reasons given by those who advocate such an approach. I will argue that the strategy of refusing to allow families into a clinic unless they agree to vaccinate their children is misguided, and the arguments for doing so fail to stand up to close scrutiny. Such a strategy does not benefit the child or the health of the community, and may have a negative impact on both. Furthermore, some of the arguments in support of dismissal policies ignore the importance of professional obligation and appear to favor self-interest over the interest of the patient.

  10. Marketing physician services in an academic medical center.

    PubMed

    Eudes, J A; Divis, K L; Vaughan, D G; Fottler, M D

    1987-01-01

    As a result of recent environmental changes in the health care industry, marketing has become a vital necessity for the survival of most hospitals. Kotler's conceptual framework is used to study and evaluate an innovative program for marketing physician services in a large urban medical center. This program was quite successful in increasing admissions and referrals and won a national award in 1984.

  11. The grief process for patient, family, and physician.

    PubMed

    Bruce, Christine A

    2002-09-01

    In the grieving process, patient, family, and health professionals have the same needs-rest, relaxation, nourishment, a sense of security, trust, hope in the future, and humor among them. Grief, defined as a shared, universal, and natural neuropsychobiologic expression in response to loss, is distinct from mourning, a practice that varies in expression across diverse cultures. To aid in an understanding of grief and its effects, the author looks at the models for grief proposed by Kubler-Ross, Bowlby, Parkes, Worden, and Wolfelt. Addressing patients' concerns requires physicians be empathic, attentive, and respective and have willingness to take time, be present, and listen.

  12. Commentary: "Who was caring for Mary?" revisited: a call for all academic physicians caring for patients to focus on systems and quality improvement.

    PubMed

    Southwick, Frederick S; Spear, Steven J

    2009-12-01

    Over 15 years have passed since Mary's near death (Annals of Internal Medicine. 1993;118:146-148). Disappointment in the care by fellow academic physicians persists; however, a reanalysis of her case through the lens of complex systems design and performance yields a more accurate and actionable perspective. Mary's suffering was not due to human failure alone. Human failure was provoked and exacerbated by broken processes including ambiguous assignments of responsibility; inadequate transfers of information and authority; unreliable or unavailable protocols for providing safe, effective treatment; and a failure to integrate the deep but narrow perspectives of individual specialists into a complete picture of Mary's condition. Her case exemplifies, in personal terms, many of the system challenges academic medical centers face: Faculty have other missions that can conflict with patient care; disease complexity is high, requiring input from multiple subspecialists; clinical departments serve as roadblocks to communication; and novice physicians, requiring close supervision, have primary responsibility for the day-to-day care of acutely ill patients. The academic physicians who first cared for Mary unwittingly accepted flawed systems, and they failed to work around them. At great monetary and emotional expense, last-minute heroics saved Mary. In a dysfunctional system, even the most conscientious physician may be viewed as uncaring. As Mary's case so clearly illustrates, patients and their families see the system and the physician as one. Only by working to improve the systems of delivery will academic physicians again be consistently viewed as caring.

  13. Academic physicians' assessment of the effects of computers on health care.

    PubMed Central

    Detmer, W. M.; Friedman, C. P.

    1994-01-01

    We assessed the attitudes of academic physicians towards computers in health care at two academic medical centers that are in the early stages of clinical information-system deployment. We distributed a 4-page questionnaire to 470 subjects, and a total of 272 physicians (58%) responded. Our results show that respondents use computers frequently, primarily to perform academic-oriented tasks as opposed to clinical tasks. Overall, respondents viewed computers as being slightly beneficial to health care. They perceive self-education and access to up-to-date information as the most beneficial aspects of computers and are most concerned about privacy issues and the effect of computers on the doctor-patient relationship. Physicians with prior computer training and greater knowledge of informatics concepts had more favorable attitudes towards computers in health care. We suggest that negative attitudes towards computers can be addressed by careful system design as well as targeted educational activities. PMID:7949990

  14. Mobile tablet use among academic physicians and trainees.

    PubMed

    Sclafani, Joseph; Tirrell, Timothy F; Franko, Orrin I

    2013-02-01

    The rapid adoption rate and integration of mobile technology (tablet computing devices and smartphones) by physicians is reshaping the current clinical landscape. These devices have sparked an evolution in a variety of arenas, including educational media dissemination, remote patient data access and point of care applications. Quantifying usage patterns of clinical applications of mobile technology is of interest to understand how these technologies are shaping current clinical care. A digital survey examining mobile tablet and associated application usage was administered via email to all ACGME training programs. Data regarding respondent specialty, level of training, and habits of tablet usage were collected and analyzed. 40% of respondents used a tablet, of which the iPad was the most popular. Nearly half of the tablet owners reported using the tablet in clinical settings; the most commonly used application types were point of care and electronic medical record access. Increased level of training was associated with decreased support for mobile computing improving physician capabilities and patient interactions. There was strong and consistent desire for institutional support of mobile computing and integration of mobile computing technology into medical education. While many physicians are currently purchasing mobile devices, often without institutional support, successful integration of these devices into the clinical setting is still developing. Potential reasons behind the low adoption rate may include interference of technology in doctor-patient interactions or the lack of appropriate applications available for download. However, the results convincingly demonstrate that physicians recognize a potential utility in mobile computing, indicated by their desire for institutional support and integration of mobile technology into medical education. It is likely that the use of tablet computers in clinical practice will expand in the future. Thus, we believe

  15. [On the military physician Cui and his academic achievements].

    PubMed

    Wang, S

    1996-01-01

    Based on the 385 pieces of recipes and its discourses quoted from Cui's by Wai Tai Mi Yao (Medical secret of an official), this author discusses the brief biography of Cui Zhiti, a military physician of the Tang Dynasty and his achievements on field epidemics, field internal medicine, field surgery and comes to a conclusion that Cui Zhiti and his "Cui's Collected Essential Recipes" is of significance in China's military medical history.

  16. Managing diabetes during pregnancy. Guide for family physicians.

    PubMed Central

    Sempowski, Ian P.; Houlden, R. L.

    2003-01-01

    OBJECTIVE: To provide a guide family physicians can use to interpret current evidence on treating women with pregestational and gestational diabetes mellitus (GDM) and to develop a model for managing these patients. QUALITY OF EVIDENCE: A MEDLINE search from January 1980 to December 2002 found randomized controlled trials (RCTs) and descriptive studies that had conflicting results regarding screening recommendations. Studies of intensive insulin therapy were predominantly large RCTs (level I evidence). Glycemic targets and guidelines for monitoring pregnant women are based primarily on consensus statements from large national societies. MAIN MESSAGE: Most pregnant women should be screened for GDM. Good glycemic control during pregnancy reduces congenital anomalies and stillbirths. Women failing to meet glycemic targets should be referred to multidisciplinary teams and considered for insulin therapy. Intensive insulin therapy reduces the risk of macrosomia and might reduce cesarean section rates and other serious outcomes. CONCLUSION: Despite controversy, family physicians can follow a plan for managing diabetic patients during pregnancy that is supported by the best available evidence. PMID:12836864

  17. Infertility evaluation and management. Strategies for family physicians.

    PubMed Central

    Case, Allison M.

    2003-01-01

    OBJECTIVE: To review family physicians' role in investigation and management of infertile couples. QUALITY OF EVIDENCE: MEDLINE and PubMed were searched using the MeSH headings infertility, advanced maternal age, polycystic ovarian syndrome, clomiphene citrate, and insulin sensitizers. Bibliographies of review articles and textbooks were also searched. Review articles, randomized trials, observational studies, and case series are cited. MAIN MESSAGE: Approximately 8% of Canadian couples have difficulty conceiving. Mother's age significantly affects ability to conceive. Infertility assessment focuses on ovulatory dysfunction, tubal factors, sexual factors, and male factors. Women older than 35 years more than 12 months infertile; women younger than 35 more than 18 months infertile; women likely to have such problems as anovulation, tubal disease, or endometriosis; women whose partners' semen tests abnormal; and women who request referral should be referred. Patients treated with clomiphene citrate should be aware of its potential side effects. CONCLUSION: Family physicians have an important role in preconception counseling. Detailed and focused assessment facilitates initial investigations and treatment and can identify couples who could benefit from referral for further assessment. PMID:14649985

  18. Investigating the barriers to teaching family physicians' and specialists' collaboration in the training environment: a qualitative study

    PubMed Central

    Beaulieu, Marie-Dominique; Samson, Louise; Rocher, Guy; Rioux, Marc; Boucher, Laurier; Del Grande, Claudio

    2009-01-01

    Background Collaboration between physicians in different specialties is often taken for granted. However, poor interactions between family physicians and specialists contribute significantly to the observed discontinuity between primary and specialty care. The objective of this study was to explore how collaboration between family physicians and specialists was conceptualised as a competency and experienced in residency training curricula of four faculties of medicine in Canada. Methods This is a multiple-case study based on Abbott's theory of professions. Programs targeted were family medicine, general psychiatry, radiology, and internal medicine. The content of the programs' objectives was analyzed. Associate deans of postgraduate studies, program directors, educators, and residents were interviewed individually or in focus groups (47 residents and 45 faculty members). Results The training objectives related to family physicians-specialists collaboration were phrased in very general terms and lacked specificity. Obstacles to effective collaboration were aggregated under themes of professional responsibility and questioned expertise. Both trainees and trainers reported increasing distances between specialty and general medicine in three key fields of the professional system: the workplace arena, the training setting, and the production of academic knowledge. Conclusion The challenges of developing collaborating skills between generalists and specialist physicians are comparable in many ways to those encountered in inter-professional collaboration and should be given more consideration than they currently receive if we want to improve coordination between primary and specialty care. PMID:19500409

  19. Solution-focused therapy. Counseling model for busy family physicians.

    PubMed Central

    Greenberg, G.; Ganshorn, K.; Danilkewich, A.

    2001-01-01

    OBJECTIVE: To provide family doctors in busy office practices with a model for counseling compatible with patient-centred medicine, including the techniques, strategies, and questions necessary for implementation. QUALITY OF EVIDENCE: The MEDLINE database was searched from 1984 to 1999 using the terms psychotherapy in family practice, brief therapy in family practice, solution-focused therapy, and brief psychotherapy. A total of 170 relevant articles were identified; 75 abstracts were retrieved and a similar number of articles read. Additional resources included seminal books on solution-focused therapy (SFT), bibliographies of salient articles, participation in workshops on SFT, and observation of SFT counseling sessions taped by leaders in the field. MAIN MESSAGE: Solution-focused therapy's concentration on collaborative identification and amplification of patient strengths is the foundation upon which solutions to an array of problems are built. Solution-focused therapy offers simplicity, practicality, and relative ease of application. From the perspective of a new learner, MECSTAT provides a framework that facilitates development of skills. CONCLUSION: Solution-focused therapy recognizes that, even in the bleakest of circumstances, an emphasis on individual strength is empowering. In recognizing patients as experts in self-care, family physicians support and accentuate patient-driven change, and in so doing, are freed from the hopelessness and burnout that can accompany misplaced feelings of responsibility. PMID:11768927

  20. Academic and Family Conditions Associated with Intrinsic Academic Motivation in Japanese Medical Students: A Pilot Study

    ERIC Educational Resources Information Center

    Tanaka, Masaaki; Watanabea, Yasuyoshi

    2012-01-01

    Objective: Intrinsic academic motivation is one of the most important psychological concepts in education, and it is related to academic outcomes in medical students. This study examined the relationships between academic and family conditions and intrinsic academic motivation. Design: Cross-sectional design. Setting: The study group consisted of…

  1. Family Income, School Attendance, and Academic Achievement in Elementary School

    ERIC Educational Resources Information Center

    Morrissey, Taryn W.; Hutchison, Lindsey; Winsler, Adam

    2014-01-01

    Low family income is associated with poor academic achievement among children. Higher rates of school absence and tardiness may be one mechanism through which low family income impacts children's academic success. This study examines relations between family income, as measured by receipt of free or reduced-price lunch, school attendance, and…

  2. Empowering women in a violent society. Role of the family physician.

    PubMed Central

    Archer, L. A.

    1994-01-01

    Despite erosion of key societal institutions, family physicians have remained a focal point for many troubled individuals--particularly women. The prevalence and types of abuse women experience and the effects on women's lives are summarized. Disclosures of abuse can affect family physicians. Increased awareness of gender role socialization messages for women is also relevant to family practice. PMID:8038640

  3. An Algorithm Using Administrative Data to Identify Patient Attachment to a Family Physician

    PubMed Central

    Provost, Sylvie; Pérez, José; Pineault, Raynald; Borgès Da Silva, Roxane; Tousignant, Pierre

    2015-01-01

    Background. Commonly self-reported questions in population health surveys, such as “do you have a family physician?”, represent one of the best-known sources of information about patients' attachment to family physicians. Is it possible to find a proxy for this information in administrative data? Objective. To identify the type of patient attachment to a family physician using administrative data. Methods. Using physician fee-for-service database and patients enrolment registries (Quebec, Canada, 2008–2010), we developed a step-by-step algorithm including three dimensions of the physician-patient relationship: patient enrolment with a physician, complete annual medical examinations (CME), and concentration of visits to a physician. Results. 68.1% of users were attached to a family physician; for 34.4% of them, attachment was defined by enrolment with a physician, for 31.5%, by CME without enrolment, and, for 34.1%, by concentration of visits to a physician without enrolment or CME. Eight types of patient attachment were described. Conclusion. When compared to findings with survey data, our measure comes out as a solid conceptual framework to identify patient attachment to a family physician in administrative databases. This measure could be of great value for physician/patient-based cohort development and impact assessment of different types of patient attachment on health services utilization. PMID:26413320

  4. Perceived Learning Needs of Family Physicians in British Columbia

    PubMed Central

    Craig, Jennifer

    1990-01-01

    To determine family physicians' preferences for time, location, instructional format, and topics, the Division of Continuing Medical Education at the University of British Columbia conducted a survey, in which 1200 questionnaires were mailed to a stratified, proportional random sample of the 3270 general practitioners in the province, the stratifications being urban or rural and decade of graduation. A return rate of 61% yielded 648 usable questionnaires, which exceeds the sample required for analysis with no stratifications. Most popular days for involvement in continuing medical education were Fridays and Saturdays in the months of February, March, October, and November. Common skin disorders and hypertension headed the list of most relevant topics for the whole group and for the urban stratification. Hypertension was superseded by eye emergencies in the rural stratification. PMID:21234037

  5. E-Learning Readiness in Medicine: Turkish Family Medicine (FM) Physicians Case

    ERIC Educational Resources Information Center

    Parlakkiliç, Alaattin

    2015-01-01

    This research investigates e-learning readiness level of family medicine physicians (FM) in Turkey. The study measures the level of e-learning readiness of Turkish FM physicians by an online e-learning readiness survey. According to results five areas are ready at Turkish FM physicians but need a few improvements:…

  6. Attitudes of academic-based and community-based physicians regarding EMR use during outpatient encounters.

    PubMed Central

    Penrod, L. E.; Gadd, C. S.

    2001-01-01

    Physician satisfaction with EMR implementations has been reported in a number of recent studies. Most of these have reported on implementation of an EMR in a uniform practice setting rather than comparing satisfaction with implementation between settings. Our objectives in this study were to: 1) compare and contrast the attitudes of academic-based and community-based primary care physicians toward EMR use 6 months after implementation, and 2) investigate some of the factors influencing their attitudes toward the EMR implementation. Although physicians in both settings regularly use computers, the academic-based physicians use computers for a wider range of activities. Both groups endorse improvements in quality and communication as well as concern over rapport with the patient and privacy. There is considerable discrepancy between the two settings in ratings of the impact on workflow, with the community-based physicians being much more positive about the EMR. Factors that may account for this discrepancy may include overall expectations of computer systems as well as different rates of adaptation to use of the system. PMID:11825244

  7. Team Development Curriculum. Family Nurse Practitioner/Physician Assistant Program.

    ERIC Educational Resources Information Center

    Dostal, Lori

    A curriculum consisting of four modules is presented to help nurse practitioners, physician assistants, and physicians develop team practices and improve and increase the utilization of nurse practitioners and physician assistants in primary care settings. The curriculum was prepared in 1981-1982 by the California Area Health Education Center…

  8. Team Development Manual. Family Nurse Practitioner/Physician Assistant Program.

    ERIC Educational Resources Information Center

    Dostal, Lori

    A manual is presented to help incorporate team development into training programs for nurse practitioners, physician assistants, and primary care physicians. It is also directed to practitioners who wish to improve teamwork and is designed to improve the utilization of the nurse practitioners and physician assistants. A group of one or more…

  9. Death by request in The Netherlands: facts, the legal context and effects on physicians, patients and families

    PubMed Central

    2010-01-01

    In this article I intend to describe an issue of the Dutch euthanasia practice that is not common knowledge. After some general introductory descriptions, by way of formulating a frame of reference, I shall describe the effects of this practice on patients, physicians and families, followed by a more philosophical reflection on the significance of these effects for the assessment of the authenticity of a request and the nature of unbearable suffering, two key concepts in the procedure towards euthanasia or physician-assisted suicide. This article does not focus on the arguments for or against euthanasia and the ethical justification of physician-assisted dying. These arguments have been described extensively in Kimsma and Van Leeuwen (Asking to die. Inside the Dutch debate about euthanasia, Kluwer Academic Publishers, Dordrecht, 1998). PMID:20668949

  10. Procedures in ambulatory care. Which family physicians do what in southwestern Ontario?

    PubMed Central

    Wetmore, S. J.; Agbayani, R.; Bass, M. J.

    1998-01-01

    OBJECTIVE: To determine how often family physicians perform 12 ambulatory care procedures and factors associated with procedure performance. DESIGN: Mailed, self-administered survey. The survey was conducted according to the Dillman Total Design method. SETTING: Family physicians' offices in London, Ont, and in surrounding communities. PARTICIPANTS: A total of 395 family physicians practising within the London area were mailed surveys, 237 in London and 158 outside London. Response rates were 80.6% and 75.9%, respectively. Nonresponders did not differ significantly from responders in sex but included more solo practitioners. MAIN OUTCOME MEASURES: Performance of ambulatory care procedures, sex, and practice characteristics of participant family physicians. RESULTS: For all responders, activities significantly associated with procedure performance were delivering babies, managing psychological problems, working emergency, and teaching. Mean total procedure scores ranged from 6.55 for managing psychological problems to 7.68 for working emergency. Sex-specific analysis showed that practice location and years in practice were significant factors for female but not for male family physicians. Mean total procedure scores for female physicians were 7.06 (outside London) and 4.74 (in London). CONCLUSIONS: Factors associated with procedure performance for family physicians in and around London included delivering babies, working in emergency, managing psychological problems, and teaching. Practice location was a significant factor for only female family physicians; those practising outside London performed procedures more than their urban counterparts and at similar rates to male physicians. PMID:9559192

  11. Caring for adult survivors of child sexual abuse. Issues for family physicians.

    PubMed

    Bala, M

    1994-05-01

    Traditional medical education has not taught physicians about the long-term effects of child sexual abuse. Family physicians often feel poorly equipped to appreciate the effect of such a childhood history on current health or to recognize and treat survivors. This article links the experience of the sexually abused child to long-term effects and outlines the role of family physicians in screening and caring for survivors.

  12. Learning behaviour and preferences of family medicine residents under a flexible academic curriculum

    PubMed Central

    Sy, Alice; Wong, Eric; Boisvert, Leslie

    2014-01-01

    Abstract Objective To determine family medicine residents’ learning behaviour and preferences outside of clinical settings in order to help guide the development of an effective academic program that can maximize their learning. Design Retrospective descriptive analysis of academic learning logs submitted by residents as part of their academic training requirements between 2008 and 2011. Setting London, Ont. Participants All family medicine residents at Western University who had completed their academic program requirements (N = 72) by submitting 300 or more credits (1 credit = 1 hour). Main outcome measures Amount of time spent on various learning modalities, location where the learning took place, resources used for self-study, and the objective of the learning activity. Results A total of 72 residents completed their academic requirements during the study period and logged a total of 25 068 hours of academic learning. Residents chose to spend most of their academic time engaging in self-study (44%), attending staff physicians’ teaching sessions (20%), and participating in conferences, courses, or workshops (12%) and in postgraduate medical education sessions (12%). Textbooks (26%), medical journals (20%), and point-of-care resources (12%) were the 3 most common resources used for self-study. The hospital (32%), residents’ homes (32%), and family medicine clinics (14%) were the most frequently cited locations where academic learning occurred. While all physicians used a variety of educational activities, most residents (67%) chose self-study as their primary method of learning. The topic for academic learning appeared to have some influence on the learning modalities used by residents. Conclusion Residents used a variety of learning modalities and chose self-study over other more traditional modalities (eg, lectures) for most of their academic learning. A successful academic program must take into account residents’ various learning preferences and

  13. Time-motion analysis of emergency radiologists and emergency physicians at an urban academic medical center.

    PubMed

    Perry, Warren M; Lee, Christoph I; Steers, W Neil; Post, Lori A; Forman, Howard P

    2013-10-01

    Our objective was to characterize the tasks of emergency radiologists and emergency physicians and quantify the proportion of time spent on these tasks to assess their roles in patient evaluation. Our study involved emergency radiologists and emergency physicians at an urban academic level I trauma medical center. Participants were observed for continuous 2-h periods during which all of their activities were timed and categorized into the following tasks: patient history, patient physical findings, assessment/plan, procedures, technical/administration, paperwork, and personal time. We performed multivariate analyses to compare the proportion of time spent on task categories between specialties. Twenty physicians (10 emergency medicine and 10 radiology) were observed for a total of 146,802 s (2,446.7 min). Radiologists spent a significantly larger combined proportion of time on determining physical findings and paperwork than emergency physicians (61.9 vs. 28.3 %, p<0.0001). Emergency physicians spent a significantly larger proportion of time than radiologists on determining patient history (17.5 vs. 2.5 %, p=0.0008) and assessment/plan (42.3 vs. 19.3 %, p<0.0001). Both specialties devoted minimal time toward personal tasks. Radiologists play a major role in the diagnostic evaluation of a subset of acute patients, spending significantly more of their time determining physical findings than their emergency physician counterparts.

  14. Managing Diabetes Mellitus: A Survey of Attitudes and Practices Among Family Physicians.

    PubMed

    Fogelman, Yacov; Goldfracht, Margalit; Karkabi, Khaled

    2015-10-01

    Due to the increasing prevalence of diabetes and the shortage of endocrinologists, family physicians have an important role in diabetes management. The purpose of this study was to examine the sources of knowledge, attitudes and practices of family physicians regarding the management of type 2 diabetes. Attendees at continuous medical education (CME) programs in Israel were requested to respond anonymously to written questions about their sources of knowledge about diabetes, the methods of diabetes management they advise their patients, their knowledge of diabetes medication treatments, and their attitudes toward people with type 2 diabetes. Questionnaires were completed by 362 family physicians (79% response rate). Of them, 329 (91%) reported that they usually manage their patients' diabetes care, including that of patients with concomitant risk factors. Their most common recommendations for diabetes control were: to increase physical activity, decrease total calorie intake, consult with a dietitian and undergo weight loss counseling. Almost all physicians (97%) reported providing lifestyle change counseling. Sixty percent reported lacking knowledge about nutritional issues. Only 58% answered correctly regarding the effect of the anti-diabetic drug, GLP1 analog. Board certified family physicians and their residents exhibited more knowledge about diabetes practice than did non-board certified family physicians. The great majority of family physicians surveyed usually manage their patients' diabetes themselves, and do not refer them to diabetes specialists. The implementation of strategies that will enhance the competencies and confidence of family physicians in diabetes management are important for achieving successful treatment.

  15. Situational Analysis of Human Resources in Family Physician Program: Survey from Iran

    PubMed Central

    Kalhor, Rohollah; Azmal, Mohammad; Kiaei, Mohammad Zakaria; Eslamian, Maryam; Tabatabaee, Seyed Saeed; Jafari, Mehdi

    2014-01-01

    Introduction: Family physician is the increasing efforts to promote physician and other human resources in the health care systems. Goal: Investigate Human resources situation of the family physician program in six pilot cities in Khuzestan province in the southwest of Iran. Methods: A cross-sectional descriptive study was conducted to examine the family physician program in 2011. In this study, 15 healthcare teams in six pilot cities in Iran were assessed. Data was compiled from family physician officer document in vice treatment of Ahwaz University of medical sciences. National instructions of family physician was used to identify current gaps. Results: The survey findings indicated that there is a doctor’s shortage about 36% in the health team that deployed in the first level of referral system. Also on the team, the 34% shortage of nurses and 60% shortages of nutrition personnel are seen. Specialists with offices in cities of second referral level, there have not welcomed the program. Conclusions: It seems that to facilitate patient access to physicians under contract with family physician program and the referral system in level two and level three, adopting arrangements to attract specialists and improving their maintenance is necessary. PMID:25126016

  16. Moving towards an electronic patient record: a survey to assess the needs of community family physicians.

    PubMed Central

    Strasberg, H. R.; Tudiver, F.; Holbrook, A. M.; Geiger, G.; Keshavjee, K. K.; Troyan, S.

    1998-01-01

    OBJECTIVE: To determine the needs of community family physicians regarding electronic patient records (EPRs). DESIGN: A comprehensive survey was sent to 101 community family physicians in Hamilton, Ontario, who had expressed an interest in EPRs. RESULTS: 46 physicians responded (46%). 87% felt that an EPR would result in their providing better patient care. A wide variety of items were deemed to be important to be included on the EPR "front page". Desired functionality emphasized labs, medications, consultation, hospital follow-up and health maintenance. Family physicians tended to prefer templates to other data entry methods such as typing and dictating. Respondents were more willing to view information from the hospital than to let the hospital view information from their own offices. CONCLUSION: This survey provided useful information on the perceived EPR needs of community-based family physicians. It will be repeated post-computerization. PMID:9929216

  17. The role of family of origin in physicians referred to a CME course.

    PubMed

    Samenow, Charles P; Yabiku, Scott T; Ghulyan, Marine; Williams, Betsy; Swiggart, William

    2012-06-01

    Few studies exist which look at psychological factors associated with physician sexual misconduct. In this study, we explore family dysfunction as a possible risk factor associated with physician sexual misconduct. Six hundred thirteen physicians referred to a continuing medical education (CME) course for sexual misconduct were administered the FACES-II survey, a validated and reliable measure of family dynamics. The survey was part of a self-learning activity. We collected data from February 2000 to February 2009. Participants were predominantly white, middle-aged males who represented the full range of medical specialties. Their results were compared against a sample of 177 physicians. The FACES-II is a self-report test that measures family of origin (the family in which one was raised) dynamics on two dimensions (1) flexibility, ranging from too flexible (chaotic) to not flexible enough (rigid) and (2) cohesion ranging from too close (enmeshed) to not close enough (disengaged). The most common family pattern observed among physicians accused of sexual misconduct was rigid flexibility paired with disengaged cohesion, indicative of unhealthy family functioning. This pattern was significantly different than the pattern observed in the comparison group. Physicians who engage in sexual misconduct are more likely to have family of origin dysfunction. Ethics is developmental and learned in one's family of origin. Family of origin dynamics may be one risk factor predisposing one to ethical violations. These findings have important implications for screening, education, and treatment across the medical education continuum.

  18. Employed Family Physician Satisfaction and Commitment to Their Practice, Work Group, and Health Care Organization

    PubMed Central

    Karsh, Ben-Tzion; Beasley, John W; Brown, Roger L

    2010-01-01

    Objective Test a model of family physician job satisfaction and commitment. Data Sources/Study Setting Data were collected from 1,482 family physicians in a Midwest state during 2000–2001. The sampling frame came from the membership listing of the state's family physician association, and the analyzed dataset included family physicians employed by large multispecialty group practices. Study Design and Data Collection A cross-sectional survey was used to collect data about physician working conditions, job satisfaction, commitment, and demographic variables. Principal Findings The response rate was 47 percent. Different variables predicted the different measures of satisfaction and commitment. Satisfaction with one's health care organization (HCO) was most strongly predicted by the degree to which physicians perceived that management valued and recognized them and by the extent to which physicians perceived the organization's goals to be compatible with their own. Satisfaction with one's workgroup was most strongly predicted by the social relationship with members of the workgroup; satisfaction with one's practice was most strongly predicted by relationships with patients. Commitment to one's workgroup was predicted by relationships with one's workgroup. Commitment to one's HCO was predicted by relationships with management of the HCO. Conclusions Social relationships are stronger predictors of employed family physician satisfaction and commitment than staff support, job control, income, or time pressure. PMID:20070386

  19. An assessment of practice support and continuing medical education needs of rural Pennsylvania family physicians.

    PubMed

    Forti, E M; Martin, K E; Jones, R L; Herman, J M

    1996-01-01

    Family physicians provide the greatest proportion of care in rural communities. Yet, the number of physicians choosing family practice and rural practice has continued to decline. Undesirable aspects of rural practice, such as professional isolation and a lack of or inadequate resources, are assumed to be associated with this decline. This article reports on the practice support and continuing medical education needs of rural family physicians. A mail survey was conducted in 1993 on a purposive sample of family physicians in 39 of 67 rural-designated or urban Pennsylvania counties with low population densities. The physicians identified needs that included patient education materials and programs, community health promotion, federal regulation updates, technical assistance with computers and business management, database software and a videotape lending library, a drug hotline, and mini-fellowships on clinical skill development. A majority of respondents were willing to participate in clinical educational experiences for students and residents. Some physicians indicated a lack of interest in access to information through telecommunications, e.g., video conference referrals and consultations. Overall, findings revealed that family physicians need and are receptive to a variety of practice support and continuing education programs. A practice support program coupled with policy coordination among public and private organizations is likely to lessen complaints by rural primary care physicians.

  20. How the Medical Culture Contributes to Coworker-Perpetrated Harassment and Abuse of Family Physicians

    PubMed Central

    Miedema, Baukje; MacIntyre, Leslie; Tatemichi, Sue; Lambert-Lanning, Anita; Lemire, Francine; Manca, Donna; Ramsden, Vivian

    2012-01-01

    PURPOSE Harassment and abuse in the workplace of family physicians has been associated with higher levels of stress, increased consumption of alcohol, and higher risk for developing mental health problems. Few studies have examined issues contributing to abusive encounters in the workplace of family physicians. METHODS For the overall study we used a mixed methods design, which included a cross-sectional survey of a randomly selected sample of active family physicians from the database of the College of Family Physicians of Canada and telephone interviews with those who reported experiencing work related harassment and abuse in the last year. The data presented here arise from the qualitative interviews of the study, which were analyzed thematically. RESULTS The interview arm of the study included 23 female and 14 male participants. The major themes that emerged from the study were (1) modeling of abusive behaviors, (2) status hierarchy among various medical disciplines, (3) shortage of physicians, and (4) lack of transparent policies and follow-up procedures after abusive encounters. The results are discussed using the broken window theory. CONCLUSION Many family physicians experience harassing and abusive encounters during their training or in the workplace. The current medical culture appears to contribute to harassment and abuse in the workplace of family physicians in Canada. We described the components that intentionally or unintentionally facilitate abusive behavior in the medical culture. PMID:22412002

  1. Academic Achievements of Children in Immigrant Families

    ERIC Educational Resources Information Center

    Han, Wen-Jui

    2006-01-01

    Utilizing data on approximately 16,000 children from the Early Childhood Longitudinal Survey-Kindergarten Cohort and a rich set of mediating factors on 16 immigrant groups, this paper examined the associations between children's immigrant generation status and their academic performance. The changes in academic achievements during kindergarten and…

  2. Work-Family Balance and Academic Advancement in Medical Schools

    ERIC Educational Resources Information Center

    Fox, Geri; Schwartz, Alan; Hart, Katherine M.

    2006-01-01

    Objective: This study examines various options that a faculty member might exercise to achieve work-family balance in academic medicine and their consequences for academic advancement. Method: Three data sets were analyzed: an anonymous web-administered survey of part-time tenure track-eligible University of Illinois College of Medicine (UI-COM)…

  3. Divorce, Family Structure, and the Academic Success of Children.

    ERIC Educational Resources Information Center

    Jeynes, William

    The goal of this book is to examine the relationship between parental family structure, especially parental divorce and/or remarriage, and the academic achievement of children. Much has been written about the need to raise the academic achievement of students from minority backgrounds. However, minority is often defined in terms of skin color and…

  4. The Internet and Academics' Workload and Work-Family Balance

    ERIC Educational Resources Information Center

    Heijstra, Thamar M.; Rafnsdottir, Gudbjorg Linda

    2010-01-01

    The aim of this article is to analyse whether the Internet and other ICT technologies support a work-family balance amongst academics. The study is based on 20 in-depth interviews with academics in Iceland and analysed according to the Grounded Theory Approach. This study challenges the notion that the Internet, as part of ICT technology, makes it…

  5. A Critical Look at the Family Physician's Role in Preventing Childhood Injuries

    PubMed Central

    Rosser, W.; Feldman, W.; McGrath, P.

    1987-01-01

    Childhood injuries stand as the most common causes of death among Canadian children. Physician advice and advocacy of appropriate legislation, parent education and legislative action could reduce this toll. There is a role for family physicians in the important process of providing a safer environment for our children. PMID:21263865

  6. Short-Term Educational Intervention Improves Family Physicians' Knowledge of Depression

    ERIC Educational Resources Information Center

    Kutcher, Stanley; Lauria-Horner, Bianca; MacLaren, Connie; Bujas-Bobanovic, Maja; Karlovic, Zlatko

    2003-01-01

    Introduction: Depression is frequently unrecognized and undertreated. Therefore, there is a need to increase the knowledge and skills of primary care physicians regarding management of depression. The aim of this study was to determine if a brief educational intervention can affect family physicians' knowledge of the diagnosis and treatment of…

  7. Medical abortion and family physicians. Survey of residents and practitioners in two Ontario settings.

    PubMed Central

    Raymond, Elin; Kaczorowski, Janusz; Smith, Pat; Sellors, John; Walsh, Allyn

    2002-01-01

    OBJECTIVE: To determine the knowledge, attitudes, and interest in providing medical abortion reported by family physicians and residents in rural and urban settings. DESIGN: A self-administered mailed survey using the modified Dillman method. SETTING: Hamilton and Thunder Bay County in Ontario. PARTICIPANTS: Family medicine residents (n = 93) and physicians (n = 234) in predominantly urban (Hamilton) and rural (Thunder Bay) settings. All faculty family physicians at McMaster University practising general family medicine and all family physicians in Thunder Bay County were surveyed. MAIN OUTCOME MEASURES: Knowledge of, attitudes toward, and interest in providing medical abortion. RESULTS: Overall response rate to the survey was 62.7% (n = 327); 74.2% (69/93) of residents responded; 58.1% (136/234) of physicians responded. Physicians and residents rated their knowledge about medical abortion as poor, but most were interested in receiving more information and training in this area. Many (83.1%, 157/189) reported that medical abortion was an acceptable procedure for family physicians to perform, and 52.0% (64/123) of the physicians would consider providing medical abortions for their patients. Residents training in the more rural Thunder Bay program were less likely to support first-trimester abortions for both medical and nonmedical reasons than those training in Hamilton (P < .05). Male respondents were significantly less supportive of abortion for nonmedical reasons and were less likely to consider providing medical abortions for their patients (P < .05). CONCLUSION: Most family physicians and residents showed interest in receiving more information about and training in medical abortion. PMID:11935718

  8. Indochinese Refugee Families and Academic Achievement.

    ERIC Educational Resources Information Center

    Caplan, Nathan; And Others

    1992-01-01

    The children of the Southeast Asian boat people excel in the U.S. school system. A review of the factors underlying this achievement suggests that the U.S. educational crisis is more social than academic. (KR)

  9. Irritable bowel syndrome. Strategy for the family physician.

    PubMed Central

    Thompson, W. G.

    1994-01-01

    Irritable bowel syndrome is one of the most common reasons for disability and health care seeking. A sensible strategy for management incorporates a confident diagnosis based upon history, physical examination, and pertinent tests. The physician can then reassure the patient, offer dietary and stress management advice, and recommend bran to relieve constipation and to evoke the placebo response. Patients who do not respond could require supportive psychotherapy or a drug for the dominant symptom. A few require careful referral, but overall responsibility should remain with the primary physician. Images Figures 1-2 PMID:8130678

  10. Perceptions of the first family physicians to adopt advanced access in the province of Quebec, Canada.

    PubMed

    Breton, Mylaine; Maillet, Lara; Paré, Isabelle; Abou Malham, Sabina; Touati, Nassera

    2016-09-08

    In Quebec, several primary care physicians have made the transition to the advanced access model to address the crisis of limited access to primary care. The objectives are to describe the implementation of the advanced access model, as perceived by the first family physicians; to analyze the factors influencing the implementation of its principles; and to document the physicians' perceptions of its effects on their practice, colleagues and patients. Qualitative methods were used to explore, through semi-structured interviews, the experiences of 21 family physicians who had made the transition to advanced access. Of the 21 physicians, 16 succeeded in adopting all five advanced access principles to varying degrees. Core implementation issues revolved around the dynamics of collaboration between physicians, nurses and other colleagues. Secretaries' functions, in particular, had to be expanded. Facilitating factors were mainly related to the physicians' leadership and the professional resources available in the organizations. Impediments related to resource availability and team functioning were also encountered. This is the first exploratory study to examine the factors influencing the adoption of the advanced access model conducted with early-adopter family physicians. The lessons drawn will inform discussions on scaling up to other settings experiencing the same problems. Copyright © 2016 John Wiley & Sons, Ltd.

  11. The Foreigner Talk of a Family Physician: An Observational Study.

    ERIC Educational Resources Information Center

    Nelson, Dana Kristine

    A study analyzed the characteristics of one male physician's foreigner talk over the telephone with non-native speakers (NNSs) of English and compared it to that of native speakers (NSs). The conversations all related to requests that patients come into the office for a periodic, preventative physical exam. Data came from tape recordings of the…

  12. The future role of the family physician in the United States: a rigorous exercise in definition.

    PubMed

    Phillips, Robert L; Brundgardt, Stacy; Lesko, Sarah E; Kittle, Nathan; Marker, Jason E; Tuggy, Michael L; Lefevre, Michael L; Borkan, Jeffrey M; Degruy, Frank V; Loomis, Glenn A; Krug, Nathan

    2014-01-01

    As the U.S. health care delivery system undergoes rapid transformation, there is an urgent need to define a comprehensive, evidence-based role for the family physician. A Role Definition Group made up of members of seven family medicine organizations developed a statement defining the family physician's role in meeting the needs of individuals, the health care system, and the country. The Role Definition Group surveyed more than 50 years of foundational manuscripts including published works from the Future of Family Medicine project and Keystone III conference, external reviews, and a recent Accreditation Council on Graduate Medical Education Family Medicine Milestones definition. They developed candidate definitions and a "foil" definition of what family medicine could become without change. The following definition was selected: "Family physicians are personal doctors for people of all ages and health conditions. They are a reliable first contact for health concerns and directly address most health care needs. Through enduring partnerships, family physicians help patients prevent, understand, and manage illness, navigate the health system and set health goals. Family physicians and their staff adapt their care to the unique needs of their patients and communities. They use data to monitor and manage their patient population, and use best science to prioritize services most likely to benefit health. They are ideal leaders of health care systems and partners for public health." This definition will guide the second Future of Family Medicine project and provide direction as family physicians, academicians, clinical networks, and policy-makers negotiate roles in the evolving health system.

  13. Adoption of Liquid-Based Cervical Cancer Screening Tests by Family Physicians and Gynecologists

    PubMed Central

    Rappaport, Karen M; Forrest, Christopher B; Holtzman, Neil A

    2004-01-01

    Objective To examine reasons for the adoption of liquid-based cervical cancer screening tests. Data Sources/Study Setting A mailed survey of 250 family physicians and 250 gynecologists in Maryland in 2000. Additional data were obtained from the AMA Master File of Physicians. Study Design Key outcome variables in this cross-sectional survey were early adoption of a liquid-based test by the end of 1997 and overall adoption by the time of the survey. Adoption was viewed in terms of a supply and demand theoretical framework with marketing influencing physician and patient demand as well as supply by insurance companies and laboratories. Data Collection Random samples of family physicians and gynecologists were selected from the AMA Master File of Physicians. The overall response rate was 61.9 percent. Principal Findings By 2000, 96 percent of gynecologists and 75 percent of family physicians in Maryland were using liquid-based cervical cancer screening tests, most commonly the ThinPrep® Pap Test™. Gynecologists were more likely than family physicians to have been early adopters (34 percent versus 5 percent, p<.01). Part of this variation in adoption was due to aggressive marketing to gynecologists, who were more likely than family physicians to receive information in the mail from the test manufacturer (89 percent versus 56 percent, p<.01) and to have been informed by the manufacturer that a patient had inquired about physicians' use of the test (22 percent versus 8 percent, p<.01). Conclusions The rapid diffusion of liquid-based cervical cancer screening tests occurred despite general agreement that the Pap smear has been one of the most successful cancer prevention interventions ever. Commercial marketing campaigns appear to contribute to the more rapid rate of diffusion of technology among specialists compared with generalists. PMID:15230935

  14. Oncologists and family physicians. Using a standardized letter to improve communication.

    PubMed Central

    Braun, Ted C.; Hagen, Neil A.; Smith, Colum; Summers, Nancy

    2003-01-01

    PROBLEM BEING ADDRESSED: Communication between oncologists at a regional cancer centre and family physicians caring for palliative cancer patients in the community was ineffective. OBJECTIVE OF PROGRAM: To improve communication between oncologists and family physicians by routine use of a template for dictated letters concerning follow-up care. PROGRAM DESCRIPTION: A consultation letter template was constructed and tested at a single clinic. The template was designed to guide oncologists dictating letters to family physicians for patients' follow-up visits. Effectiveness of the standardized letter was evaluated with a before-after survey. CONCLUSION: Using the template letter improved communication with respect to the relevance, timeliness, format, and amount of information. As care for patients at the end of life increasingly shifts to the community, ongoing efforts are required to improve communication between cancer centres and primary care physicians. PMID:12901484

  15. Genealogy and Family History in the Academic Library.

    ERIC Educational Resources Information Center

    Null, David G.

    1985-01-01

    Addresses public and scholarly interest in the fields of family history and genealogy. Highlights include attitudes before and after publication of Alex Haley's "Roots," library literature on genealogy, history of the family as a field of study, and academic library collection development and services. Twenty-five references are provided. (EJS)

  16. Family Religious Involvement, Parenting Practices and Academic Performance in Adolescents

    ERIC Educational Resources Information Center

    Park, Hae Seong; Bonner, Patricia

    2008-01-01

    This project investigated the impacts of family religious involvement and family religious affiliations on parenting practices and academic performance. This study utilized data from the base-year and first follow-up of the Education Longitudinal Study: 2002/2004 (ELS). A series of statistical techniques were incorporated to examine the nature of…

  17. Family Structure and Academic Skills among Finnish Adolescents

    ERIC Educational Resources Information Center

    Bjorn, Piia Maria; Kyttala, Minna

    2011-01-01

    This study investigated whether family structure accounts for adolescent academic performance in Finland in the analysis. The thirteen- to fourteen-year-old (grade 8) students' (N = 171) literacy skills were measured and their mathematical performance was tested. Information about family structure was gathered via a questionnaire sent to their…

  18. Using Conjoint Analysis to Elicit GPs’ Preferences for Family Physician Contracts: A Case Study in Iran

    PubMed Central

    Ranjbar Ezatabadi, Mohammad; Rashidian, Arash; Shariati, Mohammad; Rahimi Foroushani, Abbas; Akbari Sari, Ali

    2016-01-01

    Background Family physician plans in Iran face several challenges, one of which is developing attractive and efficient contracts that motivate physicians to participate in the plan. Objectives This study aimed to elicit GPs’ preferences for family physician contracts. Patients and Methods In a cross-sectional study using the conjoint analysis technique, 580 GPs selected from the family physician database in Iran in 2014. Through qualitative and quantitative methods, 18 contract scenarios were developed via orthogonal design i.e., the impact of each attribute is measured independently from changes in other attributes and a questionnaire was developed. Data were collected through this questionnaire and analyzed using the ordered logistic regression (OLR) model. Results The results show that “quotas for admission to specialized courses” is the strongest preference of GPs (β = 1.123). In order of importance, the other preferences are having the right to provide services outside of the specified package (β = 0.962), increased number of covered population (β = 0.814), capitation payment + 15% bonus (β = 0.644), increased catchment area to 5 km (β = 0.349), and increased length of contract to five years (β = 0.345). Conclusions The conjoint analysis results show that GPs concerned about various factors of family physician contracts. These results can be helpful for policy-makers as they complete the process of creating family physician plans, which can help increase the motivation of GPs to participate in the plan. PMID:28191339

  19. Family physicians clinical aptitude for the nutritional management of type 2 diabetes mellitus in Guadalajara, Mexico.

    PubMed

    Cabrera Pivaral, C E; Gutiérrez Roman, E A; Gonzalez Pérez, G; Gonzalez Reyes, F; Valadez Toscano, F; Gutiérrez Ruvalcaba, C; Rios Riebeling, C D

    2008-02-01

    There are 180,000 new Diabetes Mellitus cases in Mexico each year (1). This chronic, complex and multifactor disease requires an adequate nutritional management plan to be prescribed by family physicians. They should be trained to identify the potential difficulties in the patient's dietary schedule and orientate their management from an integrative point of view. The purpose of this study was to detect and measure family physician's clinical aptitudes for the nutritional management of Type 2 diabetes, in a representative family physician's sample from five Family Medicine Units of the Mexican Institute of Social Security in Guadalajara, Jalisco, Mexico. A structured and validated instrument was applied to 117 physicians from a total of 450 in Guadalajara, Jalisco. The main study variable was clinical aptitude for nutritional management of Type 2 diabetes. Aptitude levels were defined by an ordinal scale and related to the other variables using the median, Mann-Whitney's U test and Kruskal Wallis (KW) test. Global results showed a median of 30 points that relates to a low and a very low aptitude level for the 72% of physicians without statistical significance (KW: p>0.05) with the rest of variables. These results reflect family physician's difficulties to orientate the nutritional management of Type 2 diabetes, as well as the lack of work environments that facilitate case reflection and formative educational strategies.

  20. Noise-induced hearing loss: the family physician's role

    SciTech Connect

    Dobie, R.A.

    1987-12-01

    Noise is an environmental health problem that has not received sufficient attention. Physicians should become knowledgeable about the medical consequences of excessive noise, support legislation to reduce the problem and promote programs aimed at noise control and prevention of hearing loss. Questions about noise and hearing should be incorporated into the medical history, and pure-tone audiometry should be a part of periodic physical evaluations.

  1. Effect of communication style and physician-family relationships on satisfaction with pediatric chronic disease care.

    PubMed

    Swedlund, Matthew P; Schumacher, Jayna B; Young, Henry N; Cox, Elizabeth D

    2012-01-01

    Over 8% of children have a chronic disease and many are unable to adhere to treatment. Satisfaction with chronic disease care can impact adherence. We examine how visit satisfaction is associated with physician communication style and ongoing physician-family relationships. We collected surveys and visit videos for 75 children ages 9-16 years visiting for asthma, diabetes, or sickle cell disease management. Raters assessed physician communication style (friendliness, interest, responsiveness, and dominance) from visit videos. Quality of the ongoing relationship was measured with four survey items (parent-physician relationship, child-physician relationship, comfort asking questions, and trust in the physician), while a single item assessed satisfaction. Correlations and chi square were used to assess association of satisfaction with communication style or quality of the ongoing relationship. Satisfaction was positively associated with physician to parent (p < 0.05) friendliness. Satisfaction was also associated with the quality of the ongoing parent-physician (p < 0.001) and child-physician relationships (p < 0.05), comfort asking questions (p < 0.001), and trust (p < 0.01). This shows that both the communication style and the quality of the ongoing relationship contribute to pediatric chronic disease visit satisfaction.

  2. More Comprehensive Care Among Family Physicians is Associated with Lower Costs and Fewer Hospitalizations

    PubMed Central

    Bazemore, Andrew; Petterson, Stephen; Peterson, Lars E.; Phillips, Robert L.

    2015-01-01

    PURPOSE Comprehensiveness is lauded as 1 of the 5 core virtues of primary care, but its relationship with outcomes is unclear. We measured associations between variations in comprehensiveness of practice among family physicians and healthcare utilization and costs for their Medicare beneficiaries. METHODS We merged data from 2011 Medicare Part A and B claims files for a complex random sample of family physicians engaged in direct patient care, including 100% of their claimed care of Medicare beneficiaries, with data reported by the same physicians during their participation in Maintenance of Certification for Family Physicians (MC-FP) between the years 2007 and 2011. We created a measure of comprehensiveness from mandatory self-reported survey items as part of MC-FP examination registration. We compared this measure to another derived from Medicare’s Berenson-Eggers Type of Service (BETOS) codes. We then examined the association between the 2 measures of comprehensiveness and hospitalizations, Part B payments, and combined Part A and B payments. RESULTS Our full family physician sample consists of 3,652 physicians providing the plurality of care to 555,165 Medicare beneficiaries. Of these, 1,133 recertified between 2007 and 2011 and cared for 185,044 beneficiaries. There was a modest correlation (0.30) between the BETOS and self-reported comprehensiveness measures. After adjusting for beneficiary and physician characteristics, increasing comprehensiveness was associated with lower total Medicare Part A and B costs and Part B costs alone, but not with hospitalizations; the association with spending was stronger for the BETOS measure than for the self-reported measure; higher BETOS scores significantly reduced the likelihood of a hospitalization. CONCLUSIONS Increasing family physician comprehensiveness of care, especially as measured by claims measures, is associated with decreasing Medicare costs and hospitalizations. Payment and practice policies that enhance

  3. A proposal for the curriculum and evaluation for training rural family physicians in enhanced surgical skills

    PubMed Central

    Caron, Nadine; Iglesias, Stuart; Friesen, Randall; Berjat, Vanessa; Humber, Nancy; Falk, Ryan; Prins, Mark; Haines, Victoria Vogt; Geller, Brian; Janke, Fred; Woollard, Robert; Batchelor, Bret; Van Bussel, Jared

    2015-01-01

    Summary Rural western Canada relies heavily on family physicians with enhanced surgical skills (ESS) for surgical services. The recent decision by the College of Family Physicians of Canada (CFPC) to recognize ESS as a “community of practice” section offers a potential home akin to family practice anesthesia and emergency medicine. To our knowledge, however, a skill set for ESS in Canada has never been described formally. In this paper the Curriculum Committee of the National ESS Working Group proposes a generic curriculum for the training and evaluation of the ESS skill set. PMID:26574835

  4. Academic Growth Trajectories and Family Relationships among African American Youth

    PubMed Central

    Dotterer, Aryn M.; Lowe, Katie; McHale, Susan M.

    2016-01-01

    This study explored trajectories of African American youths’ academic functioning and assessed whether changes in parent-adolescent relationships were associated with changes in youths’ academic functioning. The data were drawn from a three-year longitudinal study of gender socialization and development in two-parent African American families and included 197 families. Findings revealed gender differences in achievement trajectories and indicated that boys not only had lower levels of academic achievement compared to girls, but also experienced steeper declines in school self-esteem during adolescence. Changes in parent-adolescent relationship quality were linked to changes in academic functioning: Increases in conflict were related to decreases in GPA, school bonding, and school self-esteem and increases in warmth were related to increases in school bonding and school self-esteem. PMID:27122959

  5. [GPs' self-perception of their own role compared with hospital, ambulatory, academic, and health organisation physicians].

    PubMed

    Daghio, Maria Monica; Gaglianò, Giuseppe; Bevini, Massimo; Cadioli, Tiziano; Delvecchio, Carlo; Guidetti, Patrizia; Lorenzetti, Manuela; Fattori, Giuseppe; Ciardullo, Anna Vittoria

    2005-05-01

    Aim of the present study was to explore how the 76 general practitioners (GPs) - serving Carpi district (90,000 residents) - value their own role compared with the hospital, ambulatory, academic, and health organisation physicians'. GPs had a positive self-image only in comparison with health organisation doctors (7 vs 7 grades). GPs disappointed with themselves when comparing their role with ambulatory (-1.6 grades), academic (-1.9 grades) and hospital doctors (-2.2 grades). Secondarily, GPs perceived patients' valuing their professional role mostly 'subordinate' to the other physicians', except health organisation colleagues'.

  6. Family Physicians' Satisfaction with Current Practice: What Is the Role of Their Interactions with Specialists?

    PubMed Central

    Thind, Amardeep; Freeman, Tom; Thorpe, Cathy; Burt, Andrea; Stewart, Moira

    2009-01-01

    Provision of high-quality care sometimes necessitates a referral to, and receipt of timely feedback from, specialist physicians. Interaction with specialists is a key role of family physicians, but it has not received significant attention with respect to its impact on family physician satisfaction. The authors conducted a cross-sectional analysis of data gathered from a decennial census of family physicians in southwestern Ontario. The conceptual framework was based on the model developed by the Society of General Internal Medicine (SGIM) Career Satisfaction Work Group. More than two-thirds of respondents were “very satisfied” with their current practice. Stepwise regression analysis based on a generalized linear model showed that greater difficulty in referring patients to specialists was associated with 23% lower odds of being “very satisfied”. Not receiving a timely response from specialists was associated with 26% higher odds of not being “very satisfied.” Marital status, teaching involvement and practice volume were also associated with satisfaction. The findings indicate that the practice of family medicine offers a fulfilling career in today's medical marketplace. However, linkages and feedback between family physicians and specialists need to be augmented. PMID:19377349

  7. Does having regular care by a family physician improve preventive care?

    PubMed Central

    McIsaac, W. J.; Fuller-Thomson, E.; Talbot, Y.

    2001-01-01

    OBJECTIVE: To assess whether regular care from a family physician is associated with receiving preventive services. DESIGN: Secondary analysis of the 1994 National Population Health Survey. SETTING: Cross-sectional sample of the Canadian population. PARTICIPANTS: A total of 15,731 non-institutionalized adults. MAIN OUTCOME MEASURES: Reported visits to general practitioners and specialists in the previous year and reports of having had blood pressure measurements, mammography, and Pap smears. RESULTS: A graded relationship was observed between level of regular care by a family physician in the previous year (none, some, regular) and receiving preventive services. Those without regular doctors and those reporting only some care by a family physician were less likely to have ever had their blood pressure checked than adults receiving ongoing care from a regular family physician. Women reporting some or no care were less likely to have had mammography within 2 years or to have ever had Pap smears. CONCLUSION: Adults who receive regular care from a family physician are more likely to receive recommended preventive services. PMID:11212436

  8. Are family physicians the answer to ED doctor shortage, or 'blasphemy'?

    PubMed

    2011-01-01

    Some organizations maintain that family physicians have the skills and training necessary to practice in the ED and help combat the current physician shortage, while others maintain their training is inadequate. Here are some issues to take into consideration with such candidates: Have they obtained thorough experience the necessary skills to practice in the ED? Have they received a significant amount of clinical training in an ED? Has their training progress been monitored by a teaching attending?

  9. Collaborative approaches to patient education in the family physician's office.

    PubMed

    Hankey, T L; Elandt, N J

    1988-12-01

    The collaboration of a doctor and nurse in a solo family practice provides a model for implementation of various modalities of patient education. This requires an integrated approach in which patient education becomes part of the routine visit. The impediments and advantages of solo family practice with respect to delivering patient education are discussed. The importance of continuity of care is emphasized. Fifteen "practical tips" for successful patient education in this setting are offered so that they may be reproduced elsewhere.

  10. [Zurich physician-pharmacist family Lavater and Johann Wolfgang von Goethe].

    PubMed

    Mannetstätter, A; Friedrich, C

    1998-01-01

    The aim of this paper is to demonstrate the connections between Johann Wolfgang von Goethe (1749-1832) and the physician and pharmacist family Lavater in Zurich. The analysis of the correspondence between Johann Bartholomäus Trommsdorff (1770-1837) and the Lavater family and between the Lavater family and the government of the duchy of Weimar shows an interesting story about a picture "Goethe in Italy".

  11. Continuing educational needs in computers and informatics. McGill survey of family physicians.

    PubMed Central

    McClaran, J.; Snell, L.; Duarte-Franco, E.

    2000-01-01

    OBJECTIVE: To describe family physicians' perceived educational needs in computers and informatics. DESIGN: Mailed survey. SETTING: General or family practices in Canada. PARTICIPANTS: Physicians (489 responded to a mailing sent to 2,500 physicians) who might attend sessions at the McGill Centre for CME. Two duplicate questionnaires were excluded from the analysis. METHOD: Four domains were addressed: practice profile, clinical CME needs, professional CME needs, and preferred learning formats. Data were entered on dBASE IV; analyses were performed on SPSS. MAIN FINDINGS: In the 487 questionnaires retained for analysis, "informatics and computers" was mentioned more than any other clinical diagnostic area, any other professional area, and all but three patient groups and service areas as a topic where improvement in knowledge and skills was needed in the coming year. Most physicians had no access to computer support for practice (62.6%); physicians caring for neonates, toddlers, or hospital inpatients were more likely to report some type of computer support. CONCLUSIONS: Family physicians selected knowledge and skills for computers and informatics as an area for improvement in the coming year more frequently than they selected most traditional clinical CME topics. This educational need is particularly great in small towns and in settings where some computerized hospital data are already available. PMID:10790816

  12. Satisfaction and Dissatisfaction Toward Urban Family Physician Program: A Population Based Study in Shiraz, Southern Iran

    PubMed Central

    Honarvar, Behnam; Lankarani, Kamran Bagheri; Ghahramani, Sulmaz; Akbari, Maryam; Tabrizi, Reza; Bagheri, Zahra; Poostforoushfard, Sima

    2016-01-01

    Background: A national project of extending a family physician program to urban areas has been started since May 2013 in Iran. The present study aimed to detect correlates of people's satisfaction and dissatisfaction about urban family physician program. Methods: This cross-sectional and population-based study was conducted in Shiraz, Southern Iran. Multistage and proportional to size random sampling were used. Different items about satisfaction and dissatisfaction toward urban family physician program were queried. Single variable and then multiple variable analyses of data were done using SPSS software (Chicago, IL. USA). Results: Mean age of 1257 participants in the study was 38.1 ± 13.2 years. Respondents included men (634; 50.4%), married (882; 70.2%), those who were educated at universities (529; 42%) and self-employed groups (405; 32.2%). One thousand fifty-eight (84.1%) were covered by the family physician program. Mean of referral times to a family physician was 2.2 ± 2.9 during the year before the study. Satisfaction toward urban family physician program was high in 198 (15.8%), moderate in 394 (31.3%), and low in 391 (31.1%). Dissatisfaction about this program was more among younger than 51-year-old groups (for 31–50 years odds ratio [OR] =2.3, 95% confidence interval [CI] =1.4–3.7, P < 0.001 and for 18–30 years OR = 2, 95% CI = 1.2–3.4, P = 0.005), less knowledgeable ones (OR = 2.2, 95% CI = 1.3–3.6, P = 0.001), singles (OR = 2.1, 95% CI = 1.2–3.4, P = 0.003), and those with more than 4 of family members (OR = 1.3, 95% CI = 1–1.7, P = 0.05). Conclusions: Overall, the majority of the people are not very satisfied with the urban family physician program. This shows the need for a multi-disciplinary approach including training, improvement of infrastructures and referral system, continuous supervision, and frequent monitoring of user's and provider's feedback about this program. According the results, the family physician program should be

  13. How are family physicians managing osteoporosis? Qualitative study of their experiences and educational needs.

    PubMed Central

    Jaglal, Susan B.; Carroll, June; Hawker, Gillian; McIsaac, Warren J.; Jaakkimainen, Liisa; Cadarette, Suzanne M.; Cameron, Cathy; Davis, Dave

    2003-01-01

    OBJECTIVE: To explore family physicians' experiences and perceptions of osteoporosis and to identify their educational needs in this area. DESIGN: Qualitative study using focus groups. SETTING: Four Ontario sites: one each in Thunder Bay and Timmins, and two in Toronto, chosen to represent a range of practice sizes, populations, locations, and use of bone densitometry. PARTICIPANTS: Thirty-two FPs participated in four focus groups. Physicians were identified by investigators or local contacts to provide maximum variation sampling. METHOD: Focus groups using a semistructured interview guide were audiotaped and transcribed. The constant comparative method of data analysis was used to identify key words and concepts until saturation of themes was reached. MAIN FINDINGS: Family physicians order bone densitometry and try to manage osteoporosis appropriately, but lack a rationale for testing and are confused about management. Participants' main concern was clinical management, followed by disease prevention and their educational needs. CONCLUSION: Family physicians are confused about how to manage osteoporosis. To reduce the burden of illness due to osteoporosis, educational interventions should be tailored to family physicians' needs. PMID:12729242

  14. Assisting Undergraduate Physician Assistant Training in Psychiatry: The Role of Academic Psychiatry Departments.

    PubMed

    Rakofsky, Jeffrey J; Ferguson, Britnay A

    2015-12-01

    Physician assistants (PAs) are medical professionals who practice medicine with the supervision of a physician through delegated autonomy. PA school accreditation standards provide limited guidance for training PAs in psychiatry. As a result, PA students may receive inconsistent and possibly inadequate exposure to psychiatry. Providing broad and in-depth exposure to the field of psychiatry is important to attract PA students to pursue careers in psychiatry and provide a possible solution to the shortage of psychiatrists nationwide. Additionally, this level of exposure will prepare PA students who pursue careers in other fields of medicine to recognize and address their patient's psychiatric symptoms in an appropriate manner. This training can be provided by an academic department of psychiatry invested in the education of PA students. We describe a training model implemented at our university that emphasizes psychiatrist involvement in the preclinical year of PA school and full integration of PA students into the medical student psychiatry clerkship during the clinical years. The benefits and challenges to implementing this model are discussed as well.

  15. Impact of an electronic link between the emergency department and family physicians: a randomized controlled trial

    PubMed Central

    Lang, Eddy; Afilalo, Marc; Vandal, Alain C.; Boivin, Jean-François; Xue, Xiaoqing; Colacone, Antoinette; Léger, Ruth; Shrier, Ian; Rosenthal, Stephen

    2006-01-01

    Background Electronic information exchange is believed to improve efficiency and reduce resource utilization. We developed a Web-based standardized communication system (SCS) that enables family physicians to receive detailed reports of their patients' care in the emergency department. We sought to determine the impact of the SCS on measures of resource utilization in the emergency department and family physician offices. Methods We used an open 4-period crossover cluster-randomized controlled design. During 2 separate 10-week intervention phases, family physicians received detailed reports of their patients' emergency department visits over the Internet, and in the alternating control phases they received a 1-page copy of the emergency department notes by mail. The primary outcome was the number of repeat visits to the emergency department within 14 days of the initial visit. Secondary outcomes included duplication of test and specialty consultation requests by the emergency and family physician. Outcomes were measured using the hospital database and questionnaires sent to the family physicians. Results A total of 2022 patient visits to the emergency department from 23 practices were used in the study. Use of the SCS failed to reduce the number of repeat visits to the emergency department within 14 days (odds ratio [OR] 1.10, 95% confidence interval [CI] 0.8–1.51) and 28 days (OR 1.01, 95% CI 0.8–1.27). There was no significant duplication of requests for diagnostic tests between the emergency and family physician during the intervention and control phases (24 v. 22, p = 0.93), but there was significantly greater duplication in specialty consultation requests in the intervention phase than in the control phase (20 v. 8, p = 0.049). Interpretation An electronic link between emergency and family physicians did not result in a significant reduction in resource utilization at either service point. Investments in improved electronic information exchange between

  16. Take aim and fire again: laboratory investigation and the family physician.

    PubMed

    Emson, H E

    1988-02-01

    This article discusses the attitude of the family physician to laboratory investigation and specifically reviews changes that have taken place in the last 12 years. It focuses on the problems of allocation of limited resources, the planning of laboratory services, out-of-laboratory testing, and responsibility for quality assurance. As well as bearing individual responsibility for the optimal use of a limited resource, the family physician has a co-operative part to exercise in support of the pathologist's role in organizing and planning the service on which their patients depend.

  17. Factors associated with the decision of family physicians to provide intrapartum care.

    PubMed Central

    Smith, L F; Reynolds, J L

    1995-01-01

    OBJECTIVE: To investigate which characteristics and beliefs of family physicians determine their decision to provide intrapartum care. DESIGN: Confidential survey questionnaire mailed in spring 1993. SETTING: Alberta and Ontario. SUBJECTS: Random selection of 207 physicians who had graduated from medical school between 1953 and 1990 and were thought to be in family or general practice. Of 178 eligible physicians, usable replies were received from 104 (58.4%). OUTCOME MEASURES: Beliefs (measured on a 7-point Likert scale) about the relevance of 16 primary factors to the type of obstetric care provided; demographic, training and practice characteristics. RESULTS: The respondents who provided intrapartum care differed from those who did not in their beliefs about the availability of a local hospital suitable for intrapartum care (p < 0.001), their practice partners' views on the role of family physicians in providing obstetric care (p < 0.002), their own concept of the role of family physicians in providing obstetric care (p < 0.001) and women's views on the type of obstetric care they want (p < 0.002). They also differed, although less significantly, in their beliefs about the adequacy of their obstetric training before entering family practice (p < 0.04), the expected effects of providing obstetric care on their free time (p < 0.006), their fear of malpractice litigation (p < 0.028) and their perceived competence in performing practical obstetric procedures (p < 0.05). Logistic regression analysis revealed that certain secondary factors were particularly relevant to the respondents' provision of intrapartum care at present. These included the physician's perceived competence at managing postpartum maternal hemorrhage (odds ratio [OR] 48.90, 90% confidence interval [CI] 4.70 to 509), the belief that medical insurance premiums should not be affected by the type of obstetric care provided (OR 3.55, 90% CI 1.67 to 7.57]) and the number of practice partners who provided

  18. Family Meals and Child Academic and Behavioral Outcomes

    ERIC Educational Resources Information Center

    Miller, Daniel P.; Waldfogel, Jane; Han, Wen-Jui

    2012-01-01

    This study investigates the link between the frequency of family breakfasts and dinners and child academic and behavioral outcomes in a panel sample of 21,400 children aged 5-15. It complements previous work by examining younger and older children separately and by using information on a large number of controls and rigorous analytic methods to…

  19. Family Disruption and Academic Functioning in Urban, Black Youth

    ERIC Educational Resources Information Center

    Somers, Cheryl L.; Chiodo, Lisa M.; Yoon, Jina; Ratner, Hilary; Barton, Elizabeth; Delaney-Black, Virginia

    2011-01-01

    The purpose of this study was to examine from an ecological perspective the relationships between multiple levels of family disruption and children's academic functioning in a sample of 390 urban, Black adolescents at age 14. Subjects in this cohort have been followed longitudinally since before their birth. Data from previous assessments at birth…

  20. Should Medical Anthropology be Required for Family Physicians?

    PubMed Central

    Deagle, George L.

    1992-01-01

    The educational preparation of practitioners might change as family medicine shifts its emphasis to a more humanistic approach. Medical anthropology offers particular promise as a training experience. Learning about the role of culture, including beliefs and values surrounding illness, can supplement basic science training. Improved delivery of health care is likely if caregivers are sensitive to cultural dimensions of patients' illnesses. Imagesp1178-ap1179-ap1180-a PMID:21221336

  1. Rural Women Family Physicians: Strategies for Successful Work-Life Balance

    PubMed Central

    Phillips, Julie; Hustedde, Carol; Bjorkman, Sarah; Prasad, Rupa; Sola, Orlando; Wendling, Andrea; Bjorkman, Kurt; Paladine, Heather

    2016-01-01

    PURPOSE Women family physicians experience challenges in maintaining work-life balance while practicing in rural communities. We sought to better understand the personal and professional strategies that enable women in rural family medicine to balance work and personal demands and achieve long-term career satisfaction. METHODS Women family physicians practicing in rural communities in the United States were interviewed using a semistructured format. Interviews were recorded, professionally transcribed, and analyzed using an immersion and crystallization approach, followed by detailed coding of emergent themes. RESULTS The 25 participants described a set of strategies that facilitated successful work-life balance. First, they used reduced or flexible work hours to help achieve balance with personal roles. Second, many had supportive relationships with spouses and partners, parents, or other members of the community, which facilitated their ability to be readily available to their patients. Third, participants maintained clear boundaries around their work lives, which helped them to have adequate time for parenting, recreation, and rest. CONCLUSIONS Women family physicians can build successful careers in rural communities, but supportive employers, relationships, and patient approaches provide a foundation for this success. Educators, employers, communities, and policymakers can adapt their practices to help women family physicians thrive in rural communities. PMID:27184995

  2. The role of expert searching in the Family Physicians' Inquiries Network (FPIN)*

    PubMed Central

    Ward, Deborah; Meadows, Susan E.; Nashelsky, Joan E.

    2005-01-01

    Objective: This article describes the contributions of medical librarians, as members of the Family Physicians' Inquiries Network (FPIN), to the creation of a database of clinical questions and answers that allows family physicians to practice evidence-based medicine using high-quality information at the point of care. The medical librarians have contributed their evidence-based search expertise and knowledge of information systems that support the processes and output of the consortium. Methods: Since its inception, librarians have been included as valued members of the FPIN community. FPIN recognizes the search expertise of librarians, and each FPIN librarian must meet qualifications demonstrating appropriate experience and training in evidence-based medicine. The consortium works collaboratively to produce the Clinical Inquiries series published in family medicine publications. Results: Over 170 Clinical Inquiries have appeared in Journal of Family Practice (JFP) and American Family Physician (AFP). Surveys have shown that this series has become the most widely read part of the JFP Website. As a result, FPIN has formalized specific librarian roles that have helped build the organizational infrastructure. Conclusions: All of the activities of the consortium are highly collaborative, and the librarian community reflects that. The FPIN librarians are valuable and equal contributors to the process of creating, updating, and maintaining high-quality clinical information for practicing primary care physicians. Of particular value is the skill of expert searching that the librarians bring to FPIN's products. PMID:15685280

  3. Nurses versus physicians' knowledge, attitude, and performance on care for the family members of dying patients

    PubMed Central

    Abdollahimohammad, Abdolghani; Firouzkouhi, Mohammadreza; Amrollahimishvan, Fatemeh; Alimohammadi, Nasrollah

    2016-01-01

    Purpose: Nurses and physicians must be competent enough to provide care for the clients. As a lack of knowledge and a poor attitude result in a low performance of delivering care, this study aimed to explore the nurses versus physicians’ knowledge, attitude, and performance on care for the family members of dying patients (FMDPs). Methods: This descriptive study was conducted at the educational hospitals in Isfahan, Iran. The samples were 110 nurses and 110 physicians. The data were collected through a convenience sampling method and using a valid and reliable questionnaire. Results: The average knowledge, attitude, and performance on care for the FMDPs were not significantly different between nurses and physicians (p>0.05). The majority of nurses (55.4%) and physician (63.6%) were at a moderate and a fair level of knowledge of care for the FMDPs. Most of the nurses (81%) and physicians (87.3%) had a positive attitude towards caring the FMDPs. Most of the nurses (70%) and physicians (86.3%) had a moderate and fair performance. Conclusion: Having enough knowledge and skills, and a positive attitude are necessary for caring the FMDPs. Nurses’ and physicians' competencies must be improved through continuing educational programs and holding international and national conferences with a focus on the palliative care. PMID:26838571

  4. Coordination of cancer care between family physicians and cancer specialists

    PubMed Central

    Easley, Julie; Miedema, Baukje; Carroll, June C.; Manca, Donna P.; O’Brien, Mary Ann; Webster, Fiona; Grunfeld, Eva

    2016-01-01

    Abstract Objective To explore health care provider (HCP) perspectives on the coordination of cancer care between FPs and cancer specialists. Design Qualitative study using semistructured telephone interviews. Setting Canada. Participants A total of 58 HCPs, comprising 21 FPs, 15 surgeons, 12 medical oncologists, 6 radiation oncologists, and 4 GPs in oncology. Methods This qualitative study is nested within a larger mixed-methods program of research, CanIMPACT (Canadian Team to Improve Community-Based Cancer Care along the Continuum), focused on improving the coordination of cancer care between FPs and cancer specialists. Using a constructivist grounded theory approach, telephone interviews were conducted with HCPs involved in cancer care. Invitations to participate were sent to a purposive sample of HCPs based on medical specialty, sex, province or territory, and geographic location (urban or rural). A coding schema was developed by 4 team members; subsequently, 1 team member coded the remaining transcripts. The resulting themes were reviewed by the entire team and a summary of results was mailed to participants for review. Main findings Communication challenges emerged as the most prominent theme. Five key related subthemes were identified around this core concept that occurred at both system and individual levels. System-level issues included delays in medical transcription, difficulties accessing patient information, and physicians not being copied on all reports. Individual-level issues included the lack of rapport between FPs and cancer specialists, and the lack of clearly defined and broadly communicated roles. Conclusion Effective and timely communication of medical information, as well as clearly defined roles for each provider, are essential to good coordination of care along the cancer care trajectory, particularly during transitions of care between cancer specialist and FP care. Despite advances in technology, substantial communication challenges still

  5. Evidence-based medicine in primary care: qualitative study of family physicians

    PubMed Central

    Tracy, C Shawn; Dantas, Guilherme Coelho; Upshur, Ross EG

    2003-01-01

    Background The objectives of this study were: a) to examine physician attitudes to and experience of the practice of evidence-based medicine (EBM) in primary care; b) to investigate the influence of patient preferences on clinical decision-making; and c) to explore the role of intuition in family practice. Method Qualitative analysis of semi-structured interviews of 15 family physicians purposively selected from respondents to a national survey on EBM mailed to a random sample of Canadian family physicians. Results Participants mainly welcomed the promotion of EBM in the primary care setting. A significant number of barriers and limitations to the implementation of EBM were identified. EBM is perceived by some physicians as a devaluation of the 'art of medicine' and a threat to their professional/clinical autonomy. Issues regarding the trustworthiness and credibility of evidence were of great concern, especially with respect to the influence of the pharmaceutical industry. Attempts to become more evidence-based often result in the experience of conflicts. Patient factors exert a powerful influence on clinical decision-making and can serve as trumps to research evidence. A widespread belief that intuition plays a vital role in primary care reinforced views that research evidence must be considered alongside other factors such as patient preferences and the clinical judgement and experience of the physician. Discussion Primary care physicians are increasingly keen to consider research evidence in clinical decision-making, but there are significant concerns about the current model of EBM. Our findings support the proposed revisions to EBM wherein greater emphasis is placed on clinical expertise and patient preferences, both of which remain powerful influences on physician behaviour. PMID:12740025

  6. What Motivates Family Physicians to Participate in Training Programs in Shared Decision Making?

    ERIC Educational Resources Information Center

    Allaire, Anne-Sophie; Labrecque, Michel; Giguere, Anik; Gagnon, Marie-Pierre; Legare, France

    2012-01-01

    Introduction: Little is known about the factors that influence family physician (FP) participation in continuing professional development (CPD) programs in shared decision making (SDM). We sought to identify the factors that motivate FPs to participate in DECISION+, a CPD program in SDM. Methods: In 2007-2008, we collected data from 39 FPs who…

  7. Preventing crises in palliative care in the home. Role of family physicians and nurses.

    PubMed Central

    Howarth, G.; Willison, K. B.

    1995-01-01

    With the current shift to community care, the need for palliative care in the home involving the family physician has increased. Potential causes of crises in the home care of the dying are identified. Strategies to prevent crises are suggested that rely on a team's providing comprehensive and anticipatory care. PMID:7539653

  8. Urban family physician plan in Iran: challenges of implementation in Kerman

    PubMed Central

    Dehnavieh, Reza; Kalantari, Ali Reza; Jafari Sirizi, Mohammad

    2015-01-01

    Background: The Family Physician Plan has recently been implemented in three provinces of Iran on a pilot basis and is going to be implemented throughout Iran in the future. Through a qualitative design, this study aims to determine probable implementation challenges of Family Physician Plan in Kerman. Methods: This study was conducted in Kerman in 2013. Data were collected through interviews with 21 experts in the field. Sampling continued until data saturation level was achieved. All interviews were recorded and then analyzed, and main themes and subgroups were extracted from them based on a framework analysis model. Results: most prevalent establishment challenges of Family Physician Plan were classified into policy-making, financial supply, laws and resources. Conclusion: The urban Family Physician Plan can be carried out more effectively by implementing this plan step by step, highlighting the relationships between the related organizations, using new payment mechanisms e.g Per Capita, DRG, make national commitment and proper educational programs for providers, development the health electronic Record, justifying providers and community about advantages of this plan, clarifying regulatory status about providers' Duties and most importantly considering a specific funding source. PMID:26913266

  9. Barriers to Physician Identification and Treatment of Family Violence: Lessons from Five Communities.

    ERIC Educational Resources Information Center

    Cohen, Stu; And Others

    1997-01-01

    A study involving over 480 interviews in five diverse communities (Atlanta, Georgia; Duluth, Minnesota; Providence, Rhode Island; Riverside, California; Roswell, New Mexico) identified barriers facing physicians and other health care providers in identifying, treating, and referring victims of family violence, and illuminated the relationships of…

  10. Marital and job satisfaction among non-resident physicians at a Hispanic academic medical center, 2006-2007.

    PubMed

    Colón-de Martí, Luz N; Acevedo, Luis F; Céspedes-Gómez, Wayca R

    2009-01-01

    Marital satisfaction has been previously associated with job satisfaction although few studies have addressed this issue among Hispanic physicians. Marital and job satisfaction were assessed in a sample of 92 legally married non-residents physicians working at a Hispanic Academic Medical Center during the 2006-2007 academic year. Marital satisfaction was assessed using the Dyadic Adjustment Scale (DAS) and job satisfaction was measured using a 18-item scale. Response rate was 34.8%. Most (70.7%) of the subjects were males. Forty- five percent (45.0%) belonged to the surgical specialties group. The mean scale value for marital satisfaction was found to be in the average range. Almost all (88.7%) the participants reported being "satisfied "to "very satisfied" with their job. Ninety percent (90.0%) of the surgical specialists and 86.9% of the non-surgical specialists reported being satisfied with their job. The percentage of participants that reported to be "very satisfied" with their job, was higher among the group of surgical specialists (23.3%) than among the non-surgical specialists (13.0%) There was no significant relationship between marital satisfaction and job satisfaction. Also, no statistically significant difference was observed in the level of marital satisfaction and job satisfaction when surgical and non-surgical physicians were compared. The findings on marital satisfaction obtained in this sample were similar to those observed in a previous study of resident physicians at the same academic medical center.

  11. Family income, school attendance, and academic achievement in elementary school.

    PubMed

    Morrissey, Taryn W; Hutchison, Lindsey; Winsler, Adam

    2014-03-01

    Low family income is associated with poor academic achievement among children. Higher rates of school absence and tardiness may be one mechanism through which low family income impacts children's academic success. This study examines relations between family income, as measured by receipt of free or reduced-price lunch, school attendance, and academic achievement among a diverse sample of children from kindergarten to 4th grade (N = 35,419) using both random and within-child fixed-effects models. Generally, results suggest that the receipt of free or reduced-price lunch and duration of receipt have small but positive associations with school absences and tardies. Poor attendance patterns predict poorer grades, with absences more associated with grades than tardies. Given the small associations between receipt of free or reduced-price lunch and school attendance, and between the duration of receipt of free or reduced-price lunch and children's grades, results do not provide strong evidence that absences and tardies meaningfully attenuate relations between the duration of low family income and student achievement; poorer attendance and persistent low income independently predict poorer grades. Implications for policy and future research are discussed.

  12. Practice patterns of rural family physicians based on the American Diabetes Association standards of care.

    PubMed

    Zoorob, R J; Mainous, A G

    1996-06-01

    The purpose of this study was to examine practice patterns of rural family physicians in the care of non-insulin-dependent diabetes mellitus based on the standards of care of the American Diabetes Association (ADA). One hundred patient charts were randomly chosen, twenty for each physician, from the practices of five family physicians in rural Ohio. A standardized collection protocol was used, based upon the ADA recommendations. The charts were reviewed for compliance with the ADA parameters. The patients' records demonstrated 66% compliance with dietary counseling and 33% with counseling about exercise. Moreover, there was low compliance with physical examination guidelines. Specifically, 66% of the patients had fundoscopic examination and 64% had a complete foot examination done. With respect to the laboratory guidelines, 70% of the charts reviewed had a urinalysis ordered and 45% annual lipids measured. However, glycosylated hemoglobin was performed in only 15% of the patients. The results suggest that rural family physicians do not consistently follow the ADA standards of care.

  13. Parental divorce, sibship size, family resources, and children's academic performance.

    PubMed

    Sun, Yongmin; Li, Yuanzhang

    2009-09-01

    Using data from 19,839 adolescents from the National Education Longitudinal Study, this study investigates whether the effects of parental divorce on adolescents' academic test performance vary by sibship size. Analyses show that the negative effect of divorce on adolescent performance attenuates as sibship size increases. On the other side of the interaction, the inverse relationship between sibship size and test performance is weaker in disrupted than in two-biological-parent families. Trends of such interactions are evident when sibship size is examined either as a continuous or a categorical measure. Finally, the observed interactions on adolescents' academic performance are completely explained by variations in parental financial, human, cultural, and social resources. In sum, this study underlines the importance of treating the effect of parental divorce as a variable and calls for more research to identify child and family features that may change the magnitude of such an effect.

  14. Knowledge, Attitude, Practice, and Perceived Barriers of Colorectal Cancer Screening among Family Physicians in National Guard Health Affairs, Riyadh

    PubMed Central

    2014-01-01

    Objectives. The objective of this study is to explore the current knowledge, attitude, and practice of family physicians working in family medicine clinics in National Guard Health Affairs (NGHA), Riyadh, toward colorectal cancer (CRC) screening and to identify the barriers of the screening. Methods. Data were collected using a validated self-administered questionnaire adopted from the National Cancer Institute in USA, customized by adding and eliminating questions to be in line with the institution (NGHA) characteristics. Results. Of the 130 physicians, 56.2% of the physicians were not practicing CRC screening although 94.6% considered CRC screening effective. Board certified physicians had higher knowledge score and were practicing CRC screening more when compared to other physicians. Physicians who reported practicing CRC screening scored more on the knowledge score than those not practicing. Male physicians scored better on attitude score than female physicians. The study found that barriers were cited in higher rates among physicians not practicing CRC screening compared with practicing physicians. Lack of patients' awareness was the most cited barrier. Conclusion. Large percentage of family physicians in this study do not practice CRC screening, despite the knowledge level and the positive attitude. PMID:25328703

  15. ‘Meeting People Where They’re At’: Experiences of Family Physicians Engaging Women Who Use Illicit Drugs

    PubMed Central

    Woolhouse, Susan; Brown, Judith Belle; Thind, Amardeep

    2011-01-01

    PURPOSE There is little research exploring the experiences of family physicians caring for women who use illicit drugs. This study explores the experiences of these physicians in order to better understand the process of engaging these women in the patient-physician relationship. METHODS We conducted a phenomenologic, qualitative study using individual, in-depth interviews with 10 family physicians working in inner-city Toronto and Ottawa, Ontario. An iterative and interpretive analysis was used. RESULTS Three broad themes emerged from the analysis. The predominant theme was that of the patient-physician relationship, which consisted of 2 phases: the engagement phase and the maintenance phase. During the engagement phase, issues such as access and women’s experiences of trauma and violence were evident and impeded participants’ ability to engage with this population. As such, the patient-physician relationship during the engagement phase was tenuous. Trust and presence were paramount during this phase. Once a family physician engaged a woman, the transition to the maintenance phase was made. Within the maintenance phase, 2 subthemes were identified: continuity of care and “meeting people where they’re at” (finding common ground). CONCLUSIONS This study identified a 2-phase process of the patient-physician relationship from the perspective of family physicians caring for women using illicit drugs: the engagement and maintenance phases. Our findings identified strategies to support the patient-physician relationship during each of these phases that have implications for improving the health of these women. PMID:21555752

  16. How Do Physicians Assess Their Family Physician Colleagues' Performance? Creating a Rubric to Inform Assessment and Feedback

    ERIC Educational Resources Information Center

    Sargeant, Joan; MacLeod, Tanya; Sinclair, Douglas; Power, Mary

    2011-01-01

    Introduction: The Colleges of Physicians and Surgeons of Alberta and Nova Scotia (CPSNS) use a standardized multisource feedback program, the Physician Achievement Review (PAR/NSPAR), to provide physicians with performance assessment data via questionnaires from medical colleagues, coworkers, and patients on 5 practice domains: consultation…

  17. Community resources for psychiatric and psychosocial problems. Family physicians' referral patterns in urban Ontario.

    PubMed Central

    Craven, M. A.; Allen, C. J.; Kates, N.

    1995-01-01

    OBJECTIVE: To document the number and pattern of psychiatric and psychosocial referrals to community resources by family physicians (FPs) and to determine whether referral practices correlate with physician variables. DESIGN: Cross-sectional survey of referrals by FPs to 34 key psychiatric and psychosocial community resources identified by a panel of FPs, psychiatric social workers, psychiatric nurses, public health nurses, and the local community information service. SETTING: Regional municipality of 434,000 persons in Ontario. PARTICIPANTS: Twenty-seven of 34 (79%) community agencies identified 261 FPs who made 4487 referrals to participating agencies (range 0 to 65, median 15, mean 17.19 +/- 13.42). MAIN OUTCOME MEASURES: Number of referrals to all agencies; variables, such as physician sex, school of graduation, year of graduation, and certificate status in the College of Family Physicians of Canada, related to referral patterns. RESULTS: Referrals to outpatient psychiatric clinics, support services, and general counseling services accounted for 96% of all referrals. Physicians' average annual referral profile was as follows: 8.6 patients to a support service, 6.3 to an outpatient psychiatric service, 1.6 to a counseling service, and 0.46 to a substance abuse service. Referral profiles of individual physicians varied greatly. Female FPs made fewer referrals than male FPs to support services, but both made similar numbers of referrals to psychiatric, counseling, and substance abuse services. The more recent the year of graduation, the greater the number of referrals to psychiatric (r = 0.158, P = 0.0107) and counseling services (r = 0.137, P = 0.0272) and the higher the fraction of referrals to psychiatric services (r = 0.286, P = 0.0001). CONCLUSIONS: Family physicians in Hamilton-Wentworth made few referrals to psychiatric and psychosocial services. Only physician sex and year of graduation correlated significantly with numbers of referrals made. Recent

  18. Predictors of job satisfaction among academic family medicine faculty

    PubMed Central

    Krueger, Paul; White, David; Meaney, Christopher; Kwong, Jeffrey; Antao, Viola; Kim, Florence

    2017-01-01

    Abstract Objective To identify predictors of job satisfaction among academic family medicine faculty members. Design A comprehensive Web-based survey of all faculty members in an academic department of family medicine. Bivariate and multivariable analyses (logistic regression) were used to identify variables associated with job satisfaction. Setting The Department of Family and Community Medicine at the University of Toronto in Ontario and its 15 affiliated community teaching hospitals and community-based teaching practices. Participants All 1029 faculty members in the Department of Family and Community Medicine were invited to complete the survey. Main outcome measures Faculty members’ demographic and practice information; teaching, clinical, administration, and research activities; leadership roles; training needs and preferences; mentorship experiences; health status; stress levels; burnout levels; and job satisfaction. Faculty members’ perceptions about supports provided, recognition, communication, retention, workload, teamwork, respect, resource distribution, remuneration, and infrastructure support. Faculty members’ job satisfaction, which was the main outcome variable, was obtained from the question, “Overall, how satisfied are you with your job?” Results Of the 1029 faculty members, 687 (66.8%) responded to the survey. Bivariate analyses revealed 26 predictors as being statistically significantly associated with job satisfaction, including faculty members’ ratings of their local department and main practice setting, their ratings of leadership and mentorship experiences, health status variables, and demographic variables. The multivariable analyses identified the following 5 predictors of job satisfaction: the Maslach Burnout Inventory subscales of emotional exhaustion and personal accomplishment; being born in Canada; the overall quality of mentorship that was received being rated as very good or excellent; and teamwork being rated as very

  19. Practice-Generated Questions: A Method of Formulating True Learning Needs of Family Physicians

    PubMed Central

    Jennett, Penny A.; Lockyer, Jocelyn M.; Parboosingh, I. John P.; Maes, William R.

    1989-01-01

    The importance of identifying true learning needs prior to planning and conducting educational programs is well documented. In this study a collection of 579 clinical questions forwarded by 87 family physicians in southern Alberta was reviewed and analysed to determine if the questions would cluster and, therefore, be useful as sources for planning continuing medical education (CME) conferences and newsletters. The nature of submitted questions was also examined to determine if particular groups of physicians, as identified by socio-demographic characteristics, significanly differed by type of questions submitted. The study findings indicate that the questions generated by the clinical practices of family practitioners did cluster into meaningful categories, and did vary significantly by identified physician groups. Questions relating to the genito-urinary system; adverse drug effects, interactions and contraindications; and nervous system and sense organs were most frequently submitted. The nature of questions generated differed significantly by gender, size of practice setting, and year and place of medical graduation. When highly relevant and specific clinical questions, as contrasted with broadly expressed needs, serve as sources of identified learning needs for CME planners, the daily clinical problems faced by practitioners are better addressed. The learning needs identified by this approach provide an optimum framework for planned CME to influence physician behaviour or practice patterns. PMID:21248985

  20. Smoking behaviour, knowledge and attitudes among Family Medicine physicians and nurses in Bosnia and Herzegovina

    PubMed Central

    Hodgetts, Geoffrey; Broers, Teresa; Godwin, Marshall

    2004-01-01

    Background Smoking rates among the general population in Bosnia and Herzegovina are extremely high, and national campaigns to lower smoking rates have not yet begun. As part of future activities of the Queen's University Family Medicine Development Program in the Balkans Region, technical assistance may be provided to Bosnia and Herzegovina to develop of national tobacco control strategies. This assistance may focus on training doctors and nurses on smoking cessation strategies with a view to helping their patients to stop smoking. Given this important role that health professionals have, data is needed on smoking rates as well as on smoking behaviour among doctors and nurses in Bosnia and Herzegovina. This study therefore seeks to determine the smoking rates and behaviour of family medicine physicians and nurses in Bosnia and Herzegovina and to determine how well prepared they feel with respect to counselling their patients on smoking cessation strategies. Methods The WHO Global Health Professional Survey, a self-administered questionnaire, was distributed to physicians and nurses in 19 Family Medicine Teaching Centres in Bosnia and Herzegovina in June 2002. Smoking rates and behaviour, as well as information on knowledge and attitudes regarding smoking were determined for both physicians and nurses. Results Of the 273 physicians and nurses currently working in Family Medicine Teaching Centres, 209 (77%) completed the questionnaire. Approximately 45% of those surveyed currently smoke, where 51% of nurses smoked, compared to 40% of physicians. With respect to knowledge and attitudes, all respondents agreed that smoking is harmful to one's health. However, "ever" smokers, compared to "never" smokers, were less likely to agree that health professionals who smoke were less likely to advise patients to quit smoking than non-smoking health professionals. Less than half of physicians and nurses had received formal training in smoking cessations strategies, but about two

  1. How do family physicians measure blood pressure in routine clinical practice?

    PubMed Central

    Kaczorowski, Janusz; Myers, Martin G.; Gelfer, Mark; Dawes, Martin; Mang, Eric J.; Berg, Angelique; Grande, Claudio Del; Kljujic, Dragan

    2017-01-01

    Abstract Objective To describe the techniques currently used by family physicians in Canada to measure blood pressure (BP) for screening for, diagnosing, and treating hypertension. Design A Web-based cross-sectional survey distributed by e-mail. Setting Stratified random sample of family physicians in Canada. Participants Family physician members of the College of Family Physicians of Canada with valid e-mail addresses. Main outcome measures Physicians’ self-reported routine methods for recording BP in their practices to screen for, diagnose, and manage hypertension. Results A total of 774 valid responses were received, for a response rate of 16.2%. Respondents were similar to nonrespondents except for underrepresentation of male physicians. Of 769 respondents, 417 (54.2%) indicated that they used manual office BP measurement with a mercury or aneroid device and stethoscope as the routine method to screen patients for high BP, while 42.9% (330 of 769) reported using automated office BP (AOBP) measurement. The method most frequently used to make a diagnosis of hypertension was AOBP measurement (31.1%, 240 of 771), followed by home BP measurement (22.4%, 173 of 771) and manual office BP measurement (21.4%, 165 of 771). Ambulatory BP monitoring (ABPM) was used for diagnosis by 14.4% (111 of 771) of respondents. The most frequently reported method for ongoing management was home BP monitoring (68.7%, 528 of 769), followed by manual office BP measurement (63.6%, 489 of 769) and AOBP measurement (59.2%, 455 of 769). More than three-quarters (77.8%, 598 of 769) of respondents indicated that ABPM was readily available for their patients. Conclusion Canadian family physicians exhibit overall high use of electronic devices for BP measurement, However, more efforts are needed to encourage practitioners to follow current Canadian guidelines, which advocate the use of AOBP measurement for hypertension screening, ABPM and home BP measurement for making a diagnosis, and both

  2. Quality of care in hospital emergency departments and family physicians' offices.

    PubMed Central

    Spasoff, R. A.; Lane, P.; Steele, R.

    1977-01-01

    Indicator conditions were used to evaluate the quality of 686 episodes of care provided in two emergency departments and in five family physicians' offices. Overall, the care was considered adequate in 53% of the emergency department cases and in 40% of the cases dealt with in family physicians' offices, the difference being significant (P less than 0.01). Referrals were very common in both settings, and when quality was assessed solely on the basis of the care actually given by the primary-care providers the difference between the two settings disappeared. Half the observed deficiencies in care related to failure to document the findings from history-taking and physical examination. From these and earlier findings we conclude that the emergency department can be an appropriate setting for the care of nontraumatic illness. PMID:880525

  3. Relationship between Size of Broken and Intact Families and Academic Achievement.

    ERIC Educational Resources Information Center

    Cherian, Varghese I.

    1991-01-01

    Compares relationship between family size and academic achievement of children from broken and intact families among Black African Xhosa-speaking children between the ages of 13 and 17. Results indicate a negative relationship between family size and academic achievement, regardless of broken or intact families. (Author/NL)

  4. Patient, family physician and community pharmacist perspectives on expanded pharmacy scope of practice: a qualitative study

    PubMed Central

    Donald, Maoliosa; King-Shier, Kathryn; Tsuyuki, Ross T.; Al Hamarneh, Yazid N.; Jones, Charlotte A.; Manns, Braden; Tonelli, Marcello; Tink, Wendy; Scott-Douglas, Nairne; Hemmelgarn, Brenda R.

    2017-01-01

    Background: The RxEACH trial was a randomized trial to evaluate the efficacy of community pharmacy-based case finding and intervention in patients at high risk for cardiovascular (CV) events. Community-dwelling patients with poorly controlled risk factors were identified and their CV risk reduced through patient education, prescribing and follow-up by their pharmacist. Perspectives of patients, family physicians and community pharmacists were obtained regarding pharmacists' identification and management of patients at high risk for CV events, to identify strategies to facilitate implementation of the pharmacist's expanded role in routine patient care. Methods: We used a qualitative methodology (individual semistructured interviews) with conventional qualitative content analysis to describe perceptions about community pharmacists' care of patients at high risk for CV events. Perceptions were categorized into macro (structure), meso (institution) and micro (practice) health system levels, based on a conceptual framework of care for optimizing scopes of practice. Results: We interviewed 48 participants (14 patients, 13 family physicians and 21 community pharmacists). Patients were supportive of the expanded scope of practice of pharmacists. All participant groups emphasized the importance of communication, ability to share patient information, trust and better understanding of the roles, responsibilities, accountabilities and liabilities of the pharmacist within their expanded role. Interpretation: Despite support from patients and changes to delivery of care in primary care settings, ongoing efforts are needed to understand how to best harmonize family physician and community pharmacist roles across the health system. This will require collaboration and input from professional associations, regulatory bodies, pharmacists, family physicians and patients.

  5. Barriers to physician identification and treatment of family violence: lessons from five communities.

    PubMed

    Cohen, S; De Vos, E; Newberger, E

    1997-01-01

    Since the Surgeon General's Workshop on Violence and Public Health (Leesburg, Virginia, October 27-29, 1985), a substantial literature has developed about the limitations of the health care response to family violence. Many contributions have reflected experiences in limited numbers of practice settings (e.g., a single emergency department or hospital). Until 1990, however, there had been no community-based studies. The Robert Wood Johnson Foundation asked a multidisciplinary team from Education Development Center, Inc. and Children's Hospital (Boston) to investigate the health care responses to family violence in five diverse communities. This qualitative study, comprising more than 480 interviews, provided a vivid picture of the barriers facing physicians and other health care providers in identifying, treating, and referring victims of family violence. It also illuminated the relations of the health care systems in these communities with other key sectors, including agencies and the judiciary. The key findings from the five-city study remain relevant because (1) it is the only large-scale, multi-community-based assessment of the barriers facing physicians; (2) it identified, or in some cases confirmed, both institutional and educational barriers limiting the effectiveness of even the most committed physicians; (3) it identified, or in some cases confirmed, specific areas of knowledge, attitudes, and skills development that should be incorporated in medical education; and (4) its conclusions continue to be reflected in subsequent contributions to the literature. In each of these ways, therefore, it informs the other articles in this supplement.

  6. The Experience of Risk-Adjusted Capitation Payment for Family Physicians in Iran: A Qualitative Study

    PubMed Central

    Esmaeili, Reza; Hadian, Mohammad; Rashidian, Arash; Shariati, Mohammad; Ghaderi, Hossien

    2016-01-01

    Background When a country’s health system is faced with fundamental flaws that require the redesign of financing and service delivery, primary healthcare payment systems are often reformed. Objectives This study was conducted with the purpose of exploring the experiences of risk-adjusted capitation payment of urban family physicians in Iran when it comes to providing primary health care (PHC). Materials and Methods This is a qualitative study using the framework method. Data were collected via digitally audio-recorded semi-structured interviews with 24 family physicians and 5 executive directors in two provinces of Iran running the urban family physician pilot program. The participants were selected using purposive and snowball sampling. The codes were extracted using inductive and deductive methods. Results Regarding the effects of risk-adjusted capitation on the primary healthcare setting, five themes with 11 subthemes emerged, including service delivery, institutional structure, financing, people’s behavior, and the challenges ahead. Our findings indicated that the health system is enjoying some major changes in the primary healthcare setting through the implementation of risk-adjusted capitation payment. Conclusions With regard to the current challenges in Iran’s health system, using risk-adjusted capitation as a primary healthcare payment system can lead to useful changes in the health system’s features. However, future research should focus on the development of the risk-adjusted capitation model. PMID:27340558

  7. The birth of a collaborative model: obstetricians, midwives, and family physicians.

    PubMed

    Pecci, Christine Chang; Mottl-Santiago, Julie; Culpepper, Larry; Heffner, Linda; McMahan, Therese; Lee-Parritz, Aviva

    2012-09-01

    In the United States, the challenges of maternity care include provider workforce, cost containment, and equal access to quality care. This article describes a collaborative model of care involving midwives, family physicians, and obstetricians at the Boston Medical Center, which serves a low-income multicultural population. Leadership investment in a collaborative model of care from the Department of Obstetrics and Gynecology, Section of Midwifery, and the Department of Family Medicine created a culture of safety and commitment to patient-centered care. Essential elements of the authors' successful model include a commitment to excellence in patient care, communication, and interdisciplinary education.

  8. Academic procrastination: associations with personal, school, and family variables.

    PubMed

    Rosário, Pedro; Costa, Marta; Núñez, José Carlos; González-Pienda, Julio; Solano, Paula; Valle, Antonio

    2009-05-01

    Procrastination is a common behavior, mainly in school settings. Only a few studies have analyzed the associations of academic procrastination with students' personal and family variables. In the present work, we analyzed the impact of socio-personal variables (e.g., parents' education, number of siblings, school grade level, and underachievement) on students' academic procrastination profiles. Two independent samples of 580 and 809 seventh to ninth graders, students attending the last three years of Portuguese Compulsory Education, have been taken. The findings, similar in both studies, reveal that procrastination decreases when the parents' education is higher, but it increases along with the number of siblings, the grade level, and the underachievement. The results are discussed in view of the findings of previous research. The implications for educational practice are also analyzed.

  9. Investigating fatigue of less than 6 months' duration. Guidelines for family physicians.

    PubMed Central

    Godwin, M.; Delva, D.; Miller, K.; Molson, J.; Hobbs, N.; MacDonald, S.; MacLeod, C.

    1999-01-01

    OBJECTIVE: To develop an evidence-based systematic approach to assessment of adult patients who present to family physicians complaining of fatigue of less than 6 months' duration. The guidelines present investigative options, making explicit what should be considered in all cases and what should be considered only in specific situations. They aim to provide physicians with an approach that, to the extent possible, is based on evidence so that time and cost are minimized and detection and management of the cause of the fatigue are optimized. QUALITY OF EVIDENCE: MEDLINE was searched from 1966 to 1997 using the key words "family practice" and "fatigue." Articles about chronic fatigue syndrome were excluded. Articles with level 3 evidence were found, but no randomized trials, cohort studies, or case-control studies were found. Articles looking specifically at the epidemiology, demographics, investigations, and diagnoses of patients with fatigue were chosen. Articles based on studies at referral and specialty centres were given less weight than those based on studies in family physicians' offices. MAIN MESSAGE: Adherence to these guidelines will decrease the cost of investigating the symptom of fatigue and optimize diagnosis and management. This needs to be proved in practice, however, and with research that produces level 1 and 2 evidence. CONCLUSIONS: Adults presenting with fatigue of less than 6 months' duration should be assessed for psychosocial causes and should have a focused history and physical examination to determine whether further investigations should be done. The guidelines outline investigations to be considered. The elderly require special consideration. These guidelines have group validation, but they need to be tested by more physicians in various locations and types of practices. PMID:10065311

  10. An exploration of key issues and potential solutions that impact physician wellbeing and professional fulfillment at an academic center

    PubMed Central

    Brady, Keri J.S.; Trockel, Mickey

    2016-01-01

    Background. Physician wellness is a vital element of a well-functioning health care system. Not only is physician wellness empirically associated with quality and patient outcomes, but its ramifications span individual, interpersonal, organizational, and societal levels. The purpose of this study was to explore academic physicians’ perceptions about their work-related wellness, including the following questions: (a) What are the workplace barriers and facilitators to their wellness? (b) What workplace solutions do theythinkwouldimprove their wellness? (c)What motivates their work? and (d) What existing wellness programs are they aware of? Methods. A multi-method design was applied to conduct a total of 19 focus group sessions in 17 clinical departments. All academic faculty ranks and career lines were represented in the 64 participating physicians, who began the sessions with five open-ended survey questions pertaining to physician wellness in their work environment. Participants entered their answers into a web-based survey program that enabled anonymous data collection. The initial survey component was followed by semi-structured focus group discussion. Data analysis of this qualitative study was informed by the general inductive approach as well as a review of extant literature through September 2015 on physician wellness, professional fulfillment, satisfaction, dissatisfaction, burnout and work-life. Results. Factors intrinsic to the work of physicians dominated the expressed reasons for work motivation. These factors all related to the theme of overall contribution, with categories of meaningful work, patient care, teaching, scientific discovery, self-motivation and matching of career interests. Extrinsic factors such as perceptions of suboptimal goal alignment, inadequate support, restricted autonomy, lack of appreciation, and suboptimal compensation and benefits dominated the risk of professional dissatisfaction. Discussion. Our findings indicate that the

  11. Growing Old Together: The Influence of Population and Workforce Aging on Supply and Use of Family Physicians

    ERIC Educational Resources Information Center

    Watson, Diane E.; Reid, Robert; Roos, Noralou P.; Heppner, Petra

    2005-01-01

    Canadians have expressed concern that access to a family physician (FP) has declined precipitously. Yet FP to population ratios remained relatively stable over the last decade, and there were perceptions of physician surpluses, at least in urban centres, 10 years ago. We evaluated whether demographic changes among patients and FPs, and in the…

  12. Defining the eHealth Information Niche in the Family Physician/Patient Examination and Knowledge Transfer Process

    ERIC Educational Resources Information Center

    Ellington, Virginia Beth Elder

    2012-01-01

    This research study was undertaken to gain a richer understanding of the use of patient-introduced online health information during the physician/patient examination and knowledge transfer process. Utilizing qualitative data obtained from ten family physician interviews and workflow modeling using activity diagrams and task structure charts, this…

  13. Comparing the Performance of Allopathically and Osteopathically Trained Physicians on the American Board of Family Medicine's Certification Examination

    ERIC Educational Resources Information Center

    O'Neill, Thomas R.; Royal, Kenneth D.; Schulte, Bradley M.; Leigh, Terrence

    2009-01-01

    Background: Two medical specialty boards offer certification in family medicine: the American Board of Family Medicine (ABFM) and the American Osteopathic Board of Family Physicians (AOBFP). The AOBFP certification is offered only to graduates of osteopathic colleges; however, graduates of both osteopathic and allopathic medical schools who have…

  14. [Family health and family physician's influence on prevention psychoactive substances abuse].

    PubMed

    Lapčević, Mirjana; Dimitrijević, Ivan

    2010-01-01

    The family, as the basic social unit, has a decisive role in the health and disease of its members. It is the primary unit where health needs are formed and solved. By its own resources the family independently resolves about 75% of the total health requirements. In the paper the authors study family characteristics which influence family health and diseases, indicators of family health and the scale of life values. Also, the study evaluates social factors, communication and the influence of the usage of psychoactive substances on family health and the quality of family life. To form the personality of a child three factors are most significant: love, the feeling of safety and the presence of harmonious relationship between the parents. Life harmony in a family also depends on the quality of structural components of the personality and the interaction of motivation of its members. Early childhood determines the future personality of the adult person. At that period, habits and partially attitudes are formed. In harmonious family relationships the parents are the role model to children. Verbal and non-verbal communication enrich the relationship among people and enable efforts in supporting understanding, compassion and care for others by mutual agreement. On the scale of life values of Serbian citizens health holds the first position. Immediately following the health issue is good relationship in the family. As healthcare is not only the task of healthcare services, but also of each individual, family and the society as a whole, it is on healthcare personnel to educate the citizens how to preserve and improve their own health and the health of their family by a continual healthcare and education. Above all, this concerns avoidance of bad habits, such as smoking, immoderate alcohol consumption, narcotic abuse, physical inactivity, hypercaloric nutrition, etc. Also, it is significant to make an early recognition of disease symptoms and to turn for help to the chosen

  15. The role of family physicians contracted healthcare in China: A "Cardiotonic" or a "Band-Aid" for healthcare reform?

    PubMed

    Tang, Qi; Song, Peipei; Xu, Lingzhong

    2016-09-05

    On June 6, 2016, as a mode expected to open a new prospect for tiered system of medical care in China, family physicians contracted healthcare was officially launched, intending to facilitate such healthcare be universal coverage by 2020.There are some doubts as to whether this goal is possible. The role of family physicians contracted healthcare in China should also be carefully identified. We hold that family physicians contracted healthcare will promote healthcare reform if it provides a "Cardiotonic" that alleviates the long-standing inequitable allocation of healthcare resources. However, this form of care faces many obstacles given the current state of medical care in China. It will just be a "Band-Aid" if the aforementioned issues of the shortage of family physicians, coordination with referring hospitals, and incomplete oversight are not resolved.

  16. Interprofessional education in academic family medicine teaching units

    PubMed Central

    Price, David; Howard, Michelle; Hilts, Linda; Dolovich, Lisa; McCarthy, Lisa; Walsh, Allyn E.; Dykeman, Lynn

    2009-01-01

    ABSTRACT PROBLEM ADDRESSED The new family health teams (FHTs) in Ontario were designed to enable interprofessional collaborative practice in primary care; however, many health professionals have not been trained in an interprofessional environment. OBJECTIVE OF PROGRAM To provide health professional learners with an interprofessional practice experience in primary care that models teamwork and collaborative practice skills. PROGRAM DESCRIPTION The 2 academic teaching units of the FHT at McMaster University in Hamilton, Ont, employ 6 types of health professionals and provide learning environments for family medicine residents and students in a variety of health care professions. Learners engage in formal interprofessional education activities and mixed professional and learner clinical consultations. They are immersed in an established interprofessional practice environment, where all team members are valued and contribute collaboratively to patient care and clinic administration. Other contributors to the success of the program include the physical layout of the clinics, the electronic medical record communications system, and support from leadership for the additional clinical time commitment of delivering interprofessional education. CONCLUSION This academic FHT has developed a program of interprofessional education based partly on planned activities and logistic enablers, and largely on immersing learners in a culture of long-standing interprofessional collaboration. PMID:19752260

  17. Assigning a team-based pager for on-call physicians reduces paging errors in a large academic hospital.

    PubMed

    Shieh, Lisa; Chi, Jeffrey; Kulik, Carol; Momeni, Arash; Shelton, Andrew; DePorte, Cynthia; Hopkins, Joseph

    2014-02-01

    As complexity of care of hospitalized patients has increased, the need for communication and collaboration among members of the team caring for the patient has become increasingly important. This often takes the form of a nurse's need to contact a patient's physician to discuss some aspect of care and modify treatment plans. Errors in communication delay care and can pose risk to patients. This report describes the successful implementation of a standardized team-based paging system at an academic center. Results showed a substantial improvement in nurses' perceptions of knowing how to contact the correct physician when discussion of the patient's care is needed. This improvement was found across multiple medical and surgical specialties and was particularly effective for services with the greatest communication problems.

  18. Family Physician Involvement in Cancer Care Follow-up: The Experience of a Cohort of Patients With Lung Cancer

    PubMed Central

    Aubin, Michèle; Vézina, Lucie; Verreault, René; Fillion, Lise; Hudon, Éveline; Lehmann, François; Leduc, Yvan; Bergeron, Rénald; Reinharz, Daniel; Morin, Diane

    2010-01-01

    PURPOSE There has been little research describing the involvement of family physicians in the follow-up of patients with cancer, especially during the primary treatment phase. We undertook a prospective longitudinal study of patients with lung cancer to assess their family physician’s involvement in their follow-up at the different phases of cancer. METHODS In 5 hospitals in the province of Quebec, Canada, patients with a recent diagnosis of lung cancer were surveyed every 3 to 6 months, whether they had metastasis or not, for a maximum of 18 months, to assess aspects of their family physician’s involvement in cancer care. RESULTS Of the 395 participating patients, 92% had a regular family physician but only 60% had been referred to a specialist by him/her or a colleague for the diagnosis of their lung cancer. A majority of patients identified the oncology team or oncologists as mainly responsible for their cancer care throughout their cancer journey, except at the advanced phase, where a majority attributed this role to their family physician. At baseline, only 16% of patients perceived a shared care pattern between their family physician and oncologists, but this proportion increased with cancer progression. Most patients would have liked their family physician to be more involved in all aspects of cancer care. CONCLUSIONS Although patients perceive that the oncology team is the main party responsible for the follow-up of their lung cancer, they also wish their family physicians to be involved. Better communication and collaboration between family physicians and the oncology team are needed to facilitate shared care in cancer follow-up. PMID:21060123

  19. [The addiction patient in the family physicians' practice: tools and skills for a successful performance].

    PubMed

    Neuner-Jehle, Stefan

    2014-10-01

    Addiction patients are usually perceived as problematic patients in primary care practices: Encounters often are time-consuming and the approach to the patient is difficult. Moreover, patients sometimes are hiding their addictive behaviour and behave shameful. Other barriers are a lack of experience in communication skills among physicians or their own addictive behaviour. Nevertheless, to diagnose and treat addiction as early as possible is an important task for family doctors, as patients' confidence in them is an important factor to induce a behaviour change. We present four screening tests for the early diagnosis of addiction to alcohol (AUDIT, AUDIT-C, CAGE, SMAST-G) and discuss their strengths and shortcomings. The family doctor's practice is also a useful setting for brief interventions based on motivational interviewing (MI) techniques and the transtheoretical model of behaviour change (TTM). We shortly introduce to these techniques and attitudes using addiction to alcohol and nicotine as examples, and we present innovative methods as "defined drinking" and new quit smoking methods. A respectful attitude towards the patient and communication skills seem to be key factors for family physicians to successfully approach their addiction patients.

  20. Cruising the information highway: online services and electronic mail for physicians and families.

    PubMed

    Faughnan, J G; Doukas, D J; Ebell, M H; Fox, G N

    1994-10-01

    Commercial online service providers, bulletin board services, and the Internet make up the rapidly expanding "information highway." Physicians and their families can use these services for professional and personal communication, for recreation and commerce, and to obtain reference information and computer software. Commercial providers include America Online, CompuServe, GEnie, and MCIMail. Internet access can be obtained indirectly through America Online or directly through specialized access providers. Today's online services are destined to evolve into a National Information Infrastructure that will change the way we work and play.

  1. Mining reflective continuing medical education data for family physician learning needs.

    PubMed

    Lewis, Denice Colleen; Pluye, Pierre; Rodriguez, Charo; Grad, Roland

    2016-04-06

    A mixed methods research (sequential explanatory design) studied the potential of mining the data from the consumers of continuing medical education (CME) programs, for the developers of CME programs. The quantitative data generated by family physicians, through applying the information assessment method to CME content, was presented to key informants from the CME planning community through a qualitative description study.The data were revealed to have many potential applications including supporting the creation of CME content, CME program planning and personal learning portfolios.

  2. Importance of telemedicine in diabetes care: Relationships between family physicians and ophthalmologists

    PubMed Central

    Romero-Aroca, Pedro; Sagarra-Alamo, Ramon; Pareja-Rios, Alicia; López, Maribel

    2015-01-01

    Diabetic retinopathy (DR) is the worldwide leading cause of legal blindness. In 2010, 1.9% of diabetes mellitus (DM) patients were legally blind and 10.2% had visual impairment. The control of DM parameters (glycemia, arterial tension and lipids) is the gold standard for preventing DR complications, although, unfortunately, DR still appeared in a 25% to 35% of patients. The stages of severe vision threading DR, include proliferative DR (6.96%) and diabetic macular edema (6.81%). This review aims to update our knowledge on DR screening using telemedicine, the different techniques, the problems, and the inclusion of different professionals such as family physicians in care programs. PMID:26240697

  3. Family practice in Turkey.

    PubMed

    Ozsahin, Akatli Kursad

    2014-03-01

    The national project 'Transformation in Health' was started in 2005 to provide expert primary care by family physicians, and decrease expenses in Turkey. The number of family physicians was far below the need, so public physicians were promoted to family physician status after a 10-day intensive course. The government declared some satisfactory results, but privately paid family physicians were not accepted into the system. Furthermore, the government stopped paying for their services from private settings. Some family physicians became unemployed as the major payer for all forms of medical care in Turkey denied their services. The process showed it's value in time. Nevertheless, family physicians should be the core of this transformation as family medicine is an academic and a scientific discipline and a primary care-oriented specialty with its own specific educational content, research and base of evidence, which cannot be achieved through standard medical education.

  4. Comparing the quality of oral anticoagulant management by anticoagulation clinics and by family physicians: a randomized controlled trial

    PubMed Central

    Wilson, S. Jo-Anne; Wells, Philip S.; Kovacs, Michael J.; Lewis, Geoffrey M.; Martin, Janet; Burton, Erica; Anderson, David R.

    2003-01-01

    Background There is growing evidence that better outcomes are achieved when anticoagulation is managed by anticoagulation clinics rather than by family physicians. We carried out a randomized controlled trial to evaluate these 2 models of anticoagulant care. Methods We randomly allocated patients who were expected to require warfarin sodium for 3 months either to anticoagulation clinics located in 3 Canadian tertiary hospitals or to their family physician practices. We evaluated the quality of oral anticoagulant management by comparing the proportion of time that the international normalized ratio (INR) of patients receiving warfarin sodium was within the target therapeutic range ± 0.2 INR units (expanded therapeutic range) while they were managed in anticoagulation clinics as opposed to family physicians' care over 3 months. We measured the rates of thromboembolic and major hemorrhagic events and patient satisfaction in the 2 groups. Results Of the 221 patients enrolled, 112 were randomly assigned to anticoagulation clinics and 109 to family physicians. The INR values of patients who were managed by anticoagulation clinics were within the expanded therapeutic range 82% of the time versus 76% of the time for those managed by family physicians (p = 0.034). High-risk INR values (defined as being < 1.5 or > 5.0) were more commonly observed in patients managed by family physicians (40%) than in patients managed by anticoagulation clinics (30%, p = 0.005). More INR measurements were performed by family physicians than by anticoagulation clinics (13 v. 11, p = 0.001). Major bleeding events (2 [2%] v. 1 [1%]), thromboembolic events (1 [1%] v. 2 [2%]) and deaths (5 [4%] v. 6 [6%]) occurred at a similar frequency in the anticoagulation clinic and family physician groups respectively. Of the 170 (77%) patients who completed the patient satisfaction questionnaire, more were satisfied when their anticoagulant management was managed through anticoagulation clinics than by

  5. The Family-Study Interface and Academic Outcomes: Testing a Structural Model

    ERIC Educational Resources Information Center

    Meeuwisse, Marieke; Born, Marise Ph.; Severiens, Sabine E.

    2011-01-01

    Expanding on family-work and work-study models, this article investigated a model for family-study conflict and family-study facilitation. The focus of the study was the relationship of family-study conflict and family-study facilitation with students' effortful behaviors and academic performance among a sample of university students (N = 1,656).…

  6. Mentorship perceptions and experiences among academic family medicine faculty

    PubMed Central

    Stubbs, Barbara; Krueger, Paul; White, David; Meaney, Christopher; Kwong, Jeffrey; Antao, Viola

    2016-01-01

    Abstract Objective To collect information about the types, frequency, importance, and quality of mentorship received among academic family medicine faculty, and to identify variables associated with receiving high-quality mentorship. Design Web-based survey of all faculty members of an academic department of family medicine. Setting The Department of Family and Community Medicine of the University of Toronto in Ontario. Participants All 1029 faculty members were invited to complete the survey. Main outcome measures Receiving mentorship rated as very good or excellent in 1 or more of 6 content areas relevant to respondents’ professional lives, and information about demographic and practice characteristics, faculty ratings of their local departments and main practice settings, teaching activities, professional development, leadership, job satisfaction, and health. Bivariate and multivariate analyses identified variables associated with receiving high-quality mentorship. Results The response rate was 66.8%. Almost all (95.0%) respondents had received mentorship in several areas, with informal mentorship being the most prevalent mode. Approximately 60% of respondents rated at least 1 area of mentoring as very good or excellent. Multivariate logistic regression identified 5 factors associated with an increased likelihood of rating mentorship quality as very good or excellent: positive perceptions of their local department (odds ratio [OR] = 4.02, 95% CI 2.47 to 6.54, P < .001); positive ratings of practice infrastructure (OR = 1.86, 95% CI 1.23 to 2.80, P = .003); increased frequency of receiving mentorship (OR = 2.78, 95% CI 1.59 to 4.89, P < .001); fewer years in practice (OR = 1.93, 95% CI 1.19 to 3.12, P = .007); and practising in a family practice teaching unit (OR = 1.51, 95% CI 1.01 to 2.27, P = .040). Conclusion With increasing emphasis on distributed education and community-based teachers, family medicine faculties will need to develop strategies to support

  7. LEVEL OF COMPETENCIES OF FAMILY PHYSICIANS IN KOSOVO FROM DIFFERENT PERSPECTIVES

    PubMed Central

    Bojaj, Gazmend; Skeraj, Fitim; Czabanowska, Katarzyna; Burazeri, Genc

    2016-01-01

    Aim: The aim of this analysis was to compare the level of self-perceived competencies of primary health care physicians in Kosovo with patients’ viewpoint, as well as the necessary (required) level of such competencies from decision-makers’ standpoint. Methods: Three cross-sectional studies were carried out in Kosovo in 2013 including: i) a representative sample of 1340 primary health care users aged ≥18 years (49% men; overall mean age: 50.5±17.9 years; response rate: 89%); ii) a representative sample of 597 primary health care physicians (49% men; overall mean age: 46.0±9.4 years; response rate: 90%), and; iii) a nationwide representative sample of 100 decision-makers operating at different primary health care institutions or public health agencies in Kosovo (63% men; mean age: 47.7±5.7 years). A structured self-administered questionnaire (consisting of 37 items) was used in the three surveys in order to assess physicians’ competencies regarding different domains of the quality of health care. Results: There was a significant gap in the level of self-perceived physicians’ competencies and patients’ perspective in transitional Kosovo. Furthermore, there was a gap in the level of self-perceived physicians’ competencies and the necessary (required) level of physicians’ competencies from decision-makers perspective which was less evident in Prishtina, but considerable in the other regions of Kosovo. Conclusion: Our analysis provides valuable evidence about the level of competencies of primary health care physicians in Kosovo from different stakeholders’ perspectives. There is an urgent need for continuous professional development of family physicians in post-war Kosovo. PMID:27999483

  8. A case of informed consent obtained from a patient with terminal cancer and his family using family function by the primary care physician.

    PubMed

    Tsuboi, Keiko; Minegishi, Yukiko; Harada, Toshihide; Ishizaki, Fumiko; Nitta, Kohsaku

    2007-06-01

    We evaluated the contents and characteristics of informed consent obtained by the primary care physician from a male patient with advanced cancer and his family, and clarified the influences of the informed consent on family function. This patient was diagnosed as having advanced cancer at the age of 46 years, underwent surgery/chemotherapy, but died after 4 months at the hospital. Semi-structured interviews were held with the elder daughter of the patient, and notes on the patient's disease, the course of treatment, his family's responses, and the informed consent obtained by the primary care physician were taken during the interview. The informed consent obtained by the primary care physician had the following characteristics: (1) The physician transmitted accurate and detailed information on the treatment methods, side effects, and prognosis by appropriate communication techniques with consideration for the feelings of the patient and his family, and proposed choices so that they could participate in the decision of treatment principles. (2) During the entire course, the primary care physician frequently visited the bedside and encouraged the patient and his family to express their feelings of anxiety and to ask questions, giving continuous emotional support. With the progression of the disease and explanation by the primary care physician, the patient and his family expressed and shared feelings such as grief and powerlessness and supported each another. Gradually, they began to show practical/adaptive coping behavior and could accept the patient's death. Appropriate informed consent obtained by the primary-care physician promoted the family function of this family.

  9. Access to Healthcare in Urban Family Physician Reform from Physicians and Patients’ Perspective: a survey-based project in two pilot provinces in Iran

    PubMed Central

    Jahromi, Vahid Kohpeima; Dehnavieh, Reza; Mehrolhassani, Mohammad Hossein; Anari, Hosain Saberi

    2017-01-01

    Introduction Iran introduced the urban family physician reform, based on the primary healthcare (PHC) approach, in 2012. The reform is restricted to two pilot provinces, which are Fars and Mazandaran and its policymakers request evidence of the reform progress. The study aimed to determine the accessibility of health care in the two pilot sites. Methods A cross-sectional study using Primary Care Evaluation Tool (PCET) questionnaires was performed with a multistage stratified cluster sample of the family physicians (n=141) and patients (n=710) in the two provinces between September 2015 and March 2016. The questionnaires contained essential dimensions of health accessibility: organizational, financial, geographical, and cultural access. The data were analyzed by IBM-SPSS software and the descriptive statistics. Results With an average population of 2,332, the main daily task for family physicians was patient visits (n=39). Most patients were satisfied with the current hours (80%) but visiting a family physician on holidays or after working hours were only rarely possible. The co-payment was an inconvenience to access health services in getting medicines, getting paraclinic exams and a visiting specialist. At least 70% of patients could receive their preferred healthcare facilities within 40 minutes. The majority of FPs (64%) believed there were some cultural characteristics in the population that made a limited role for providing better health services. Conclusion In the reform the providers were geographically well distributed and some features of the organizational access were relatively high. However there were some difficulties in the financial, cultural, and other features of organizational access. PMID:28243420

  10. Academic Achievement Trajectories of Adolescents from Mexican and East Asian Immigrant Families in the United States

    ERIC Educational Resources Information Center

    Jeong, Yu-Jin; Acock, Alan C.

    2014-01-01

    Drawing on the National Educational Longitudinal Survey 1988 (NELS:88), this study identified (1) the growth pattern of academic achievement of adolescent children from Mexican and East Asian immigrant families; (2) investigated to what extent ethnicity and family capital influenced the trajectories in the academic achievement of children from…

  11. [National Program of Continuous Academic Development for the General Physician (PRONADAMEG). The Chihuahua City experience].

    PubMed

    Ramos-Martínez, Ernesto

    2004-01-01

    The aim of this work is to report on the experience obtained during 8 years of the Programa Nacional de Actualización y Desarrollo Académico para el Medico General (PRONADAMEG) in Chihuahua City in Northern Mexico. During this period, 276 general physicians enrolled in PRONADAMEG and 140 concluded their training, with end effectiveness of 50.7%.

  12. Giving patients responsibility or fostering mutual response-ability: family physicians' constructions of effective chronic illness management.

    PubMed

    Thille, Patricia H; Russell, Grant M

    2010-10-01

    Current visions of family medicine and models of chronic illness management integrate evidence-based medicine with collaborative, patient-centered care, despite critiques that these constructs conflict with each other. With this potential conflict in mind, we applied a critical discursive psychology methodology to present discursive patterns articulated by 13 family physicians in Ontario, Canada, regarding care of patients living with multiple chronic illnesses. Physicians constructed competing versions of the terms "effective chronic illness management" and "patient involvement." One construction integrated individual responsibility for health with primacy of "evidence," resulting in a conceptualization consistent with paternalistic care. The second constructed effective care as involving active partnership of physician and patient, implying a need to foster the ability of both practitioners and patients to respond to complex challenges as they arose. The former pattern is inconsistent with visions of family medicine and chronic illness management, whereas the latter embodies it.

  13. Supporting frail seniors through a family physician and Home Health integrated care model in Fraser Health

    PubMed Central

    Park, Grace; Miller, Diane; Tien, George; Sheppard, Irene; Bernard, Michael

    2014-01-01

    Background A major effort is underway to integrate primary and community care in Canada's western province of British Columbia and in Fraser Health, its largest health authority. Integrated care is a critical component of Fraser Health's planning, to meet the challenges of caring for a growing, elderly population that is presenting more complex and chronic medical conditions. Description of integrated practice An integrated care model partners family physicians with community-based home health case managers to support frail elderly patients who live at home. It is resulting in faster response times to patient needs, more informed assessments of a patient's state of health and pro-active identification of emerging patient issues. Early results The model is intended to improve the quality of patient care and maintain the patients’ health status, to help them live at home confidently and safely, as long as possible. Preliminary pilot data measuring changes in home care services is showing positive trends when it comes to extending the length of a person's survival/tenure in the community (living in their home vs. admitted to residential care or deceased). Conclusion Fraser Health's case manager–general practitioner partnership model is showing promising results including higher quality, appropriate, coordinated and efficient care; improved patient, caregiver and physician interactions with the system; improved health and prevention of acute care visits by senior adult patients. PMID:24648834

  14. [Practical games as one of the forms for optimizing the academic process in physician postgraduate training].

    PubMed

    Bobrov, V A; Davydova, I V; Bilinskiĭ, E A; Beziuk, N N; Shlykova, N A; Zaĭtseva, V I; Kozlovskiĭ, V I; Aleksandrova, L A

    1998-05-01

    Described in the article is one of the forms of optimization of the instructional process in the postgraduation physician training--"business-like games". Highly skilled, competent position of the teacher who conducts a business-like game secures an active participation in learning of students, helps in opening the mind, broadening the outlook on the problem under consideration, gives much incentive to further independent work on the discussed issues.

  15. Working as a family physician in Canada and Portugal: How different is it?

    PubMed Central

    Barata, Ana Nunes

    2016-01-01

    Background: The work of a family physician is quite different in each country, and if we consider different continents, differences are even more remarkable. Social and cultural contexts justify a particular organization, not only of the health-care system but also its providers as well. Objectives: By analyzing different health-care systems, new ideas may come about which may trigger positive changes in a health-care service to diminish healthcare disparities. Methods: Description and comparison of the Primary Healthcare Service in Canada and Portugal. Results: Although both health-care systems are mainly public, organizational differences can be found that condition primary healthcare access. Conclusion: Exchanges in other health-care systems contribute for an active knowledge exchange that prompts participants to analyze options on how to improve healthcare access to citizens. This ultimately, leads to the development of primary care, the pillar of a well-functioning health-care system. PMID:28217575

  16. Factors Affecting Leave out of General Practitioners from Rural Family Physician Program: A Case of Kerman, Iran

    PubMed Central

    Amiresmaili, Mohammadreza; Khosravi, Sajad; Feyzabadi, Vahid Yazdi

    2014-01-01

    Background: Rural family physician program as the new reform in the Iranian health system has been implemented since 2005. Its success depends much on physicians’ retention. The present study aimed to identify influential factors on physicians’ willingness to leave out this program in Kerman province. Methods: The present cross-sectional study was performed in Kerman province in 2011. All family physicians working in this program (n = 271) were studied using a questionnaire. Data analysis was carried out using descriptive statistics and logistic regression through SPSS version 18.0. Results: Twenty-six percent (70) of the physicians had left out the program in the past. In addition, 77.3% (208) intended to leave out in the near future. Opportunity for continuing education, inappropriate and long working hours, unsuitable requirements of salary, irregular payments, lack of job security and high working responsibility were regarded as the most important reasons for leaving out the program in the past and intention to leave out in future orderly. According to univariate logistic regression, younger physicians (odds ratio [OR] =2.479; 95% confidence interval [CI]: 1.261-4.872) and physicians who had older children (OR = 4.743; 95% CI: 1.441-15.607) were more willing to leave out the plan in the near future, however it was not significant in multivariate logistic regression. Conclusions: Physician retention in family physician program is faced with serious doubts due to different reasons. The success of the program is endangered because of the pivotal role of human resources. Hence, the revision of human resources policies of the program seems necessary in order to reduce physicians leave out and improving its effectiveness. PMID:25400891

  17. A Family of Strangers: The Fragmented Nature of Academic Development

    ERIC Educational Resources Information Center

    Harland, Tony; Staniforth, David

    2008-01-01

    This paper draws on the experiences of 20 academic developers as they examine the proposition that the organisation and work of academic development in higher education is fragmented. Academic development was seen to have neither the status of a field nor a profession, and there was recognised tension between an institutionally focused service…

  18. Family physician access to and wait times for cancer diagnostic investigations

    PubMed Central

    Barisic, Andriana; Kish, Maxine; Gilbert, Julie; Mittmann, Nicole; Moineddin, Rahim; Sisler, Jeffrey; Vedsted, Peter; Grunfeld, Eva

    2016-01-01

    Abstract Objective To examine provincial and regional differences in FPs’ direct access to cancer diagnostic investigations and advice from other specialists regarding investigations and referrals, and to explore FPs’ perceptions about wait times for diagnostic investigations and receipt of results. Design A cross-sectional, online survey. Setting British Columbia, Manitoba, and Ontario. Participants A sample of FPs from participating provinces. Main outcome measures Direct FP access to various diagnostic investigations and advice from other specialists regarding investigations and referrals; FPs’ perceptions about wait times for diagnostic investigations ordered directly; and FPs’ perceptions about wait times for results. Results A total of 1054 surveys were completed by FPs from British Columbia (n = 229), Manitoba (n = 228), and Ontario (n = 597). Distance from a cancer centre was not significantly associated with direct access to or wait times for diagnostic investigations for most of the investigations studied; however, provincial differences were observed. Family physicians in Manitoba and British Columbia were 30% to 45% less likely to report having direct access to endoscopy and some imaging investigations compared with FPs in Ontario. Family physicians in Manitoba and British Columbia were also at increased odds of waiting longer than 12 weeks for endoscopy investigations and longer than 4 weeks for imaging investigations compared with FPs in Ontario. Most FPs reported wait times of less than 2 weeks for imaging results; however, the proportion of FPs who waited longer than 2 weeks for colonoscopy results ranged from 15% in Ontario to 96% in British Columbia. Conclusion Given the disparities observed among provinces, there is an opportunity for provinces to learn from one another to improve direct access to and shorten wait times for diagnostic investigations. This in turn has the potential to shorten the primary care interval for cancer diagnostic

  19. The duty of the physician to care for the family in pediatric palliative care: context, communication, and caring.

    PubMed

    Jones, Barbara L; Contro, Nancy; Koch, Kendra D

    2014-02-01

    Pediatric palliative care physicians have an ethical duty to care for the families of children with life-threatening conditions through their illness and bereavement. This duty is predicated on 2 important factors: (1) best interest of the child and (2) nonabandonment. Children exist in the context of a family and therefore excellent care for the child must include attention to the needs of the family, including siblings. The principle of nonabandonment is an important one in pediatric palliative care, as many families report being well cared for during their child's treatment, but feel as if the physicians and team members suddenly disappear after the death of the child. Family-centered care requires frequent, kind, and accurate communication with parents that leads to shared decision-making during treatment, care of parents and siblings during end-of-life, and assistance to the family in bereavement after death. Despite the challenges to this comprehensive care, physicians can support and be supported by their transdisciplinary palliative care team members in providing compassionate, ethical, and holistic care to the entire family when a child is ill.

  20. Family factors related to children's intrinsic/extrinsic motivational orientation and academic performance.

    PubMed

    Ginsburg, G S; Bronstein, P

    1993-10-01

    This study examined 3 familial factors--parental surveillance of homework, parental reactions to grades, and general family style--in relation to children's motivational orientation and academic performance. Family, parent, and child measures were obtained in the home from 93 fifth graders and their parents. Teachers provided a measure of classroom motivational orientation, and grades and achievement scores were obtained from school records. Higher parental surveillance of homework, parental reactions to grades that included negative control, uninvolvement, or extrinsic reward, and over- and undercontrolling family styles were found to be related to an extrinsic motivational orientation and to lower academic performance. On the other hand, parental encouragement in response to grades children received was associated with an intrinsic motivational orientation, and autonomy-supporting family styles were associated with intrinsic motivation and higher academic performance. In addition, socioeconomic level was a significant predictor of motivational orientation and academic performance.

  1. Physician-Patient Encounters: The Structure of Performance in Family and General Office Practice

    ERIC Educational Resources Information Center

    Wenghofer, Elizabeth F.; Williams, A. Paul; Klass, Daniel J.; Faulkner, Daniel

    2006-01-01

    Introduction: The College of Physicians and Surgeons of Ontario, the regulatory authority for physicians in Ontario, Canada, conducts peer assessments of physicians' practices as part of a broad quality assurance program. Outcomes are summarized as a single score and there is no differentiation between performance in various aspects of care. In…

  2. Alzheimer's Disease and Other Dementias: An Organizational Approach to Identifying and Addressing Practices and Learning Needs of Family Physicians

    ERIC Educational Resources Information Center

    Allen, Michael; Ferrier, Suzanne; Sargeant, Joan; Loney, Elaine; Bethune, Graeme; Murphy, Gerard

    2005-01-01

    Caring for patients with dementia is complex and demanding. Since family physicians (FPs) provide much of this care, we examined their practices, learning needs, and barriers to care concerning Alzheimer's disease and other dementias. We surveyed 392 (approximately 50%) Nova Scotia FPs and conducted focus groups and interviews with: FPs; staff of…

  3. A Correlational Study of Self-Directed Learning Readiness and Learning Activity Preference for Continuing Medical Education among Family Physicians

    ERIC Educational Resources Information Center

    Barrett, Theresa J.

    2014-01-01

    This quantitative, nonexperimental, correlational study sought to determine whether a relationship exists between family physicians' levels of self-directed learning readiness (SDLR) and their preferences for continuing medical education (CME) activities. The study also sought to determine whether years in clinical practice or size of clinical…

  4. Work Valence as a Predictor of Academic Achievement in the Family Context

    ERIC Educational Resources Information Center

    Porfeli, Erik; Ferrari, Lea; Nota, Laura

    2013-01-01

    This study asserts a theoretical model of academic and work socialization within the family setting. The presumed associations between parents' work valences, children's work valences and valence perceptions, and children's academic interest and achievement are tested. The results suggest that children's perceptions of parents mediate the…

  5. Immigrant College Scholars in STEM: Generational Status, Family Achievement-Orientation, and Academic Outcomes

    NASA Astrophysics Data System (ADS)

    Beason, Tiffany S.

    Previous research has demonstrated that higher academic achievement among children of immigrants is related to higher academic expectations and aspirations among immigrant parents as compared to U.S.-born parents. The current study sought to further explore how family environment impacts the relation between immigrant generational status and academic outcomes. Specifically, it was hypothesized that family achievement-orientation, or family attitudes towards success at work or school, mediates the relation between immigrant generational status and academic outcomes (i.e. college GPA and career choice as indicated by graduate program entry). Results indicate that family achievement-orientation is higher among African American/Black children of immigrants than African Americans with US-born parents. Furthermore, African American/Black children of immigrants pursue the M.D. over the Ph.D. more often than their counterparts with US-born parents. The study concludes with a discussion of implications for future research.

  6. Recognition and management of common acute conditions of the oral cavity resulting from tooth decay, periodontal disease, and trauma: an update for the family physician.

    PubMed

    Edwards, Paul C; Kanjirath, Preetha

    2010-01-01

    This article presents an overview of common and/or significant diseases of the oral cavity that the family physician is likely to encounter, with an emphasis on pathogenesis, recognition, complications, and management. Topics reviewed include the sequelae of dental caries, periodontal disease, and trauma. Prevention and early intervention strategies are emphasized. Recent updates and practical issues for the family physician are highlighted.

  7. Profile of Julie Phillips, MD, MPH: Family physician, medical educator, researcher, poet.

    PubMed

    Fogarty, Colleen T; Shapiro, Johanna

    2015-12-01

    Dr. Julie Phillips, an Associate Professor of Family Medicine at Michigan State University College of Human Medicine, has contributed several poems to Families, Systems, and Health over the last 2 years. This month's issue features her fourth poem in this journal, titled "Autumn Chores" (Phillips, 2015). We were interested in learning more about Julie's creative writing, why she writes poetry, how she balances writing and a demanding academic medical career, and what she hopes her poems might contribute to clinical practice and medical education. Colleen Fogarty interviewed her to find out the answers in this article. Julie's poems are indeed, as she says, carved from small moments in time, but they have a disproportionately large emotional impact. Her poems tackle issues such as the tension between medical and parental authority; professional boundaries; worklife balance; the still-gaping holes in our health care system; and what it means to care for others. To read her work, please search the journal index. (PsycINFO Database Record

  8. Human immunodeficiency virus risk awareness. Evaluation of a CME program for family physicians.

    PubMed Central

    Martin, F.; Murphy, P.

    1997-01-01

    OBJECTIVE: To determine whether a continuing medical education (CME) program on AIDS risk awareness would enhance physicians' knowledge of HIV and AIDS, their "intent-to-change" practice behaviour, and their ability to integrate their knowledge into hypothetical clinical scenarios; and to identify participant characteristics that affect their knowledge of risks and how they intend to behave regarding HIV testing. DESIGN: Before-and-after study using a questionnaire. SETTING: The city of Winnipeg and 16 rural communities in Manitoba. PARTICIPANTS: Convenience sample of physicians who attended the AIDS Risk Awareness Program and completed a questionnaire before the presentation (96 of 142 eligible physicians). MAIN OUTCOME MEASURE: A two-point or greater change on a Likert scale in the desired direction for each questionnaire item. RESULTS: Physicians were classified as sensitized or less sensitized depending on previous experience with HIV-positive and AIDS patients. Less sensitized physicians significantly improved their scores in all three areas. Sensitized physicians and women physicians significantly improved their knowledge and reported more intent to ask patients routinely about HIV risk behaviours. Physicians' sex, age, religion, and years in practice had an effect on these improvements. CONCLUSIONS: The AIDS Risk Awareness Program was successful in improving physicians' knowledge, attitude to intent-to-change behaviour and ability to integrate knowledge into practice scenarios. Physicians with true learning needs benefited the most from the CME program. PMID:9266123

  9. THE BUDGET, THE FAMILY PHYSICIAN AND THE PATIENT A DIFFERENT APPROACH.

    PubMed

    Keidar, Ilan

    2014-10-01

    Modern medicine offers better health and longer life expectancy, yet consumes huge budgets. The Israeli Health Insurance Law (IHIL) regulates the delivery of health services to all Israel's residents through Health Maintenance Organizations (HMOS). These organizations confront constant struggles with their budgets and have to reduce expenses as much as possible (without harming the health level rendered). In the constant necessity to restrain expenses are embedded difficulties that might cause unrest to the Public Health System (PHS). At the edge of the public health spear are the Family Physicians (FPS) who have not only to supply the best possible medicine to their patients, and at the same time confront budgetary constraints that have the potential to hinder the level of rendered medicine, but also have, at times, to mediate between the conflicting interests of their patients' wish to receive the best available health measures, the FP own medical believes, the HMO's directives and, between the FPS wish, to keep up the number of their (content) patients. One of the World Health Organization's (WHO) concepts, like Israel's one, is that soul and body are inseparable and must be addressed simultaneously in the process of healing. Real life at the Family Physicians' clinics shows, at times, that despite the Israeli physicians' very high professional level, and the Israeli Health System (IHS)'s high efficiency, such a process, due to budgetary constraints, workload and various other reasons, does not always take place and, on the personal level, there are patients who feel that the "system" has treated them incorrectly and in an unsatisfactory manner. Unsatisfied and restless patients might cause undesirable consequences to the "system", like losing faith in one's FP and HMO, which might lead to the patients' reduced cooperation in the healing process, lawsuits amplification, patients leaving their FPS and their HMOs etc. Addressing the patient's soul and body as an

  10. Same-Sex Parent Families and Children's Academic Achievement

    ERIC Educational Resources Information Center

    Potter, Daniel

    2012-01-01

    Children in traditional families (i.e., married, 2 biological parents) tend to do better than their peers in nontraditional families. An exception to this pattern appears to be children from same-sex parent families. Children with lesbian mothers or gay fathers do not exhibit the poorer outcomes typically associated with nontraditional families.…

  11. Preventing a Mass Disease: The Case of Gallstones Disease: Role and Competence for Family Physicians.

    PubMed

    Portincasa, Piero; Di Ciaula, Agostino; Grattagliano, Ignazio

    2016-07-01

    Gallstone formation is the result of a complex interaction between genetic and nongenetic factors. We searched and reviewed the available literature to define how the primary prevention of gallstones (cholesterol gallstones in particular) could be applied in general practice. Electronic bibliographical databases were searched. Prospective and retrospective cohort studies and case-controlled studies were analyzed and graded for evidence quality. The epidemiological data confirmed that genetic factors are estimated to account for only approximately 25% of the overall risk of gallstones, while metabolic/environmental factors are at least partially modifiable in stone-free risk groups, and are thus modifiable by primary prevention measures related to diet, lifestyle, and environmental factors (i.e., rapid weight loss, bariatric surgery, somatostatin or analogues therapy, transient gallbladder stasis, and hormone therapy). There is no specific recommendation for the secondary prevention of recurrent gallstones. Family physicians can contribute to preventing gallstones due to their capability to identify and effectively manage several risk factors discussed in this study. Although further studies are needed to better elucidate the involvement of epigenetic factors that may regulate the effect of environment and lifestyle on gene expression in the primary prevention of gallstone formation, preventive interventions are feasible and advisable in the general practice setting.

  12. Family physician program in Iran: considerations for adapting the policy in urban settings.

    PubMed

    Khayatzadeh-Mahani, Akram; Takian, Amirhossein

    2014-11-01

    Nationwide implementation of Family Physician (FP) program started in 2005 and targeted almost 25,000,000 citizens residing in rural areas and cities with less than 20,000 populations in Iran. Despite its blatant initiation that resulted in some modest achievements, the future of FP looks unclear in Iran. Thus far, no longitudinal evaluation of the implementation and impact of FP program has been conducted. However, meager evidence highlights the facilitating role of an existing and strong Primary Health Care (PHC) network in the implementation of FP in rural areas in Iran. A longstanding challenge, however, as emphasized by most stakeholders, remains to be the expansion of FP program into urban settings, where the PHC is undeveloped and fragile as well as the powerful private sector is resistant. Using an adapted conceptual framework of institutions, ideas, and interests, this policy perspective aims to shed light on main difficulties of FP implementation in urban areas of Iran. We analyze FP policy in the context of ongoing interactions and conflicts among institutions (the structures and rules that shape policies), interests (the groups and individuals influencing policy), and ideas (discourses around policies). Our argument will, we envisage, help plan for more appropriate implementation of FP in cities in Iran, and hopefully beyond.

  13. Barriers to the provision of smoking cessation assistance: a qualitative study among Romanian family physicians

    PubMed Central

    Panaitescu, Catalina; Moffat, Mandy A; Williams, Siân; Pinnock, Hilary; Boros, Melinda; Oana, Cristian Sever; Alexiu, Sandra; Tsiligianni, Ioanna

    2014-01-01

    Background: Smoking cessation is the most effective intervention to prevent and slow down the progression of several respiratory and other diseases and improve patient outcomes. Romania has legislation and a national tobacco control programme in line with the World Health Organization Framework for Tobacco Control. However, few smokers are advised to quit by their family physicians (FPs). Aim: To identify and explore the perceived barriers that prevent Romanian FPs from engaging in smoking cessation with patients. Methods: A qualitative study was undertaken. A total of 41 FPs were recruited purposively from Bucharest and rural areas within 600 km of the city. Ten FPs took part in a focus group and 31 participated in semistructured interviews. Analysis was descriptive, inductive and themed, according to the barriers experienced. Results: Five main barriers were identified: limited perceived role for FPs; lack of time during consultations; past experience and presence of disincentives; patients’ inability to afford medication; and lack of training in smoking cessation skills. Overarching these specific barriers were key themes of a medical and societal hierarchy, which undermined the FP role, stretched resources and constrained care. Conclusions: Many of the barriers described by the Romanian FPs reflected universally recognised challenges to the provision of smoking cessation advice. The context of a relatively hierarchical health-care system and limitations of time and resources exacerbated many of the problems and created new barriers that will need to be addressed if Romania is to achieve the aims of its National Programme Against Tobacco Consumption. PMID:25010432

  14. Visiting family physicians and naturopathic practitioners. Comparing patient-practitioner interactions.

    PubMed Central

    Boon, Heather; Stewart, Moira; Kennard, Mary Ann; Guimond, Jessica

    2003-01-01

    OBJECTIVE: To explore similarities and differences in patient visits with family physicians (FPs) and naturopathic practitioners (NPs). DESIGN: Exploratory study combining quantitative and qualitative methods. SETTING: Southern Ontario. PARTICIPANTS: A purposeful sample of 10 practitioners (five FPs and five NPs matched for age, sex, and number of years in practice): each agreed to recruit three consecutive patients with new complaints to participate in the study. MAIN OUTCOME MEASURES: Patient and visit characteristics; qualitative (content analysis of audiotaped interactions) and quantitative (ie, patient-centred care scores) information was gathered and analyzed. RESULTS: Qualitative analysis revealed that information gathering and treatment planning were very similar whether patients were visiting FPs or NPs. Most important differences were length of interaction (mean 54 minutes for NPs and 16.5 minutes for FPs) and patients' reasons for visits. Naturopathic practitioners were more likely to recommend medications (usually natural health products) than FPs. Quantitative data suggested that patients perceived no differences in patient-centred care from FPs and NPs. CONCLUSION: Overall, there were more similarities than differences in visits to the two types of practitioners. PMID:14649987

  15. Preventing a Mass Disease: The Case of Gallstones Disease: Role and Competence for Family Physicians

    PubMed Central

    Di Ciaula, Agostino; Grattagliano, Ignazio

    2016-01-01

    Gallstone formation is the result of a complex interaction between genetic and nongenetic factors. We searched and reviewed the available literature to define how the primary prevention of gallstones (cholesterol gallstones in particular) could be applied in general practice. Electronic bibliographical databases were searched. Prospective and retrospective cohort studies and case–controlled studies were analyzed and graded for evidence quality. The epidemiological data confirmed that genetic factors are estimated to account for only approximately 25% of the overall risk of gallstones, while metabolic/environmental factors are at least partially modifiable in stone-free risk groups, and are thus modifiable by primary prevention measures related to diet, lifestyle, and environmental factors (i.e., rapid weight loss, bariatric surgery, somatostatin or analogues therapy, transient gallbladder stasis, and hormone therapy). There is no specific recommendation for the secondary prevention of recurrent gallstones. Family physicians can contribute to preventing gallstones due to their capability to identify and effectively manage several risk factors discussed in this study. Although further studies are needed to better elucidate the involvement of epigenetic factors that may regulate the effect of environment and lifestyle on gene expression in the primary prevention of gallstone formation, preventive interventions are feasible and advisable in the general practice setting. PMID:27468338

  16. Family Decision-Making Style, Peer Group Affiliation and Prior Academic Achievement as Predictors of the Academic Achievement of African American Students

    ERIC Educational Resources Information Center

    Engerman, Kimarie

    2006-01-01

    A study analyzed family decision-making style, peer group affiliation, and academic achievement in 10th grade as predictors of academic achievement of African American students in 12th grade. Findings indicated that though peer groups were known to influence academic performance, affiliation with learning oriented peers in 10th grade did not…

  17. Determinants of customer satisfaction with the health care system, with the possibility to choose a personal physician and with a family doctor in a transition country.

    PubMed

    Kersnik, J

    2001-08-01

    Many Eastern and Central European counties are reforming their health care systems. The aim of this study was to determine customer satisfaction with a reformed health care system, with the possibility of free choice of a family physician and patient satisfaction with the family physician in Slovenia and their major determinants. We used a postal survey of the patients who attended their family physician's offices during the study period. We obtained an 84% response rate. Some 72.9% of the respondents were satisfied with the current organisation of health care services, 95.5% of the respondents were satisfied with the possibility of choosing their own family physician and 58% of participants were very satisfied with the level of care received from their personal family practitioners. It was shown that higher patient satisfaction with the family physician was the most powerful predictor of patients' satisfaction with the health care system. The results show that health care reform in Slovenia has a positive impact on the consumers' perceptions of health care quality, measured in terms of consumer satisfaction with the health care system, the possibility to choose a family physician and the overall satisfaction with the family physician.

  18. The Delivery of Sexuality-related Patient Education to Adolescent Patients: A Preliminary Study of Family Practice Resident Physicians

    PubMed Central

    Clark, Jeffrey K.; Brey, Rebecca A.; Banter, Amy E.; Khubchandani, Jagdish

    2012-01-01

    Background: Risky sexual behavior among adolescents is one of the leading health behaviors most associated with mortality, morbidity, and social problems. Adolescents need reliable sources of information to help them promote healthy sexual behaviors. Physicians in the United States are often seen by adolescents as a reliable and trustworthy source of accurate sexual information. However, many physicians feel uncomfortable or ill-prepared to deal with sexuality issues among their adolescent patients. Purpose: This study examined the impact of family resident physicians’ sexual attitudes, knowledge, and comfort, on the delivery of sexuality-related patient education to their adolescent patients. Materials and Methods: Pre-post-test scales were administered to 21 physicians. Data were also collected for patient (n=644) charts. Factors that determined the delivery of sexuality-related patient education were analyzed. Results: Results indicate that sexuality-related patient education was rarely provided to adolescent patients. Conclusions: Adolescent sexuality education is not a high priority for physicians. Professional medical organizations should play a leadership role in training physicians on delivering sexuality education to adolescent patients. PMID:24478998

  19. Socioeconomic Stress and Academic Adjustment among Asian American Adolescents: The Protective Role of Family Obligation

    ERIC Educational Resources Information Center

    Kiang, Lisa; Andrews, Kandace; Stein, Gabriela L.; Supple, Andrew J.; Gonzalez, Laura M.

    2013-01-01

    Socioeconomic stress has long been found to place youth at risk, with low family income conferring disadvantages in adolescents' school achievement and success. This study investigates the role of socioeconomic stress on academic adjustment, and pinpoints family obligation as a possible buffer of negative associations. We examined direct and…

  20. Investigating whether and when Family Ethnic/Race Socialization Improves Academic Performance

    ERIC Educational Resources Information Center

    Brown, Tony N.; Tanner-Smith, Emily E.; Lesane-Brown, Chase L.

    2009-01-01

    This study examined the link between family ethnic/race socialization and Black kindergarteners' and first graders' academic performance as measured by their general knowledge, math, and reading assessment scores. Drawing on identity theory, the authors predicted that repeated instances of family ethnic/race socialization would increase academic…

  1. Postdivorce Family Stability and Changes in Adolescents' Academic Performance: A Growth-Curve Model

    ERIC Educational Resources Information Center

    Sun, Yongmin; Li, Yuanzhang

    2009-01-01

    Three waves of panel data from 7,897 adolescents in the National Education Longitudinal Studies have been used to investigate whether a stabilized postdivorce family environment benefits adolescents' academic performance trajectories. The analyses indicate that compared with peers who grow up in stable postdivorce families, children of divorce who…

  2. Effects of Family Functioning and Parenting Style on Early Entrants' Academic Performance and Program Completion

    ERIC Educational Resources Information Center

    Huey, Erron L.; Sayler, Michael F.; Rinn, Anne N.

    2013-01-01

    The purpose of the current study was to examine the predictive nature of parenting style and overall family environment on the academic performance and program completion of early college entrants. Furthermore, gender and family form were examined as possible moderators to these relationships. A total of 88 early college entrants participated in…

  3. Relations between Early Family Risk, Children's Behavioral Regulation, and Academic Achievement

    ERIC Educational Resources Information Center

    Sektnan, Michaella; McClelland, Megan M.; Acock, Alan; Morrison, Frederick J.

    2010-01-01

    This study examined relations among early family risk, children's behavioral regulation at 54 months and kindergarten, and academic achievement in first grade using data on 1298 children from the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development. Family risk was indexed by ethnic…

  4. Continuity of Care Evaluation: The View of Patients and Professionals about Urban Family Physician Program

    PubMed Central

    Jahromi, Vahid Kohpeima; Mehrolhassani, Mohammad Hossein; Dehnavieh, Reza; Anari, Hosein Saberi

    2017-01-01

    Background: A responsibility of the family physician (FP) and one of the four aspects of the delivery of primary care services is continuity of care (COC). This study aimed to determine the COC of health care in urban health centers. Methods: Between September 2015 and March 2016, we conducted a cross-sectional study using Primary Care Evaluation Tool questionnaires with multistage stratified cluster sample of FPs (n = 141) and patients (n = 710) in two provinces in Iran, Fars and Mazandaran. The questionnaires contained essential dimensions of COC: Informational, interpersonal, and longitudinal COC. Results: Almost all FPs had a computer. The FPs hadn’t kept their patients’ medical records routinely. The software had some problems, so the FPs couldn’t produce lists of patients based on their health risk and they couldn’t monitor their population. Almost 88% of FPs have written referral letters for all referred patients but 57% of them got medical feedback from specialists. About 80% of patients’ consultation times were up to 10 min. 29% of FPs knew the past problems and illnesses of the patients. From 40% to 50% of the patients stated that their FPs asked them for their desire about prescribed medicine and gave clear explanation about their illnesses. On average, patients visited their doctor 5.5 times during the previous year. Generally, patients and FPs in Mazandaran could summarize their experiences better than Fars in most topics of COC. Conclusions: It seems that after 3 years of using urban FP program in two pilot provinces, there were still some problems in COC. Strengthen software program, introducing incentives for FPs, and promoting patients’ responsibility can be used by policy-makers when they seek to enhance COC. PMID:28299031

  5. Academic Failure and Child-to-Parent Violence: Family Protective Factors

    PubMed Central

    Ibabe, Izaskun

    2016-01-01

    A reduction in academic achievement over the course of adolescence has been observed. School failure is characterized by difficulties to teaching school goals. A variety of other behavioral problems are often associated with school failure. Child-to-parent violence has been associated with different school problems. The main objective of current study was to examine the contribution of family variables (parental education level, family cohesion, and positive family discipline) on academic failure and child-to-parent violence of adolescents from a community sample. Moreover, a goal was to explore if academic failure was a valid predictor of child-to-parent violence. To this end, it has been developed a comprehensive statistical model through Structural Equation Modeling (SEM). Participants were 584 children from eight secondary schools in the Basque Country (Spain) and aged between 12 and 18. Among other scales Conflict Tactics Scale and Family Environment Scale were administrated for measuring child-to-parent violence and family cohesion environment, respectively. The structural model revealed that parental education level is a relevant protective factor against academic failure. Positive family discipline (inductive discipline, supervision, and penalty) show a significant association with child-to-parent violence and academic failure. Disciplinary practices could be more efficient to prevent child-to-parent violence or school failure if children perceive a positive environment in their home. However, these findings could be explained by inverse causality, because some parents respond to child-to-parent violence or academic failure with disciplinary strategies. School failure had indirect effects on child-to-parent violence through family cohesion. For all that, education policies should focus on parental education courses for disadvantaged families in order to generate appropriate learning environments at home and to foster improvement of parent

  6. Academic Failure and Child-to-Parent Violence: Family Protective Factors.

    PubMed

    Ibabe, Izaskun

    2016-01-01

    A reduction in academic achievement over the course of adolescence has been observed. School failure is characterized by difficulties to teaching school goals. A variety of other behavioral problems are often associated with school failure. Child-to-parent violence has been associated with different school problems. The main objective of current study was to examine the contribution of family variables (parental education level, family cohesion, and positive family discipline) on academic failure and child-to-parent violence of adolescents from a community sample. Moreover, a goal was to explore if academic failure was a valid predictor of child-to-parent violence. To this end, it has been developed a comprehensive statistical model through Structural Equation Modeling (SEM). Participants were 584 children from eight secondary schools in the Basque Country (Spain) and aged between 12 and 18. Among other scales Conflict Tactics Scale and Family Environment Scale were administrated for measuring child-to-parent violence and family cohesion environment, respectively. The structural model revealed that parental education level is a relevant protective factor against academic failure. Positive family discipline (inductive discipline, supervision, and penalty) show a significant association with child-to-parent violence and academic failure. Disciplinary practices could be more efficient to prevent child-to-parent violence or school failure if children perceive a positive environment in their home. However, these findings could be explained by inverse causality, because some parents respond to child-to-parent violence or academic failure with disciplinary strategies. School failure had indirect effects on child-to-parent violence through family cohesion. For all that, education policies should focus on parental education courses for disadvantaged families in order to generate appropriate learning environments at home and to foster improvement of parent

  7. Work and family conflict in academic science: patterns and predictors among women and men in research universities.

    PubMed

    Fox, Mary Frank; Fonseca, Carolyn; Bao, Jinghui

    2011-10-01

    This article addresses work-family conflict as reported among women and men academic scientists in data systematically collected across fields of study in nine US research universities. Arguing that academic science is a particularly revealing case for studying work-family conflict, the article addresses: (1) the bi-directional conflict of work with family, and family with work, reported among the scientists; (2) the ways that higher, compared with lower, conflict, is predicted by key features of family, academic rank, and departments/institutions; and (3) patterns and predictors of work-family conflict that vary, as well as converge, by gender. Results point to notable differences, and commonalties, by gender, in factors affecting interference in both directions of work-family conflict reported by scientists. These findings have implications for understandings of how marriage and children, senior compared with junior academic rank, and departmental climates shape work-family conflict among women and men in US academic science.

  8. Family Socioeconomic Status and Academic Achievement among Korean Adolescents: Linking Mechanisms of Family Processes and Adolescents' Time Use

    ERIC Educational Resources Information Center

    Bae, Dayoung; Wickrama, K. A. S.

    2015-01-01

    This study examined pathways through which family socioeconomic status may influence adolescents' academic achievement. We focused on parental monitoring and adolescents' after-school time-use patterns as linking mechanisms. Participants were 441 twelve- to fourteen-year-old Korean adolescents who participated in the Korea Welfare Panel Study.…

  9. A Qualitative Study on Factors that Influence Turkish Medical Students’ Decisions to Become Family Physicians After the Health Transformation Programme

    PubMed Central

    Tanriover, Ozlem; Hidiroglu, Seyhan; Akan, Hulya; Ay, Pinar; Erdogan, Yalcin; Karavus, Melda; Vitrinel, Ayca; Hayran, Osman

    2014-01-01

    Background: In Turkey, general practitioners were authorized to work as family physicians without specialization, within the scope of the Health Transformation Programme, due to inadequate number of family medicine specialists since 2004. With this new implementation Family Medicine specialty became a less preferable option for medical students. Aims: The study was to investigate the perspectives of medical students and understand the issues to choose Family Medicine specialty as a career option. Materials and Methods: This qualitative study was performed with 48 final year medical students using a convenience sample from two medical universities. Results: Three main categories emerged from the data viewing Family Medicine ‘as a specialty’, ‘as an employment’, and finally ‘as a system’. Very few students stated that Family Medicine would be their choice for specialty. Conclusions: Family Medicine does not seem to be an attractive option in career planning by medical students. Several factors that may constrain students from choosing Family Medicine include: not perceiving Family Medicine as a field of expertise, and the adverse conditions at work which may originate from duality in the system. PMID:25006564

  10. Family influences and academic success: the perceptions of individuals using AAC.

    PubMed

    Rackensperger, Tracy

    2012-06-01

    Positive family influences have a significant impact on addressing school barriers to academic success for students from socially disadvantaged backgrounds. Due to inequities and attitudes toward people with complex communication needs, positive family influences may be critical in the academic success of students using AAC. This study asked the following question of eight United States high school graduates who have used augmentative and alternative communication (AAC): How do family influences positively affect the ability of students who use AAC to succeed in the secondary academic environment? Five themes emerged from the qualitative analysis of participants' narratives: (a) the impact of the family in seeking appropriate education, (b) homework as a challenge that was made easier through the involvement of the family, (c) the role of the family in communicating the importance of education, (d) mothers as driving forces of support, and (e) family encouragement for self-determination. This research allows families and schools to recognize the needs of students and to take action to meet them. It identifies the needs of families and schools in establishing relationships with each other, in terms of supporting requirements for accommodation, learning, motivation, and self-determination of students with complex commmunication needs.

  11. The After-Death Call to Family Members: Academic Perspectives

    ERIC Educational Resources Information Center

    LoboPrabhu, Sheila; Molinari, Victor; Pate, Jennifer; Lomax, James

    2008-01-01

    Objective: The authors discuss clinical and teaching aspects of a telephone call by the treating clinician to family members after a patient dies. Methods: A MEDLINE search was conducted for references to an after-death call made by the treating clinician to family members. A review of this literature is summarized. Results: A clinical application…

  12. Perceptions of the Utilization of Family Nurse Practitioners by Current Air Force Outpatient Physicians

    DTIC Science & Technology

    1996-03-26

    setting. The nurses had constant caseloads, did patient education , instruction, interpretation of laboratory work, though they neither examined...increase the amount of patient education " , were obtained from a 1985 study in which physician perceptions were surveyed for association with nurse...Utjlization *To increase the amount of patient education provided? *To increase the amount of counseling given to patients? *To allow physicians to

  13. [The physicians role in a quarreling family of a demented patriarch].

    PubMed

    Wettstein, A

    2009-01-07

    The physician of a demented patient whose wealth is disputed by two fractions of his quarreling familiy had to examine his power of judgement and his ability to controll authorized persons. The courts up to the supreme court of Switzerland based their decisions on the physisians findings. Physicians have to base their opinion on carefull examination of the patients mental ability to understand and reason the contested issues.

  14. Learning from history: the legacy of Title VII in academic family medicine.

    PubMed

    Newton, Warren; Arndt, Jane E

    2008-11-01

    The current renaissance of interest in primary care could benefit from reviewing the history of federal investment in academic family medicine. The authors review 30 years of experience with the Title VII, Section 747 Training in Primary Care Medicine and Dentistry (Title VII) grant program, addressing three questions: (1) What Title VII grant programs were available to family medicine, and what were their goals? (2) How did Title VII change the discipline? and (3) What impact did Title VII family medicine programs have outside the discipline?Title VII grant programs evolved from broad support for the new discipline of family medicine to a sharper focus on specific national workforce objectives such as improving care for underserved and vulnerable populations and increasing diversity in the health professions. Grant programs were instrumental in establishing family medicine in nearly all medical schools and in supporting the educational underpinnings of the field. Title VII grants helped enhance the social capital of the discipline. Outside family medicine, Title VII fostered the development of innovative ambulatory education, institutional initiatives focusing on underserved and vulnerable populations, and primary care research capacity. Adverse effects include relative inattention to clinical and research missions in family medicine academic units and, institutionally, the development of medical education initiatives without core institutional support, which has put innovation and extension of education to communities at risk as grant funding has decreased. Reinvestment in academic family medicine can yield substantial benefits for family medicine and help reorient academic health centers. This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

  15. What keeps family physicians busy in Portugal? A multicentre observational study of work other than direct patient contacts

    PubMed Central

    Granja, Mónica; Ponte, Carla; Cavadas, Luís Filipe

    2014-01-01

    Objectives To quantify the time spent by family physicians (FP) on tasks other than direct patient contact, to evaluate job satisfaction, to analyse the association between time spent on tasks and physician characteristics, the association between the number of tasks performed and physician characteristics and the association between time spent on tasks and job satisfaction. Design Cross-sectional, using time-and-motion techniques. Two workdays were documented by direct observation. A significance level of 0.05 was adopted. Setting Multicentric in 104 Portuguese family practices. Participants A convenience sample of FP, with lists of over 1000 patients, teaching senior medical students and first-year family medicine residents in 2012, was obtained. Of the 217 FP invited to participate, 155 completed the study. Main outcomes measured Time spent on tasks other than direct patient contact and on the performance of more than one task simultaneously, the number of direct patient contacts in the office, the number of indirect patient contacts, job satisfaction, demographic and professional characteristics associated with time spent on tasks and the number of different tasks performed, and the association between time spent on tasks and job satisfaction. Results FP (n=155) spent a mean of 143.6 min/day (95% CI 135.2 to 152.0) performing tasks such as prescription refills, teaching, meetings, management and communication with other professionals (33.4% of their workload). FP with larger patient lists spent less time on these tasks (p=0.002). Older FP (p=0.021) and those with larger lists (p=0.011) performed fewer tasks. The mean job satisfaction score was 3.5 (out of 5). No association was found between job satisfaction and time spent on tasks. Conclusions FP spent one-third of their workday in coordinating care, teaching and managing. Time devoted to these tasks decreases with increasing list size and physician age. PMID:24934208

  16. Financial Strain, Major Family Life Events, and Parental Academic Involvement During Adolescence.

    PubMed

    Camacho-Thompson, Daisy E; Gillen-O'Neel, Cari; Gonzales, Nancy A; Fuligni, Andrew J

    2016-06-01

    Parental academic involvement-whether through school participation and communication, or supervision and assistance at home-often has been cited as a way to enhance academic achievement. Yet, little is known about how the financial and life pressures faced by families can compromise parents' ability to become involved in their adolescents' education. In the current study, these dynamics were examined among Mexican-origin families, who often may face challenging financial and familial circumstances, and whose students may have more difficulty in secondary school. Parents of Mexican-origin ninth and tenth grade students from two high schools in Los Angeles (N = 428; 50 % female) completed quantitative interviews. The results revealed that financial strain predicted less involvement at school, and major family life events predicted less involvement at home, even after controlling for potentially confounding factors. Moreover, both of the associations between parental stress and parental academic involvement were mediated by lower levels of relationship quality between parents and adolescents, but not by conflict within the parent-adolescent dyad or parental depressive and somatic symptoms. The findings suggest that stress may limit parents' ability to become involved their adolescents' education, and highlight the importance of understanding family dynamics when examining parental academic involvement among Mexican-origin families.

  17. Constructing and Communicating Privacy Boundaries: How Family Medicine Physicians Manage Patient Requests for Religious Disclosure in the Clinical Interaction.

    PubMed

    Canzona, Mollie Rose; Peterson, Emily Bylund; Villagran, Melinda M; Seehusen, Dean A

    2015-01-01

    Religion/spirituality (R/S) is an important component of some patients' psychosocial framework when facing illness. While many patients report an increased desire for R/S dialogue in clinical interaction, especially when facing a frightening diagnosis, some physicians report discomfort talking about R/S and hold various beliefs regarding the appropriateness of such discussions. Not only do physicians manage conversations centering on patient disclosures in the clinical visit, they must also navigate requests to share their own personal information. Farber et al. (2000) found that over a 12-month period nearly 40% of physicians reported that patients asked questions that transgressed professional boundaries. This article uses Petronio's communication privacy management theory as a lens through which to situate our understanding of how family medicine physicians construct and communicate privacy boundaries in response to patient requests for religious disclosure. Results provide an in-depth theoretical understanding of issues surrounding religious disclosure in the medical visit and expand the discussion on health care providers' personal and professional privacy boundaries as documented by Petronio and Sargent (2011). Implications for health care training and practice are discussed.

  18. Patient Protection and Affordable Care Act of 2010: Summary, Analysis, and Opportunities for Advocacy for the Academic Emergency Physician

    PubMed Central

    Kline, Jeffrey A.; Walthall, Jennifer D.H.

    2010-01-01

    The Patient Protection and Affordable Care Bill, commonly referred to as the “Health Care Bill” or the “Health Care Reform Bill,” became enacted in March, 2010. This article is a review and analysis of the sections of this Act that are relevant to researchers and teachers of emergency care. The purpose of this document is to serve as a citable reference for interested parties and a reference to quickly locate the sections of the Bill relevant to academic emergency physicians. When appropriate, text was copied verbatim from the bill. The source of the downloaded Act, and the page numbers of the text sections, are provided to help the reader to find the sections described. This review is presented in two parts. Part 1 presents 11 sections extirpated from the Act, with short interpretations of the significance of each section. Part II presents an analysis of the sections that the authors believe represent opportunities for emergency care researchers and teachers to make the most impact, through active involvement with the various departments and agencies of the federal government that will be charged with interpreting and implementing this Act. The Act contains sections that could lead to new funding opportunities for research in emergency care, especially for comparative clinical trials and clinical studies that focus on integration and efficiency of health care delivery. The Act will establish several new institutes, centers, and committees that will create policies highly relevant to emergency care. The authors conclude that this Act can be expected to have a profound influence on research and training in emergency care. PMID:20653573

  19. Family physician and endocrinologist coordination as the basis for diabetes care in clinical practice

    PubMed Central

    Duran, Alejandra; Runkle, Isabelle; Matía, Pilar; de Miguel, Maria P; Garrido, Sofia; Cervera, Emilio; Fernandez, Maria D; Torres, Pilar; Lillo, Tomas; Martin, Patricia; Cabrerizo, Lucio; de la Torre, Nuria Garcia; Calle, Jose R; Ibarra, Jose; Charro, Aniceto L; Calle-Pascual, Alfonso L

    2008-01-01

    Background To estimate the proportion of diabetic patients (DPts) with peripheral vascular disease treated at a primary health care site after an endocrinologist-based intervention, who meet ATP III and Steno targets of metabolic control, as well as to compare the outcome with the results of the patients treated by endocrinologists. Methods A controlled, prospective over 30-months period study was conducted in area 7 of Madrid. One hundred twenty six eligible diabetic patients diagnosed as having peripheral vascular disease between January 2003 and June 2004 were included in the study. After a treatment period of three months by the Diabetes team at St Carlos Hospital, 63 patients were randomly assigned to continue their follow up by diabetes team (Group A) and other 63 to be treated by the family physicians (FP) at primary care level with continuous diabetes team coordination (Group B). 57 DPts from Group A and 59 from Group B, completed the 30 months follow-up period. At baseline both groups were similar in age, weight, time from diagnosis and metabolic control. The main outcomes of this study were the proportion of patients meeting ATP III and Steno goals for HbA1c (%), Cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, blood pressure, albumine-to-creatinine excretion ratio (ACR), body mass index (BMI), waist circumference (WC), anti-aggregation treatment and smoking status. Results At the end of the follow up, no differences were found between the groups. More than 37% of diabetic patients assigned to be treated by FP achieved a HbA1c < 6.5%, more than 50% a ACR < 30 mg/g, and more than 80% reached low risk values for cholesterol, LDL cholesterol, triglycerides, diastolic blood pressure and were anti-aggregated, and 12% remained smokers. In contrast, less than 45% achieved a systolic blood pressure < 130 mm Hg, less than 12% had a BMI < 25 Kg.m-2 (versus 23% in group A; p < 0.05) and 49%/30% (men/women) had a waist circumference of low risk

  20. Factors affecting the opinions of family physicians regarding generic drugs – a questionnaire based study

    PubMed Central

    Lewek, Pawel; Smigielski, Janusz; Kardas, Przemyslaw

    2015-01-01

    A range of factors are believed to exert a negative influence on opinions of physicians about generic drugs. The aim of this study was to survey the opinions of primary care doctors on generics, and determine the factors which may affect them. A questionnaire comprising thirty eight questions was distributed among primary care doctors working in seventy out-patient clinics of the Lodzkie province, Poland, during the period of January 1, 2010 – December 31, 2010. A total of 170 of 183 participants completed the survey (average age 48.5; 70.0% women): a 92.9% response rate. While 38.8% of physicians claimed that generics were worse than brand name drugs, 54.1% considered them to be better. However, 36.5% of the doctors did not choose generics for their own use. Two key opinions were identified among the responses concerning the effectiveness of generic drugs: use of generic drugs by the physician (p<0.001), and their opinion that pharmacists do inform patients about generic drugs (p<0.05). Although existing evidence confirms that generic and brand name drugs are equally effective, many physicians doubt this, which prevents them from being used as cost effective drug therapy. In order to increase healthcare savings through the use of generics, these factors should be addressed: for example, convincing a physician to adopt generics for personal use may be an efficient way to support more cost effective treatment of his patients. PMID:25725136

  1. Family Instability, School Context, and the Academic Careers of Adolescents

    ERIC Educational Resources Information Center

    Cavanagh, Shannon E.; Fomby, Paula

    2012-01-01

    An emerging literature suggests that the increasingly complex family histories of American children are linked with multiple domains of adolescent development. Much of this scholarship focuses on associations at the individual level. Here, the authors consider whether key dimensions of the school context, specifically the aggregate level of family…

  2. Family Resource Allocation after Firstborns Leave Home: Implications for Secondborns' Academic Functioning.

    PubMed

    Jensen, Alexander C; Whiteman, Shawn D; Bernard, Julia M; McHale, Susan M

    2015-12-29

    This study assessed secondborn adolescents' perceptions of changes in the allocation of family resources following their firstborn siblings' departure from home after high school, and whether perceived changes were related to changes over 1 year in secondborns' academic functioning. Participants were secondborn siblings (mean age = 16.58, SD = 0.91) from 115 families in which the older sibling had left the family home in the previous year. Allocation of resources was measured via coded qualitative interviews. Most (77%) secondborns reported increases in at least one type of family resource (i.e., parental companionship, attention, material goods), and many reported an increase in multiple types of resources in the year following their older sibling's departure. Consistent with resource dilution theory, perceptions of increases in fathers' companionship, fathers' attention, and mothers' companionship were related to improvements over time in secondborns' academic functioning.

  3. "Sometimes I Feel Overwhelmed": Educational Needs of Family Physicians Caring for People with Intellectual Disability

    ERIC Educational Resources Information Center

    Wilkinson, Joanne; Dreyfus, Deborah; Cerreto, Mary; Bokhour, Barbara

    2012-01-01

    Primary care physicians who care for adults with intellectual disability often lack experience with the population, and patients with intellectual disability express dissatisfaction with their care. Establishing a secure primary care relationship is particularly important for adults with intellectual disability, who experience health disparities…

  4. Helping Family Physicians Improve Their Cardiac Auscultation Skills with an Interactive CD-ROM.

    ERIC Educational Resources Information Center

    Roy, Douglas; Sargeant, Joan; Gray, Jean; Hoyt, Brian; Allen, Michael; Fleming, Michael

    2002-01-01

    Physicians (n=42) studied cardiac auscultation using a 15-hour CD-ROM program. Nine months later, 21 who completed a posttest showed significant improvement in identifying heart sounds. CDs were valued for opportunities to review material at an individual pace. Lack of computer skills hindered use. (Contains 26 references.) (SK)

  5. Structured oral interview. One way to identify family physicians' educational needs.

    PubMed Central

    Jacques, A.; Sindon, A.; Bourque, A.; Bordage, G.; Ferland, J. J.

    1995-01-01

    OBJECTIVE: To design and test a structured oral interview that would elicit information on the educational needs of physicians in order to help them plan individualized continuing education. DESIGN: Seven different sets of problems were prepared, each including 40 cases, of which 26 are common. Each pilot test candidate was interviewed by two physician-interviewers during a 1-day session. After each answer, candidates were told the predetermined correct answer. PARTICIPANTS: Six candidates were selected at random from among Montreal physicians aged 50 and older with no hospital privileges. All had to have no history of professional complaints or prosecution and to be unknown to the interviewers. MAIN OUTCOME MEASURES: Inter-rater reliability and perceived difficulty of the cases. RESULTS: Candidates rated the interview process and cases used pertinent, credible, and not too difficult. Candidates' performance level was about 50%. Agreement between interviewers averaged 91.2%. CONCLUSIONS: A structured oral interview appears to be a credible instrument for helping determine practising physicians' deficiencies in clinical knowledge and reasoning. PMID:7580383

  6. What makes a top research medical school? A call for a new model to evaluate academic physicians and medical school performance.

    PubMed

    Goldstein, Matthew J; Lunn, Mitchell R; Peng, Lily

    2015-05-01

    Since the publication of the Flexner Report in 1910, the medical education enterprise has undergone many changes to ensure that medical schools meet a minimum standard for the curricula and clinical training they offer students. Although the efforts of the licensing and accrediting bodies have raised the quality of medical education, the educational processes that produce the physicians who provide the best patient care and conduct the best biomedical research have not been identified. Comparative analyses are powerful tools to understand the differences between institutions, but they are challenging to carry out. As a result, the analysis performed by U.S. News & World Report (USN&WR) has become the default tool to compare U.S. medical schools. Medical educators must explore more rigorous and equitable approaches to analyze and understand the performance of medical schools. In particular, a better understanding and more thorough evaluation of the most successful institutions in producing academic physicians with biomedical research careers are needed. In this Perspective, the authors present a new model to evaluate medical schools' production of academic physicians who advance medicine through basic, clinical, translational, and implementation science research. This model is based on relevant and accessible objective criteria that should replace the subjective criteria used in the current USN&WR rankings system. By fostering a national discussion about the most meaningful criteria that should be measured and reported, the authors hope to increase transparency of assessment standards and ultimately improve educational quality.

  7. A brief family and academic biography of Benson E. Ginsburg.

    PubMed

    Maxson, Stephen C

    2011-11-01

    This is a brief personal biography of Benson E. Ginsburg, my friend, colleague and mentor. This is personal in several ways. First, it is about Benson's family as well as his career. Second, much of what I write is based on discussions with Benson. Third, after 1960, Benson's story is a big part of my story. I have been there for more than 50 years as it has unfolded.

  8. Temperament and IQ mediate the effects of family history of substance abuse and family dysfunction on academic achievement.

    PubMed

    Blackson, T C

    1995-01-01

    In this study of sons of substance-abusing (n = 57) and normal (n = 71) fathers, it was hypothesized that sons' positive affective temperament (PAT) and intellectual ability (FSIQ) would mediate the effects of paternal substance abuse and family dysfunction on sons' reading achievement scores. Hierarchical, linear, and path analytic regression analyses were computed to test the hypotheses. It was found that (1) sons' FSIQ and PAT each partially mediated the effects of paternal substance abuse on sons' reading achievement scores and (2) that sons' PAT mediated the relationship between family dysfunction and their reading achievement scores. Because reading achievement is pivotal to academic success and school failure is associated with early age substance use, the importance of identifying processes that promote academic success is discussed.

  9. Faculty Writing Groups: A Support for Women Balancing Family and Career on the Academic Tightrope

    ERIC Educational Resources Information Center

    Penney, Sharon; Young, Gabrielle; Badenhorst, Cecile; Goodnough, Karen; Hesson, J.; Joy, Rhonda; McLeod, Heather; Pickett, Sarah; Stordy, Mary; Vaandering, Dorothy

    2015-01-01

    This qualitative research project explored the experiences of women who juggle the demands of family or parenthood while engaging in academic careers at a faculty of education. The researcher-participants consisted of 11 women; 9 women provided a written narrative, and all women participated in the data analysis. The data consisted of the…

  10. Longitudinal Effects of Parenting on Children's Academic Achievement in African American Families

    ERIC Educational Resources Information Center

    Qi, Sen

    2006-01-01

    A study explores the concurrent and longitudinal effects of parenting practice on children's academic achievement in 2,247 African American families using data from the Early Childhood Longitudinal Study Kindergarten Class of 1998-1999. Results show that parental expectations of children's highest educational attainment and parental beliefs in…

  11. The Quality of Family Communication and Academic Achievement in Early Adolescence.

    ERIC Educational Resources Information Center

    Ullrich, Manuela; Kreppner, Kurt

    This study focused on the role of family communication patterns as they affect children's academic achievement, as determined by grades. Sixty-two children (average age: 11.6 years) and their parents were observed and videotaped in dyadic settings (mother-child, father-child) in their homes while discussing everyday topics presented to them in a…

  12. Parenting Practices and Children's Academic Success in Low-SES Families

    ERIC Educational Resources Information Center

    Mayo, Aziza; Siraj, Iram

    2015-01-01

    Given the disadvantaged position of working-class children in the education system, it is important to understand how parents and families might support their children to succeed academically. This paper reports on 35 case studies that were conducted as part of the Effective Provision of Pre-School, Primary and Secondary Education (EPPSE 3-16)…

  13. Effects of Cumulative Family Risk Factors on American Students' Academic Performance

    ERIC Educational Resources Information Center

    Dunst, Carl J.; Hamby, Deborah W.

    2016-01-01

    The relationships between cumulative family risk factors and American students' academic performance were examined in all 50 States and the District of Columbia. Data from the 2007 "American Community Survey" were used to ascertain the percent of birth to 18 year old children in the United States who experienced three or more risk…

  14. Explaining the Relation between Academic Motivation and Substance Use: Effects of Family Relationships and Self Esteem.

    ERIC Educational Resources Information Center

    Andrews, Judy A.; And Others

    The inverse relation between academic motivation and substance use has been well established, but the direction of the influence remains to be specified; two possible influences are the mediating and moderating effects of family relationships and self-esteem. In this study, investigators used General Estimating Equation (GEE) models based on data…

  15. Socioeconomic stress and academic adjustment among Asian American adolescents: the protective role of family obligation.

    PubMed

    Kiang, Lisa; Andrews, Kandace; Stein, Gabriela L; Supple, Andrew J; Gonzalez, Laura M

    2013-06-01

    Socioeconomic stress has long been found to place youth at risk, with low family income conferring disadvantages in adolescents' school achievement and success. This study investigates the role of socioeconomic stress on academic adjustment, and pinpoints family obligation as a possible buffer of negative associations. We examined direct and interactive effects at two time points in the same sample of Asian American adolescents-early high school (N = 180 9th-10th graders; 60 % female) and 2 years later in late high school (N = 156 11th-12th graders; 87% of original sample). Results suggest that socioeconomic stress is indeed associated with poor academic adjustment, measured broadly through self-reported GPA, importance of academic success, and educational aspirations and expectations. Family obligation was positively related to adjustment, and also was found to buffer the negative effects of socioeconomic stress, but only during adolescents' later high school years. Adolescents reporting more family obligation experienced less of the negative effects of financial stress on academic outcomes than those reporting lower obligation. Cultural and developmental implications are discussed in light of these direct and moderating effects.

  16. The Effects of Family Leadership Orientation on Social Entrepreneurship, Generativity and Academic Success of College Students

    ERIC Educational Resources Information Center

    Baloglu, Nuri

    2017-01-01

    In this study, the effects of family leadership orientation on social entrepreneurship, generativity and academic education success were examined with the views of college students. The study was conducted at a state university in Central Anatolia in Turkey. 402 college students who attending at three different colleges voluntarily participated in…

  17. A Prospective Study of Mexican American Adolescents' Academic Success: Considering Family and Individual Factors

    ERIC Educational Resources Information Center

    Roosa, Mark W.; O'Donnell, Megan; Cham, Heining; Gonzales, Nancy A.; Zeiders, Katherine H.; Tein, Jenn-Yun; Knight, George P.; Umana-Taylor, Adriana

    2012-01-01

    Mexican American youth are at greater risk of school failure than their peers. To identify factors that may contribute to academic success in this population, this study examined the prospective relationships from 5th grade to 7th grade of family (i.e., human capital [a parent with at least a high school education], residential stability,…

  18. Mother-Adolescent Language Proficiency and Adolescent Academic and Emotional Adjustment among Chinese American Families

    ERIC Educational Resources Information Center

    Liu, Lisa L.; Benner, Aprile D.; Lau, Anna S.; Kim, Su Yeong

    2009-01-01

    This study examined the role of adolescents' and mothers' self-reports of English and heritage language proficiency in youth's academic and emotional adjustment among 444 Chinese American families. Adolescents who were proficient in English tended to exhibit higher reading achievement scores, math achievement scores, and overall GPA. Mothers who…

  19. Effects of Family Structure Type and Stability on Children's Academic Performance Trajectories

    ERIC Educational Resources Information Center

    Sun, Yongmin; Li, Yuanzhang

    2011-01-01

    Using five waves of panel data from 8,008 children in the ECLS-K, the current study compared children's academic performance growth curves from kindergarten through fifth grade among three types of nondisrupted and three types of disrupted families. The analyses found that children in nondisrupted two-biological-parent and nondisrupted stepparent…

  20. Social, Academic, and Behavioral Competence of Depressed Children: Relationship to Diagnostic Status and Family Interaction Style.

    ERIC Educational Resources Information Center

    Hamilton, Elizabeth Burney; And Others

    1997-01-01

    The social adjustment and academic performance of 15 children hospitalized for depression were compared to 14 children with schizophrenia and 20 normal children, ages 7 to 14. Analyses reveal an association between children's adaptive functioning and both diagnostic status and family transactional processes. (SLD)

  1. Physicians' interactions with health care teams and systems in the care of dying patients: perspectives of dying patients, family members, and health care professionals.

    PubMed

    Carline, Jan D; Curtis, J Randall; Wenrich, Marjorie D; Shannon, Sarah E; Ambrozy, Donna M; Ramsey, Paul G

    2003-01-01

    This study investigated the specific physician skills required to interact with health care systems in order to provide high quality care at the end of life. We used focus groups of patients with terminal diseases, family members, nurses and social workers from hospice or acute care settings, and physicians. We performed content analysis based on grounded theory. Groups were interviewed. Two domains were found related to physician interactions with health care systems: 1) access and continuity, and 2) team communication and coordination. Components of these domains most frequently mentioned included taking as much time as needed with the patient, accessibility, and respect shown in working with health team members. This study highlights the need for both physicians and health care systems to improve accessibility for patients and families and increase coordination of efforts between health care team members when working with dying patients and their families.

  2. Communication between Physicians and Family Caregivers about Care at the End of Life: When Do Discussions Occur and What Is Said?

    PubMed Central

    CHERLIN, EMILY; FRIED, TERRI; PRIGERSON, HOLLY G.; SCHULMAN-GREEN, DENA; JOHNSON-HURZELER, ROSEMARY; BRADLEY, ELIZABETH H.

    2006-01-01

    Background: Few studies have examined physician-family caregiver communication at the end of life, despite the important role families have in end-of-life care decisions. We examined family caregiver reports of physician communication about incurable illness, life expectancy, and hospice; the timing of these discussions; and subsequent family understanding of these issues. Design: Mixed methods study using a closed-ended survey of 206 family caregivers and open-ended, in-depth interviews with 12 additional family caregivers. Setting/Subjects: Two hundred eighteen primary family caregivers of patients with cancer enrolled with hospice between October 1999 and June 2002 Measurements: Family caregiver reports provided at the time of hospice enrollment of physician discussions of incurable illness, life expectancy, and hospice. Results: Many family caregivers reported that a physician never told them the patient’s illness could not be cured (20.8%), never provided life expectancy (40% of those reportedly told illness was incurable), and never discussed using hospice (32.2%). Caregivers reported the first discussion of the illness being incurable and of hospice as a possibility occurred within 1 month of the patient’s death in many cases (23.5% and 41.1%, respectively). In open-ended interviews, however, family caregivers expressed ambivalence about what they wanted to know, and their difficulty comprehending and accepting “bad news” was apparent in both qualitative and quantitative data. Conclusion: Our findings suggest that ineffective communication about end-of-life issues likely results from both physician’s lack of discussion and family caregiver’s difficulty hearing the news. Future studies should examine strategies for optimal physician-family caregiver communication about incurable illness, so that families and patients can begin the physical, emotional, and spiritual work that can lead to acceptance of the irreversible condition. PMID:16351531

  3. [Inspection of a corpse by the family physician (general practitioner) in practice and nursing home].

    PubMed

    Peschel, O; Graw, M

    2005-05-12

    Inspection of a corpse by the physician is a responsible last service he can offer his patient. Apart from reliably establishing death and the time of its occurrence, the physician must thoroughly inspect the corpse to clarify the cause of death. Regrettably, the results of an autopsy are often at odds with the cause of death as entered in the death certificate. Poor nursing care and homicides can be detected only on the basis of correct information about the cause of death. Only then do statistics on causes of death in the population make sense and can provide useful data. If an unnatural cause of death is suspected, or if it is not possible to ascertain the cause, the police or public prosecutor (coroner) must be notified.

  4. Emerging Role of the Army Family Physician in Primary Health Care Delivery.

    DTIC Science & Technology

    1976-12-13

    IN PRI1Y~?f IfALTh CARE DELIVERY BY COLONEL DAVID G. LbANE VEDICAL CORPs ~~~ CORRESPONDING COURSE _ _ _ _ _ _ _ _ _ _ _ ~ AR...Physician in Primary Health Care Delivery. Research Project 6. PERFORMING ORG. REPORT NUMBER 7. AUTHORft ) 8. CONTRACT OR GRANT NUMBER(.) Doane, David G...influence of specialists of all kinds. Emphasis was placed on research , medical education, government grants, publishing H and training of super

  5. Financing U.S. Graduate Medical Education: A Policy Position Paper of the Alliance for Academic Internal Medicine and the American College of Physicians.

    PubMed

    Butkus, Renee; Lane, Susan; Steinmann, Alwin F; Caverzagie, Kelly J; Tape, Thomas G; Hingle, Susan T; Moyer, Darilyn V

    2016-07-19

    In this position paper, the Alliance for Academic Internal Medicine and the American College of Physicians examine the state of graduate medical education (GME) financing in the United States and recent proposals to reform GME funding. They make a series of recommendations to reform the current funding system to better align GME with the needs of the nation's health care workforce. These recommendations include using Medicare GME funds to meet policy goals and to ensure an adequate supply of physicians, a proper specialty mix, and appropriate training sites; spreading the costs of financing GME across the health care system; evaluating the true cost of training a resident and establishing a single per-resident amount; increasing transparency and innovation; and ensuring that primary care residents receive training in well-functioning ambulatory settings that are financially supported for their training roles.

  6. An Asclepiad family - The Chamberlens and DeLaunes, 1569-1792: Five generations of surgeons, physicians, accoucheurs and apothecaries.

    PubMed

    Russell, Lesley

    2016-11-01

    When in 1747 Dr Peter Chamberlen wrote in his apologia, 'A Voice in Rhama', that he was nursed up (as from the Cradle) to all Parts of Physick, and that in Asclepiad-Families, he was not referring simply to his father and uncle, the Peters (Younger and Elder) Chamberlen of obstetric forceps' fame. They were surgeons and accoucheurs; his mother's family counted clergymen as well as physicians and apothecaries among their number and the young Peter must indeed have grown up in a family steeped in both medical practice and religious study. Both families were refugees from the religious terrors of sixteenth century France, arriving in England in the second half of the reign of Elizabeth l. Both were to find fortune and royal patronage as they became established in their new lives. One was to found a medical dynasty that lasted through five generations, the other to produce a generation whose varied accomplishments died as the eldest son outlived all his siblings, only one of whose children became an apothecary - and he was to predecease his uncle. This is a brief biography of these two families, bound together by the ties of marriage, profession, faith and nationality.

  7. Family medicine education in rural communities as a health service intervention supporting recruitment and retention of physicians

    PubMed Central

    Soles, Trina Larsen; Ruth Wilson, C.; Oandasan, Ivy F.

    2017-01-01

    Abstract Objective To develop a pan-Canadian rural education road map to advance the recruitment and retention of family physicians in rural, remote, and isolated regions of Canada in order to improve access and health care outcomes for these populations. Composition of the task force Members of the task force were chosen from key stakeholder groups including educators, practitioners, the College of Family Physicians of Canada education committee chairs, deans, chairs of family medicine, experts in rural education, and key decision makers. The task force members were purposefully selected to represent a mix of key perspectives needed to ensure the work produced was rigorous and of high quality. Observers from the Canadian Medical Association and Health Canada’s Council on Health Workforce, and representatives from the Royal College of Physicians and Surgeons of Canada, were also invited to provide their perspectives and to encourage and coordinate multiorganization action. Methods The task force commissioned a focused literature review of the peer-reviewed and gray literature to examine the status of rural medical education, training, and practice in relation to the health needs of rural and remote communities in Canada, and also completed an environmental scan. Report The environmental scan included interviews with more than 100 policy makers, government representatives, providers, educators, learners, and community leaders; 17 interviews with practising rural physicians; and 2 surveys administered to all 17 faculties of medicine. The gaps identified from the focused literature review and the results of the environmental scan will be used to develop the task force’s recommendations for action, highlighting the role of key partners in implementation and needed action. Conclusion The work of the task force provides an opportunity to bring the various partners together in a coordinated way. By understanding who is responsible and the actions each stakeholder

  8. Reproducibility and reliability of the ankle-brachial index as assessed by vascular experts, family physicians and nurses.

    PubMed

    Holland-Letz, Tim; Endres, Heinz G; Biedermann, Stefanie; Mahn, Matthias; Kunert, Joachim; Groh, Sabine; Pittrow, David; von Bilderling, Peter; Sternitzky, Reinhardt; Diehm, Curt

    2007-05-01

    The reliability of ankle-brachial index (ABI) measurements performed by different observer groups in primary care has not yet been determined. The aims of the study were to provide precise estimates for all effects influencing the variability of the ABI (patients' individual variability, intra- and inter-observer variability), with particular focus on the performance of different observer groups. Using a partially balanced incomplete block design, 144 unselected individuals aged > or = 65 years underwent double ABI measurements by one vascular surgeon or vascular physician, one family physician and one nurse with training in Doppler sonography. Three groups comprising a total of 108 individuals were analyzed (only two with ABI < 0.90). Errors for two repeated measurements for all three observer groups did not differ (experts 8.5%, family physicians 7.7%, and nurses 7.5%, p = 0.39). There was no relevant bias among observer groups. Intra-observer variability expressed as standard deviation divided by the mean was 8%, and inter-observer variability was 9%. In conclusion, reproducibility of the ABI measurement was good in this cohort of elderly patients who almost all had values in the normal range. The mean error of 8-9% within or between observers is smaller than with established screening measures. Since there were no differences among observers with different training backgrounds, our study confirms the appropriateness of ABI assessment for screening peripheral arterial disease (PAD) and generalized atherosclerosis in the primary case setting. Given the importance of the early detection and management of PAD, this diagnostic tool should be used routinely as a standard for PAD screening. Additional studies will be required to confirm our observations in patients with PAD of various severities.

  9. Family physicians' management of genetic aspects of a cardiac disease: a scenario-based study from slovenia.

    PubMed

    Klemenc-Ketiš, Z; Peterlin, B

    2014-06-01

    The aim of this study was to find out how Slovenian family physicians (FPs) would manage a hypothetical clinical case, to explore their views about possible ethical dilemmas associated with this clinical case and to determine possible associations with demographic and other characteristics of FPs. This was an observational cross-sectional postal study in the Slovenian FPs' surgeries. The study population consisted of the whole population of Slovenian FPs (n = 950). The main outcome measures were the percentages of the answers of FPs on different questions about the clinical case on the management of patient and his relative with hereditary cardiomyopathy. There were 271 FPs who answered the questionnaire (response rate was 27.1%). A sample included 66 (24.4%) men and the mean age of all respondents was 45.5 ± 10.6 years. When dealing with the clinical case, most FPs expressed willingness to take the patient's family history. Only 34.2% FPs did not believe that ordering genetic tests was part of their job. Additionally, only 50.0% of them felt competent to interpret the genetic risk, 25.0% of them would give information about genetic testing and only 6.0% would interpret the results of the genetic testing. Family physicians in Slovenia were willing to include genetic tasks into routine management of their patients, but they do not feel competent enough to interpret the genetic risks and the results of genetic testing. However, an important part of FPs would not refer patients at risk to genetic counseling. The inclusion of genetic topics to family medicine specialization curriculum is needed.

  10. Enlightened physicians: setting out on an elite academic career in the second half of the eighteenth century.

    PubMed

    Rieder, Philip; Louis-Courvoisier, Micheline

    2010-01-01

    In the second half of the eighteenth century, medical doctors faced heavy competition. They competed for patients and for institutional positions and sought a variety of means to enhance their reputations. Among rank-and-file physicians, some strove to respond to the high expectations and rational discourse fueled by Enlightenment philosophy. They aimed to build a new medicine on rational and empirical principals. Concentrating on the rich correspondence left by young physicians born in Geneva, this article maps out the social and moral dilemmas encountered by ambitious young physicians in the second half of the eighteenth century, who, like many thousands of others, flocked to Edinburgh, "the first medical school" in Europe. Conscious that they formed but one group among a series of possible practitioners, they pondered over cultural codes, civilities and economic realities as they strove to promote the figure of a knowledgeable, experienced, gentlemanlike physician.

  11. Evaluation of Physicians' and Nurses' Knowledge, Attitudes, and Compliance With Family Presence During Resuscitation in an Emergency Department Setting After an Educational Intervention.

    PubMed

    Ferrara, Gineen; Ramponi, Denise; Cline, Thomas W

    2016-01-01

    Family presence during resuscitation (FPDR) has been an ongoing topic of discussion in many hospital emergency departments throughout the United States. With the current emphasis promoting patient- and family-centered care, families are now exercising their right to be present at the bedside during resuscitation. With or without a policy, there is continued resistance to allow families to remain with their loved ones during resuscitation. The purpose of this study was to evaluate if an evidence-based educational intervention would increase physicians' and nurses' knowledge, attitudes, and compliance with allowing FPDR. This quasi-experimental study evaluated 30 attending physicians' and 65 registered nurses' knowledge of an existing family presence policy and their attitudes toward family presence post-educational intervention in an emergency department setting. Compliance of family presence was observed for 2 months pre- and post-educational intervention. Results show that most physicians and nurses either were not sure or were not aware that there was an existing written policy. The study demonstrated that nurses agree more than physicians that the option of FPDR is a patient/family right. The results also showed that the educational intervention had no effect on the physicians and nurses attitudes for FPDR, but it did change behaviors. Of the events involving professionals who were exposed to the educational intervention, family members were present 87.5% of the time. In contrast, only 23% of the events involving professionals who did not receive the educational intervention had families present. Ongoing staff education will heighten awareness to FPDR, make the staff more comfortable with families being present, and will presumably continue to increase invitations for FPDR.

  12. A Novel Network for Mentoring Family Physicians on Mental Health Issues Using E-Mail

    ERIC Educational Resources Information Center

    Hunter, Jon J.; Rockman, Patricia; Gingrich, Nadine; Silveira, Jose; Salach, Lena

    2008-01-01

    Objective: Family practitioners are significant providers of mental health care and routinely report difficulty acquiring timely support in this area. The Collaborative Mental Health Care Network assembled groups of family practitioners and provided them with mental health practitioner mentors. This article addresses communication in the Network,…

  13. The acute hospital setting as a place of death and final care: a qualitative study on perspectives of family physicians, nurses and family carers.

    PubMed

    Reyniers, Thijs; Houttekier, Dirk; Cohen, Joachim; Pasman, H Roeline; Deliens, Luc

    2014-05-01

    While the focus of end-of-life care research and policy has predominantly been on 'death in a homelike environment', little is known about perceptions of the acute hospital setting as a place of final care or death. Using a qualitative design and constant comparative analysis, the perspectives of family physicians, nurses and family carers were explored. Participants generally perceived the acute hospital setting to be inadequate for terminally ill patients, although they indicated that in some circumstances it might be a 'safe haven'. This implies that a higher quality of end-of-life care provision in the acute hospital setting needs to be ensured, preferably by improving communication skills. At the same time alternatives to the acute hospital setting need to be developed or expanded.

  14. Law, policy and the use of non-physicians in family planning service delivery.

    PubMed

    Paxman, J M

    1979-04-01

    A great deal of attention is being devoted to the use of nonphysicians to provide such fertility control services as contraception, sterilization, and abortion. Legal obstacles exist, however, which must be overcome before the role of nonphysicians can be expanded. Such obstacles include medical practice statutes, nursing and midwifery legislation, and laws and regulations directly related to such fertility control measures as the provision of contraceptions and the performance of sterilizations. On the other hand, the following 3 main approaches have been used to permit increased participation of nonphysicians: delegation of tasks by physicians, liberal interpretation of existing laws, and authorization. Thus, the important elements in expanding the roles of nonphysicians are 1) authorization; 2) training; 3) qualification; 4) supervision; and 5) opportunities for referrals to physicians. The ultimate role of paramedicals will depend upon the continued simplification of technology, the results of research on the quality of care which they can provide, the attitudes of the medical profession, and the elimination of the legal ambiguities and obstacles which exist.

  15. City mouse, country mouse: a mixed-methods evaluation of perceived communication barriers between rural family physicians and urban consultants in Newfoundland and Labrador, Canada

    PubMed Central

    Renouf, Tia; Alani, Sabrina; Whalen, Desmond; Harty, Chris; Pollard, Megan; Morrison, Megan; Coombs-Thorne, Heidi; Dubrowski, Adam

    2016-01-01

    Objectives To examine perceived communication barriers between urban consultants and rural family physicians practising routine and emergency care in remote subarctic Newfoundland and Labrador (NL). Design This study used a mixed-methods design. Quantitative and qualitative data were collected through exploratory surveys, comprised of closed and open-ended questions. The quantitative data was analysed using comparative statistical analyses, and a thematic analysis was applied to the qualitative data. Participants 52 self-identified rural family physicians and 23 urban consultants were recruited via email. Rural participants were also recruited at the Family Medicine Rural Preceptor meetings in St John's, NL. Setting Rural family physicians and urban consultants in NL completed a survey assessing perceived barriers to effective communication. Results Data confirmed that both groups perceived communication difficulties with one another; with 23.1% rural and 27.8% urban, rating the difficulties as frequent (p=0.935); 71.2% rural and 72.2% urban as sometimes (p=0.825); 5.8% rural and 0% urban acknowledged never perceiving difficulties (p=0.714). Overall, 87.1% of participants indicated that perceived communication difficulties impacted patient care. Primary trends that emerged as perceived barriers for rural physicians were time constraints and misunderstanding of site limitations. Urban consultants' perceived barriers were inadequate patient information and lack of native language skills. Conclusions Barriers to effective communication are perceived between rural family physicians and urban consultants in NL. PMID:27154475

  16. Differences between willingness to pay and willingness to accept for visits by a family physician: A contingent valuation study

    PubMed Central

    2010-01-01

    Background The economic value attributed by users of health services in public health systems can be useful in planning and evaluation. This value can differ from the perspectives of Willingness to Pay (WTP) and Willingness to Accept [Compensation] (WTA). Our objective was to study the perceptions of the patient about the service provided by the family physician by means of the WTA/WTP ratio. Methods An economic evaluation study by the Contingent Valuation Method was designed. Interviews were conducted with 451 subjects at six health centres (four urban and two rural) in areas with different socioeconomic characteristics. A payment card was used to measure the WTP and WTA. Other characteristics of the subject or service that could influence these responses were collected. An explicative model was constructed to study the WTA/WTP relationship. Results Four hundred and four subjects (89.6%) expressed a WTP and WTA different from zero. The WTA/WTP quotient showed a median of 1.55 (interquartile range 1-3.08) and a mean of 3.30 (IC 95%: 2.84-3.75). The WTA/WTP ratio increases with age and in low-income areas. It decreases in professional groups with more specialized activities, with growing family income, and in the chronically ill. Other characteristics related to the perception of state of health, accessibility to the service, satisfaction, or perception of risk were not explicative. Conclusions Subjects who were older and had a less favourable socioeconomic situation expressed a higher WTA/WTP ratio when valuing the visit to the family physician. These characteristics could identify a profile of "aversion to loss" with respect to this service. PMID:20459714

  17. Replacing an academic internal medicine residency program with a physician assistant--hospitalist model: a comparative analysis study.

    PubMed

    Dhuper, Sunil; Choksi, Sonia

    2009-01-01

    This study describes a comparative analysis of replacing medical residents with physician assistants and hospitalists on patient outcomes in a community hospital. Prospective data during the physician assistants-hospitalists service for 2 years was compared with 2 years of retrospective data of the medical residents model. Outcome measures included mortality, adverse events, readmissions, and patient satisfaction. For physician assistants- hospitalists versus medical residents models, all-cause and case mix index-adjusted mortality was 107/5508 (1.94%) and 0.019 versus 156/5458 (2.85%) and 0.029, respectively (P < or = .001). The adverse event cases were 9 versus 5 ( P = .29), and the readmission rate within 30 days was 64 versus 69 (P = .34). Patient satisfaction was 95% versus 96% (P = .33). Quality of care provided by the physician assistants-hospitalists model was equivalent. All-cause and case mix index- adjusted mortality was significantly lower during the physician assistants-hospitalists period.Although the application of these findings to other institutions requires further study, the authors found no intrinsic barriers that would impede implementation elsewhere.

  18. Correlates of Family Health History Discussions between College Students and Physicians: Does Family Cancer History Make a Difference?

    ERIC Educational Resources Information Center

    Smith, Matthew Lee; Sosa, Erica T.; Hochhalter, Angela K.; Covin, Julie; Ory, Marcia G.; McKyer, E. Lisako J.

    2011-01-01

    Effective communication between young adults and their healthcare providers can contribute to early detection of risk for developing cancer and establishment of lifelong habits for engagement in healthcare and health promotion behaviors. Our objectives were to examine factors influencing family health history discussions between college students…

  19. Professional Success and Gender in Family Medicine: Design of Scales and Examination of Gender Differences in Subjective and Objective Success Among Family Physicians.

    PubMed

    Delgado, Ana; Saletti-Cuesta, Lorena; López-Fernández, Luis Andrés; Toro-Cárdenas, Silvia; Luna del Castillo, Juan de Dios

    2016-03-01

    Two components of professional success have been defined: objective career success (OCS) and subjective career success (SCS). Despite the increasing number of women practicing medicine, gender inequalities persist. The objectives of this descriptive, cross-sectional, and multicenter study were (a) to construct and validate OCS and SCS scales, (b) to determine the relationships between OCS and SCS and between each scale and professional/family characteristics, and (c) to compare these associations between male and female family physicians (FPs). The study sample comprised 250 female and 250 male FPs from urban health centers in Andalusia (Spain). Data were gathered over 6 months on gender, age, care load, professional/family variables, and family-work balance, using a self-administered questionnaire. OSC and SCS scales were examined by using exploratory factorial analysis and Cronbach's α, and scores were compared by gender-stratified bivariate and multiple regression analyses. Intraclass correlation coefficients were calculated using a multilevel analysis. The response rate was 73.6%. We identified three OCS factors and two SCS factors. Lower scores were obtained by female versus male FPs in the OCS dimensions, but there were no gender differences in either SCS dimension.

  20. Revealing a cancer diagnosis to patients: attitudes of patients, families, friends, nurses, and physicians in Lebanon—results of a cross-sectional study

    PubMed Central

    Farhat, F.; Othman, A.; el Baba, G.; Kattan, J.

    2015-01-01

    Background Disclosure of a cancer diagnosis to patients is a major problem for physicians in Lebanon. Our survey aimed to identify the attitudes of patients, families and friends, nurses, and physicians regarding disclosure of a cancer diagnosis. Methods Study participants included 343 physicians, nurses, cancer patients, families, and friends from clinics in two major hospitals in Lebanon. All completed a 29-item questionnaire that assessed, by demographic group, the information provided about cancer, opinions about the disclosure of the diagnosis to cancer patients, perceived consequences to patients, and the roles of family, friends, and religion. Results Overall, 7.8% of the patients were convinced that cancer is incurable. Nearly 82% preferred to be informed about their diagnosis. Similarly, 83% of physicians were in favour of disclosing a cancer diagnosis to their patients. However, only 14% of the physicians said that they revealed the truth to the patients themselves, with only 9% doing so immediately after confirmation of the diagnosis. Disclosure of a cancer diagnosis was preferred before the start of the treatment by 59% of the patients and immediately after confirmation of the diagnosis by 72% of the physicians. Overall, 86% of physicians, 51% of nurses, and 69% of patients and their families believed that religion helped with the acceptance of a cancer diagnosis. A role for family in accepting the diagnosis was reported by 74% of the patients, 56% of the nurses, and 88% of the physicians. All participants considered that fear was the most difficult feeling (63%) experienced by cancer patients, followed by pain (29%), pity (8%), and death (1%), with no statistically significant difference between the answers given by the participant groups. Conclusions The social background in Lebanese society is the main obstacle to revealing the truth to cancer patients. Lebanese patients seem to prefer direct communication of the truth, but families take the opposite

  1. New conceptual model of EMR implementation in interprofessional academic family medicine clinics

    PubMed Central

    Halas, Gayle; Singer, Alexander; Styles, Carol; Katz, Alan

    2015-01-01

    Abstract Objective To capture users’ experiences with a newly implemented electronic medical record (EMR) in family medicine academic teaching clinics and to explore their perceptions of its use in clinical and teaching processes. Design Qualitative study using focus group discussions guided by semistructured questions. Setting Three family medicine academic teaching clinics in Winnipeg, Man. Participants Faculty, residents, and support staff. Methods Focus group discussions were audiorecorded and transcribed. Data were analyzed by open coding, followed by development of consensus on a final coding strategy. We used this to independently code the data and analyze them to identify salient events and emergent themes. Main findings We developed a conceptual model to reflect and summarize key themes that we identified from participant comments regarding EMR implementation and use in an academic setting. These included training and support, system design, information management, work flow, communication, and continuity. Conclusion This is the first specific analysis of user experience with a newly implemented EMR in urban family medicine teaching clinics in Canada. The experiences of our participants with EMR implementation were similar to those reported in earlier investigations, but highlight organizational influences and integration strategies. Learning how to use and transitioning to EMRs has implications for clinical learners. This points to the need for further research to gain a more in-depth understanding of the effects of EMRs on the learning environment. PMID:26167563

  2. Factors Associated with Behavior Change in Family Physicians After CME Presentation.

    ERIC Educational Resources Information Center

    Ferguson, Kristi J.; And Others

    1984-01-01

    Registrants of a four-day family practice refresher course responded to a survey assessing their reaction to a brief presentation recommending the use of penile anesthesia in newborn circumcision. The results suggest that evaluation of behavior change should consider attitudinal variables. (Author/MLW)

  3. Practice patterns of family physicians with 2-year residency v. 1-year internship training: do both roads lead to Rome?

    PubMed

    Sheps, S B; Schechter, M T; Grantham, P; Finlayson, N; Sizto, R

    1989-04-15

    Are there differences in patterns of practice between actively practising physicians who have been certified after a 2-year family practice residency and matched physicians without certification who have completed the standard 1-year internship? With the use of billing files prepared by the British Columbia Medical Association a group of 65 family practice certificants in active practice in British Columbia was compared with a control group of 130 internship trainees matched by year and school of graduation, category of billing (i.e., solo or group) and region. A wide range of practice features was assessed for the fiscal years 1984-85, 1985-86 and 1986-87. No differences were detected between the groups in 1986-87 for the following practice variables: number of patients (1888 and 1842 respectively), number of personal services billed for (7265 and 7173), number of personal services per patient (3.9), amount of funding for personal services ($140,192 and $140,100) and amount per patient for personal services ($77 and $79). Age-adjusted costs for male and female patients were similar in the two groups. Of six services thought to be influenced by type of training, only maternity care generated a significantly higher number of billings in the study group (341 v. 249). These results suggest that there is no demonstrable effect of training on patterns of practice. However, the question of the effect of training on quality of care and whether the 2-year residency may have a longer effect on practice patterns should be the focus of future research.

  4. Psychiatric rehabilitation education for physicians.

    PubMed

    Rudnick, Abraham; Eastwood, Diane

    2013-06-01

    As part of a rapidly spreading reform toward recovery-oriented services, mental health care systems are adopting Psychiatric/Psychosocial Rehabilitation (PSR). Accordingly, PSR education and training programs are now available and accessible. Although psychiatrists and sometimes other physicians (such as family physicians) provide important services to people with serious mental illnesses and may, therefore, need knowledge and skill in PSR, it seems that the medical profession has been slow to participate in PSR education. Based on our experience working in Canada as academic psychiatrists who are also Certified Psychiatric Rehabilitation Practitioners (CPRPs), we offer descriptions of several Canadian initiatives that involve physicians in PSR education. Multiple frameworks guide PSR education for physicians. First, guidance is provided by published PSR principles, such as the importance of self-determination (www.psrrpscanada.ca). Second, guidance is provided by adult education (andragogy) principles, emphasizing the importance of addressing attitudes in addition to knowledge and skills (Knowles, Holton, & Swanson, 2011). Third, guidance in Canada is provided by Canadian Medical Education Directives for Specialists (CanMEDS) principles, which delineate the multiple roles of physicians beyond that of medical expert (Frank, 2005) and have recently been adopted in Australia (Boyce, Spratt, Davies, & McEvoy, 2011).

  5. State of Colorado Consumer & Family Studies CORE Curriculums of Life Management & Relationships Crosswalk with the Colorado Academic Content Standards.

    ERIC Educational Resources Information Center

    Colorado State Community Coll. and Occupational Education System, Denver.

    This document cross-references Colorado's consumer and family studies core curriculums in life management and relationships with Colorado's academic content standards. Colorado's academic standards for students in grades 9-12 in the areas of reading and writing, geography, science, history, and mathematics are cross-referenced with student…

  6. Whose responsibility is medication reconciliation: Physicians, pharmacists or nurses? A survey in an academic tertiary care hospital.

    PubMed

    Al-Hashar, Amna; Al-Zakwani, Ibrahim; Eriksson, Tommy; Al Za'abi, Mohammed

    2017-01-01

    Background: Medication errors occur frequently at transitions in care and can result in morbidity and mortality. Medication reconciliation is a recognized hospital accreditation requirement and designed to limit errors in transitions in care. Objectives: To identify beliefs, perceived roles and responsibilities of physicians, pharmacists and nurses prior to the implementation of a standardized medication reconciliation process. Methods: A survey was distributed to the three professions: pharmacists in the pharmacy and physicians and nurses in hospital in-patient units. It contained questions about the current level of medication reconciliation practices, as well as perceived roles and responsibilities of each profession when a standardized process is implemented. Value, barriers to implementing medication reconciliation and the role of information technology were also assessed. Analyses were performed using univariate statistics. Results: There was a lack of clarity of current medication reconciliation practices as well as lack of agreement between the three professions. Physicians and pharmacists considered their professions as the main providers while nurses considered physicians followed by themselves as the main providers with limited roles for pharmacists. The three professions recognize the values and benefits of medication reconciliation yet pharmacists, more than others, stated limited time to implement reconciliation is a major barrier. Obstacles such as unreliable sources of medication history, patient knowledge and lack of coordination and communication between the three professions were expressed. Conclusions: The three health care professions recognize the value of medication reconciliation and want to see it implemented in the hospital, yet there is a lack of agreement with regard to roles and responsibilities of each profession within the process. This needs to be addressed by the hospital administration to design clear procedures and defined roles

  7. Assessment of the impact of family physicians in the district health system of the Western Cape, South Africa

    PubMed Central

    Mash, Bob; Naledi, Tracey

    2014-01-01

    Background: In 2007, South Africa made family medicine a new speciality. Family physicians that have trained for this new speciality have been employed in the district health system since 2011. The aim of the present study was to explore the perceptions of district managers on the impact of family physicians on clinical processes, health system performance and health outcomes in the district health system (DHS) of the Western Cape. Methods: Nine in-depth interviews were performed: seven with district managers and two with the chief directors of the metropolitan and rural DHS. Interviews were recorded, transcribed and analysed using the ATLAS-ti and the framework method. Results: There was a positive impact on clinical processes for HIV/AIDS, TB, trauma, non-communicable chronic diseases, mental health, maternal and child health. Health system performance was positively impacted in terms of access, coordination, comprehensiveness and efficiency. An impact on health outcomes was anticipated. The impact was not uniform throughout the province due to different numbers of family physicians and different abilities to function optimally. There was also a perception that the positive impact attributed to family physicians was in the early stages of development. Unanticipated effects included concerns with their roles in management and training of students, as well as tensions with career medical officers. Conclusion: Early feedback from district managers suggests that where family physicians are employed and able to function optimally, they are making a significant impact on health system performance and the quality of clinical processes. In the longer term, this is likely to impact on health outcomes. Evaluation de l'impact des médecins de famille dans le système de santé du district du Western Cape, en Afrique du Sud. Contexte: En 2007, l'Afrique du Sud a institué une nouvelle spécialité, la médecine de famille. Les médecins de famille qui se sont sp

  8. Family physicians can play important role helping women overcome drinking problems.

    PubMed Central

    Lechky, O

    1995-01-01

    When alcoholic women seek medical assistance, it is more likely to be because of distress over interpersonal or family problems, and their complaints of anxiety, depression and insomnia will be treated with prescription drugs. The alcoholism, which presents differently in women than men, is often left undiagnosed and untreated. However, even when women seek help for a drinking problem, traditional and male-dominated support groups may not meet their unique needs. When it comes to alcoholism, men and women are certainly not created equal. PMID:7728702

  9. Race, Class, and Family Intervention: Engaging Parents and Families for Academic Success

    ERIC Educational Resources Information Center

    Sampson, William Alfred

    2007-01-01

    In recent times, actor, comedian, and educator, Bill Cosby sparked a national debate over the role of poor black families in raising their children. Additionally, scholars including Reginald Clark, Annette Lareau, John Ogbu, Javier Tapia, James Comer, and William A. Sampson have done research that suggests that many poor black and Latino families…

  10. A Third-Year Family Medicine Clerkship Based in an Academic Family Practice Center.

    ERIC Educational Resources Information Center

    Taylor, Robert B; And Others

    1984-01-01

    A 5-week family medicine clerkship is described that uses several innovative techniques: problem-based learning focusing on patient management tutorials; consultation with specialists; supervised patient care and a nursing home inpatient teaching service; and workshops on topics such as office-surgical techniques, practice management, and…

  11. Academic promotion and tenure in U.S. family medicine units.

    PubMed

    Holloway, R L; Hale, K L; Rakel, R E

    1989-05-01

    The authors interviewed by telephone the heads (or their representatives) of 101 of the 120 family practice units in U.S. medical schools in 1987. Each respondent was asked for his or her personal perceptions of the relative importances of research, teaching, patient care, and administrative activities in the academic promotion process. Respondents were also asked for their views of their units' and institutions' perceptions of the importances of the same four activities in the promotion process, as well as other related questions about promotion and tenure. The findings indicate that there is still a significant incongruence between the value structure of most family practice units and that of their institutions but that many family practice units are beginning to achieve parity of promotion and tenure with other departments in their institutions.

  12. Family, school, and community factors and relationships to racial-ethnic attitudes and academic achievement.

    PubMed

    Smith, Emilie Phillips; Atkins, Jacqueline; Connell, Christian M

    2003-09-01

    This study examined family, school, and community factors and the relationships to racial-ethnic attitudes and academic achievement among 98 African American fourth-grade children. It has been posited that young people who feel better about their racial-ethnic background have better behavioral and academic outcomes, yet there is a need for more empirical tests of this premise. Psychometric information is reported on measures of parent, teacher, and child racial-ethnic attitudes. Path analysis was used to investigate ecological variables potentially related to children's racial-ethnic attitudes and achievement. Parental education and level of racial-ethnic pride were correlated and both were related to children's achievement though in the final path model, only the path from parental education level was statistically significant. Children whose teachers exhibited higher levels of racial-ethnic trust and perceived fewer barriers due to race and ethnicity evidenced more trust and optimism as well. Children living in communities with higher proportions of college-educated residents also exhibited more positive racial-ethnic attitudes. For children, higher racial-ethnic pride was related to higher achievement measured by grades and standardized test scores, while racial distrust and perception of barriers due to race were related to reduced performance. This study suggests that family, school, and community are all important factors related to children's racial-ethnic attitudes and also to their academic achievement.

  13. Teaching high-value, cost-conscious care to residents: the Alliance for Academic Internal Medicine–American College of Physicians Curriculum.

    PubMed

    Smith, Cynthia D

    2012-08-21

    Health care expenditures are projected to reach nearly 20% of the U.S. gross domestic product by 2020. Up to $765 billion of this spending has been identified as potentially avoidable; many of the avoidable costs have been attributed to unnecessary services. Postgraduate trainees have historically received little specific training in the stewardship of health care resources and minimal feedback on resource utilization and its effect on the cost of care. This article describes a new curriculum that was developed collaboratively by the Alliance for Academic Internal Medicine and the American College of Physicians to address this training gap. The curriculum introduces a simple, stepwise framework for delivering high-value care and focuses on teaching trainees to incorporate high-value, cost-conscious care principles into their clinical practice. It consists of ten 1-hour, case-based, interactive sessions designed to be flexibly incorporated into the existing conference structure of a residency training program.

  14. Demography and early academic skills of students from immigrant families: The kindergarten class of 2011.

    PubMed

    Sullivan, Amanda L; Houri, Alaa; Sadeh, Shanna

    2016-06-01

    Children from immigrant families are one of the fastest growing and most diverse groups in America's schools. This study provides a demographic portrait of immigrant children who entered kindergarten in 2010 and describes patterns and predictors of early educational outcomes of students from immigrant families. A nationally representative sample of 13,530 students who participated in the Early Childhood Longitudinal Study-Kindergarten Class of 2010-11 was analyzed. Descriptive statistics were used to estimate the sociodemographic characteristics of this population. Regression was used to examine the relations between nativity, child characteristics, and family characteristics to reading and mathematics skills in kindergarten. Approximately 27% of kindergartners in the class of 2011 came from immigrant families. These students were more racially, linguistically, and socioeconomically diverse than students from U.S.-born parents. Educational outcomes varied by parents' region of origin. Children's early academic skills were significantly related to parent's region of origin, but these relations were attenuated when child health, language, family structure, and socioeconomic status were accounted for. These results indicate the importance of considering parent nativity when examining the outcomes and needs of students from immigrant families. Because of the diversity of characteristics and outcomes of children of immigrants, researchers should consider the implications of nativity for students' experiences and needs. (PsycINFO Database Record

  15. Family Physicians with a Certificate of Added Qualifications (CAQs) in Sports Medicine Spend the Majority of Their Time Practicing Sports Medicine.

    PubMed

    Rankin, Wade M; Cochrane, Anneli; Puffer, James C

    2015-01-01

    While family physicians holding certificates of added qualifications in sports medicine practice in multiple settings, little is currently known about the proportion of their time devoted exclusively to the practice of sports medicine. We found that most spend a majority of their time doing so, and this number has been increasing over the past decade.

  16. Sources of evidence in HIV/AIDS care: pilot study comparing family physicians and AIDS service organization staff

    PubMed Central

    Stefanski, Kasia E; Tracy, C Shawn; Upshur, Ross EG

    2004-01-01

    Background The improvement of the quality of the evidence used in treatment decision-making is especially important in the case of patients with complicated disease processes such as HIV/AIDS for which multiple treatment strategies exist with conflicting reports of efficacy. Little is known about the perceptions of distinct groups of health care workers regarding various sources of evidence and how these influence the clinical decision-making process. Our objective was to investigate how two groups of treatment information providers for people living with HIV/AIDS perceive the importance of various sources of treatment information. Methods Surveys were distributed to staff at two local AIDS service organizations and to family physicians at three community health centres treating people living with HIV/AIDS. Participants were asked to rate the importance of 10 different sources of evidence for HIV/AIDS treatment information on a 5-point Likert-type scale. Mean rating scores and relative rankings were compared. Results Findings suggest that a discordance exists between the two health information provider groups in terms of their perceptions of the various sources of evidence. Furthermore, AIDS service organization staff ranked health care professionals as the most important source of information whereas physicians deemed AIDS service organizations to be relatively unimportant. The two groups appear to share a common mistrust for information from pharmaceutical industries. Conclusions Discordance exists between medical "experts" from different backgrounds relating to their perceptions of evidence. Further investigation is warranted in order to reveal any effects on the quality of treatment information and implications in the decision-making process. Possible effects on collaboration and working relationships also warrant further exploration. PMID:15245578

  17. Mother-Adolescent Language Proficiency and Adolescent Academic and Emotional Adjustment Among Chinese American Families

    PubMed Central

    Benner, Aprile D.; Lau, Anna S.; Kim, Su Yeong

    2009-01-01

    This study examined the role of adolescents’ and mothers’ self-reports of English and heritage language proficiency in youth’s academic and emotional adjustment among 444 Chinese American families. Adolescents who were proficient in English tended to exhibit higher reading achievement scores, math achievement scores, and overall GPA. Mothers who were English proficient tended to have children with higher academic achievement and fewer depressive symptoms. Results also indicated that adolescents’ heritage language maintenance was associated with positive adjustment, particularly amongst foreign-born youth and for youth whose parents were highly proficient in the heritage language. Mother-adolescent match in heritage language proficiency was related to higher math achievement scores and overall GPA. Additionally, higher heritage language proficiency was associated with fewer depressive symptoms for foreign-born but not U.S.-born youth. Overall, the findings suggest that proficiency in both the English and heritage language may confer advantages to Chinese American youth. PMID:19636729

  18. Mother-adolescent language proficiency and adolescent academic and emotional adjustment among Chinese American families.

    PubMed

    Liu, Lisa L; Benner, Aprile D; Lau, Anna S; Kim, Su Yeong

    2009-04-01

    This study examined the role of adolescents' and mothers' self-reports of English and heritage language proficiency in youth's academic and emotional adjustment among 444 Chinese American families. Adolescents who were proficient in English tended to exhibit higher reading achievement scores, math achievement scores, and overall GPA. Mothers who were English proficient tended to have children with higher academic achievement and fewer depressive symptoms. Results also indicated that adolescents' heritage language maintenance was associated with positive adjustment, particularly amongst foreign-born youth and for youth whose parents were highly proficient in the heritage language. Mother-adolescent match in heritage language proficiency was related to higher math achievement scores and overall GPA. Additionally, higher heritage language proficiency was associated with fewer depressive symptoms for foreign-born but not U.S.-born youth. Overall, the findings suggest that proficiency in both the English and heritage language may confer advantages to Chinese American youth.

  19. US physician practices for diagnosing familial hypercholesterolemia: data from the CASCADE-FH registry

    PubMed Central

    Ahmad, Zahid S.; Andersen, Rolf L.; Andersen, Lars H.; O'Brien, Emily C.; Kindt, Iris; Shrader, Peter; Vasandani, Chandna; Newman, Connie B.; deGoma, Emil M.; Baum, Seth J.; Hemphill, Linda C.; Hudgins, Lisa C.; Ahmed, Catherine D.; Kullo, Iftikhar J.; Gidding, Samuel S.; Duffy, Danielle; Neal, William; Wilemon, Katherine; Roe, Matthew T.; Rader, Daniel J.; Ballantyne, Christie M.; Linton, MacRae F.; Duell, P. Barton; Shapiro, Michael D.; Moriarty, Patrick M.; Knowles, Joshua W.

    2017-01-01

    Background In the US familial hypercholesterolemia (FH), patients are underidentified, despite an estimated prevalence of 1:200 to 1:500. Criteria to identify FH patients include Simon Broome, Dutch Lipid Clinic Network (DLCN), or Make Early Diagnosis to Prevent Early Deaths (MEDPED). The use of these criteria in US clinical practices remains unclear. Objective To characterize the FH diagnostic criteria applied by US lipid specialists participating in the FH Foundation's CASCADE FH (CAscade SCreening for Awareness and DEtection of Familial Hypercholesterolemia) patient registry. Methods We performed an observational, cross-sectional analysis of diagnostic criteria chosen for each adult patient, both overall and by baseline patient characteristics, at 15 clinical sites that had contributed data to the registry as of September 8, 2015. A sample of 1867 FH adults was analyzed. The median age at FH diagnosis was 50 years, and the median pretreatment low-density lipoprotein cholesterol (LDL-C) value was 238 mg/dL. The main outcome was the diagnostic criteria chosen. Diagnostic criteria were divided into five nonexclusive categories: “clinical diagnosis,” MEDPED, Simon Broome, DLCN, and other. Results Most adults enrolled in CASCADE FH (55.0%) received a “clinical diagnosis.” The most commonly used formal criteria was Simon–Broome only (21%), followed by multiple diagnostic criteria (16%), MEDPED only (7%), DLCN only (1%), and other (0.5%), P < .0001. Of the patients with only a “clinical diagnosis,” 93% would have met criteria for Simon Broome, DLCN, or MEDPED based on the data available in the registry. Conclusions Our findings demonstrate heterogeneity in the application of FH diagnostic criteria in the United States. A nationwide consensus definition may lead to better identification, earlier treatment, and ultimately CHD prevention. PMID:27678440

  20. Family physician-led, team-based, lifestyle intervention in patients with metabolic syndrome: results of a multicentre feasibility project

    PubMed Central

    Jeejeebhoy, Khursheed; Dhaliwal, Rupinder; Heyland, Daren K.; Leung, Roger; Day, Andrew G.; Brauer, Paula; Royall, Dawna; Tremblay, Angelo; Mutch, David M.; Pliamm, Lew; Rhéaume, Caroline; Klein, Doug

    2017-01-01

    Background: Metabolic syndrome (MetS) is a medical condition with major complications and health care costs. Previous research has shown that diet and exercise can improve and reverse this condition. The goal of this study was to test the feasibility and effectiveness of implementing the Canadian Health Advanced by Nutrition and Graded Exercise (CHANGE) program into diverse family medicine practices to improve MetS. Methods: In this longitudinal before-after study, 305 adult patients with MetS were recruited from 3 diverse family medicine team-based organizations to the CHANGE personalized diet and exercise program. Participants were followed for 12 months. Primary outcomes included feasibility and reversal of MetS. Secondary outcomes included improvement in MetS components, changes in diet quality, aerobic fitness and cardiovascular risk. Results: Participants attended 76% and 90% of the kinesiologist and dietitian visits, respectively. At 12 months, 19% of patients (95% confidence interval [CI] 14%-24%) showed reversal of MetS, VO2max increased by 16% (95% CI 13%-18%), and Healthy Eating Index and Mediterranean Diet Scores improved by 9.6% (95% CI 7.6%-11.6%) and 1.4% (1.1%-1.6%), respectively. In addition, the Prospective Cardiovascular Munster (PROCAM) 10-year risk of acute coronary event decreased by 1.4%, from a baseline of 8.6%. Interpretation: A team-based program led by the family physician that educates patients about the risks of MetS, and with a dietitian and kinesiologist, empowers them to undertake an individualized supervised program of diet modification and exercise, is feasible, improves aerobic capacity and diet quality, reverses MetS and improves MetS components at 12 months.

  1. The family, neuroscience, and academic skills: An interdisciplinary account of social class gaps in children's test scores.

    PubMed

    Potter, Daniel; Mashburn, Andrew; Grissmer, David

    2013-03-01

    Current explanations of social class gaps in children's early academic skills tend to focus on non-cognitive skills that more advantaged children acquire in the family. Accordingly, social class matters because the cultural resources more abundant in advantaged families cultivate children's repertories and tool kits, which allow them to more easily navigate social institutions, such as schools. Within these accounts, parenting practices matter for children's academic success, but for seemingly arbitrary reasons. Alternatively, findings from current neuroscience research indicate that family context matters for children because it cultivates neural networks that assist in learning and the development of academic skills. That is, children's exposure to particular parenting practices and stimulating home environments contribute to the growth in neurocognitive skills that affect later academic performance. We synthesize sociological and neuroscience accounts of developmental inequality by focusing on one such skill-fine motor skills-to illustrate how family context alters children's early academic performance. Our findings support an interdisciplinary account of academic inequality, and extend current accounts of the family's role in the transmission of social inequality.

  2. School climate, family structure, and academic achievement: a study of moderation effects.

    PubMed

    O'Malley, Meagan; Voight, Adam; Renshaw, Tyler L; Eklund, Katie

    2015-03-01

    School climate has been lauded for its relationship to a host of desirable academic, behavioral, and social-emotional outcomes for youth. The present study tested the hypothesis that school climate counteracts youths' home-school risk by examining the moderating effects of students' school climate perceptions on the relationship between family structure (i.e., two-parent, one-parent, foster-care, and homeless households), and academic performance (i.e., self-reported [grade point average] GPA). The present sample consisted of 902 California public high schools, including responses from over 490,000 students in Grades 9 and 11. Results indicated that, regardless of family structure, students with more positive school climate perceptions self-reported higher GPAs. Youths with two-parent, one-parent, and homeless family structures displayed stepwise, linear improvements in self-reported GPA as perceptions of climate improved. Foster-care students' positive school climate perceptions had a weaker effect on their self-reported GPA compared with students living in other family structures. A unique curvilinear trend was found for homeless students, as the relationship between their school climate perceptions and self-reported GPA was stronger at lower levels. Overall, the moderation effect of positive school climate perceptions on self-reported GPA was strongest for homeless youth and youth from one-parent homes, suggesting that school climate has a protective effect for students living in these family structures. A protective effect was not found for youth in foster-care. Implications for research and practice are discussed.

  3. Knowledge and Practice of People toward their Rights in Urban Family Physician Program: A Population-Based Study in Shiraz, Southern Iran

    PubMed Central

    Honarvar, Behnam; Lankarani, Kamran Bagheri; Rostami, Sara; Honarvar, Fatemeh; Akbarzadeh, Armin; Odoomi, Neda; Honarvar, Hossein; Malekmakan, Leila; Rabiye, Parisa; Arefi, Nafiseh

    2015-01-01

    Background: Urban family physician program has been launched as a pilot in Fars and Mazandaran provinces of Iran since 2012. Attitudes of policy makers and people toward urban family physician program have become challenging. This study shows what people know and practice toward this program. Methods: This cross-sectional population-based study was conducted by a multistage randomized sampling in Shiraz, Southern Iran. Knowledge and practice of adults toward urban family physician program were queried through filing the questionnaires. Single and multiple variable analyzes of data were performed. Results: Participation rate was 1257 of 1382 (90.9%), and the mean age of the respondents was 38.1 ± 13.2 years. Of 1257, 634 (50.4%) were men and 882 (70.2%) were married. Peoples’ total knowledge toward urban family physician program was 5 ± 2.7 of 19, showed that 1121 (89.2%) had a low level of knowledge. This was correlated positively and in order to being under coverage of this program (P < 0.001), being under coverage of one of the main insurance systems (P = 0.04) and being married (P = 0.002). The mean score of people's practice toward the program was 2.3 ± 0.9 of total score 7, showed that 942 (74%) had poor performance, and it was correlated positively and in order to being under coverage of this program (P < 0.001) and having higher than 1000$ monthly income (P = 0.004). Correlation of people's knowledge and practice toward the program was 24%. Conclusions: Current evidences show a low level of knowledge, poor practice and weak correlation of knowledge-practice of people toward urban family physician program. PMID:26124943

  4. Depressive symptoms, anxiety and academic motivation in youth: Do schools and families make a difference?

    PubMed

    Elmelid, Andrea; Stickley, Andrew; Lindblad, Frank; Schwab-Stone, Mary; Henrich, Christopher C; Ruchkin, Vladislav

    2015-12-01

    This longitudinal study aimed to examine the association between depressive and anxiety symptoms and academic motivation by gender, and whether positive school and family factors would be associated with academic motivation, in spite of the presence of such symptoms. Study participants were predominantly economically disadvantaged youths aged 13-15 years in a Northeastern US urban public school system. The Social and Health Assessment (SAHA) served as the basis for a survey undertaken in 2003 and 2004 with information being used from students who participated at both time points (N = 643). Multiple linear regression analyses showed that depressive symptoms were negatively associated with academic motivation, while anxiety was positively related to academic motivation in both genders. Teacher support, school attachment and parental control were positively related to academic motivation even in the presence of internalizing problems. The negative association of depressive symptoms with academic motivation may be potentially decreased by attachment to school.

  5. First Generation College Students in Engineering: A Grounded Theory Study of Family Influence on Academic Decision Making

    ERIC Educational Resources Information Center

    Simmons, Denise Rutledge

    2012-01-01

    This work develops a constructivist grounded theory describing the influence of family and those that serve a role similar to family on the academic decision making of undergraduate first generation in college (FGC) students majoring in engineering. FGC students, in this study, are students with neither parent having attained a bachelor's…

  6. Effect of a Physician Assistant as Triage Liaison Provider on Patient Throughput in an Academic Emergency Department

    PubMed Central

    Nestler, David M.; Fratzke, Alesia R.; Church, Christopher J.; Scanlan-Hanson, Lori; Sadosty, Annie T.; Halasy, Michael P.; Finley, Janet L.; Boggust, Andy; Hess, Erik P.

    2012-01-01

    Objectives Overcapacity issues plague emergency departments (EDs). Studies suggest triage liaison providers (TLPs) may shorten patient length of stay (LOS) and reduce the proportion of patients who leave without being seen (LWBS), but these results are not universal. Previous studies used physicians as TLPs. We evaluated whether a physician assistant (PA), acting as a TLP, would shorten LOS and decrease LWBS rates. Methods The authors used an observational cohort controlled before-and-after study design with predefined outcome measures, comparing eight pilot days to eight control days. The TLP evaluated all Emergency Severity Index (ESI) level 3, 4, and 5 patients, excluding pediatric and behavioral health patients. Results Three hundred fifty-three patients were included on pilot days, and 371 on control days. LOS was shorter on pilot days than control days (median 229 minutes [IQR 168 to 303 minutes] vs. 270 minutes [IQR 187 to 372 minutes], p < 0.001). Waiting room times were similar between pilot and control days (median 69 minutes [IQR 20 to 119 minutes] vs. 70 minutes [IQR 19 to 137 minutes], p = 0.408), but treatment room times were shorter (median 151 minutes [IQR 92 to 223 minutes] vs. 187 minutes [IQR 110 to 254 minutes], p < 0.001). Finally, a lower proportion of patients LWBS on pilot days (1.4% vs. 9.7%, p < 0.001). Conclusions The addition of a PA as a TLP was associated with a 41 minute decrease in median total LOS, and a lower proportion of patients who LWBS. The decrease in total LOS is likely attributable to the addition of the TLP, with patients having shorter duration in treatment rooms on pilot days compared to control days. PMID:23167853

  7. The role of economic evaluation in the decision-making process of family physicians: design and methods of a qualitative embedded multiple-case study

    PubMed Central

    Lessard, Chantale; Contandriopoulos, André-Pierre; Beaulieu, Marie-Dominique

    2009-01-01

    Background A considerable amount of resource allocation decisions take place daily at the point of the clinical encounter; especially in primary care, where 80 percent of health problems are managed. Ignoring economic evaluation evidence in individual clinical decision-making may have a broad impact on the efficiency of health services. To date, almost all studies on the use of economic evaluation in decision-making used a quantitative approach, and few investigated decision-making at the clinical level. An important question is whether economic evaluations affect clinical practice. The project is an intervention research study designed to understand the role of economic evaluation in the decision-making process of family physicians (FPs). The contributions of the project will be from the perspective of Pierre Bourdieu's sociological theory. Methods/design A qualitative research strategy is proposed. We will conduct an embedded multiple-case study design. Ten case studies will be performed. The FPs will be the unit of analysis. The sampling strategies will be directed towards theoretical generalization. The 10 selected cases will be intended to reflect a diversity of FPs. There will be two embedded units of analysis: FPs (micro-level of analysis) and field of family medicine (macro-level of analysis). The division of the determinants of practice/behaviour into two groups, corresponding to the macro-structural level and the micro-individual level, is the basis for Bourdieu's mode of analysis. The sources of data collection for the micro-level analysis will be 10 life history interviews with FPs, documents and observational evidence. The sources of data collection for the macro-level analysis will be documents and 9 open-ended, focused interviews with key informants from medical associations and academic institutions. The analytic induction approach to data analysis will be used. A list of codes will be generated based on both the original framework and new themes

  8. Appropriate osteoporosis treatment by family physicians in response to FRAX vs CAROC reporting: results from a randomized controlled trial.

    PubMed

    Beattie, Karen A; Ioannidis, George; MacDermid, Joy C; Grewal, Ruby; Papaioannou, Alexandra; Adachi, Jonathan D; Hodsman, Anthony B

    2014-01-01

    Canadian guidelines recommend either the FRAX or the Canadian Association of Radiologists and Osteoporosis Canada (CAROC) fracture risk assessment tools to report 10-yr fracture risk as low (<10%), moderate (10%-20%) or high (>20%). It is unknown whether one reporting system is more effective in helping family physicians (FPs) identify individuals who require treatment. Individuals ≥50 yr old with a distal radius fracture and no previous osteoporosis diagnosis or treatment were recruited. Participants underwent a dual-energy x-ray absorptiometry scan and answered questions about fracture risk factors. Participants' FPs were randomized to receive either a FRAX report or the standard CAROC-derived bone mineral density report currently used by the institution. Only the FRAX report included statements regarding treatment recommendations. Within 3 mo, all participants were asked about follow-up care by their FP, and treatment recommendations were compared with an osteoporosis specialist. Sixty participants were enrolled (31 to FRAX and 29 to CAROC). Kappa statistics of agreement in treatment recommendation were 0.64 for FRAX and 0.32 for bone mineral density. The FRAX report was preferred by FPs and resulted in better postfracture follow-up and treatment that agreed more closely with a specialist. Either the clear statement of fracture risk or the specific statement of treatment recommendations on the FRAX report may have supported FPs to make better treatment decisions.

  9. Intrapartum care by general practitioners and family physicians. Provincial trends from 1984-1985 to 1994-1995.

    PubMed Central

    Kaczorowski, J.; Levitt, C.

    2000-01-01

    OBJECTIVE: To determine provincial trends in provision of intrapartum care by general practitioners and family physicians (GP/FPs) for the 11 years from 1984 to 1995. DESIGN: Analyses of provincial Medical Care Fee-for-Service Utilization data for births from 1984-1985 to 1994-1995. SETTING: 10 provinces of Canada. MAIN OUTCOME MEASURES: Proportion of vaginal births billed by GP/FPs (expressed as total number of vaginal births billed by GP/FPs divided by total number of vaginal births). RESULTS: In 1994-1995, the proportion of vaginal births billed by GP/FPs ranged from 77.2% in British Columbia and 70.8% in Nova Scotia to 28.9% in Ontario and 23.6% in Prince Edward Island. These proportions have remained relatively high and stable during the period studied in some provinces, such as British Columbia and Nova Scotia, and have declined steadily and notably in others. CONCLUSIONS: Data show that GP/FPs' involvement in vaginal births in most Canadian provinces is decreasing. This trend demonstrates a shift in GP/FPs' practice patterns and could indicate a coming shortage of obstetrical care providers. PMID:10751998

  10. Family attitudes in youth as a possible precursor of cancer among physicians: a search for explanatory mechanisms

    SciTech Connect

    Shaffer, J.W.; Duszynski, K.R.; Thomas, C.B.

    1982-06-01

    A measure of youthful family attitudes, the Closeness to Parents Scale, has continued to be predictive of cancer among physicians in a prospective study of medical students. Nonetheless, questions have remained concerning the meaning and reliability of this measure and whether its predictive value is diminishing over time. Perhaps more important, it is necessary to ascertain whether the relationship is the result of some methodological artifact or whether it is mediated by an association with known risk factors, such as smoking, drinking, and radiation exposure. Each of these issues was examined in turn, using a variety of statistical techniques to refine the scale and to equate cancer and control groups with respect to risk factors as well as possible artifacts. In a group of 913 men, it was found that the scale is primarily a function of good father-son relationships and that its association with later cancer persists even after the influence of possible mediating and artifactual variables is statistically controlled. Several possible explanations for these findings are discussed.

  11. Perceptions of Family Physician Trainees and Trainers Regarding the Usefulness of a Virtual Community of Practice

    PubMed Central

    Jones, Sandra C; Bennett, Sue; Iverson, Don; Bonney, Andrew

    2013-01-01

    Background Training for Australian general practice, or family medicine, can be isolating, with registrars (residents or trainees) moving between rural and urban environments, and between hospital and community clinic posts. Virtual communities of practice (VCoPs), groups of people sharing knowledge about their domain of practice online and face-to-face, may have a role in overcoming the isolation associated with general practice training. Objective This study explored whether Australian general practice registrars and their supervisors (trainers) would be able to use, and would be interested in using, a VCoP in the form of a private online network for work and training purposes. It also sought to understand the facilitators and barriers to intention to use such a community, and considers whether any of these factors may be modifiable. Methods A survey was developed assessing computer, Internet, and social media access and usage, confidence, perceived usefulness, and barriers, facilitators, and intentions to use a private online network for training purposes. The survey was sent by email link to all 139 registrars and 224 supervisors in one of Australia’s 17 general practice training regions. Complete and usable responses were received from 131 participants (response rate=0.4). Results Most respondents had access to broadband at home (125/131, 95.4%) and at work (130/131, 99.2%). Registrars were more likely to spend more than 2 hours on the Internet (P=.03), and to use social media sites for nonwork purposes (P=.01). On a 5-point Likert scale, confidence was high (mean 3.93, SD 0.63) and was negatively associated with higher age (P=.04), but not associated with training stage. Social media confidence was lower, with registrars more confident than supervisors for almost all social media activities. On a 5-point Likert scale, overall usefulness was scored positively (n=123, mean 3.63, SD 0.74), and was not significantly associated with age or training level. The

  12. Teacher-child relationship quality and academic achievement of Chinese American children in immigrant families.

    PubMed

    Ly, Jennifer; Zhou, Qing; Chu, Keira; Chen, Stephen H

    2012-08-01

    This study examined the cross-sectional relations between teacher-child relationship quality (TCRQ) and math and reading achievement in a socio-economically diverse sample of Chinese American first- and second-grade children in immigrant families (N=207). Teachers completed a questionnaire measuring TCRQ dimensions including closeness, conflict, and intimacy, and children completed a questionnaire measuring overall TCRQ. Standardized tests were used to assess children's math and reading skills. Analyses were conducted to (a) test the factor structure of measures assessing TCRQ among Chinese American children, (b) examine the associations between teacher- and child-rated TCRQ and children's academic achievement, controlling for demographic characteristics, and (c) examine the potential role of child gender as a moderator in the relations between TCRQ and achievement. Results indicated that teacher-rated TCRQ Warmth was positively associated with Chinese American children's reading achievement. Two child gender-by-TCRQ interactions were found: (a) teacher-rated TCRQ Conflict was negatively associated with girls' (but not boys') math achievement, and (b) child-rated Overall TCRQ was positively associated with boys' (but not girls') reading achievement. These findings highlight the valuable role of TCRQ in the academic success of school-aged children in immigrant families.

  13. Childhood bullying: implications for physicians.

    PubMed

    Lyznicki, James M; McCaffree, Mary Anne; Robinowitz, Carolyn B

    2004-11-01

    Childhood bullying has potentially serious implications for bullies and their targets. Bullying involves a pattern of repeated aggression, a deliberate intent to harm or disturb a victim despite the victim's apparent distress, and a real or perceived imbalance of power. Bullying can lead to serious academic, social, emotional, and legal problems. Studies of successful antibullying programs suggest that a comprehensive approach in schools can change student behaviors and attitudes, and increase adults' willingness to intervene. Efforts to prevent bullying must address individual, familial, and community risk factors, as well as promote an understanding of the severity of the problem. Parents, teachers, and health care professionals must become more adept at identifying possible victims and bullies. Physicians have important roles in identifying at-risk patients, screening for psychiatric comorbidities, counseling families about the problem, and advocating for bullying prevention in their communities.

  14. Behavioral and emotional adjustment, family functioning, academic performance, and social relationships in children with selective mutism.

    PubMed

    Cunningham, Charles E; McHolm, Angela; Boyle, Michael H; Patel, Sejal

    2004-11-01

    This study addressed four questions which parents of children with selective mutism (SM) frequently ask: (1) Is SM associated with anxiety or oppositional behavior? (2) Is SM associated with parenting and family dysfunction? (3) Will my child fail at school? and (4) Will my child make friends or be teased and bullied? In comparison to a sample of 52 community controls, 52 children with SM were more anxious, obsessive, and prone to somatic complaints. In contrast, children with SM were less oppositional and evidenced fewer attentional difficulties at school. We found no group differences in family structure, economic resources, family functioning, maternal mood difficulties, recreational activities, or social networks. While parents reported no differences in parenting strategies, children with SM were described as less cooperative in disciplinary situations. The academic (e.g., reading and math) and classroom cooperative skills of children with SM did not differ from controls. Parents and teachers reported that children with SM had significant deficits in social skills. Though teachers and parents rated children with SM as less socially assertive, neither teachers nor parents reported that children with SM were victimized more frequently by peers.

  15. Perspectives of patients, family caregivers and physicians about the use of opioids for refractory dyspnea in advanced chronic obstructive pulmonary disease

    PubMed Central

    Rocker, Graeme; Young, Joanne; Donahue, Margaret; Farquhar, Morag; Simpson, Catherine

    2012-01-01

    Background: A recent national practice guideline recommends the use of opioids for the treatment of refractory dyspnea in patients with advanced chronic obstructive pulmonary disease (COPD). We conducted two qualitative studies to explore the experiences of patients and family caregivers with opioids for refractory COPD-related dyspnea and the perspectives and attitudes of physicians toward opioids in this context. Methods: Patients (n = 8; 5 men, 3 women), their caregivers (n = 12; 5 men, 7 women) and physicians (n = 28, 17 men, 11 women) in Nova Scotia participated in the studies. Semistructured interviews were recorded, transcribed verbatim, coded conceptually and analyzed for emergent themes using interpretive description methodology. Results: Patients reported that opioids provided a sense of calm and relief from severe dyspnea. Family caregivers felt that opioids helped patients to breathe more “normally,” observed improvements in patients’ symptoms of anxiety and depression, and experienced reductions in their own stress. Patients reported substantial improvements in their quality of life. All patients and family caregivers wanted opioid therapy to continue. Most physicians were reluctant to prescribe opioids for refractory dyspnea, describing a lack of related knowledge and experience, and fears related to the potential adverse effects and legal censure. Interpretation: Discrepancies between the positive experiences of patients and family caregivers with opioids and the reluctance of physicians to prescribe opioids for refractory dyspnea constitute an important gap in care. Bridging this gap will require initiatives to improve the uptake of practice guidelines and to increase confidence in prescribing opioids for dyspnea refractory to conventional treatment. PMID:22529167

  16. Physician and Family Recommendations to Obtain a Mammogram and Mammography Intentions: The Moderating Effects of Perceived Seriousness and Risk of Breast Cancer

    PubMed Central

    Molina, Yamile; Thompson, Beti; Ceballos, Rachel M

    2014-01-01

    A growing body of literature has demonstrated psychosocial factors enable mammography intentions and usage among Latinas. Although these factors (e.g., family recommendations, breast cancer perceptions) likely influence one another, little research has examined interactive effects. The current study assessed the moderating effect of perceived breast cancer seriousness and risk on associations between recommendations to obtain mammography and mammography intentions. This sample included 97 Latinas in rural Eastern Washington State. After adjusting for age, two significant interactions emerged: perceived seriousness × physician recommendation and perceived risk × family recommendation. This exploratory study provides important directions for future communication research and planning to improve screening disparities. PMID:25558437

  17. Family Background, School-Age Trajectories of Activity Participation, and Academic Achievement at the Start of High School

    PubMed Central

    Crosnoe, Robert; Smith, Chelsea; Leventhal, Tama

    2014-01-01

    Applying latent class and regression techniques to data from the NICHD Study of Early Child Care and Youth Development (n = 997), this study explored the potential academic advantages of time spent in out-of-school activities. Of particular interest was how these potential advantages played out in relation to the timing and duration of activity participation and the family contexts in which it occurred. Participation closer to the start of high school—including consistent participants and latecomers—was associated with higher grades at the transition into high school, especially for youth from low-income families. Sensitivity analyses indicated that this link between school-age activity participation and adolescent academic progress was unlikely to be solely a function of selection. It also tended to be more pronounced among youth from lower-income families, although without varying by other aspects of family status or process. PMID:26279615

  18. Effortful Control, Behavior Problems and Peer Relations: What Predicts Academic Adjustment in Kindergarteners from Low-income Families?

    PubMed Central

    Morris, Amanda Sheffield; John, Aesha; Halliburton, Amy L.; Morris, Michael D. S.; Robinson, Lara R.; Myers, Sonya S.; Aucoin, Katherine J.; Keyes, Angela W.; Terranova, Andrew

    2013-01-01

    This study examined the role of effortful control, behavior problems, and peer relations in the academic adjustment of 74 kindergarten children from primarily low-income families using a short-term longitudinal design. Teachers completed standardized measures of children’s effortful control, internalizing and externalizing problems, school readiness, and academic skills. Children participated in a sociometric interview to assess peer relations. Research Findings: Correlational analyses indicate that children’s effortful control, behavior problems in school, and peer relations are associated with academic adjustment variables at the end of the school year, including school readiness, reading skills, and math skills. Results of regression analyses indicate that household income and children’s effortful control primarily account for variation in children’s academic adjustment. The associations between children’s effortful control and academic adjustment did not vary across sex of the child or ethnicity. Mediational analyses indicate an indirect effect of effortful control on school readiness, through children’s internalizing problems. Practice or Policy: Effortful control emerged as a strong predictor of academic adjustment among kindergarten children from low-income families. Strategies for enhancing effortful control and school readiness among low-income children are discussed. PMID:24163572

  19. Effortful Control, Behavior Problems and Peer Relations: What Predicts Academic Adjustment in Kindergarteners from Low-income Families?

    PubMed

    Morris, Amanda Sheffield; John, Aesha; Halliburton, Amy L; Morris, Michael D S; Robinson, Lara R; Myers, Sonya S; Aucoin, Katherine J; Keyes, Angela W; Terranova, Andrew

    2013-01-01

    This study examined the role of effortful control, behavior problems, and peer relations in the academic adjustment of 74 kindergarten children from primarily low-income families using a short-term longitudinal design. Teachers completed standardized measures of children's effortful control, internalizing and externalizing problems, school readiness, and academic skills. Children participated in a sociometric interview to assess peer relations. Research Findings: Correlational analyses indicate that children's effortful control, behavior problems in school, and peer relations are associated with academic adjustment variables at the end of the school year, including school readiness, reading skills, and math skills. Results of regression analyses indicate that household income and children's effortful control primarily account for variation in children's academic adjustment. The associations between children's effortful control and academic adjustment did not vary across sex of the child or ethnicity. Mediational analyses indicate an indirect effect of effortful control on school readiness, through children's internalizing problems. Practice or Policy: Effortful control emerged as a strong predictor of academic adjustment among kindergarten children from low-income families. Strategies for enhancing effortful control and school readiness among low-income children are discussed.

  20. Dying patients' need for emotional support and personalized care from physicians: perspectives of patients with terminal illness, families, and health care providers.

    PubMed

    Wenrich, Marjorie D; Curtis, J Randall; Ambrozy, Donna A; Carline, Jan D; Shannon, Sarah E; Ramsey, Paul G

    2003-03-01

    This study addressed the emotional and personal needs of dying patients and the ways physicians help or hinder these needs. Twenty focus groups were held with 137 individuals, including patients with chronic and terminal illnesses, family members, health care workers, and physicians. Content analyses were performed based on grounded theory. Emotional support and personalization were 2 of the 12 domains identified as important in end-of-life care. Components of emotional support were compassion, responsiveness to emotional needs, maintaining hope and a positive attitude, and providing comfort through touch. Components of personalization were treating the whole person and not just the disease, making the patient feel unique and special, and considering the patient's social situation. Although the levels of emotional support and personalization varied, there was a minimal level, defined by compassion and treating the whole person and not just the disease, that physicians should strive to meet in caring for all dying patients. Participants also identified intermediate and advanced levels of physician behavior that provide emotional and personal support.

  1. Academic Performance in ADHD when Controlled for Comorbid Learning Disorders, Family Income, and Parental Education in Brazil

    ERIC Educational Resources Information Center

    Carmine Pastura, Giuseppe Mario; Mattos, Paulo; Campos Araujo, Alexandra Prufer de Queiroz

    2009-01-01

    Objective: Scholastic achievement in a nonclinical sample of ADHD children and adolescents was evaluated taking into consideration variables such as comorbid learning disorders, family income, and parental education which may also be associated with poor academic performance. Method: After screening for ADHD in 396 students, the authors compared…

  2. Adding Academics to the Work/Family Puzzle: Graduate Student Parents in Higher Education and Student Affairs

    ERIC Educational Resources Information Center

    Sallee, Margaret W.

    2015-01-01

    Based on interviews with 18 parents who were enrolled in higher education and student affairs master's programs and also employed on college and university campuses, this article explores the ways that student parents navigate their academic, familial, and professional responsibilities. Using role conflict theory as a theoretical guide, this study…

  3. An Examination of the Interrelationships between Self-Esteem, Others' Expectations, Family Support, Learning Approaches and Academic Achievement

    ERIC Educational Resources Information Center

    Roman, Sergio; Cuestas, Pedro J.; Fenollar, Pedro

    2008-01-01

    The current research represents an initial step into the analysis of the effect of self-esteem, others' (peers and teachers) expectations and family support on academic achievement through learning approaches (deep processing, surface processing and effort). Data were gathered from 553 university students from different faculties of a Spanish…

  4. Family Background, Students' Academic Self-Efficacy, and Students' Career and Life Success Expectations

    ERIC Educational Resources Information Center

    Kim, Mihyeon

    2014-01-01

    This study examined the relationship of family background on students' academic self-efficacy and the impact of students' self-efficacy on their career and life success expectations. The study used the national dataset of the Educational Longitudinal Study of 2002 (ELS: 2002), funded by the U.S. Department of Education. Based on a path…

  5. A Longitudinal Daily Diary Study of Family Assistance and Academic Achievement among Adolescents from Mexican, Chinese, and European Backgrounds

    ERIC Educational Resources Information Center

    Telzer, Eva H.; Fuligni, Andrew J.

    2009-01-01

    A longitudinal daily diary method was employed to examine the implications of family assistance for the academic achievement of 563 adolescents (53% female) from Mexican (n = 217), Chinese (n = 206), and European (n = 140) backgrounds during the high school years (mean age 14.9 years in 9th grade to 17.8 years in 12th grade). Although changes in…

  6. When Teachers' and Parents' Values Differ: Teachers' Ratings of Academic Competence in Children from Low-Income Families.

    ERIC Educational Resources Information Center

    Hauser-Cram, Penny; Sirin, Selcuk R.; Stipek, Deborah

    2003-01-01

    Examines predictors of teachers' ratings of academic competence of 105 kindergarten children from low-income families. Controlling for children's skills and socioeconomic status, teachers rated children as less competent when they perceived value differences with parents. The findings suggest a mechanism by which some children from low-income…

  7. Experiences of Latina First Generation College Students: Exploring Resources Supporting the Balancing of Academic Pursuits and Family Life

    ERIC Educational Resources Information Center

    Corona-Ordonez, Hercilia B.

    2013-01-01

    This study used a qualitative interview approach and thematic analysis (Braune and Clark, 2006) to interview first generation college student Latinas, exploring their experiences with higher education, their navigation/negotiation of resources for academic success and for wellness of self and family, and barriers they face as they attempt to both…

  8. A longitudinal daily diary study of family assistance and academic achievement among adolescents from Mexican, Chinese, and European backgrounds.

    PubMed

    Telzer, Eva H; Fuligni, Andrew J

    2009-04-01

    A longitudinal daily diary method was employed to examine the implications of family assistance for the academic achievement of 563 adolescents (53% female) from Mexican (n = 217), Chinese (n = 206), and European (n = 140) backgrounds during the high school years (mean age 14.9 years in 9th grade to 17.8 years in 12th grade). Although changes in family assistance time within individual adolescents were not associated with simultaneous changes in their Grade Point Averages (GPAs), increases in the proportion of days spent helping the family were linked to declines in the GPAs of students from Mexican and Chinese backgrounds. The negative implications of spending more days helping the family among these two groups was not explained by family background factors or changes in study time or school problems. These results suggest that the chronicity rather than the amount of family assistance may be difficult for adolescents from Mexican and Chinese backgrounds.

  9. [Preschool familial environment and academic difficulties: A 10-year follow-up from kindergarten to middle school].

    PubMed

    Câmara-Costa, H; Pulgar, S; Cusin, F; Dellatolas, G

    2016-02-01

    The persistence of academic difficulties from childhood through adulthood has led researchers to focus on the identification of the early factors influencing children's subsequent achievement in order to improve the efficient screening of children who might be at risk of school failure. The foundations of academic achievement can be accurately traced back to the preschool years prior to children's entry in formal schooling and are largely influenced by environmental determinants. Importantly, some environmental conditions act as early risk factors undermining children's later academic achievement due to the well-established relation between underachievement and exposure to moderate to high levels of environmental risk. In the present study, we aimed to investigate the longitudinal effects of environment-level factors (sociodemographic and family characteristics) and early risk exposure at kindergarten on children's subsequent academic achievement at the end of middle school (grade 9). The sample of analysis comprised 654 kindergarteners aged 5-6 years (2001-2002 school year) followed through the end of middle school when they were aged 14-15 years (2010-2011 school year). At kindergarten, assessment included questionnaire-based measures of sociodemographic and family background characteristics. These included an original set of information pertaining to family background including parental nationality, education level, history of reading difficulties, type of early childcare, family situation, family size, and language-based bedtime routines, as well as individual-level factors such as children's first language, medical history, language delay, birth weight, age of walking onset, and gestation period. At grade 9, outcome measures were composed of children's results in the national evaluations performed at the end of middle school ("Diplôme National du Brevet"), or history of repetition for a second year of the same class. The results indicated that all family

  10. Family physicians' ability to perform population management is associated with adoption of other aspects of the patient-centered medical home.

    PubMed

    Ottmar, Jessica; Blackburn, Brenna; Phillips, Robert L; Peterson, Lars E; Jaén, Carlos Roberto

    2015-04-01

    The patient-centered medical home (PCMH) model is considered a promising approach to improving population health, but how elements of these advanced practice models relate to population health capability is unknown. To measure associations between family physicians' performance of population management with PCMH components, a cross-sectional survey was conducted with physicians accessing the American Board of Family Medicine Web site in 2011. Bivariate analysis and logistic regression tested associations between physician and practice demographics and specific PCMH features. The primary outcome was performance of population management. The final sample included 3855 physicians, 37.3% of whom reported performing population management. Demographic characteristics significantly associated with greater use of population management were female sex and graduation from an international medical school. PCMH components that remained associated with population management after adjustment were access to clinical case managers (odds ratio [OR]=2.01, 95% confidence interval [95% CI]: 1.69, 2.39), behavioral health collaboration (OR=1.49, 95% CI: 1.26, 1.77), having an electronic health record that supports meaningful use (OR=1.47, 95% CI: 1.25, 1.74), recent participation in a quality improvement project (OR=2.47, 95% CI: 2.12, 2.89), and routine measurement of patient difficulty securing an appointment (OR=2.87, 95% CI: 2.45, 3.37). Performance of population management was associated with several PCMH elements and resources not present in traditional primary care offices. Attention to these elements likely will enhance delivery of population management services in primary care.

  11. An Analytical Comparison of the Opinions of Physicians Working in Emergency and Trauma Surgery Departments at Tabriz and Vienna Medical Universities Regarding Family Presence during Resuscitation

    PubMed Central

    Soleimanpour, Hassan; Behringer, Wilhelm; Tabrizi, Jafar Sadegh; Sarahrudi, Kambiz; Golzari, Samad E J; Hajdu, Stefan; Rasouli, Maryam; Nikakhtar, Mehdi; Mehdizadeh Esfanjani, Robab

    2015-01-01

    The present study evaluated the opinions of physicians working in the emergency and trauma surgery departments of Vienna Medical University, in Austria, and Tabriz Medical University, in Iran, regarding the presence of patients’ relatives during resuscitation. In a descriptive-analytical study, the data obtained from questionnaires that had been distributed randomly to 40 specialists and residents at each of the participating universities were analyzed. The questionnaire consisted of two sections aimed at capturing the participants’ demographic data, the participants’ opinions regarding their support for the family’s presence during resuscitation, and the multiple potential factors affecting the participants’ attitudes, including health beliefs, triggers that could facilitate the procedure, self-efficacy, intellectual norms, and perceived behavioral control. The questionnaire also included a direct question (Question 16) on whether the participants approved of family presence. Each question could be answered using a Likert-type scale. The results showed that the mean scores for Question 16 were 4.31 ± 0.64 and 3.57 ± 1.31 for participants at Vienna and Tabriz universities, respectively. Moreover, physicians at Vienna University disapproved of the presence of patients’ families during resuscitation to a higher extent than did those at Tabriz University (P = 0.018). Of the studied prognostic factors affecting the perspectives of Vienna Medical University’s physicians, health beliefs (P = 0.000; B = 1.146), triggers (P = 0.000; B = 1.050), and norms (P = 0.000; B = 0.714) were found to be significant. Moreover, of the studied prognostic factors affecting the perspectives of Tabriz Medical University’s physicians, health beliefs (P = 0.000; B = 0.875), triggers (P = 0.000; B = 1.11), self-efficacy (P = 0.001; B = 0.5), and perceived behavioral control (P = 0.03; B = 0.713) were significant. Most physicians at Vienna and Tabriz Medical universities

  12. Educational needs of family physicians in the domains of health and conformity with continuing education in Fasa University of Medical Sciences

    PubMed Central

    ZARIF SANAIEY, NAHID; KARAMNEJAD, SAHAR; REZAEE, RITA

    2015-01-01

    Introduction Assessment and prioritization are the first steps of planning. According to the family physician's idea, evaluating programs in order to improve them is one of the necessities of promoting quality and increases the efficiency and effectiveness of continuing education. This study aimed to determine family physicians’ educational needs regarding health and its applicability in continuous medical education in Fasa University of Medical Sciences. Methods In this cross-sectional study, viewpoints of 45 general physicians working at Fasa University of Medical Sciences in 2013 were studied. Samples were selected through census. Data collection was done using a researcher-made questionnaire using 10-point Likert scale and a checklist with Delphi technique.  Content validity of the questionnaire and its reliability were confirmed by the experts’ opinion and Cronbach's alpha of 80%.  The data were analyzed through SPSS software version 16, using both descriptive and inferential statistics (mean and standard deviation, standard score (SQ), t-test, ANOVAs). A significance level of <0.05 was considered. Results The highest educational priority was in the field of mental health (SQ= 0.38), and environmental and professional health was the lowest priority (SQ= _0.24). Additionally, within each of the areas above specific priorities were determined. Based on the results of this study, gender, graduation date, cooperation time, and university they were educated in did not affect expressing educational needs (p>0.05). The most educational conformity with continuing education was in the diseases area (topic 27%, content 37%). In the areas of environmental and professional health and health education, compliance was zero. Conclusions The physicians stated that mental health was the first educational need and environmental and professional health was the last one. According to the results, proper continuing medical programs should be coordinated with educational

  13. Knowledge and management of Adolescent Idiopathic Scoliosis among family physicians, pediatricians, chiropractors and physiotherapists in Québec, Canada: An exploratory study

    PubMed Central

    Théroux, Jean; Grimard, Guy; Beauséjour, Marie; Labelle, Hubert; Feldman, Debbie Ehrmann

    2013-01-01

    Background: Health professionals (HPs) are likely to encounter adolescent idiopathic scoliosis (AIS) patients. Best practice dictates that early detection leads to better decision making regarding optimal management. The aim of our study was to appraise the basic knowledge, evaluation and management skills concerning AIS care among family physicians, pediatricians, chiropractors, and physiotherapists. Methods: A semi-structured questionnaire including 3 clinical scenarios was developed. Telephone interviews were conducted with 51 HPs to assess their knowledge of the clinical signs, risk factors, and management options of AIS and their preferences in clinical guidelines for AIS care. Results: The majority of HPs (70–90%) would refer the patient who required prompt referral, but only 38–60% actually rated the case as requiring prompt referral. Forty percent of HPs (predominantly physiotherapists and family physicians) stated that they would not be comfortable providing AIS patient follow-up. Access to specialized care was considered a problem, and nearly all believed that establishment of clinical guidelines would be beneficial. Conclusions: Considerable gaps exist regarding the knowledge of the clinical signs and risk factors of AIS. The importance of a patient in need of a prompt referral is recognized by the majority of the HPs, but they believe that there are problems regarding accessibility to a specialist. Interprofessional collaboration is discussed as a promising approach to improve the management of AIS. PMID:23997251

  14. The Physician-Scientist: An Endangered Species.

    ERIC Educational Resources Information Center

    Legato, Marianne, J.

    1983-01-01

    The number of physician-scientists in training decreased below the recommended level in 1976. Reasons young doctors are not attracted to research training and why these academic physicians are needed are discussed. The demise of the academic medical community will begin an ice age in American medicine. (SR)

  15. Medical Students' vs. Family Physicians' Assessment of Practical and Logical Values of Pathophysiology Multiple-Choice Questions

    ERIC Educational Resources Information Center

    Secic, Damir; Husremovic, Dzenana; Kapur, Eldan; Jatic, Zaim; Hadziahmetovic, Nina; Vojnikovic, Benjamin; Fajkic, Almir; Meholjic, Amir; Bradic, Lejla; Hadzic, Amila

    2017-01-01

    Testing strategies can either have a very positive or negative effect on the learning process. The aim of this study was to examine the degree of consistency in evaluating the practicality and logic of questions from a medical school pathophysiology test, between students and family medicine doctors. The study engaged 77 family medicine doctors…

  16. Three generations of family medicine: a comparison of social identities.

    PubMed

    Fox, T G; Cole, D R; Lieberman, J A

    1984-01-01

    Recent studies have shown that students and residents choosing Family Medicine career orientations have attained an academic parity with their counterparts in other specialties which was not demonstrated by their general practitioner predecessors. Similarly, the advent of Family Practice residencies and undergraduate course work has significantly altered the educational experience of today's medical students. This study adds to the literature by comparing a third element, the social character of Family Medicine oriented students, residents and practicing physicians. Three subgroups of Family Medicine oriented individuals; students, residents, and physicians, were surveyed through a mailed questionnaire. A study population of 768 individuals yielded a 73% response rate. The findings show that students and residents share a common pattern of identities and that this pattern is not shared with the physician subgroup. This results in rejection of the cohort replication theory. It also suggests a need for Family Practice training to provide role models from the new and emerging generation of family physicians.

  17. Physician Perspectives on Comparative Effectiveness Research: Implications for Practice-based Evidence.

    PubMed

    Pierce, Beverly A; Chesney, Margaret A; Witt, Claudia M; Berman, Brian M

    2012-09-01

    Comparative effectiveness research (CER) is defined by the Institute of Medicine as "the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care." The goal of CER is to provide timely, useful evidence to healthcare decision makers including physicians, patients, policymakers, and payers. A prime focus for the use of CER evidence is the interaction between physician and patient. Physicians in primary practice are critical to the success of the CER enterprise. A 2009 survey suggests, however, that physician attitudes toward CER may be mixed-somewhat positive toward the potential for patient care improvement, yet negative toward potential restriction on physician freedom of practice. CER methods and goals closely parallel those of practice-based research, an important movement in family medicine in the United States since the 1970s. This article addresses apparent physician ambivalence toward CER and makes a case for family medicine engagement in CER to produce useful practice-based evidence. Such an effort has potential to expand care options through personalized medicine, individualized guidelines, focus on patient preferences and patient-reported outcomes, and study of complex therapeutic interventions, such as integrative care. Academic medical researchers will need to collaborate with experienced family physicians to identify significant practice-based research questions and design meaningful studies. Such collaborations would shape CER to produce high-quality practice-based evidence to inform family and community medicine.

  18. Mothers' and fathers' involvement with school-age children's care and academic activities in Navajo Indian families.

    PubMed

    Hossain, Ziarat; Anziano, Michael C

    2008-04-01

    This exploratory study examined mothers' and fathers' reports of time involvement in their school-age children's care and academic activities. The study also explored the relationship between parents' socioeconomic status (SES) variables (age, education, income, work hours, and length of marriage) and their relative involvement with children. Mother and father dyads from 34 two-parent Navajo (Diné) Indian families with a second- or third-grade child participated in the study. Repeated measures analysis of variance showed that mothers invested significantly more time in children's care on demand and academic activities than fathers, but the differences in maternal and paternal perceptions of time involvement in routine care were not significant. The gender of the child did not influence the amount of time parents invested in children's care and academic activities. Mothers' involvement with children was not related to any of the SES variables. Fathers' involvement was significantly associated with work hours and length of marriage, and work hours produced significant interaction with fathers' involvement with children. Findings are discussed in light of gender role differences in parental involvement with children within Navajo families.

  19. A Study to Develop a Uniform Measure of Clinical Productivity among Family Practice Physicians from Selected Army Community Hospitals

    DTIC Science & Technology

    1988-11-01

    9 2. ro Problem Noted ....... ................... . 80 3. V700 - Exam, medical .......... .................... 81 4. V7231 - Exam...97 20. 7840 - Headacne .......... ...................... 98 iv I. INTRODUCTION Conditions Which Prompted the Study Medical ...They were chosen because there is a close comparison between these medical care facilities in regard to the scope and breadth of family practice ifn

  20. The views of key leaders in South Africa on implementation of family medicine: critical role in the district health system

    PubMed Central

    2014-01-01

    Background Integrated team-based primary care is an international imperative. This is required more so in Africa, where fragmented verticalised care dominates. South Africa is trying to address this with health reforms, including Primary Health Care Re-engineering. Family physicians are already contributing to primary care despite family medicine being only fully registered as a full specialty in South Africa in 2008. However the views of leaders on family medicine and the role of family physicians is not clear, especially with recent health reforms. The aim of this study was to understand the views of key government and academic leaders in South Africa on family medicine, roles of family physicians and human resource issues. Methods This was a qualitative study with academic and government leaders across South Africa. In-depth interviews were conducted with sixteen purposively selected leaders using an interview guide. Thematic content analysis was based on the framework method. Results Whilst family physicians were seen as critical to the district health system there was ambivalence on their leadership role and ‘specialist’ status. National health reforms were creating both threats and opportunities for family medicine. Three key roles for family physicians emerged: supporting referrals; clinical governance/quality improvement; and providing support to community-oriented care. Respondents’ urged family physicians to consolidate the development and training of family physicians, and shape human resource policy to include family physicians. Conclusions Family physicians were seen as critical to the district health system in South Africa despite difficulties around their precise role. Whilst their role was dominated by filling gaps at district hospitals to reduce referrals it extended to clinical governance and developing community-oriented primary care - a tall order, requiring strong teamwork. Innovative team-based service delivery is possible despite human

  1. [Physician--where to?].

    PubMed

    Luban-Plozza, B

    1993-06-08

    These questions are addressed: What does it mean to be a physician, and how can a physician continue his education? Where is his place in family crises? The psychosomatic point of view of diseases is not a specialty, but a concept, a basic attitude, a global principle encompassing all medical specialties. In particular, disorders of relations and basic needs are discussed in the context of a novel therapeutic access. The doctor as a 'drug' corresponds to a therapeutic alliance, also in group work. The problems of communication, even as a flash, influence the language of the patient and the physician. In the tension between anxiety and trust, psychosomatic thinking and medical intervention come to life also for the experience of disease and in the search for a meaning. The physician is not as much an achiever than a provider.

  2. “Maternal Health and Family Planning Distance Education” experience among physicians: a three-phase study to determine the educational needs, develop education program, and evaluate efficacy of the education administered

    PubMed Central

    Ciftci, Bestami; Uzel, Nesibe; Ozel, M Onur; Zergeroglu, Sema; Deger, Cetin; Turasan, S Sare; Karakoc, Ayse Gul; Ozbalci, Semra

    2016-01-01

    Aim This study aims to assess the educational needs of family practitioners and evaluate the efficacy of the ongoing “Maternal Health and Family Planning Distance Education” program conducted by the General Directorate of Health Research (SAGEM) of the Turkish Ministry of Health. Methods This study consisted of three phases. In the first phase, an online survey on maternal health and family planning educational needs was sent to 20,611 physicians via e-mail. Of the 20,611 physicians, 4,729 completed the survey. In the second phase, of the 1,061 physicians registered to the education program, 632 physicians with active participation were included. In the third phase, the preeducation expectations of 287 physicians and posteducation satisfaction of 54 physicians were analyzed with a questionnaire. Results The majority of the physicians were employed in a family health center (97.4%) and practicing for 16–20 years (23.2%) without any prior in-service training (60.9%). High-to-very high educational need was expressed by 56.4% of physicians for pregnancy, delivery, and puerperality. Topics that the physicians, including both those with ≥16 years in practice and without prior in-service training, expressed need for more detailed content were pregnancy, delivery, and puerperality (37.5%); emergency obstetric approach in the primary care setting (33.1%); and gynecological infectious diseases and treatment approach (32.4%). Following the education program, the participants’ expectations were fulfilled in terms of refreshing their knowledge, particularly in the field of Maternal Health and Family Planning (87.1% and 75.9%) and the percentage of participants who expressed that they had sufficient high level knowledge increased from 55% to 68.5%. Conclusion The education on Maternal Health and Family Planning refreshed the knowledge of participants and highly met the preeducation expectations. Determining the educational needs and expectations of the target

  3. Associations between Early Family Risk, Children's Behavioral Regulation, and Academic Achievement in Portugal

    ERIC Educational Resources Information Center

    Cadima, Joana; Gamelas, Ana M.; McClelland, Megan; Peixoto, Carla

    2015-01-01

    Research Findings: This study examined concurrent associations between family sociodemographic risk, self-regulation, and early literacy and mathematics in young children from Azores, Portugal (N = 186). Family sociodemographic risk was indexed by low maternal education, low family income, and low occupational status. Behavioral aspects of…

  4. The Effects of the Family-Involved SDLMI on Academic Engagement and Goal Attainment of Middle School Students with Disabilities Who Exhibit Problem Behavior

    ERIC Educational Resources Information Center

    Kim, Nam Hee; Park, Jiyeon

    2012-01-01

    The purpose of this study is to investigate the effects of the Family-Involved Self-Determination Learning Model of Instruction (SDLMI) on academic engagement and goal attainment of middle school students with disabilities who exhibit problem behavior. Intervention was provided to the experimental group (12 students with their families and special…

  5. Indirect Effects of the Family Check-up on School-Age Academic Achievement through Improvements in Parenting in Early Childhood

    ERIC Educational Resources Information Center

    Brennan, Lauretta M.; Shelleby, Elizabeth C.; Shaw, Daniel S.; Gardner, Frances; Dishion, Thomas J.; Wilson, Melvin

    2013-01-01

    This project examined the hypothesis that the impact of the Family Check-Up on parent use of positive behavior support would indirectly improve academic achievement scores at school age. The study included a sample of 731 high-risk families recruited from Women, Infant, and Children Supplemental Nutrition Program settings in 3 geographically…

  6. Teacher Outreach to Families across the Transition to School: An Examination of Teachers' Practices and Their Unique Contributions to Children's Early Academic Outcomes

    ERIC Educational Resources Information Center

    Hindman, Annemarie H.; Skibbe, Lori E.; Morrison, Frederick J.

    2013-01-01

    This descriptive study explored teachers' outreach to families in preschool, kindergarten, and first grade, and its relations to children's early growth in language, literacy, and mathematics. Teachers (n = 62) completed surveys reporting the frequency of outreach practices to families, and children's (n = 210) early academic skills…

  7. More Family Physicians or More Primary Care? An Analysis of the Family Practice Act (S. 3418). Health Manpower Policy Discussion Paper Series No. D.1.

    ERIC Educational Resources Information Center

    Wright, George E., Jr.

    The crisis in primary care has long been discussed and the dismal litany of statistics is now familiar. The G.P. is vanishing from the medical scene. Over one-third of the active general practitioners are now over 60. In 1970 the U.S. Congress responded to the declining availability of primary health care by passing the Family Practice Act. The…

  8. Female and Underrepresented Minority Faculty in Academic Departments of Family Medicine: Are Women and Minorities Better Off in Family Medicine?

    ERIC Educational Resources Information Center

    Lewis-Stevenson, Sherri; Hueston, William J.; Mainous, Arch G., III; Bazell, Carol; Ye, Xiaobu

    2001-01-01

    Surveyed departments of family medicine to determine workforce composition and rank of women and minority faculty. Found that while faculty were more likely to be female or minority than in other medical disciplines, women and minorities were less likely to be associate or full professors. Found no institutional or departmental characteristics…

  9. The Academic Adaptation of Children of Immigrants in New and Established Settlement States: The Role of Family, Schools, and Neighborhoods

    PubMed Central

    Potochnick, Stephanie

    2016-01-01

    The dispersion of immigrants has challenged educators in new immigrant destinations to adapt to the needs of their first cohorts of children of immigrants. This paper evaluates how families, schools, and neighborhoods shape the academic adaptation of immigrants’ children in new and established immigrant states. Using the Educational Longitudinal Study (ELS) from 2002, the paper examines how 10th grade math and reading test scores differ across three settlement locations: established, new, and other immigrant states. Results indicate that achievement in math and reading is highest in new immigrant states. While demographic differences between settlement locations largely explained differences in achievement, families and schools in new immigrant states also strongly influenced achievement. PMID:26900193

  10. Stay in the Game: Gender, Family Formation and Alternative Trajectories in the Academic Life Course

    ERIC Educational Resources Information Center

    Wolfinger, Nicholas H.; Mason, Mary Ann; Goulden, Marc

    2009-01-01

    Academic careers have traditionally been conceptualized as pipelines, through which young scholars move seamlessly from graduate school to tenure-track positions. This model often fails to capture the experiences of female Ph.D. recipients, who become tenure-track assistant professors at lower rates than do their male counterparts. What do these…

  11. Warning: Children in the Library! Welcoming Children and Families into the Academic Library

    ERIC Educational Resources Information Center

    Tvaruzka, Kathryn

    2009-01-01

    While library programming for children is a staple in most public libraries, it is quite rare in the academic setting. In 2006 the education librarian at the University of Wisconsin-Eau Claire began offering literacy programs in a library that traditionally discouraged children and community members from using its resources. Successful programs…

  12. Continuity or Change? Gender, Family, and Academic Work for Junior Faculty in Ontario Universities

    ERIC Educational Resources Information Center

    Acker, Sandra; Webber, Michelle; Smyth, Elizabeth

    2016-01-01

    Over the past 40 or so years, women's share of faculty positions in Canada and elsewhere has increased considerably, if not yet reaching parity. Yet working in the gendered university remains problematic. This article uses data from a qualitative research project in which 38 junior academics were interviewed about their responses to being on the…

  13. School Climate, Family Structure, and Academic Achievement: A Study of Moderation Effects

    ERIC Educational Resources Information Center

    O'Malley, Meagan; Voight, Adam; Renshaw, Tyler L.; Eklund, Katie

    2015-01-01

    School climate has been lauded for its relationship to a host of desirable academic, behavioral, and social-emotional outcomes for youth. The present study tested the hypothesis that school climate counteracts youths' home-school risk by examining the moderating effects of students' school climate perceptions on the relationship between family…

  14. Single-Parent Families: The Role of Parent's and Child's Gender on Academic Achievement

    ERIC Educational Resources Information Center

    Lee, Sang Min; Kushner, Jason

    2008-01-01

    Using national survey data, the present study investigated whether adolescents living with parents of their same gender fare better on academic achievement than their peers living with opposite-gender parents. Multiple analyses of covariance (MANCOVA) procedures were employed to examine the effects of the children's gender in single-father and…

  15. Personal and family perfectionism of Taiwanese college students: relationships with depression, self-esteem, achievement motivation, and academic grades.

    PubMed

    Wang, Kenneth T

    2012-01-01

    An increasing number of perfectionism studies have been conducted across different countries outside of the Western framework. Using an international egalitarian approach that adopts indigenous frameworks and concepts from the cultural context of the population studied is imperative. This study examines different groups of perfectionists with a sample of 348 Taiwanese college students, emphasizing the collectivistic culture. In particular, this is a follow-up study to further explore characteristics of a group with low standards/high discrepancy--a feeling that they are not good enough despite having low standards--found in a previous study with Taiwanese students. More specifically, this study investigates whether the source of the high discrepancy scores among this group is related to having higher perfectionistic standards from their family. Perfectionism was examined not only from a personal/individualistic perspective, but also from a familistic dimension to reflect Taiwanese collectivistic cultural values. Results partially supported the hypotheses--this group reported having higher family discrepancy, but not family standards, than nonperfectionists. However, this group of participants reported lower academic grades, which implies the possibility of their discrepancy being associated with poorer performance. Four cluster groups--adaptive perfectionists, maladaptive perfectionists, nonperfectionists, and those with low standards/high discrepancy--were compared on their levels of depression, self-esteem, achievement motivation, and academic grades. Maladaptive perfectionists reported the highest depression level, while adaptive perfectionists reported the highest self-esteem. Results also show that aspects of personal perfectionism and family perfectionism related to self-esteem differently among this sample. Findings and implications are discussed with consideration of the collectivistic cultural context in Taiwan.

  16. Medical students' vs. family physicians' assessment of practical and logical values of pathophysiology multiple-choice questions.

    PubMed

    Secic, Damir; Husremovic, Dzenana; Kapur, Eldan; Jatic, Zaim; Hadziahmetovic, Nina; Vojnikovic, Benjamin; Fajkic, Almir; Meholjic, Amir; Bradic, Lejla; Hadzic, Amila

    2017-03-01

    Testing strategies can either have a very positive or negative effect on the learning process. The aim of this study was to examine the degree of consistency in evaluating the practicality and logic of questions from a medical school pathophysiology test, between students and family medicine doctors. The study engaged 77 family medicine doctors and 51 students. Ten questions were taken from cardiac pathophysiology and 10 questions from pulmonary pathophysiology, and each question was assessed on the criteria of practicality and logic. A nonparametric Mann-Whitney test was used to test the difference between evaluators. On the criteria of logic, only four out of 20 items were evaluated differently by students in comparison to doctors, two items each from the fields of cardiology and pulmonology. On the criteria of practicality, for six of the 20 items there were statistically significant differences between the students and doctors, with three items each from cardiology and pulmonology. Based on these indicative results, students should be involved in the qualitative assessment of exam questions, which should be performed regularly under a strictly regulated process.

  17. Family Socioeconomic Status, Parental Expectations, and Adolescents' Academic Achievements: A Case of China

    ERIC Educational Resources Information Center

    Long, Haiying; Pang, Weiguo

    2016-01-01

    This study examines direct and indirect effects of family socioeconomic status (SES) and parental expectations on adolescents' mathematics and problem-solving achievement in mainland China. SES here is composed of family wealth, home educational resources, and parental education. Over 5,000 ninth-grade students in 5 geographical districts of China…

  18. Academic Promises and Family (Dis)Enchantments: Clues for Guidance and Counselling in Higher Education

    ERIC Educational Resources Information Center

    Dias, Diana; Sá, Maria José

    2016-01-01

    Family has an undeniable influence upon the career construction of higher education (HE) students, since it is a primary source of their socialisation. This article presents a qualitative analysis of 30 interviews conducted with first-year students, aimed at understanding the relationship between family sociocultural status and career choice and…

  19. Demography and Early Academic Skills of Students from Immigrant Families: The Kindergarten Class of 2011

    ERIC Educational Resources Information Center

    Sullivan, Amanda L.; Houri, Alaa; Sadeh, Shanna

    2016-01-01

    Children from immigrant families are one of the fastest growing and most diverse groups in America's schools. This study provides a demographic portrait of immigrant children who entered kindergarten in 2010 and describes patterns and predictors of early educational outcomes of students from immigrant families. A nationally representative sample…

  20. Optimal older adult emergency care: introducing multidisciplinary geriatric emergency department guidelines from the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine.

    PubMed

    Carpenter, Christopher R; Bromley, Marilyn; Caterino, Jeffrey M; Chun, Audrey; Gerson, Lowell W; Greenspan, Jason; Hwang, Ula; John, David P; Lyons, William L; Platts-Mills, Timothy F; Mortensen, Betty; Ragsdale, Luna; Rosenberg, Mark; Wilber, Scott

    2014-07-01

    In the United States and around the world, effective, efficient, and reliable strategies to provide emergency care to aging adults is challenging crowded emergency departments (EDs) and strained healthcare systems. In response, geriatric emergency medicine clinicians, educators, and researchers collaborated with the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine to develop guidelines intended to improve ED geriatric care by enhancing expertise, educational, and quality improvement expectations, equipment, policies, and protocols. These Geriatric Emergency Department Guidelines represent the first formal society-led attempt to characterize the essential attributes of the geriatric ED and received formal approval from the boards of directors of each of the four societies in 2013 and 2014. This article is intended to introduce emergency medicine and geriatric healthcare providers to the guidelines while providing recommendations for continued refinement of these proposals through educational dissemination, formal effectiveness evaluations, cost-effectiveness studies, and eventually institutional credentialing.

  1. Optimal older adult emergency care: introducing multidisciplinary geriatric emergency department guidelines from the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine.

    PubMed

    Carpenter, Christopher R; Bromley, Marilyn; Caterino, Jeffrey M; Chun, Audrey; Gerson, Lowell W; Greenspan, Jason; Hwang, Ula; John, David P; Lyons, William L; Platts-Mills, Timothy F; Mortensen, Betty; Ragsdale, Luna; Rosenberg, Mark; Wilber, Scott

    2014-07-01

    In the United States and around the world, effective, efficient, and reliable strategies to provide emergency care to aging adults is challenging crowded emergency departments (EDs) and a strained health care system. In response, geriatric emergency medicine (EM) clinicians, educators, and researchers collaborated with the American College of Emergency Physicians (ACEP), American Geriatrics Society (AGS), Emergency Nurses Association (ENA), and the Society for Academic Emergency Medicine (SAEM) to develop guidelines intended to improve ED geriatric care by enhancing expertise, educational, and quality improvement expectations; equipment; policies; and protocols. These "Geriatric Emergency Department Guidelines" represent the first formal society-led attempt to characterize the essential attribute of the geriatric ED and received formal approval from the boards of directors for each of the four societies in 2013 and 2014. This article is intended to introduce EM and geriatric health care providers to the guidelines, while providing proposals for educational dissemination, refinement via formal effectiveness evaluations and cost-effectiveness studies, and institutional credentialing.

  2. Five Weekend National Family Medicine Fellowship

    PubMed Central

    Talbot, Yves; Batty, Helen; Rosser, Walter W.

    1997-01-01

    PROBLEM ADDRESSED Many faculty development programs are thought time-consuming and inaccessible to academic family physicians or physicians wanting to move into academic positions. This is largely due to difficulty in leaving their practices for extended periods. Canadian family medicine needs trained leaders who can work in teams and are well grounded in the principles of their discipline as they relate to education, management, research, and policy making. OBJECTIVE OF PROGRAM To develop a team of leaders in family medicine. MAIN COMPONENTS OF PROGRAM The Five Weekend National Family Medicine Fellowship Program focuses on the essentials of education, management, communication, critical appraisal skills, and the principles of family medicine to develop leadership and team-building skills for faculty and community-based family physicians entering academic careers. This unique 1-year program combines intensive weekend seminars with small-group projects between weekends. It emphasizes a broader set of skills than just teaching, has regional representation, and focuses on leadership and teamwork using a time-efficient format. CONCLUSION The program has graduated 34 Fellows over the last 3 years. More than 90% of the 35 projects developed through course work have been presented in national or provincial peer-reviewed settings. Quantitative ratings of program structure, course content, and course outcomes have been positive. PMID:9426934

  3. Ethical issues in the response to Ebola virus disease in United States emergency departments: a position paper of the American College of Emergency Physicians, the Emergency Nurses Association, and the Society for Academic Emergency Medicine.

    PubMed

    Venkat, Arvind; Asher, Shellie L; Wolf, Lisa; Geiderman, Joel M; Marco, Catherine A; McGreevy, Jolion; Derse, Arthur R; Otten, Edward J; Jesus, John E; Kreitzer, Natalie P; Escalante, Monica; Levine, Adam C

    2015-05-01

    The 2014 outbreak of Ebola virus disease (EVD) in West Africa has presented a significant public health crisis to the international health community and challenged U.S. emergency departments (EDs) to prepare for patients with a disease of exceeding rarity in developed nations. With the presentation of patients with Ebola to U.S. acute care facilities, ethical questions have been raised in both the press and medical literature as to how U.S. EDs, emergency physicians (EPs), emergency nurses, and other stakeholders in the health care system should approach the current epidemic and its potential for spread in the domestic environment. To address these concerns, the American College of Emergency Physicians, the Emergency Nurses Association, and the Society for Academic Emergency Medicine developed this joint position paper to provide guidance to U.S. EPs, emergency nurses, and other stakeholders in the health care system on how to approach the ethical dilemmas posed by the outbreak of EVD. This paper will address areas of immediate and potential ethical concern to U.S. EDs in how they approach preparation for and management of potential patients with EVD.

  4. Academic success across the transition from primary to secondary schooling among lower-income adolescents: understanding the effects of family resources and gender.

    PubMed

    Serbin, Lisa A; Stack, Dale M; Kingdon, Danielle

    2013-09-01

    Successful academic performance during adolescence is a key predictor of lifetime achievement, including occupational and social success. The present study investigated the important transition from primary to secondary schooling during early adolescence, when academic performance among youth often declines. The goal of the study was to understand how risk factors, specifically lower family resources and male gender, threaten academic success following this "critical transition" in schooling. The study involved a longitudinal examination of the predictors of academic performance in grades 7-8 among 127 (56 % girls) French-speaking Quebec (Canada) adolescents from lower-income backgrounds. As hypothesized based on transition theory, hierarchical regression analyses showed that supportive parenting and specific academic, social and behavioral competencies (including spelling ability, social skills, and lower levels of attention problems) predicted success across this transition among at-risk youth. Multiple-mediation procedures demonstrated that the set of compensatory factors fully mediated the negative impact of lower family resources on academic success in grades 7-8. Unique mediators (social skills, spelling ability, supportive parenting) also were identified. In addition, the "gender gap" in performance across the transition could be attributed statistically to differences between boys and girls in specific competencies observed prior to the transition, as well as differential parenting (i.e., support from mother) towards girls and boys. The present results contribute to our understanding of the processes by which established risk factors, such as low family income and gender impact development and academic performance during early adolescence. These "transitional" processes and subsequent academic performance may have consequences across adolescence and beyond, with an impact on lifetime patterns of achievement and occupational success.

  5. Revealing a Child's Pathology: Physicians' Experiences

    ERIC Educational Resources Information Center

    Scelles, Regine; Aubert-Godard, Anne; Gargiulo, Marcela; Avant, Monique; Gortais, Jean

    2010-01-01

    In this study, 12 physicians and 12 care-givers were interviewed using semi-structured interviews. We explored physicians' experiences when they revealed a diagnosis. We also tried to understand which family members the physician was thinking of, with whom they identified themselves, and their first choice of the person to whom they prefer to…

  6. Physician, heal thyself

    PubMed Central

    Blais, Régis; Safianyk, Catherine; Magnan, Anne; Lapierre, André

    2010-01-01

    ABSTRACT OBJECTIVE To document the opinions of the users of the Quebec Physicians Health Program (QPHP) about the services they received. DESIGN Mailed questionnaire. SETTING Quebec. PARTICIPANTS A total of 126 physicians who used QPHP services between 1999 and 2004. MAIN OUTCOME MEASURES Users’ overall rating of the QPHP services, their opinions about the program, and whether their situations improved as a result of accessing QPHP services. RESULTS Ninety-two of the 126 physicians surveyed returned their completed questionnaires, providing a response rate of 73%. Most respondents thought that the QPHP services were good or excellent (90%), most would use the program again (86%) or recommend it (96%), and most thought the Quebec physician associations and the Collège des médecins du Québec should continue funding the QPHP (97%). Most respondents thought the service confidentiality was excellent (84%), as was staff professionalism (82%), and 62% thought the quality of the services they were referred to was excellent. However, only 57% believed their situations had improved with the help of the QPHP. CONCLUSION The QPHP received good marks from its users. Given the effects of physician burnout on patients and on the health care system, it is not only a personal problem, but also a collective problem. Thus, actions are needed not only to set up programs like the QPHP for those suffering from burnout, but also to prevent these types of problems. Because family physicians are likely to be the first ones consulted by their physician patients in distress, they play a key role in acknowledging these problems and referring those colleagues to the appropriate help programs when needed. PMID:20944027

  7. Gender, Family Negotiations and Academic Success of Young Moroccan Women in Spain

    ERIC Educational Resources Information Center

    Tarrés, Marta Bertran; Ponferrada-Arteaga, Maribel; Rovira, Jordi Pàmies

    2016-01-01

    This article examines the lives of pioneering young women from Morocco, the first to enjoy educational and social success in Catalonia, by analyzing the family negotiations entered into during this process. The study is based on the life stories of these young Moroccan women and on ideas that emerge from discussion groups involving the women…

  8. Predictors of Suicide Ideation and Depression in Hong Kong Adolescents: Perceptions of Academic and Family Climates

    ERIC Educational Resources Information Center

    Lee, Margaret T. Y.; Wong, Betty P.; Chow, Bonnie W.-Y.; McBride-Chang, Catherine

    2006-01-01

    The unique dimensions of perceptions of school and family contributing to depression and suicide ideation in Hong Kong adolescents were examined in two studies. In Study 1, among 327 Hong Kong Chinese female students ages 13-18, 47% reported some suicide ideation. Suicide ideation was significantly associated with depression, test anxiety,…

  9. Ahiska Refugee Families' Configuration of Resettlement and Academic Success in U.S. Schools

    ERIC Educational Resources Information Center

    Bal, Aydin; Arzubiaga, Angela E.

    2014-01-01

    In this article, we report on an ethnographic study of figured worlds of resettlement and identities that Muslim refugee youth from the Russian Federation coconstructed in an urban school at the Southwestern U.S. border. In the school, multiple cultural-historical discourses came together within a global context: refugee families, a global Islamic…

  10. Helping Academics Have Families and Tenure Too: Universities Discover Their Self-Interest

    ERIC Educational Resources Information Center

    Marcus, Jon

    2007-01-01

    "Did you have a kid and, if so, how?" is one of the hottest questions everywhere in higher education. Even as women overtake men among Americans receiving doctorates, a substantial body of new research shows that they are being discouraged from careers in academia because the timing and requirements of tenure make it so hard to raise families. In…

  11. A Classification of Developmental Activities of Academic Family Medicine Supported by Federal Grants.

    ERIC Educational Resources Information Center

    Davis, Junius A.; And Others

    1991-01-01

    Analysis of 61 successful grant applications for the federal Establishment of Departments of Family Medicine grants program identified three dimensions for classifying supported developmental activities: (1) the functional area of the activity; (2) the objectives of the activity; and (3) the strategies to be used to attain the objectives.…

  12. School-Family Relationships, School Satisfaction and the Academic Achievement of Young People

    ERIC Educational Resources Information Center

    Hampden-Thompson, Gillian; Galindo, Claudia

    2017-01-01

    Families' perceptions of, and interactions with, schools and teachers can play an essential role in young people's educational outcomes. According to Bronfenbrenner's ecological systems theory, young people grow within multiple nested systems of influence interacting with each other. Thus, their development is affected by persons, processes, and…

  13. Predicting Kindergarten Academic Skills: Interactions among Child Care, Maternal Education, and Family Literacy Environments.

    ERIC Educational Resources Information Center

    Christian, Kate; Morrison, Frederick J.; Bryant, Fred B.

    1998-01-01

    Examined sources of children's reading, vocabulary, general information, mathematics, and letter-recognition skills upon entrance to kindergarten. Predictors included ethnicity, gender, child IQ, family environment, maternal education, and months in child care. Found the need for strong parental involvement in children's development and subsidized…

  14. Collaborative Care for Older Adults with low back pain by family medicine physicians and doctors of chiropractic (COCOA): study protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Low back pain is a prevalent and debilitating condition that affects the health and quality of life of older adults. Older people often consult primary care physicians about back pain, with many also receiving concurrent care from complementary and alternative medicine providers, most commonly doctors of chiropractic. However, a collaborative model of treatment coordination between these two provider groups has yet to be tested. The primary aim of the Collaborative Care for Older Adults Clinical Trial is to develop and evaluate the clinical effectiveness and feasibility of a patient-centered, collaborative care model with family medicine physicians and doctors of chiropractic for the treatment of low back pain in older adults. Methods/design This pragmatic, pilot randomized controlled trial will enroll 120 participants, age 65 years or older with subacute or chronic low back pain lasting at least one month, from a community-based sample in the Quad-Cities, Iowa/Illinois, USA. Eligible participants are allocated in a 1:1:1 ratio to receive 12 weeks of medical care, concurrent medical and chiropractic care, or collaborative medical and chiropractic care. Primary outcomes are self-rated back pain and disability. Secondary outcomes include general and functional health status, symptom bothersomeness, expectations for treatment effectiveness and improvement, fear avoidance behaviors, depression, anxiety, satisfaction, medication use and health care utilization. Treatment safety and adverse events also are monitored. Participant-rated outcome measures are collected via self-reported questionnaires and computer-assisted telephone interviews at baseline, and at 4, 8, 12, 24, 36 and 52 weeks post-randomization. Provider-rated expectations for treatment effectiveness and participant improvement also are evaluated. Process outcomes are assessed through qualitative interviews with study participants and research clinicians, chart audits of progress notes and content

  15. Financial implications of serving as team physician.

    PubMed

    Lemak, Larry

    2007-04-01

    Time is the greatest negative financial burden that you accept as a sports medicine physician, because the only way to produce revenue as a physician is with your time. This cost measured in time of doing business as a team physician can be high. Unless being a team physician is very rewarding to you through personal satisfaction or the other intangible indirect benefits associated with the role, being a team physician may not be a good financial decision for you as a person and a physician, or for your practice and your family.

  16. The development and construct validation of a Spanish version of an Academic Self-Concept scale for middle school Hispanic students from families of low socioeconomic levels.

    PubMed

    Menjares, P C; Michael, W B; Rueda, R

    2000-05-01

    For a sample of 305 6th, 7th and 8th grade students, of whom 95% was from economically disadvantaged Hispanic families and for whom English was their second language, evidence was sought regarding the reliability and construct validity of scores on a Spanish version of an academic self-concept measure entitled Dimensions of Self-Concept (DOSC), comprising five subscales bearing the same names as those of the five hypothesized constructs that they were intended to operationalize: Level of Aspiration, Anxiety, Academic Interest and Satisfaction, Leadership and Initiative, and Identification versus Alienation. Reliability estimates varying between .72 and .80 were judged to be reasonably satisfactory. Results from oblique factor analysis lent empirical support for the hypothesized constructs of Anxiety, Leadership and Initiative, and Identification versus Alienation. Scores associated with the subscales of Level of Aspiration and Academic Interest and Satisfaction generated a factor interpreted as a fusion of the two constructs of Level of Aspiration and Academic Interest and Satisfaction.

  17. The Role of Institutional, Family and Peer-Based Discourses and Practices in the Construction of Students' Socio-Academic Trajectories

    ERIC Educational Resources Information Center

    Poveda, David; Jociles, Maria Isabel; Franze, Adela; Moscoso, Maria Fernanda; Calvo, Albano

    2012-01-01

    In this article, we discuss findings from multi-level ethnography conducted in a secondary school located in Madrid (Spain). The study focuses on the variety of institutional, family and peer-based factors that contribute to the construction of students' socio-academic trajectories. In particular, we attempt to understand the role these social…

  18. The Role of Academic-Language Features for Reading Comprehension of Language-Minority Students and Students from Low-SES Families

    ERIC Educational Resources Information Center

    Heppt, Birgit; Haag, Nicole; Böhme, Katrin; Stanat, Petra

    2015-01-01

    Academic language is frequently assumed to be especially challenging for students from families of low socioeconomic status (SES) and even more so for language-minority students. Due to their often especially disadvantaged position regarding socioeconomic background and exposure to the language of instruction, language minority students are…

  19. [Burnout syndrome among family physicians].

    PubMed

    Sánchez-Cruz, Juan; Mugártegui-Sánchez, Sharon

    2013-01-01

    Introducción: el síndrome de agotamiento profesional es un estado de agotamiento físico y emocional que puede presentarse en trabajadores que interactúan con otras personas. El objetivo de esta investigación fue conocer la prevalencia de este síndrome y los factores relacionados en médicos familiares de Mérida, Yucatán, México. Métodos: se realizó una encuesta transversal en la que se aplicó el Maslach Burnout Inventory a médicos familiares seleccionados mediante muestreo no probabilístico por conveniencia. Se analizaron las medidas de tendencia central y dispersión y se determinó la prevalencia del síndrome de agotamiento profesional. La significación estadística de los factores asociados se determinó mediante χ(2). Resultados: se obtuvieron 59 casos de síndrome de agotamiento profesional: 36 con afectación en un componente del Maslach Burnout Inventory, 15 en dos y ocho en los tres. El 35 % de los casos indicó trabajar en promedio 10 turnos extra al mes (p = 0.013); tener un segundo trabajo también se relacionó con el síndrome. Conclusiones: los resultados son consistentes con los obtenidos en estudios similares. Trabajar turnos extra o tener otro trabajo fueron los factores relacionados con el síndrome de agotamiento profesional.

  20. There are considerable drawbacks to oral anticoagulant for monitoring patients at home which should lead family physicians to discuss alternative or enhanced solutions: a cross-sectional study

    PubMed Central

    2013-01-01

    Background INR (International Normalized Ratio) is the biological reference test for the monitoring of vitamin K antagonist (VKA) therapy. Overdosage of VKAs causes about 17,000 hospitalizations and 5,000 deaths each year in France. To avoid these complications, monitoring and blood sampling conditions must be rigorous. In France, more than half of INRs are carried out at home. The aim was to determine blood-sampling conditions at home, transit time and the quality of the laboratory reagents used. Method Questionnaire-based, descriptive epidemiological cross-sectional prevalence study involving home care nurses, family physicians (FPs) and clinical laboratories. Setting: Brittany, France, 2008. Study of the pre-analytical phase of INRs sampled at home and its influence on INR results. Results The study included 291 FPs, 249 home care nurses, and 49 laboratories. 32.5% of reported INRs were outside the therapeutic range. Samples were drawn into unsuitable tubes in 5.5% of cases and delivered in a chilled condition in 9% of cases. In urban areas 50% of the tubes took more than 2 hours to reach the laboratory compared with 71% from rural areas. The average International Sensitivity Index (ISI) of the thromboplastin was 1.62. The INRs provided by the laboratories were not analyzable in 64.7% of cases where blood samples had been taken at home. Conclusion Blood sample quality, transit time and the reagents used are currently inadequate. The majority of INRs taken at home are not reliable. FPs should consider these drawbacks in comparison with alternative solutions to increase patient safety. PMID:24024556

  1. Family Practice—What's The Difference?

    PubMed Central

    Brown, D. C.

    1979-01-01

    Twelve significant differences of family practice are presented with supporting information from the literature. Seven differences between family physicians and other primary care physicians are presented. PMID:20469306

  2. Early Academic Achievement Among American Low-Income Black Students from Immigrant and Non-Immigrant Families.

    PubMed

    Calzada, Esther; Barajas-Gonzalez, R Gabriela; Dawson-McClure, Spring; Huang, Keng-Yen; Palamar, Joseph; Kamboukos, Dimitra; Brotman, Laurie Miller

    2015-11-01

    At least half of the well-documented achievement gap for low-income Black children is already present in kindergarten, due in part to limited opportunities for acquiring foundational skills necessary for school success. There is some evidence that low-income minority children from immigrant families have more positive outcomes than their non-immigrant counterparts, although little is known about how the immigrant paradox may manifest in young children. This study examines foundational school readiness skills (academic and social-emotional learning) at entry into pre-kindergarten (pre-k) and achievement in kindergarten and second grade among Black children from low-income immigrant and non-immigrant families (N = 299). Immigrant and non-immigrant children entered pre-k with comparable readiness scores; in both groups, reading scores decreased significantly from kindergarten to second grade and math scores decreased significantly for non-immigrant children and marginally for immigrant children. Regardless of immigrant status, pre-k school readiness and pre-k classroom quality were associated with elementary school achievement. However, declines in achievement scores were not as steep for immigrant children and several predictive associations were moderated by immigrant status, such that among those with lower pre-k school readiness or in lower quality classrooms, immigrant children had higher achievement test scores than children from non-immigrant families. Findings suggest that immigrant status provides young Black students with some protection against individual- and classroom-level risk factors for early underachievement in elementary school.

  3. An open cluster-randomized, 18-month trial to compare the effectiveness of educational outreach visits with usual guideline dissemination to improve family physician prescribing

    PubMed Central

    2014-01-01

    Background The Portuguese National Health Directorate has issued clinical practice guidelines on prescription of anti-inflammatory drugs, acid suppressive therapy, and antiplatelets. However, their effectiveness in changing actual practice is unknown. Methods The study will compare the effectiveness of educational outreach visits regarding the improvement of compliance with clinical guidelines in primary care against usual dissemination strategies. A cost-benefit analysis will also be conducted. We will carry out a parallel, open, superiority, randomized trial directed to primary care physicians. Physicians will be recruited and allocated at a cluster-level (primary care unit) by minimization. Data will be analyzed at the physician level. Primary care units will be eligible if they use electronic prescribing and have at least four physicians willing to participate. Physicians in intervention units will be offered individual educational outreach visits (one for each guideline) at their workplace during a six-month period. Physicians in the control group will be offered a single unrelated group training session. Primary outcomes will be the proportion of cyclooxygenase-2 inhibitors prescribed in the anti-inflammatory class, and the proportion of omeprazole in the proton pump inhibitors class at 18 months post-intervention. Prescription data will be collected from the regional pharmacy claims database. We estimated a sample size of 110 physicians in each group, corresponding to 19 clusters with a mean size of 6 physicians. Outcome collection and data analysis will be blinded to allocation, but due to the nature of the intervention, physicians and detailers cannot be blinded. Discussion This trial will attempt to address unresolved issues in the literature, namely, long term persistence of effect, the importance of sequential visits in an outreach program, and cost issues. If successful, this trial may be the cornerstone for deploying large scale educational outreach

  4. A qualitative study of work-life choices in academic internal medicine.

    PubMed

    Isaac, Carol; Byars-Winston, Angela; McSorley, Rebecca; Schultz, Alexandra; Kaatz, Anna; Carnes, Mary L

    2014-03-01

    The high attrition rate of female physicians pursuing an academic medicine research career has not been examined in the context of career development theory. We explored how internal medicine residents and faculty experience their work within the context of their broader life domain in order to identify strategies for facilitating career advancement. Semi-structured interviews were conducted with a purposeful sample of 18 residents and 34 faculty members representing male and female physicians at different career stages. Using thematic analysis, three themes emerged: (1) the love of being a physician ("Raison d'être"), (2) family obligations ("2nd Shift"), and (3) balancing work demands with non-work life ("Negotiating Academic Medicine"). Female researchers and educators reported more strategies for multiple role planning and management than female practitioners. Interventions aimed at enhancing academic internists' planning and self-efficacy for multiple role management should be investigated as a potential means for increasing participation and facilitate advancement.

  5. [Exploration on academic thoughts of four medical families of acupuncture-moxibustion of the LING, YAN, SHI and SHENG in northern Zhejiang Province].

    PubMed

    Chen, Feng

    2013-12-01

    The academic origin and characteristics of medical families of acupuncture-moxibustion in northern Zhejiang Province were explored in this paper. With acupuncture-moxibustion characteristic of medical families in northern Zhejiang Province such as the LING (see text), the YAN (see text), the SHI (see text) and the SHENG (see text) analyzed and arranged, it was found out that taking the Internal Canon of Medicine as theory basis, their academic thoughts comprehensively absorbed acupuncture-moxibustion theories in all ages, and they continuously made innovations through constant practices, resulting in academic thoughts that focusing on application of acupuncture-moxibustion in clinic, using moxibustion for deficient illness and adopting acupuncture-moxibustion and Chinese herbs for severe and acute patients. The academic thoughts of medical families of acupuncture and moxibustion in northern Zhejiang Province are featured by unique acupoint selection and ma nipulation, thorough moxibustion methods and combined application of Chinese herbs and acupuncture-moxibustion, which is a clinical system of diagnosis and treatment with typical Jiangnan features.

  6. A computerized faculty time-management system in an academic family medicine department.

    PubMed

    Daugird, Allen J; Arndt, Jane E; Olson, P Richard

    2003-02-01

    The authors describe the development, implementation, and evaluation of a computerized faculty time-management system (FTMS) in the Department of Family Medicine at the University of North Carolina-Chapel Hill. The FTMS is presented as an integrated set of computerized spreadsheets used annually to allocate faculty time across all mission activities of the department. It was first implemented in 1996 and has been continuously developed since then. An iterative approach has been used to gain consensus among faculty about time resources needed for various tasks of all missions of the department. These time-resource assumptions are used in the computerized system. Faculty time is allocated annually by the department vice chair in negotiation with individual faculty, making sure that the activities planned do not exceed the work time each faculty member has available for the year. During this process, faculty preferences are balanced against department aggregate needs to meet mission commitments and obligations. The authors describe how the computerized FTMS is used for faculty time management and career development, department planning, budget planning, clinical scheduling, and mission cost accounting. They also describe barriers and potential abuses and the challenge of building an organizational culture willing to discuss faculty time openly and committed to developing a system perceived as fair and accurate. The spreadsheet file is available free from the authors for use in other departments.

  7. Family economic stress and academic well-being among Chinese-American youth: the influence of adolescents' perceptions of economic strain.

    PubMed

    Mistry, Rashmita S; Benner, Aprile D; Tan, Connie S; Kim, Su Yeong

    2009-06-01

    This study examined the pathways by which family economic stress influenced youth's educational outcomes in a sample of 444 Chinese American adolescents (M ages = 13.0, 17.1 years at waves 1 and 2, respectively). Using latent variable structural equation modeling, results across two waves of data, spanning early to late adolescence, demonstrated that the influence of parent report of economic stress on youth academic achievement (i.e., GPA), school engagement, and positive attitudes about education was mediated through youth's perceptions of family economic strain and self-reports of depressive symptoms. These relationships were observed to remain significant after accounting for selection bias using individual fixed-effects models. Finally, youth's perceptions of family economic strain were found to more strongly predict depressive symptoms during later, as compared to earlier, adolescence; all other modeled relationships were equivalent across the two time periods. Implications for expanding theoretical tenets of the Family Economic Stress Model are discussed.

  8. Academic Support by Significant Others and Educational Resilience in Mexican-Origin Ninth Grade Students from Intact Families

    ERIC Educational Resources Information Center

    Plunkett, Scott W.; Henry, Carolyn S.; Houltberg, Benjamin J.; Sands, Tovah; Abarca-Mortensen, Sandra

    2008-01-01

    This study used dominance analysis to examine the relative importance of ninth grade, Mexican-origin adolescents' perceptions of academic support from significant others (i.e., mothers, fathers, teachers, and friends) in relation to aspects of academic success. Self-report and school record data were collected from 216 Mexican-origin adolescents…

  9. The Mindful Physician and Pooh

    ERIC Educational Resources Information Center

    Winter, Robin O.

    2013-01-01

    Resident physicians are particularly susceptible to burnout due to the stresses of residency training. They also experience the added pressures of multitasking because of the increased use of computers and mobile devices while delivering patient care. Our Family Medicine residency program addresses these problems by teaching residents about the…

  10. A Study of the Educationally Influential Physician.

    ERIC Educational Resources Information Center

    Kaufman, David M.; Ryan, Kurt; Hodder, Ian

    1999-01-01

    A survey of 172 family doctors found that they approached educationally influential (EI) physicians they knew through their hospitals; only 20% used e-mail and 40% the Internet for medical information; EI physicians helped extend their knowledge and validate innovations found in the literature; and health care reform was negatively affecting…

  11. [Collaboration between occupational physicians and other specialists including insurance physicians].

    PubMed

    Rijkenberg, A M; van Sprundel, M; Stassijns, G

    2013-09-01

    Collaboration between various stakeholders is essential for a well-operating vocational rehabilitation process. Researchers have mentioned, among other players, insurance physicians, the curative sector and employers. In 2011 the WHO organised the congress "Connecting Health and Labour: What role for occupational health in primary care". The congress was also attended by representatives of the WONCA (World Organisations of Family Medicine). In general, everyone agreed that occupational health aspects should continue to be seen as an integral part of primary health care. However, it is not easy to find literature on this subject. For this reason we conducted a review. We searched for literature relating to collaboration with occupational physicians in Dutch, English and German between 2001 and autumn 2011. Our attention focused on cooperation with specialists and insurance physicians. Therefore, we searched PUBMED using MeSH terms and made use of the database from the "Tijdschrift voor bedrijfs- en verzekeringsgeneeskunde (TBV) [Dutch Journal for Occupational - and Insurance Medicine]". We also checked the database from the "Deutsches Arzteblatt [German Medical Journal]" and made use of the online catalogue from THIEME - eJOURNALS. Last but not least, I used the online catalogue from the German paper "Arbeits -, Sozial -, Umweltmedizin [Occupational -, Social -, Milieu Medicine]". Additionally, we made use of the "snowball - method" to find relevant literature. We found many references to this subject. The Netherlands in particular has done a lot of research in this field. However, there is little research on the cooperation between occupational physicians and specialists; in particular insurance physicians. This is interesting, because several authors have mentioned its importance. However, cooperation with other specialists seems not to be the norm. Therefore, cooperation between curative physicians (specialists but also family doctors), insurance physicians and

  12. Sex role ideology among physicians.

    PubMed Central

    Leichner, P.; Harper, D.

    1982-01-01

    Physicians have been accused by some feminist writers of having traditional views on sex roles that make them part of society's oppressive power structure and therefore responsible in part for the high incidence of psychologic problems and drug dependency among women. To assess whether physicians' attitudes towards women are indeed polarized in a traditional fashion, a sex role ideology questionnaire was given to all practising physicians belonging to the Manitoba Medical Association. Overall the physicians were found to be more feminist than male college students and a group of women with traditional beliefs. Psychiatrists, who had the highest adjusted group mean score on a sex role ideology scale (high indicating feminist beliefs), were found to be significantly more feminist than family practitioners, surgeons, and obstetricians and gynecologists, although not more so than internists, radiologists, pediatricians and anesthesiologists. These findings do not support the assumption that physicians have traditional views that reflect those of society. However, the significant differences between specialties emphasize the need for educating physicians and medical students in the behaviour of women. PMID:7104916

  13. Pharmaceutical marketing research and the prescribing physician.

    PubMed

    Greene, Jeremy A

    2007-05-15

    Surveillance of physicians' prescribing patterns and the accumulation and sale of these data for pharmaceutical marketing are currently the subjects of legislation in several states and action by state and national medical associations. Contrary to common perception, the growth of the health care information organization industry has not been limited to the past decade but has been building slowly over the past 50 years, beginning in the 1940s when growth in the prescription drug market fueled industry interest in understanding and influencing prescribing patterns. The development of this surveillance system was not simply imposed on the medical profession by the pharmaceutical industry but was developed through the interactions of pharmaceutical salesmen, pharmaceutical marketers, academic researchers, individual physicians, and physician organizations. Examination of the role of physicians and physician organizations in the development of prescriber profiling is directly relevant to the contemporary policy debate surrounding this issue.

  14. Academic detailing.

    PubMed

    Shankar, P R; Jha, N; Piryani, R M; Bajracharya, O; Shrestha, R; Thapa, H S

    2010-01-01

    There are a number of sources available to prescribers to stay up to date about medicines. Prescribers in rural areas in developing countries however, may not able to access some of them. Interventions to improve prescribing can be educational, managerial, and regulatory or use a mix of strategies. Detailing by the pharmaceutical industry is widespread. Academic detailing (AD) has been classically seen as a form of continuing medical education in which a trained health professional such as a physician or pharmacist visits physicians in their offices to provide evidence-based information. Face-to-face sessions, preferably on an individual basis, clear educational and behavioural objectives, establishing credibility with respect to objectivity, stimulating physician interaction, use of concise graphic educational materials, highlighting key messages, and when possible, providing positive reinforcement of improved practices in follow-up visits can increase success of AD initiatives. AD is common in developed countries and certain examples have been cited in this review. In developing countries the authors have come across reports of AD in Pakistan, Sudan, Argentina and Uruguay, Bihar state in India, Zambia, Cuba, Indonesia and Mexico. AD had a consistent, small but potentially significant impact on prescribing practices. AD has much less resources at its command compared to the efforts by the industry. Steps have to be taken to formally start AD in Nepal and there may be specific hindering factors similar to those in other developing nations.

  15. Patient Relationships and the Personal Physician in Tomorrow's Health System: A Perspective from the Keystone IV Conference.

    PubMed

    Colwill, Jack M; Frey, John J; Baird, Macaran A; Kirk, John W; Rosser, Walter W

    2016-01-01

    A group of senior leaders from the early generation of academic family medicine reflect on the meaning of being a personal physician, based on their own clinical experiences and as teachers of residents and students in academic health centers. Recognizing that changes in clinical care and education at national and local systems levels have added extraordinary demands to the role of the personal physician, the senior group offers examples of how the discipline might go forward in changing times. Differently organized care such as the Family Health Team model in Ontario, Canada; value-based payment for populations in large health systems; and federal changes in reimbursement for populations can have positive effects on physician satisfaction. These changes and examples of changes in medical student and residency education also have the potential to positively affect the primary care workforce. The authors conclude that, without substantive educational and health system reform, the ability to truly serve as a personal physician and adhere to the values of continuity, responsibility, and accountability will continue to be threatened.

  16. Predicting Academic Entitlement in Undergraduates

    ERIC Educational Resources Information Center

    Sohr-Preston, Sara; Boswell, Stefanie S.

    2015-01-01

    Academic entitlement (AE) is a common source of frustration for college personnel. This investigation examined predictors (self-concept, academic dishonesty, locus of control, and family functioning) of AE in male and female college students. Academic dishonesty and the interaction between locus of control and family functioning significantly…

  17. Changing the Conversation From Burnout to Wellness: Physician Well-being in Residency Training Programs

    PubMed Central

    Eckleberry-Hunt, Jodie; Van Dyke, Anne; Lick, David; Tucciarone, Jennifer

    2009-01-01

    Background The existing literature either does not address physician wellness or defines it as a lack of burnout. The goal of this article is to call attention to this important gap in the literature and provide ideas for how to fill it. We need a culture change, and we propose that this change begin within graduate medical education. Methods We describe a case example of culture change and definitions of wellness at William Beaumont Hospitals, Troy Family Medicine Residency Program, a community-based, university-affiliated program in suburban Detroit, Michigan. Results We developed a toolbox of practical steps to create a culture that emphasizes wellness. We present a general timeline illustrating necessary steps toward accomplishing a true cultural change. Discussion The time has come for academic medicine to move beyond a simple discussion of physician burnout. To do this, we must first develop a shared definition of physician wellness followed by interventional strategies to bolster it. The benefits of cultural change include providing a more positive educational environment for residents and faculty, raising awareness of burnout and its symptoms, decreasing the stigma associated with admitting burnout symptoms, enabling the development of prevention strategies, and creating a more positive, strength-based approach to understanding the toll of physician-patient relationships on physicians. PMID:21975983

  18. Physician transition plans: planning for physician slowdown.

    PubMed

    Walker Keegan, Deborah

    2008-01-01

    Transition is a natural progression for physicians in a medical practice. At some point, at least one physician will seek to deviate from the work norm of the group, either due to retirement, need for part-time status, or other reason. Medical practices that have a formal transition plan in place have a competitive advantage over other practices in terms of physician recruitment and retention. Not only do the formal transition plans permit physicians to proactively plan for work slowdown, but they also permit the medical practice to ensure its financial health and effectively position itself for the future. Key issues addressed in physician transition plans include governance, continuity of care, eligibility, time limits, on-call schedules, practice overhead, and physician compensation.

  19. Navigating Government Service as a Physician

    ERIC Educational Resources Information Center

    Koh, Howard K.

    2016-01-01

    Working in government can be a remarkable life experience for anyone but particularly for those who have trained in the worlds of medicine and public health. This article describes some lessons learned from a physician initially based in academic medicine and public health who has since spent more than a decade serving in leadership positions at…

  20. Leadership Attributes of Physician Assistant Program Directors

    ERIC Educational Resources Information Center

    Eifel, Raymond Leo

    2014-01-01

    Physician assistant (PA) program directors perform an essential role in the initiation, continuation, and development of PA education programs in the rapidly changing environments of both health care and higher education. However, only limited research exists on this academic leader. This study examined the leadership roles of PA program directors…

  1. Mothers' Academic Gender Stereotypes and Education-Related Beliefs about Sons and Daughters in African American Families

    ERIC Educational Resources Information Center

    Wood, Dana; Kurtz-Costes, Beth; Rowley, Stephanie J.; Okeke-Adeyanju, Ndidi

    2010-01-01

    The role of African American mothers' academic gender stereotype endorsement in shaping achievement-related expectations for and perceptions of their own children was examined. Mothers (N = 334) of 7th and 8th graders completed measures of expectations for their children's future educational attainment, perceptions of their children's academic…

  2. Meeting Multicultural Needs in School Libraries: An Examination of Mexican Migrant Families and Factors that Influence Academic Success

    ERIC Educational Resources Information Center

    Plocharczyk, Leah

    2005-01-01

    The children of Mexican migrants face a number of hardships and difficulties that greatly hamper their ability to succeed in American schools. This paper examines some of the major difficulties and suggests multicultural programs that school librarians can implement in order to help migrant children achieve academic success.

  3. Teacher Ratings of Academic Achievement of Children between 6 and 12 Years Old from Intact and Non-Intact Families

    ERIC Educational Resources Information Center

    Molepo, Lephodisa S.; Maunganidze, Levison; Mudhovozi, Pilot; Sodi, Tholene

    2010-01-01

    We investigated teacher ratings of the impact of parental divorce on academic achievement of children between 6 and 12 years old up to 12 months after their parents divorced. A purposive sample of 120 children attending four different primary schools in a small South African town took part in the study. One third (n = 40) of the children had…

  4. Career changes among Saskatchewan physicians.

    PubMed Central

    Shaw, S; Goplen, G; Houston, D S

    1996-01-01

    OBJECTIVE: To determine how often Saskatchewan physicians changed career paths during medical training and practice. DESIGN: Population survey (mailed questionnaire). SETTING: Saskatchewan. PARTICIPANTS: All 1077 active members of the Saskatchewan Medical Association were sent a questionnaire; 493 (45.8%) responded. OUTCOME MEASURES: Long-term career goal or plan in next-to-last year of undergraduate medical school, probable choice of career if forced to choose at that time, and number of physicians who changed their field of training or practice at any time since graduation. RESULTS: In all, 57.8% (237/410) of the respondents were currently practising in a field different from that planned in their next-to-last year of medical school, 63.5% (275/436) were not practising in the field they would have chosen if forced to at that time, and 42.9% (211/492) had changed their field of training or practice at some time since graduation. Older physicians, those who graduated outside of Canada and specialists were the most likely to have changed career paths, family physicians, and those who graduated in Saskatchewan were the least likely to have changed. CONCLUSION: The current system of postgraduate training in Canada does not permit career changes of the sort made by most of the practising Saskatchewan physicians in the survey sample. The implications of this new system are as yet unknown but require careful monitoring. PMID:8625024

  5. [Scientific publications: a resource for the physician's intellectual development].

    PubMed

    Zárate, Arturo

    2013-01-01

    The physician's professional life involves reading and analysis of scientific journals, regardless of the specialization field. The hospital and academic areas lead to the scientific-literary activity development. The aim of this editorial is to make some reflections about the way a physician reaches intellectual development, through the creation of a culture of writing and reading scientific publications.

  6. Survey reveals physicians' experiences with cults.

    PubMed

    Lottick, E A

    1993-02-01

    In late June 1992, a stratified random sample of Pennsylvania physicians (5,400) were mailed a two-page questionnaire asking about experiences with destructive cults, either personal, professional, or both. Professional experience was defined as "with patients or their families," and personal experience was defined as "with self, family, or friends." The survey sample group was drawn from primary care physicians (family practice, general practice, internal medicine, and pediatrics) and psychiatrists. Surveys were returned by 1,396 participants, a 26 percent rate of return. A number of the returned surveys (173) included personal observations and comments.

  7. In defense of industry-physician relationships.

    PubMed

    Nakayama, Don K

    2010-09-01

    The objective was to examine the economic, ethical, and legal foundations for conflict of interest restrictions between physicians and pharmaceutical and medical device industries ("industry"). Recently academic medical centers and professional organizations have adopted policies that restrict permissible interactions between industry and physicians. The motive is to avoid financial conflicts of interest that compromise core values of altruism and fiduciary relationships. Productive relationships between industry and physicians provide novel drugs and devices of immense benefit to society. The issues are opposing views of medical economics, profit motives, medical professionalism, and extent to which interactions should be lawfully restricted. Industry goals are congruent with those of physicians: patient welfare, safety, and running a profitable business. Profits are necessary to develop drugs and devices. Physician collaborators invent products, refine them, and provide feedback and so are appropriately paid. Marketing is necessary to bring approved products to patients. Economic realities limit the extent to which physicians treat their patients altruistically and as fiduciaries. Providing excellent service to patients may be a more realistic standard. Statements from industry and the American College of Surgeons appropriately guide professional behavior. Preservation of industry-physician relationships is vital to maintain medical innovation and progress.

  8. Physician-assisted death.

    PubMed Central

    1995-01-01

    Physician-assisted death includes both euthanasia and assistance in suicide. The CMA urges its members to adhere to the principles of palliative care. It does not support euthanasia and assisted suicide. The following policy summary includes definitions of euthanasia and assisted suicide, background information, basic ethical principles and physician concerns about legalization of physician-assisted death. PMID:7632208

  9. Patient–physician mistrust and violence against physicians in Guangdong Province, China: a qualitative study

    PubMed Central

    Tucker, Joseph D; Cheng, Yu; Wong, Bonnie; Gong, Ni; Nie, Jing-Bao; Zhu, Wei; McLaughlin, Megan M; Xie, Ruishi; Deng, Yinghui; Huang, Meijin; Wong, William C W; Lan, Ping; Liu, Huanliang; Miao, Wei; Kleinman, Arthur

    2015-01-01

    Objective To better understand the origins, manifestations and current policy responses to patient–physician mistrust in China. Design Qualitative study using in-depth interviews focused on personal experiences of patient–physician mistrust and trust. Setting Guangdong Province, China. Participants One hundred and sixty patients, patient family members, physicians, nurses and hospital administrators at seven hospitals varying in type, geography and stages of achieving goals of health reform. These interviews included purposive selection of individuals who had experienced both trustful and mistrustful patient–physician relationships. Results One of the most prominent forces driving patient–physician mistrust was a patient perception of injustice within the medical sphere, related to profit mongering, knowledge imbalances and physician conflicts of interest. Individual physicians, departments and hospitals were explicitly incentivised to generate revenue without evaluation of caregiving. Physicians did not receive training in negotiating medical disputes or humanistic principles that underpin caregiving. Patient–physician mistrust precipitated medical disputes leading to the following outcomes: non-resolution with patient resentment towards physicians; violent resolution such as physical and verbal attacks against physicians; and non-violent resolution such as hospital-mediated dispute resolution. Policy responses to violence included increased hospital security forces, which inadvertently fuelled mistrust. Instead of encouraging communication that facilitated resolution, medical disputes sometimes ignited a vicious cycle leading to mob violence. However, patient–physician interactions at one hospital that has implemented a primary care model embodying health reform goals showed improved patient–physician trust. Conclusions The blind pursuit of financial profits at a systems level has eroded patient–physician trust in China. Restructuring incentives

  10. Physician Enabling Skills Questionnaire

    PubMed Central

    Hudon, Catherine; Lambert, Mireille; Almirall, José

    2015-01-01

    Abstract Objective To evaluate the reliability and validity of the newly developed Physician Enabling Skills Questionnaire (PESQ) by assessing its internal consistency, test-retest reliability, concurrent validity with patient-centred care, and predictive validity with patient activation and patient enablement. Design Validation study. Setting Saguenay, Que. Participants One hundred patients with at least 1 chronic disease who presented in a waiting room of a regional health centre family medicine unit. Main outcome measures Family physicians’ enabling skills, measured with the PESQ at 2 points in time (ie, while in the waiting room at the family medicine unit and 2 weeks later through a mail survey); patient-centred care, assessed with the Patient Perception of Patient-Centredness instrument; patient activation, assessed with the Patient Activation Measure; and patient enablement, assessed with the Patient Enablement Instrument. Results The internal consistency of the 6 subscales of the PESQ was adequate (Cronbach α = .69 to .92). The test-retest reliability was very good (r = 0.90; 95% CI 0.84 to 0.93). Concurrent validity with the Patient Perception of Patient-Centredness instrument was good (r = −0.67; 95% CI −0.78 to −0.53; P < .001). The PESQ accounts for 11% of the total variance with the Patient Activation Measure (r2 = 0.11; P = .002) and 19% of the variance with the Patient Enablement Instrument (r2 = 0.19; P < .001). Conclusion The newly developed PESQ presents good psychometric properties, allowing for its use in practice and research. PMID:26889507

  11. Family and School Influences on Youths' Behavioral and Academic Outcomes: Cross-Level Interactions between Parental Monitoring and Character Development Curriculum.

    PubMed

    Top, Namik; Liew, Jeffrey; Luo, Wen

    2017-01-01

    The authors examined the joint (interactive) roles of the Second Step curriculum (a validated social-emotional learning and bullying prevention program; Committee for Children, Seattle, WA) and parenting practices on students' behavioral and academic outcomes in Grades 5-8. Participants were 763 parents and their children from 22 schools (8 control and 14 treatment). A 2-level random coefficient model was conducted to assess the effect of parental monitoring on school outcomes, as well as the interaction between character development curriculum and parental monitoring. Results indicated that parental monitoring was a significant predictor of school behaviors and school grades. Furthermore, the Second Step curriculum moderated the relationship between parental monitoring and problem behaviors, prosocial behaviors, and grades at school. Specifically, in schools without the Second Step curriculum parental monitoring predicted higher school grades but had no impact on students' school behaviors. By contrast, in schools with the Second Step curriculum, parental monitoring predicted fewer problem behaviors as well as more prosocial behaviors. The study results highlight the joint influences of the family and the school in children's behavioral and academic trajectories. Results have implications for education and intervention, including improving the school climate, student behaviors, and learning or achievement.

  12. The relation of dialogic, control, and racial socialization practices to early academic and social competence: effects of gender, ethnicity, and family socioeconomic status.

    PubMed

    Barbarin, Oscar; Jean-Baptiste, Esther

    2013-01-01

    This research tests the relations of parental practices to child competence and assertions that practices differ by gender of the child. Home-based interviews and structured observations of parent-child interactions were conducted with an ethnically and socioeconomically diverse sample of families (N = 501) whose 4-year-old children were served in public prekindergarten. Study data confirmed the importance of parental practices for children's academic and social competence but did not support claims that use of any of the practices was related to the child's gender. Significant differences were found for economic status on dialogic practices and for ethnicity on control and ethnic socialization. Poor parents employed dialogic practices less than nonpoor parents' and African American parents employed dialogic practices less often and control and ethnic socialization more often than European Americans. Dialogic practices were related to competence, but parental control and ethnic socialization were not.

  13. Physicians and architects - not an odd couple.

    PubMed

    Ohry, Avi

    2013-01-01

    One may think that there is no apparent interface between so different occupations as medicine and architecture. The historical and present-day connections between these academic fields resulted in the creation of healthy environment, housing and hospital. This article also speaks about another meeting point of these professions: physicians who became architects (or amateur-architects) and personal friendships between physicians, scientists, and architects which resulted in fruitful and progressive architectural creations. Both professions may be regard as art and science as well.

  14. Reconceptualizing Academic Support

    ERIC Educational Resources Information Center

    Vantine, Laura

    2016-01-01

    Over the past 30 years, more and more independent schools have established academic support programs and learning centers to address their students' individual learning needs. Perhaps not surprisingly, as the number of students being evaluated has increased, even more families have requested academic accommodations and services for their children.…

  15. Barriers of and Facilitators to Physician Recommendation of Colorectal Cancer Screening

    PubMed Central

    Schwartz, J. Sanford; Armstrong, Katrina; Brown, Jamin S.; Halbert, Chanita Hughes; Shea, Judy A.

    2007-01-01

    BACKGROUND Colorectal cancer screening (CRCS) has been demonstrated to be effective and is consistently recommended by clinical practice guidelines. However, only slightly over half of all Americans have ever been screened. Patients cite physician recommendation as the most important motivator of screening. This study explored the barriers of and facilitators to physician recommendation of CRCS. METHODS A 3-component qualitative study to explore the barriers of and facilitators to physician recommendation of CRCS: in-depth, semistructured interviews with 29 purposively sampled, community- and academic-based primary care physicians; chart-stimulated recall, a technique that utilizes patient charts to probe physician recall and provide context about the barriers of and facilitators to physician recommendation of CRCS during actual clinic encounters; and focus groups with 18 academic primary care physicians. Grounded theory techniques of analysis were used. RESULTS All the participating physicians were aware of and recommended CRCS. The overwhelmingly preferred test was colonoscopy. Barriers of physician recommendation of CRCS included patient comorbidities, prior patient refusal of screening, physician forgetfulness, acute care visits, lack of time, and lack of reminder systems and test tracking systems. Facilitators to physician recommendation of CRCS included patient request, patient age 50–59, physician positive attitudes about CRCS, physician prioritization of screening, visits devoted to preventive health, reminders, and incentives. CONCLUSION There are multiple physician, patient, and system barriers to recommending CRCS. Thus, interventions may need to target barriers at multiple levels to successfully increase physician recommendation of CRCS. PMID:17939007

  16. Relationships of physician characteristics to performance quality and improvement.

    PubMed Central

    Payne, B C; Lyons, T F; Neuhaus, E

    1984-01-01

    The quality of ambulatory medical care provided by 1,135 physicians in five separate practice settings in the Midwest was measured using predetermined process criteria. Specialists performed better in their own areas of specialized training than did family/general practitioners or specialists performing outside their specialty areas. Physicians with fewer years of practice performed somewhat better than physicians with more years since medical school graduation. Board certification was not consistently related to performance. Performances of the physicians improved following quality assurance interventions in these sites. Differences in the rates of change in performance quality were not consistently related to any of the physician characteristics studied. PMID:6746295

  17. Physician stress: is it inevitable?

    PubMed

    Orman, M C

    1989-01-01

    Early attempts to understand the causes of physician stress focused almost exclusively upon the role of external stressors and demands. Recent psychosocial and behavioral research, however, suggests that individual attitudes, beliefs, personality factors, and learned coping strategies probably play a more important role. In addition, such cognitive and behavioral tendencies are within the control of each individual, and clinical experience has shown that these factors can indeed be modified. Freudenberger noted that most health professionals who are experiencing high levels of stress fail to identify the role that they themselves play in generating such symptoms. Instead, they tend to blame others as the cause of their problems and tend to react cynically toward suggestions that they could benefit from help. A large-scale study of family physicians in North Carolina, conducted by May, Revicki, and Jones in 1983, confirmed the fact that most physicians who reported a high level of professional stress also tended to score high on measures of external locus of control--i.e. the perception that external or environmental factors are mainly responsible for one's problems or successes. My own experience in treating physicians and other people with stress tends to confirm these findings. More importantly, I have found that once individuals are helped to identify the role that their own cognitive and behavioral tendencies play in the origin of their stress, they can usually bring about impressive reductions in stress and tension without significant changes in environmental factors or demands. While many people advocate stress-releasing and other relaxation skills for physicians, I have found that such approaches are often counterproductive.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Hope and Persuasion by Physicians During Informed Consent

    PubMed Central

    Miller, Victoria A.; Cousino, Melissa; Leek, Angela C.; Kodish, Eric D.

    2014-01-01

    Purpose To describe hopeful and persuasive messages communicated by physicians during informed consent for phase I trials and examine whether such communication is associated with physician and parent ratings of the likelihood of benefit, physician and parent ratings of the strength of the physician's recommendation to enroll, parent ratings of control, and parent ratings of perceived pressure. Patients and Methods Participants were children with cancer (n = 85) who were offered a phase I trial along with their parents and physicians. Informed consent conferences (ICCs) were audiotaped and coded for physician communication of hope and persuasion. Parents completed an interview (n = 60), and physicians completed a case-specific questionnaire. Results The most frequent hopeful statements related to expectations of positive outcomes and provision of options. Physicians failed to mention no treatment and/or palliative care as options in 68% of ICCs and that the disease was incurable in 85% of ICCs. When physicians mentioned no treatment and/or palliative care as options, both physicians and parents rated the physician's strength of recommendation to enroll in the trial lower. Conclusion Hopes and goals other than cure or longer life were infrequently mentioned, and a minority of physicians communicated that the disease was incurable and that no treatment and/or palliative care were options. These findings are of concern, given the low likelihood of medical benefit from phase I trials. Physicians have an important role to play in helping families develop alternative goals when no curative options remain. PMID:25199753

  19. Physician assistants in Canada

    PubMed Central

    Jones, Ian W.; Hooker, Roderick S.

    2011-01-01

    Abstract Objective To analyze the health policies related to physician assistants (PAs) and to understand the factors influencing this medical work force movement. Quality of evidence This work combines a review of the literature and qualitative information, and it serves as a historical bookmark. The approach was selected when attempts to obtain reports or literature using customary electronic bibliography (PubMed, CINAHL, Google Scholar, EBSCO, and MEDLINE) searches in English and French, from 1970 through 2010, identified only 14 documents (including gray literature) of relevance. Reports, provincial documents, and information from developers of the PA movement supplemented the literature base. Main message The historical development of the role of PAs in Canada spans 2 decades. There are now more than 250 PAs, most working in family medicine and emergency medicine. Enabling legislation for PAs has been formalized in Manitoba, and 3 provinces have recognized PAs in various policy statements or initiatives. Three universities and 1 military training centre have enrolled more than 120 students in PA programs. Retired PAs of the Canadian Forces, returning ex-patriot Canadians who had trained as PAs in PA programs in the United States, and American immigrants are working as PAs in Canada. Demonstration projects are under way to better understand the usefulness of PAs in various medical settings. Conclusion For a public health policy enactment of this size and effect, the literature on PAs in Canada is sparse and limited. In spite of this, PA employment is expanding, family medicine practices are using PAs, and there is enabling legislation planned. The result will likely be increased use of PAs. Documentation about PAs, review of their use, and outcomes research are needed to evaluate this new type of clinician in Canadian society. PMID:21402955

  20. Attitudes of patients and physicians regarding physician dress and demeanor in the emergency department.

    PubMed

    Colt, H G; Solot, J A

    1989-02-01

    To compare the opinions of patients and physicians regarding physician dress and demeanor in the emergency department, we conducted a cross-sectional survey of 190 ED patients and 129 medical specialists, family practitioners, surgeons, and emergency physicians in a community hospital. Seventy-three percent of physicians and 43% of patients thought that physical appearance influenced patient opinion of medical care. Forty-nine percent of patients believed emergency physicians should wear white coats, but only 18% disliked scrub suits. Patients were more tolerant of casual dress than were physicians. Both groups disliked excessive jewelry, prominent ruffles or ribbons, long fingernails, blue jeans, and sandals. Opinions and practices of emergency physicians were similar to those of other medical specialists. Most physicians (96%) addressed patients by surname or title, but 43% of patients preferred being called by their first names. The age, gender, income, and education of patients did not influence how they wished to be addressed. Larger studies are needed to assess the influence of age, sex, race, and depth of feeling regarding first-name address and physician attire in the ED.

  1. Can teachers' global ratings identify children with academic problems?

    PubMed

    Glascoe, F P

    2001-06-01

    Physicians often elicit ratings from teachers when making diagnostic, treatment, or referral decisions. The purpose of this study was to view the relationship between teachers' ratings and children's academic skills, assess the utility of teacher ratings in detecting academic problems, and thus determine whether physicians can depend on teacher ratings when making decisions about patients' needs. Subjects were a national sample of 80 teachers and 934 children between 6 and 13 years of age participating in a test standardization study. Families were representative of United States demographics in terms of parental level of education, income, and ethnicity, and sites were geographically diverse elementary schools. Children were administered the Comprehensive Inventory of Basic Skills--Revised (CIBS-R), a diagnostic academic achievement test. Teachers rated children's academic performance on a five-point scale ranging from far above average to far below average and were blinded to the results of the CIBS-R. Teacher ratings varied significantly with children's performance for all academic domains. Logistic regression revealed that teacher ratings were best predicted by children's performance in basic reading skills, followed by math skills, and were not influenced by race, parents' level of education, history of retention, or gender. Participation in Title I services, testing in winter or spring, and parents who spoke a language other than English produced significantly lower ratings. Nevertheless, teachers rated as average many students with mild to moderate academic difficulties. School system personnel and health care providers should avoid sole dependence on global teacher ratings when deciding which students need special education referrals or other services. Supplementing teacher ratings with standardized screening test results is needed to ensure accurate decision-making.

  2. Confronting the disruptive physician.

    PubMed

    Linney, B J

    1997-01-01

    Ignoring disruptive behavior is no longer an option in today's changing health care environment. Competition and managed care have caused more organizations to deal with the disruptive physician, rather than look the other way as many did in years past. But it's not an easy task, possibly the toughest of your management career. How should you confront a disruptive physician? By having clearly stated expectations for physician behavior and policies in place for dealing with problem physicians, organizations have a context from which to address the situation.

  3. Academic medicine in Russia.

    PubMed

    Burger, Edward J; Ziganshina, Lilia; Ziganshin, Airat U

    2004-12-01

    Academic medicine, along with professionalism of the medical community in Russia underwent a remarkable evolution from the Revolution through the decline of the Soviet Union. The Soviet period brought about an enormous expansion of numbers of admissions to medical schools and a corresponding increase in the number of new physicians. Academic medical institutions were separated from institutions of higher learning in general and medical science was separated from the mainstream of science. Many of these features have been reversed in the past 14 years and re-professionalization of medicine has resumed.

  4. Effects of the Family Bereavement Program on Academic Outcomes, Educational Expectations and Job Aspirations 6 Years Later: The Mediating Role of Parenting and Youth Mental Health Problems

    PubMed Central

    Schoenfelder, Erin N.; Tein, Jenn-Yun; Wolchik, Sharlene; Sandler, Irwin N.

    2014-01-01

    Experiencing the death of a parent during childhood is associated with a variety of difficulties, including lower academic achievement, that have implications for functioning in childhood and adulthood. This study examines effects of the Family Bereavement Program (FBP), a preventive intervention for parentally-bereaved youth and their caregivers, on grade point averages (GPA), educational expectations and job aspirations of youths 6 years after the intervention. A total of 244 bereaved youths ages 8-16 and their caregivers were randomized to either the FBP or a comparison group that received books about bereavement. Assessments occurred at pretest, post-test, and 11-month and 6-year follow-ups. Direct program effects on educational outcomes and job aspirations 6 years later were non-significant, although the program improved educational expectations for children with fewer behavior problems at program entry, and GPA for younger children. Mediational pathways for program effects on educational outcomes were also tested. Program-induced improvements in effective parenting at 11-month follow-up were associated with higher GPAs at 6-year follow-up for youth who were younger or for whom more time had passed since the loss. Program-induced improvements in parenting and teacher-rated youth mental health problems at the 6-year follow-up mediated program effects on youths’ educational expectations for those with fewer behavior problems at program entry. The implications of these findings for understanding processes related to academic and educational outcomes following the death of a parent and for prevention efforts to help bereaved and other high-risk children succeed in school are discussed. PMID:25052624

  5. Effects of the Family Bereavement Program on academic outcomes, educational expectations and job aspirations 6 years later: the mediating role of parenting and youth mental health problems.

    PubMed

    Schoenfelder, Erin N; Tein, Jenn-Yun; Wolchik, Sharlene; Sandler, Irwin N

    2015-02-01

    Experiencing the death of a parent during childhood is associated with a variety of difficulties, including lower academic achievement, that have implications for functioning in childhood and adulthood. This study examines effects of the Family Bereavement Program (FBP), a preventive intervention for parentally-bereaved youth and their caregivers, on grade point averages (GPA), educational expectations and job aspirations of youths 6 years after the intervention. A total of 244 bereaved youths ages 8-16 and their caregivers were randomized to either the FBP or a comparison group that received books about bereavement. Assessments occurred at pretest, post-test, and 11-month and 6-year follow-ups. Direct program effects on educational outcomes and job aspirations 6 years later were non-significant, although the program improved educational expectations for children with fewer behavior problems at program entry, and GPA for younger children. Mediational pathways for program effects on educational outcomes were also tested. Program-induced improvements in effective parenting at 11-month follow-up were associated with higher GPAs at 6-year follow-up for youth who were younger or for whom more time had passed since the loss. Program-induced improvements in parenting and teacher-rated youth mental health problems at the 6-year follow-up mediated program effects on youths' educational expectations for those with fewer behavior problems at program entry. The implications of these findings for understanding processes related to academic and educational outcomes following the death of a parent and for prevention efforts to help bereaved and other high-risk children succeed in school are discussed.

  6. Negotiation for physicians.

    PubMed

    Hill, Micah J; DeCherney, Alan H

    2013-05-01

    Physicians are involved in negotiations on a daily basis. Interactions with patients, support staff, nurses, fellow physicians, administrators, lawyers, and third parties all can occur within the context of negotiation. This article reviews the basic principles of negotiation and negotiation styles, models, and practical tools.

  7. Marketing specialty physician services.

    PubMed

    Olson, E A

    1993-01-01

    Physicians take into account many factors when making referral decisions, primarily provider expertise, good communication and good patient care. This professional paper will show that provider expertise and patient care are the most important factors in referral decisions, and that physicians rely primarily on direct experience for the information necessary to make a referral choice.

  8. Autism Speaks Toolkits: Resources for Busy Physicians.

    PubMed

    Bellando, Jayne; Fussell, Jill J; Lopez, Maya

    2016-02-01

    Given the increased prevalence of autism spectrum disorders (ASD), it is likely that busy primary care providers (PCP) are providing care to individuals with ASD in their practice. Autism Speaks provides a wealth of educational, medical, and treatment/intervention information resources for PCPs and families, including at least 32 toolkits. This article serves to familiarize PCPs and families on the different toolkits that are available on the Autism Speaks website. This article is intended to increase physicians' knowledge on the issues that families with children with ASD frequently encounter, to increase their ability to share evidence-based information to guide treatment and care for affected families in their practice.

  9. Questions & answers about hospice: a guide for Missouri's physicians.

    PubMed

    Zweig, Steven

    2002-01-01

    Hospice provides multidisciplinary care to dying patients with and without cancer. Most adults would prefer to be cared for in their home or that of a family member. This guide provides answers to the questions most commonly asked of physicians. Its goal is to facilitate a better understanding of what hospice does, who is eligible, physician roles, and how physicians can use hospice to help their patients.

  10. Perspective: Physician leadership in quality.

    PubMed

    Pronovost, Peter J; Miller, Marlene R; Wachter, Robert M; Meyer, Gregg S

    2009-12-01

    While advances in biomedicine are awesome, progress in patient safety and quality of care has proven slow and arduous. One factor contributing to the labored progress is the paucity of physician-leaders who can help advance the science and practice of quality and safety. This limited talent pool, which has particularly serious consequences in academic medical centers (AMCs), stems from insufficient training in quality and safety, which in turn owes to our collective failure to view the delivery of health care as a science. Even when AMCs have trained and skilled quality and safety leaders, the infrastructure to support their work is deficient, with poorly defined job descriptions, competing responsibilities, and limited formal roles in the medical school compared with the hospital. Though there is limited empiric evidence to guide recommendations, the authors support four initiatives to accelerate national progress on quality and safety: (1) invest in quality and safety science, (2) revise quality and safety governance in AMCs, and (3) integrate roles within the hospital and medical school. Many of these shortcomings can be addressed by creating a newly integrated role: the vice dean for quality and hospital director of quality and safety. For AMCs to achieve significant improvements in quality and safety, they must invest in physician-leaders and in the support these leaders need to carry out their educational and operational roles.

  11. Genetic counseling, a health department service to physicians.

    PubMed

    Jolly, E; Blum, H L

    1965-11-01

    Questions about inheritance in all kinds of diseases and defects are commonly asked of nearly all physicians. In attempting to answer these questions, however, the physician is often hampered by lack of formal instruction in clinical genetics. Since the health department, if it is to carry out its epidemiologic function, must be as concerned over the increasing identification of genetic agents in disease as it is and has been over environmental disease agents, it should come to represent a source of assistance not now generally available to the physician. In short, as it carries out those activities by which its store of general genetic information is increased, and until other sources of genetic consultation become reasonably available, the health department can be of real service to physicians as a resource to which they may turn for help when dealing with families wanting genetic information. Such a service has been provided experimentally for the last two years by the Contra Costa County Health Department. This program calls for the taking of family pedigrees by public health nurses on families with questions of a genetic nature who are health department clients and on families who are referred by their private physicians for this service. An interpretation of each pedigree is made by the department's physician in charge of the program and submitted to the family's physician for his use in counseling the family. Evidence to date suggests the process can be a highly useful service to the practitioner and his patient.

  12. Utilizing peer academic detailing to improve childhood immunization coverage levels.

    PubMed

    Boom, Julie A; Nelson, Cynthia S; Kohrt, Alan E; Kozinetz, Claudia A

    2010-05-01

    Interventions that utilize academic detailing to improve childhood immunization have been implemented across the country. This study evaluates the effectiveness of an academic detailing intervention to increase childhood immunization rates in pediatric and family medicine practices in a major metropolitan area. Educational teams of one physician, nurse, and office manager delivered 83 peer education sessions at practices in the intervention group. Postintervention immunization rates for children 12-23 months of age increased 1% in the intervention group and decreased 3% in the control group. Postintervention coverage levels for children 12-23 months of age did not differ between the intervention and control groups. Results indicated this office-based intervention was not sufficient to effect measurable changes in immunization coverage levels after 1 year of participation. Future interventions need to provide initial feedback regarding practice immunization coverage levels prior to the educational interventions and include multiple encounters.

  13. The Changing Distribution of Physicians in Regionville.

    ERIC Educational Resources Information Center

    Sorensen, Andrew A.; Kunitz, Stephen J.

    1978-01-01

    The consequences of medical reform, the myth of the family doctor, the importance of foreign medical graduates in providing medical care, the importance of facilities and innovative practice settings for the attraction of physicians, and the significance of suburbanization in influencing the growth of the local service sector are addressed in this…

  14. Revising the Definition of the Generalist Physician.

    ERIC Educational Resources Information Center

    Altman, David F.

    1995-01-01

    Although generalist physicians have traditionally been defined by their specialties (family, internal, pediatric medicine), this approach may not recognize specific competencies and training needed. A new definition based on functional requirements of generalist practice and the central role of the generalist in comprehensive care is proposed.…

  15. The physician's response to climate change.

    PubMed

    Sarfaty, Mona; Abouzaid, Safiya

    2009-05-01

    Climate change will have an effect on the health and well-being of the populations cared for by practicing physicians. The anticipated medical effects include heat- and cold-related deaths, cardiovascular illnesses, injuries and mental harms from extreme weather events, respiratory illnesses caused by poor air quality, infectious diseases that emanate from contaminated food, water, or spread of disease vectors, the injuries caused by natural disasters, and the mental harm associated with social disruption. Within several years, such medical problems are likely to reach the doorsteps of many physicians. In the face of this reality, physicians should assume their traditional roles as medical professionals, health educators, and community leaders. Clinicians provide individual health services to patients, some of whom will be especially vulnerable to the emerging health consequences of global warming. Physicians also work in academic medical institutions and hospitals that educate and provide continuing medical education to students, residents, and practitioners. The institutions also produce a measurable carbon footprint. Societies of physicians at national, state, and local levels can choose to use their well-developed avenues of communication to raise awareness of the key issues that are raised by climate change as well as other environmental concerns that have profound implications for human health and well-being.

  16. Autism Spectrum Disorder Early Screening Practices: A Survey of Physicians

    ERIC Educational Resources Information Center

    Self, Trisha L.; Parham, Douglas F.; Rajagopalan, Jagadeesh

    2015-01-01

    The American Academy of Pediatrics (AAP) released a policy statement in 2007 urging physicians to screen for autism spectrum disorder (ASD) at 18 and 24 months. This study sought to identify the screening practices of pediatricians and family physicians (FPs) in following the AAP guidelines for ASD. A survey was mailed to 1,500 pediatricians and…

  17. Physicians' Knowledge of Alcohol, Tobacco and Folic Acid in Pregnancy

    ERIC Educational Resources Information Center

    Lefebvre, L. G.; Ordean, A.; Midmer, D.; Kahan, M.; Tolomiczenko, G.

    2007-01-01

    Objective: To assess: (1) physicians' knowledge and clinical confidence regarding problematic substance use in pregnancy compared to folic acid, and (2) physicians' desire for education in this area and their preferred learning modalities tools. Design: Self-administered survey. Setting: "Family Medicine Forum 2004" in Toronto, Canada.…

  18. Determinants of Rural Physicians' Life and Job Satisfaction

    ERIC Educational Resources Information Center

    Lavanchy, Marcel; Connelly, Ian; Grzybowski, Stefan; Michalos, Alex C.; Berkowitz, Jonathan; Thommasen, Harvey V.

    2004-01-01

    Objective: To identify and quantify factors that contribute to rural physicians' satisfaction with their jobs and life as a whole. Design: Cross-sectional, mailed survey. Study population: Family physicians practicing in rural communities eligible for British Columbia's Northern and Isolation Allowance. Main measures: Demographics, Domain…

  19. Improving Physician-Patient Communication through Coaching of Simulated Encounters

    ERIC Educational Resources Information Center

    Ravitz, Paula; Lancee, William J.; Lawson, Andrea; Maunder, Robert; Hunter, Jonathan J.; Leszcz, Molyn; McNaughton, Nancy; Pain, Clare

    2013-01-01

    Objective: Effective communication between physicians and their patients is important in optimizing patient care. This project tested a brief, intensive, interactive medical education intervention using coaching and standardized psychiatric patients to teach physician-patient communication to family medicine trainees. Methods: Twenty-six family…

  20. Physician collective bargaining.

    PubMed

    Schiff, Anthony Hunter

    2009-11-01

    Current antitrust enforcement policy unduly restricts physician collaboration, especially among small physician practices. Among other matters, current enforcement policy has hindered the ability of physicians to implement efficient healthcare delivery innovations, such as the acquisition and implementation of health information technology (HIT). Furthermore, the Federal Trade Commission and Department of Justice have unevenly enforced the antitrust laws, thereby fostering an increasingly severe imbalance in the healthcare market in which dominant health insurers enjoy the benefit of largely unfettered consolidation at the cost of both consumers and providers. This article traces the history of antitrust enforcement in healthcare, describe the current marketplace, and suggest the problems that must be addressed to restore balance to the healthcare market and help to ensure an innovative and efficient healthcare system capable of meeting the demands of the 21st century. Specifically, the writer explains how innovative physician collaborations have been improperly stifled by the policies of the federal antitrust enforcement agencies, and recommend that these policies be relaxed to permit physicians more latitude to bargain collectively with health insurers in conjunction with procompetitive clinical integration efforts. The article also explains how the unbridled consolidation of the health insurance industry has resulted in higher premiums to consumers and lower compensation to physicians, and recommends that further consolidation be prohibited. Finally, the writer discusses how health insurers with market power are improperly undermining the physician-patient relationship, and recommend federal antitrust enforcement agencies take appropriate steps to protect patients and their physicians from this anticompetitive conduct. The article also suggests such steps will require changes in three areas: (1) health insurers must be prohibited from engaging in anticompetitive

  1. A Family Physician's Approach to Acne

    PubMed Central

    Turgeon, Eugene

    1981-01-01

    Because of the potential for permanent physical and psychological sequelae, acne vulgaris should be regarded as a true disease—not the “normal” physiologic response one might infer from its near universal prevalence in adolescence. Effective therapy reduces pilosebaceous unit obstruction, minimizes secondary inflammation, and lessens the chance of significant scarring. This article reviews current therapeutic modalities, and suggests a sequence for implementation of specific agents. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5 PMID:21289790

  2. Toxic Shock Syndrome: A Family Physician's Perspective

    PubMed Central

    Myhre, D. L.

    1982-01-01

    Although similar cases have been reported as far back as 1927, the term toxic shock syndrome was coined in 1978 to describe an acute fever involving Staph. aureus. The reported mortality rate in Canada is 3.8%, but may be much higher. Association with tampon use was made in 1980, but is still unclear. Treatment remains supportive and is aimed at reducing risk of recurrence, until the role of the exotoxin can be explained. This article reviews reported cases to date, listing diagnostic criteria, signs and symptoms. A high index of suspicion for this new syndrome is recommended. PMID:21286566

  3. Remembering More Jewish Physicians

    PubMed Central

    Weisz, George M.; Grzybowski, Andrzej

    2016-01-01

    The history of medicine has been an intriguing topic for both authors. The modern relevance of past discoveries led both authors to take a closer look at the lives and contributions of persecuted physicians. The Jewish physicians who died in the Holocaust stand out as a stark example of those who merit being remembered. Many made important contributions to medicine which remain relevant to this day. Hence, this paper reviews the lives and important contributions of two persecuted Jewish physicians: Arthur Kessler (1903–2000) and Bronislawa Fejgin (1883–1943). PMID:27487308

  4. Academic Performance of Native and Immigrant Students: A Study Focused on the Perception of Family Support and Control, School Satisfaction, and Learning Environment

    PubMed Central

    Santos, Miguel A.; Godás, Agustín; Ferraces, María J.; Lorenzo, Mar

    2016-01-01

    The international assessment studies of key competences, such as the PISA report of the OECD, have revealed that the academic performance of Spanish students is significantly below the OECD average. In addition, it has also been confirmed that the results of immigrant students are consistently lower than those of their native counterparts. Given the context, the first objective of this work is to observe the variables (support, control, school satisfaction, and learning environment) which distinguish between retained and non-retained native and immigrant students. The second objective is to check, by comparing the retained and non-retained native and immigrant students and separating the two levels, in order to find out which of the selected variables clearly differentiate the two groups. A sample of 1359 students was used (79.8% native students and 20.2% immigrant students of Latin American origin), who were enrolled in the 5th and 6th year of Primary Education (aged 10–11 years) and in the 1st and 2nd year of Secondary Education (aged 12–13 years). The measurement scales, which undergo a psychometric analysis in the current work, have been developed in a previous research study (Lorenzo et al., 2009). The construct validity and reliability are reported (obtaining alpha indices between 0.705 and 0.787). Subsequently, and depending on the results of this analysis, inferential analyses are performed, using as independent variables the ethno-cultural origin and being retained or not, whereas, as dependent variables, the indices referring to students' perception of family support and control, as well as the assessment of the school and learning environment. Among other results, the Group × Being retained/Not being retained [F(1, 1315) = 4.67, p < 0.01] interaction should be pointed out, indicating that native non-retained subjects perceive more control than immigrants, as well as the Group × Being retained/Not being retained [F(1, 1200) = 5.49, p < 0

  5. The Growth of a Family

    PubMed Central

    Carroll, June C.; Biringer, Anne

    1991-01-01

    Caring for a family during pregnancy and birth is an ideal opportunity for family physicians to assess family functioning and help the family adjust to the birth of a new child. Stress and support systems can influence the course of pregnancy, including obstetric and perinatal outcomes. A family-centered approach can help patients during this critical stage of family development. PMID:21229107

  6. Adoption of information technology by resident physicians.

    PubMed

    Parekh, Selene G; Nazarian, David G; Lim, Charles K

    2004-04-01

    The Internet represents a technological revolution that is transforming our society. In the healthcare industry, physicians have been typified as slow adopters of information technology. However, young physicians, having been raised in a computer-prevalent society, may be more likely to embrace technology. We attempt to characterize the use and acceptance of the Internet and information technology among resident physicians in a large academic medical center and to assess concerns regarding privacy, security, and credibility of information on the Internet. A 41-question survey was distributed to 150 pediatric, medical, and surgical residents at an urban, academic medical center. One hundred thirty-five residents completed the survey (response rate of 90%). Responses were evaluated and statistical analysis was done. The majority of resident physicians in our survey have adopted the tools of information technology. Ninety-eight percent used the Internet and 96% use e-mail. Two-thirds of the respondents used the Internet for healthcare-related purposes and a similar percentage thought that the Internet has affected their practice of medicine positively. The majority of residents thought that Internet healthcare services such as electronic medical records, peer-support websites, and remote patient monitoring would be beneficial for the healthcare industry. However, they are concerned about the credibility, privacy, and security of health and medical information online. The majority of resident physicians in our institution use Internet and information technology in their practice of medicine. Most think that the Internet will continue to have a beneficial role in the healthcare industry.

  7. Physician Assistant profession (PA)

    MedlinePlus

    ... medicine. The rest are involved in teaching, research, administration, or other nonclinical roles. PAs may practice in any setting in which a physician provides care. This allows doctors to focus their skills and knowledge in a more effective way. PAs ...

  8. Hitler's Jewish Physicians.

    PubMed

    Weisz, George M

    2014-07-01

    The mystery behind the behavior of infamous personalities leaves many open questions, particularly when related to the practice of medicine. This paper takes a brief look at two Jewish physicians who played memorable roles in the life of Adolf Hitler.

  9. The medical home: locus of physician formation.

    PubMed

    Daaleman, Timothy P

    2008-01-01

    Family medicine is currently undergoing a transformation and, amid such change, the medical home has emerged as the new polestar. This article examines the medical home through the lens of philosopher Alasdair MacIntyre and offers a perspective, informed by Hubert Dreyfus and Peter Senge, about medical homes as practical sites of formation for family physicians. The intellectual past of family medicine points to contextually sensitive patient care as a practice that is particular to the discipline, with the virtue of "placing patients within contexts over time" as a commonly held virtue. Dreyfus provides a model of knowledge and skill acquisition that is relevant to the training of family physicians in practical wisdom. In this model, there is a continuum from novice to more advanced stages of professional formation that is aided by rules that not only must be learned, but must be applied in greater contextually informed situations. Senge's emphasis on learning organizations-organizations where people are continually learning how to learn together-presents a framework for evaluating the extent to which future medical homes facilitate or retard the formation of family physicians.

  10. The Medical Home: Locus of Physician Formation

    PubMed Central

    Daaleman, Timothy P.

    2013-01-01

    Family medicine is currently undergoing a transformation and, amid such change, the medical home has emerged as the new polestar. This article examines the medical home through the lens of philosopher Alasdair MacIntyre and offers a perspective, informed by Hubert Dreyfus and Peter Senge, about medical homes as practical sites of formation for family physicians. The intellectual past of family medicine points to contextually sensitive patient care as a practice that is particular to the discipline, with the virtue of “placing patients within contexts over time” as a commonly held virtue. Dreyfus provides a model of knowledge and skill acquisition that is relevant to the training of family physicians in practical wisdom. In this model, there is a continuum from novice to more advanced stages of professional formation that is aided by rules that not only must be learned, but must be applied in greater contextually informed situations. Senge’s emphasis on learning organizations— organizations where people are continually learning how to learn together—presents a framework for evaluating the extent to which future medical homes facilitate or retard the formation of family physicians. PMID:18772299

  11. A Qualitative Study of Work-Life Choices in Academic Internal Medicine

    PubMed Central

    Isaac, Carol; Byars-Winston, Angela; McSorley, Rebecca; Schultz, Alexandra; Kaatz, Anna; Carnes, Mary L.

    2013-01-01

    The high attrition rate of female physicians pursuing an academic medicine research career has not been examined in the context of career development theory. We explored how internal medicine residents and faculty experience their work within the context of their broader life domain in order to identify strategies for facilitating career advancement. Semi-structured interviews were conducted with a purposeful sample of 18 residents and 34 faculty members representing male and female physicians at different career stages. Using thematic analysis, three themes emerged: 1) the love of being a physician (“Raison d’être”), 2) family obligations (“2nd Shift”), and 3) balancing work demands with non-work life (“Negotiating Academic Medicine”). Female researchers and educators reported more strategies for multiple role planning and management than female practitioners. Interventions aimed at enhancing academic internists’ planning and self-efficacy for multiple role management should be investigated as a potential means for increasing participation and facilitate advancement. PMID:23605099

  12. Women marginalized by poverty and violence. How patient-physician relationships can help.

    PubMed Central

    Woolhouse, Susan; Brown, Judith Belle; Lent, Barbara

    2004-01-01

    OBJECTIVE: To explore the experiences of women relegated to the margins of society by poverty or violence. DESIGN: Qualitative method of focus groups. SETTING: Shelters and transitional housing in southwestern Ontario. PARTICIPANTS: Thirty-six women staying at shelters or transitional housing. METHOD: Focus groups conducted at five locations explored the women's experiences and interactions with family physicians. MAIN FINDINGS: Two themes emerged from the analysis: power imbalances in patient-physician relationships, and the role of family physicians in creating collaborative relationships. Women who felt demeaned in patient-physician relationships described their family physicians as dominating and intimidating. Women who described relationships as collaborative felt valued and understood. CONCLUSION: Poor or abused women living in shelters who felt powerless in patient-physician relationships felt even more demeaned as they coped with the struggles associated with being poor. Women who had continuous collaborative relationships with their family physicians were able to articulate their needs more readily. PMID:15526876

  13. Academic Blogging: Academic Practice and Academic Identity

    ERIC Educational Resources Information Center

    Kirkup, Gill

    2010-01-01

    This paper describes a small-scale study which investigates the role of blogging in professional academic practice in higher education. It draws on interviews with a sample of academics (scholars, researchers and teachers) who have blogs and on the author's own reflections on blogging to investigate the function of blogging in academic practice…

  14. [Academic origin, development and characteristic of Xujiang acupuncture school].

    PubMed

    Xie, Yufeng; Yang Zongbao; Chen, Yun; Wang, Ling; Wang, Shuhui; Yang, Lixia

    2016-03-01

    The origin time, representative physicians and medical works of Xujiang acupuncture school were traced, so as to explore the academic origin and development and summarize the academic characteristic of Xujiang acupuncture school, which could make a better inheritance of academic essence and prompt the innovation and development of Xujiang acupuncture school.

  15. Workplace discrimination: experiences of practicing physicians.

    PubMed Central

    Coombs, Alice A. Tolbert; King, Roderick K.

    2005-01-01

    BACKGROUND: In response to a growing concern regarding physician discrimination in the workplace, this study was developed to: (1) describe the types of discrimination that exist for the practicing physician and (2) determine which groups of physicians are more likely to experience the various forms of discrimination. METHODS: Surveys were mailed to 1930 practicing physicians in Massachusetts. Participants were asked if they had encountered discrimination, how significant the discrimination was against a specific group, the frequency of personal discrimination, and the type of discrimination. Factor analysis identified four types of discrimination: career advancement, punitive behaviors, practice barriers and hiring barriers. RESULTS: A total of 445 responses were received (a 24% response rate). Sixty-three percent of responding physicians had experienced some form of discrimination. Respondents were women (46%), racial/ethnic minorities (42%) and international medical graduates (IMGs) (40%). In addition, 26% of those classified as white were also IMGs. Over 60% of respondents believed discrimination against IMGs was very or somewhat significant. Almost 27% of males acknowledged that gender bias against females was very or somewhat significant. IMGs were more likely to indicate that discrimination against IMGs was significant in their current organization. Of U.S. medical graduates (USMGs) 44% reported that discrimination against IMGs in their current organization was significant. Nonwhites were more likely to report that discrimination based on race/ethnicity was significant. Nearly 29% of white respondents also believed that such discrimination was very or somewhat significant. CONCLUSIONS: Physicians practicing in academic, research, and private practice sectors experience discrimination based on gender, ethnic/racial, and IMG status. Images Figure 3 Figure 4 Figure 5 PMID:15868767

  16. A family-oriented therapy program for youths with substance abuse: long-term outcomes related to relapse and academic or social status

    PubMed Central

    Wang, Liang-Jen; Lu, Shing-Fang; Chong, Mian-Yoon; Chou, Wen-Jiun; Hsieh, Yu-Lian; Tsai, Tung-ning; Chen, Ching; Lee, Yi-Hsuan

    2016-01-01

    Objective The abuse of illegal substances by youths in Taiwan has become a major public health issue. This study explores the outcomes (relapse rate and academic or social status) of a family-oriented therapy program conducted for substance-using youths who were referred by a judge to participate in it. Methods The present study includes 121 participants categorized into three groups: 36 youths underwent a weekly ten-session outpatient motivational enhancement psychotherapy (MEP) group program; 41 youths participated in a program that combined the aforementioned MEP program with an additional weekly ten-session parenting skill training (PST) program for their guardians (MEP + PST group); and 44 adolescents who received standard supervision by the court served as the control group. All participants were followed-up for a maximum of 2 years. Results Of the 121 participants (mean age: 16.1±1.1 years), 33.1% relapsed into substance use during the follow-up period. The probability of relapse did not differ significantly between the MEP group (36.1%) and the control group (40.9%), but the youths in the MEP + PST group (22.0%) were at a lower risk of relapse than the control group participants (adjusted hazard ratio =0.48, 95% confidence interval [CI] =0.21–1.09). By the end of the study follow-up period, participants in both the MEP group and the MEP + PST group were more likely to be attending school (MEP group: adjusted odds ratio [aOR] =6.61, 95% CI =1.60–27.35; MEP + PST group: aOR =8.57, 95% CI =1.94–37.82) or employed (MEP group: aOR =7.75, 95% CI =1.95–30.75; MEP + PST group: aOR =7.27, 95% CI =1.76–29.97), when compared to the control group. Conclusion This study revealed that a family-oriented treatment approach may be a more effective option for preventing youths’ relapsing into substance abuse. In comparison to individuals who received standard supervision by the court, those who received MEP experienced a better school attendance or social

  17. Academic Hospitality

    ERIC Educational Resources Information Center

    Phipps, Alison; Barnett, Ronald

    2007-01-01

    Academic hospitality is a feature of academic life. It takes many forms. It takes material form in the hosting of academics giving papers. It takes epistemological form in the welcome of new ideas. It takes linguistic form in the translation of academic work into other languages, and it takes touristic form through the welcome and generosity with…

  18. Practice setting and physician influences on judgments of colon cancer treatment by community physicians.

    PubMed Central

    McFall, S L; Warnecke, R B; Kaluzny, A D; Ford, L

    1996-01-01

    OBJECTIVE. This article compares judgments about the treatment of Dukes' B2 and C colon cancer made by general surgeons to those of internists and family practitioners. Physician and practice variables were specialty, affiliation with a Community Clinical Oncology Program (CCOP) hospital, time in practice, professional centrality (level of participation in cancer information networks), solo practice, and number of colon cancer patients. DATA COLLECTION METHODS. Data are combined from national probability samples of CCOP- and non-CCOP-affiliated physicians. This study focused on 1,138 internists, family physicians, and general surgeons who participated in decision making for patients diagnosed with Dukes' B2 or C stage colon cancer. Judgments were elicited using brief vignettes. METHODS OF ANALYSIS. Judgments of adjuvant therapy are classified as (a) consistent with the National Institutes of Health Consensus Conference recommendations (experimental for Dukes' B2, accepted for Dukes' C); (b) accepted treatment for both stages; or (c) experimental for both stages. Multinomial logit analyses were used to examine the association of practice setting and physician characteristics to judgments of treatment. RESULTS. Surgeons and CCOP-affiliated physicians were more likely to endorse the NIH consensus conference position. Surgeons, younger physicians, and those in group practice were more likely to approve of chemotherapy for both cancer stages. The most common position (chemotherapy experimental) was more likely from nonsurgeons, solo practitioners, and non-CCOP physicians. CONCLUSION. Physician and practice setting characteristics, including organized structures such as the CCOP, are possible mediating structures that can facilitate dissemination of standards of treatment. Images Figure 1 PMID:8617610

  19. The physician's reaction to a malpractice suit.

    PubMed

    Lavery, J P

    1988-01-01

    A malpractice suit can have a devastating impact on a practitioner's professional and personal life. The physician's reaction to this event is profound, affecting his own life-style and that of family, colleagues, and patients. This commentary presents an analogy between the physician's reaction to a malpractice suit and the stages of grief described by Elisabeth Kübler-Ross: the sequence of denial, anger, bargaining, depression, and acceptance. Understanding the psychodynamics of this reaction can help physicians to cope with the problems inherent in a malpractice suit and to maintain a greater stability in their personal lives. Adverse effects on medical practice and private life-style, and on the legal proceedings, can be minimized.

  20. Teaching physicians about fraud and program integrity.

    PubMed

    Lyles, Mark A

    2013-08-01

    Program integrity (PI) is defined as a comprehensive strategy to prevent fraud, abuse, errors, and waste in the U.S. health care system. PI has the goal of eliminating improper payments for health care services. In 2012, the Institute of Medicine estimated that the U.S. health care system annually loses $765 billion to waste, including improper reimbursements for unnecessary services, excess administrative costs, inefficiently delivered services, egregious pricing of services, missed prevention opportunities, and fraud. The article by Agrawal and colleagues in this issue presents an excellent overview of the concerted efforts by the Centers for Medicare and Medicaid Services and other payers to ensure the integrity of the public and private health care reimbursement systems. Egregious examples of fraud and abuse are defined easily for physicians, and common administrative mistakes are rectified with better education in billing rules and documentation requirements. However, the more ambiguous areas of PI likely will remain difficult to address. With each episode of health reform, providers and payers are reminded of the current inefficiencies and inconsistencies under which the disparate reimbursement systems in the United States operate. Thus, it is increasingly important for physicians, payers, policy makers, product makers, and patients to collaborate and to collectively define and minimize waste in the U.S. health care system. This commentary reviews current challenges to educating physicians and physicians-in-training about PI and explores a PI education curriculum already in place at a large academic medical center that might serve as a model for other institutions.

  1. Use of Physician Services by Older Adults: 1991/1992 to 2000/2001

    ERIC Educational Resources Information Center

    Watson, Diane E.; Heppner, Petra; Reid, Robert; Bogdanovic, Bogdan; Roos, Noralou P.

    2005-01-01

    Canadians have expressed concern that access to family physicians (FP) has declined. Anonymized physician services data for 1991/1992 to 2000/2001 were used to evaluate changes in supply and age-specific rates of use of FPs and specialists in Winnipeg, Manitoba. Physician-to-population ratios declined 7.5 per cent, FP-to-population ratios declined…

  2. Measuring physicians' productivity in a Veterans' Affairs Medical Center.

    PubMed

    Coleman, David L; Moran, Eileen; Serfilippi, Delchi; Mulinski, Paul; Rosenthal, Ronnie; Gordon, Bruce; Mogielnicki, R Peter

    2003-07-01

    The mission of the Department of Veterans Affairs includes patient care, education, research, and backup to the Department of Defense. Because the measurement of physicians' productivity must reflect both institutional goals and market forces, the authors designed a productivity model that uses measures of clinical workload and academic activities commensurate with the VA's investments in these activities. The productivity model evaluates four domains of physicians' activity: clinical work, education, research, and administration. Examples of the application of the productivity model in the evaluation of VA-paid physician-staff and in the composition of contracts for clinical services are provided. The proposed model is a relatively simple strategy for measuring a broad range of the work of academic physicians in VA medical centers. The model provides incentives for documentation of resident supervision and participation in administrative activities required for effective and efficient clinical care. In addition, the model can aid in determining resource distribution among clinical services and permits comparison with non-VA health care systems. A strategy for modifying the model to incorporate measures of quality of clinical care, research, education, and administration is proposed. The model has been a useful part of the process to ensure the optimum use of resources and to meet clinical and academic institutional goals. The activities and accomplishments used to define physician productivity will have a substantial influence on the character of the medical profession, the vitality of medical education and research, and the cost and quality of health care.

  3. Dismembering the ethical physician

    PubMed Central

    Genuis, S J

    2006-01-01

    Physicians may experience ethical distress when they are caught in difficult clinical situations that demand ethical decision making, particularly when their preferred action may contravene the expectations of patients and established authorities. When principled and competent doctors succumb to patient wishes or establishment guidelines and participate in actions they perceive to be ethically inappropriate, or agree to refrain from interventions they believe to be in the best interests of patients, individual professional integrity may be diminished, and ethical reliability is potentially compromised. In a climate of ever‐proliferating ethical quandaries, it is essential for the medical community, health institutions, and governing bodies to pursue a judicious tension between the indispensable regulation of physicians necessary to maintain professional standards and preserve public safety, and the support for “freedom of conscience” that principled physicians require to practise medicine in keeping with their personal ethical orientation. PMID:16597808

  4. [Family and community medicine and the university. SESPAS report 2010].

    PubMed

    Casado Vicente, Verónica; Bonal Pitz, Pablo; Cucalón Arenal, José Manuel; Serrano Ferrández, Elena; Suárez Gonzalez, Félix

    2012-03-01

    Family and community medicine is an academic subject, a medical specialty and a health profession with distinct dimensions: healthcare, teaching, research and management. In this discipline, the object of knowledge is the person, understood as a whole. Family medicine, as an academic subject, and primary care, as a health education setting, should be incorporated into the core graduate and postgraduate curricula. The absence of these elements leads to training bias and has major repercussions on quality, coordination and patient safety. The development of the Health Professions Act and the construction of the European Higher Education Area (EHEA) have created a favorable climate for the presence of this discipline in the university. Since the 1960s, family medicine has been consolidated as an academic subject with its own departments in almost all European universities, and a significant number of family physicians are teachers. A balance has been achieved between the hospital-based system (based on theory, disease, and the biological model) and the patient-centred model (based on problem solving, community-oriented and the bio-psycho-social model). The introduction of family and community medicine as a specific subject, and as a transverse subject and as an option in practicals, represents the adaptation of the educational system to social needs. This adaptation also represents a convergence with other European countries and the various legal requirements protecting this convergence. However, this new situation requires a new structure (departments) and faculty (professors and associate and assistant professors).

  5. Influences on physicians' adoption of electronic detailing (e-detailing).

    PubMed

    Alkhateeb, Fadi M; Doucette, William R

    2009-01-01

    E-detailing means using digital technology: internet, video conferencing and interactive voice response. There are two types of e-detailing: interactive (virtual) and video. Currently, little is known about what factors influence physicians' adoption of e-detailing. The objectives of this study were to test a model of physicians' adoption of e-detailing and to describe physicians using e-detailing. A mail survey was sent to a random sample of 2000 physicians practicing in Iowa. Binomial logistic regression was used to test the model of influences on physician adoption of e-detailing. On the basis of Rogers' model of adoption, the independent variables included relative advantage, compatibility, complexity, peer influence, attitudes, years in practice, presence of restrictive access to traditional detailing, type of specialty, academic affiliation, type of practice setting and control variables. A total of 671 responses were received giving a response rate of 34.7%. A total of 141 physicians (21.0%) reported using of e-detailing. The overall adoption model for using either type of e-detailing was found to be significant. Relative advantage, peer influence, attitudes, type of specialty, presence of restrictive access and years of practice had significant influences on physician adoption of e-detailing. The model of adoption of innovation is useful to explain physicians' adoption of e-detailing.

  6. Leasing physician office space.

    PubMed

    Murray, Charles

    2009-01-01

    When leasing office space, physicians should determine the effective lease rate (ELR) for each building they are considering before making a selection. The ELR is based on a number of factors, including building quality, building location, basic form of lease agreement, rent escalators and add-on factors in the lease, tenant improvement allowance, method of square footage measurement, quality of building management, and other variables. The ELR enables prospective physician tenants to accurately compare lease rates being quoted by building owners and to make leasing decisions based on objective criteria.

  7. [Hippocrates' treatise physician].

    PubMed

    Frøland, Anders

    2005-01-01

    This small treatise does not appear to have been published in Danish in its entirety. It gives a vivid picture of the physician in ancient Greece. The well known first chapter describes the attitudes and attributes of the doctor. It goes on discussing in some detail how the light should be in the surgery, the instruments to be used, the preparations of bandages and drugs, and the use of cupping instruments. The author stresses both the needs of the patient and the necessity of the physician's dignity and integrity.

  8. Mobile physician order entry.

    PubMed

    Ying, Alan

    2003-01-01

    Because both computerized physician order entry (CPOE) systems and mobile technologies such as handheld devices have the potential to greatly impact the industry's future, IT vendors, hospitals, and clinicians are simply merging them into a logical convergence--"CPOE on a handheld"--with an expectation of full functionality on all platforms: computer workstations, rolling laptops, tablet PCs, and handheld devices. For these trends to succeed together, however, this expectation must be revised to establish a distinct category--mobile physician order entry (MPOE)--that is different from CPOE in form, function, and implementation.

  9. Adoption of new drugs by physicians: a survival analysis

    PubMed Central

    2012-01-01

    Background New drugs often substitute others cheaper and with a risk-benefit balance better established. Our aim was to analyse the diffusion of new drugs during the first months of use, examining the differences between family physicians and specialists. Methods Prescription data were obtained of cefditoren, duloxetine, etoricoxib, ezetimibe, levocetirizine, olmesartan, pregabalin and tiotropium 36 months after their launching. We obtained the monthly number of prescriptions per doctor and the number prescribers of each drug by specialty. After discarding those with less than 10 prescriptions during this period, physicians were defined as adopters if the number of prescriptions was over the 25th percentile for each drug and level (primary or secondary care). The diffusion of each drug was studied by determining the number of adopter family physicians throughout the study period. Among the group of adopters, we compared the month of the first prescription by family physicians to that of other specialists using the Kaplan-Meier method. Results The adoption of the drugs in primary care follows an exponential diffusion curve that reaches a plateau at month 6 to 23. Tiotropium was the most rapidly and widely adopted drug. Cefditoren spread at a slower rate and was the least adopted. The diffusion of etoricoxib was initially slowed down due to administrative requirements for its prescription. The median time of adoption in the case of family physicians was 4-6 months. For each of the drugs, physicians of a specialty other than family physicians adopted it first. Conclusions The number of adopters of a new drug increases quickly in the first months and reaches a plateau. The number of adopter family physicians varies considerably for different drugs. The adoption of new drugs is faster in specialists. The time of adoption should be considered to promote rational prescribing by providing timely information about new drugs and independent medical education. PMID:22401169

  10. The Cultivation of Esteem and Retrieval of Scientific Knowledge in Physician Networks

    ERIC Educational Resources Information Center

    Menchik, Daniel A.; Meltzer, David O.

    2010-01-01

    This article evaluates how physicians draw upon scientific and other forms of knowledge in different professional communities. We argue that because physicians will draw upon clinical research findings to improve their reputation with colleagues, and because the terms for accruing esteem in an academic hospital may differ depending on the dominant…

  11. Identifying public health competencies relevant to family medicine.

    PubMed

    Harvey, Bart J; Moloughney, Brent W; Iglar, Karl T

    2011-10-01

    Public health situations faced by family physicians and other primary care practitioners, such as severe acute respiratory syndrome (SARS) and more recently H1N1, have resulted in an increased interest to identify the public health competencies relevant to family medicine. At present there is no agreed-on set of public health competencies delineating the knowledge and skills that family physicians should possess to effectively face diverse public health challenges. Using a multi-staged, iterative process that included a detailed literature review, the authors developed a set of public health competencies relevant to primary care, identifying competencies relevant across four levels, from "post-MD" to "enhanced." Feedback from family medicine and public health educator-practitioners regarding the set of proposed "essential" competencies indicated the need for a more limited, feasible set of "priority" areas to be highlighted during residency training. This focused set of public health competencies has begun to guide relevant components of the University of Toronto's Family Medicine Residency Program curriculum, including academic half-days; clinical experiences, especially identifying "teachable moments" during patient encounters; resident academic projects; and elective public health agency placements. These competencies will also be used to guide the development of a family medicine-public health primer and faculty development sessions to support family medicine faculty facilitating residents to achieve these competencies. Once more fully implemented, an evaluation will be initiated to determine the degree to which these public health competencies are being achieved by family medicine graduates, especially whether they attained the knowledge, skills, and confidence necessary to effectively face diverse public health situations-from common to emergent.

  12. Informational influences on physician referrals.

    PubMed

    Beltramini, R F; Sirsi, A K

    1992-01-01

    Today's health care marketers are devoting significant resources to increase physician referrals, an area vital to their continued survival. The goal of this investigation was to integrate the findings of previous research on physician referrals, and to provide an up-to-date assessment of those influences underlying physician referral behavior. A questionnaire was mailed to 1,800 physicians differing in specialty and years in practice. Three informational influences were found to affect physician referrals: Program Information, Patient Input, and Location. The results suggest a need for specialists and other organizations interested in managing physician referrals to (a) establish and maintain a network of relationships among those physicians referring patients and specialists being referred to through personal communication, (b) maintain a pool of knowledgeable professionals willing to supply relevant and current information to physicians, and (c) provide complete and prompt feedback information to the referring physician. Managerial implications and directions for future research are also discussed.

  13. Information for travellers' physicians.

    PubMed

    Allison, D J; Blinco, K

    1990-07-01

    Physicians can obtain advice about international travel for their patients from many different sources of information. The authors review some of the most common sources based on their experience at the International Travellers' Clinic operated by the New Brunswick Department of Health and Community Services in Fredericton. They identify readily available handbooks and periodicals and compare two computer software programs.

  14. Medication counselling: physicians' perspective.

    PubMed

    Bonnerup, Dorthe Krogsgaard; Lisby, Marianne; Eskildsen, Anette Gjetrup; Saedder, Eva Aggerholm; Nielsen, Lars Peter

    2013-12-01

    Medication reviews have the potential to lower the incidence of prescribing errors. To benefit from a medication review, the prescriber must adhere to medication counselling. Adherence rates vary from 39 to 100%. The aim of this study was to examine counselling-naive hospital physicians' perspectives and demands to medication counselling as well as study factors that might increase adherence to the counselling. The study was conducted as a questionnaire survey among physicians at Aarhus University Hospital, Denmark. The questionnaire was developed based on focus group interviews and literature search, and was pilot-tested among 30 physicians before being sent to 669 physicians. The questionnaire consisted of 35 items divided into four categories: attitudes (19 items), behaviours (3 items), assessment (8 items) and demographics (5 items). The response rate was 60% (400/669). Respondents were employed at psychiatric, medical or surgical departments. Eighty-five per cent of respondents agreed that patients would benefit of an extra medication review, and 72% agreed that there was a need for external medication counselling. The most important factor that could increase adherence was the clinical relevance of the counselling as 78% rated it of major importance. The most favoured method for receiving counselling was via the electronic patient record.

  15. Physicians in transition.

    PubMed

    Bluestein, P

    1995-12-01

    The study of physicians as managed care executives has been relatively recent. Much of what was written in the past focused primarily on doctors who had taken hospital-based administrative positions, especially as medical directors or vice presidents of medical affairs.1 But the '80s brought rising health care costs and the emergence of the "O's"--HMOs, PPOs, UROs, EPOs, PHOs, H2Os, and Uh-Ohs--in response. It also brought a growing number of physicians who traded their white coats and their particular "ologies" for the blue suits of executive management. I am convinced that it is important now, and will be increasingly important in the future, to better understand that transition. That belief led me to undertake, with the help and support of ACPE, the survey that is reported in this article. A questionnaire was sent in 1994 to a random sample of 300 managed care physician executive members of ACPE. Responses were returned by 225 members, a response rate of better than 80 percent. Twenty-five of the responses were not applicable, having been returned by physicians who had never made a transition from clinical careers. The remaining 230 responses form the basis for this report.

  16. Physicians and Insider Trading.

    PubMed

    Kesselheim, Aaron S; Sinha, Michael S; Joffe, Steven

    2015-12-01

    Although insider trading is illegal, recent high-profile cases have involved physicians and scientists who are part of corporate governance or who have access to information about clinical trials of investigational products. Insider trading occurs when a person in possession of information that might affect the share price of a company's stock uses that information to buy or sell securities--or supplies that information to others who buy or sell--when the person is expected to keep such information confidential. The input that physicians and scientists provide to business leaders can serve legitimate social functions, but insider trading threatens to undermine any positive outcomes of these relationships. We review insider-trading rules and consider approaches to securities fraud in the health care field. Given the magnitude of the potential financial rewards, the ease of concealing illegal conduct, and the absence of identifiable victims, the temptation for physicians and scientists to engage in insider trading will always be present. Minimizing the occurrence of insider trading will require robust education, strictly enforced contractual provisions, and selective prohibitions against high-risk conduct, such as participation in expert consulting networks and online physician forums, by those individuals with access to valuable inside information.

  17. The aeromedical physician assistant.

    PubMed

    Radi, Joshua; Brisson, Michael; Line, Michael

    2016-12-01

    The US Army aeromedical physician assistant (PA) serves aviation units in regards to crewmember medical readiness. All PAs are graduates of a 6-week flight surgeon course. They are responsible for conducting nearly 40% of the annual US Army flight physicals. This unique training and deployment illustrates the growing adaptability of PAs to assume a greater role in military medicine.

  18. Strategies for Working with Families

    PubMed Central

    Bader, Edward; Maimets, Talvi

    1991-01-01

    Family physicians are in contact with families as they pass through various stages and become aware of marital and family problems. By offering guidance and patient education before problems arise, physicians can avoid trouble and encourage healthy marital and parenting patterns. This article presents the Family Life Cycle framework and discusses the stresses that occur at marriage and at the birth of the first child. Helpful tools can be shared with patients. PMID:21228986

  19. Burnout among physicians

    PubMed Central

    Romani, Maya; Ashkar, Khalil

    2014-01-01

    Burnout is a common syndrome seen in healthcare workers, particularly physicians who are exposed to a high level of stress at work; it includes emotional exhaustion, depersonalization, and low personal accomplishment. Burnout among physicians has garnered significant attention because of the negative impact it renders on patient care and medical personnel. Physicians who had high burnout levels reportedly committed more medical errors. Stress management programs that range from relaxation to cognitive-behavioral and patient-centered therapy have been found to be of utmost significance when it comes to preventing and treating burnout. However, evidence is insufficient to support that stress management programs can help reducing job-related stress beyond the intervention period, and similarly mindfulness-based stress reduction interventions efficiently reduce psychological distress and negative vibes, and encourage empathy while significantly enhancing physicians’ quality of life. On the other hand, a few small studies have suggested that Balint sessions can have a promising positive effect in preventing burnout; moreover exercises can reduce anxiety levels and exhaustion symptoms while improving the mental and physical well-being of healthcare workers. Occupational interventions in the work settings can also improve the emotional and work-induced exhaustion. Combining both individual and organizational interventions can have a good impact in reducing burnout scores among physicians; therefore, multidisciplinary actions that include changes in the work environmental factors along with stress management programs that teach people how to cope better with stressful events showed promising solutions to manage burnout. However, until now there have been no rigorous studies to prove this. More interventional research targeting medical students, residents, and practicing physicians are needed in order to improve psychological well-being, professional careers, as well as

  20. Using FTE and RVU performance measures to assess financial viability of academic nurse-managed centers.

    PubMed

    Vonderheid, Susan; Pohl, Joanne; Schafer, Patricia; Forrest, Kathy; Poole, Michele; Barkauskas, Violet; Mackey, Thomas A

    2004-01-01

    Financial performance measures are essential to improve the fiscal management of academic nurse-managed centers (ANMCs). Measures are compared among six ANMCs in a consortium and against an external, self-sustainable, profitable ANMC and national data for family practice physicians. Performance measures help identify a center's strengths and weaknesses facilitating the development of strategies aimed at a variety of targets (business practices related to revenue and costs) to improve financial viability. Using a variety of financial performance measures to inform decision making will aid ANMCs in keeping their doors open for business.

  1. The Physician's Life Cycle: Picketing the Outposts

    PubMed Central

    McSherry, J. A.

    1981-01-01

    The changes which occur in a physician's life relate to stages of personal and professional development. The balance between the demands of practice and the needs of self and family is critical. Early establishment of personal goals and priorities makes it easy to avoid specific hazards which would otherwise compromise enjoyment of a full life and a productive career. A lifelong personal program of medical education nourishes the professional interest which sustains a busy practitioner throughout a demanding career.

  2. Frequently asked questions about family medicine in India

    PubMed Central

    Kumar, Raman

    2016-01-01

    Family medicine (FM) is an independent and distinct medical specialty in the developed countries such as USA, UK, Australia, and Canada since 1960s. FM teaching is imparted at undergraduate and postgraduate levels in countries such as Nepal, Pakistan, and Sri Lanka. Family practice is the practicing vocation of the majority doctors in India. The practitioners of FM include general practitioners, family physicians, FM specialists, and medical officers in the public sector. Medical students are largely unaware about FM career as this concept is not introduced at MBBS level. Faculty and senior doctors from other disciplines are also not able to answer the queries related to FM as they themselves also have gone through the same education system for last three decades, largely unexposed to the concept of academic family medicine. This article is a compilation of frequently asked questions, and their appropriate responses, presented here to dispel myths and misinformation about FM specialty. The answers are deliberated upon by Dr. Raman Kumar the founder president of the Academy of Family Physicians of India and the chief editor of the Journal of Family Medicine and Primary Care. This article was originally published as an interview in Docplexus, a popular online network and website for medical doctors in November 2015. PMID:27453835

  3. Frequently asked questions about family medicine in India.

    PubMed

    Kumar, Raman

    2016-01-01

    Family medicine (FM) is an independent and distinct medical specialty in the developed countries such as USA, UK, Australia, and Canada since 1960s. FM teaching is imparted at undergraduate and postgraduate levels in countries such as Nepal, Pakistan, and Sri Lanka. Family practice is the practicing vocation of the majority doctors in India. The practitioners of FM include general practitioners, family physicians, FM specialists, and medical officers in the public sector. Medical students are largely unaware about FM career as this concept is not introduced at MBBS level. Faculty and senior doctors from other disciplines are also not able to answer the queries related to FM as they themselves also have gone through the same education system for last three decades, largely unexposed to the concept of academic family medicine. This article is a compilation of frequently asked questions, and their appropriate responses, presented here to dispel myths and misinformation about FM specialty. The answers are deliberated upon by Dr. Raman Kumar the founder president of the Academy of Family Physicians of India and the chief editor of the Journal of Family Medicine and Primary Care. This article was originally published as an interview in Docplexus, a popular online network and website for medical doctors in November 2015.

  4. [Short course for primary physicians care].

    PubMed

    Eshet, I; Van Relta, R; Margalit, A; Baharir, Z

    1995-11-15

    This department of family medicine has been challenged with helping a group of Russian immigrant physicians find places in primary care clinics, quickly and at minimal expense. A 3-month course was set up based on the Family Practice Residency Syllabus and the SFATAM approach, led by teachers and tutors from our department. 30 newly immigrated Russian physicians participated. The course included: lectures and exercises in treatment and communication with patients with a variety of common medical problems in the primary care setting; improvement of fluency in Hebrew relevant to the work setting; and information on the function of primary care and professional clinics. Before-and-after questionnaires evaluating optimal use of a 10- minute meeting with a client presenting with headache were administered. The data showed that the physicians had learned to use more psychosocial diagnostic question and more psychosocial interventions. There was a cleared trend toward greater awareness of the patient's environment, his family, social connections and work. There was no change in biomedical inquiry and interventions but a clear trend to a decrease in recommendations for tests and in referrals. The authors recommend the following didactic tools: adopting a biopsychosocial attitude, active participation of students in the learning situation, working in small groups, use of simulations and video clips, and acquiring basic communication experience.

  5. Motivational determinants among physicians in Lahore, Pakistan

    PubMed Central

    2010-01-01

    Introduction Human resource crises in developing countries have been identified as a critical aspect of poor quality and low accessibility in health care. Worker motivation is an important facet of this issue. Specifically, motivation among physicians, who are an important bridge between health systems and patients, should be considered. This study aimed to identify the determinants of job motivation among physicians, a neglected perspective, especially in developing countries. Methods A stratified random sample of 360 physicians was selected from public primary, public secondary and public and private tertiary health facilities in the Lahore district, Pakistan. Pretested, semi-structured, self-administered questionnaires were used. For the descriptive part of this study, physicians were asked to report their 5 most important work motivators and demotivators within the context of their current jobs and in general. Responses were coded according to emergent themes and frequencies calculated. Of the 30 factors identified, 10 were classified as intrinsic, 16 as organizational and 4 as socio-cultural. Results Intrinsic and socio-cultural factors like serving people, respect and career growth were important motivators. Conversely, demotivators across setups were mostly organizational, especially in current jobs. Among these, less pay was reported the most frequently. Fewer opportunities for higher qualifications was a demotivator among primary and secondary physicians. Less personal safety and poor working conditions were important in the public sector, particularly among female physicians. Among private tertiary physicians financial incentives other than pay and good working conditions were motivators in current jobs. Socio-cultural and intrinsic factors like less personal and social time and the inability to financially support oneself and family were more important among male physicians. Conclusion Motivational determinants differed across different levels of care

  6. Academic writing

    NASA Astrophysics Data System (ADS)

    Eremina, Svetlana V.

    2003-10-01

    The series of workshops on academic writing have been developed by academic writing instructors from Language Teaching Centre, Central European University and presented at the Samara Academic Writing Workshops in November 2001. This paper presents only the part dealing with strucutre of an argumentative essay.

  7. A Physician's Guide to Radon

    EPA Pesticide Factsheets

    This booklet has been developed for physicians by the U.S. Environmental Protection Agency in consultation with the American Medical Association (AMA). Its purpose is to enlist physicians in the national effort to inform the American public about radon.

  8. The future for physician assistants.

    PubMed

    Cawley, J F; Ott, J E; DeAtley, C A

    1983-06-01

    Physician assistants were intended to be assistants to primary care physicians. Physicians in private practice have only moderately responded to the availability of these professionals. Cutbacks in the numbers of foreign medical graduates entering American schools for graduate medical education, concern for overcrowding in some specialties, and the economic and clinical capabilities of physician assistants have lead to new uses for these persons. Physician assistants are employed in surgery and surgical subspecialties; in practice settings in institutions such as medical, pediatric, and surgical house staff; and in geriatric facilities, occupational medicine clinics, emergency rooms, and prison health systems. The projected surplus of physicians by 1990 may affect the use of physician assistants by private physicians in primary care.

  9. The Clinical Research Forum and Association of American Physicians disagree with criticism of the NIH Roadmap.

    PubMed

    Crowley, William; Courtney, John; Jameson, Larry; Pardes, Herbert; Moskowitz, Jay; Orringer, Eugene; Rubenstein, Arthur; Wood, Alastair; Rettig, Richard; Ausiello, Dennis; Brenner, David; Collins, Francis; Elias, Jack; Greene, Warner; Horowitz, Ralph; Jameson, Larry; Kieff, Elliott; Thompson, Craig; Swain, Judith L

    2006-08-01

    As representatives of 50 leading academic medical centers focusing on clinical research and many of academic medicine's scientific leaders, the Clinical Research Forum and Association of American Physicians disagree with the JCI's recent editorials on the NIH Roadmap, Elias Zerhouni's leadership, and the future directions of biomedical research.

  10. [Is substance abuse among physicians a problem?].

    PubMed

    Akvardar, Yildiz; Türkcan, Ahmet; Cakmak, Duran

    2002-01-01

    In today's medical community, there is growing concern about substance use among physicians, not only because of their own health, but also because of the potential adverse effects on their clinical practices. Physicians affect public health both by treatment and preventive studies and as role models. Prevalence data concerning substance abuse are generally lacking. There is no consensus on the rates of substance abuse being higher among physicians than among the general public. Physicians are less likely to smoke cigarettes and use illicit substances (like marijuana, cocaine and heroin) and more likely to use alcohol and two types of prescription medications--benzodiazepines and minor opioids--compared with their age groups. Doctors are at special risk of developing addiction problems owing to the strain of medical practice, erosion of the taboo against injecting and using opiates, and particularly access to supplies. The most common precipitating factors mentioned are physical pain and illness, usually chronic, with family tragedy such as death of a wife or child next. The third most common factor is an addicted wife. Stress, overwork and marital problems are also mentioned. No data were found about physicians' substance use in Turkey. This article generally aims to review the knowledge on the prevalence of substance use among physicians, the drug of choice, the development of dependence, the treatment and prognosis and to discuss the importance of this issue by evaluating three cases treated at the Alcohol and Drug Addiction Treatment and Research Center (AMATEM), Bakirköy State Hospital for Mental and Neurological Diseases.

  11. Physicians of ancient India

    PubMed Central

    Saini, Anu

    2016-01-01

    A survey of Indian medical historiography will reveal no dearth of work on the systems of medicine and medical literature of ancient India. However, the people who were responsible for the healing have not received much attention. This article traces the evolution of the physician as a professional in ancient India. This article reviews the secondary literature on healing and medical practice in India, specifically pertaining to the individual medical practitioner, drawing from varied sources. The healers of ancient India hailed from different castes and classes. They were well-respected and enjoyed state patronage. They were held to the highest ethical standards of the day and were bound by a strict code of conduct. They underwent rigorous training in both medicine and surgery. Most physicians were multi-skilled generalists, and expected to be skilled in elocution and debate. They were reasonably well-off financially. The paper also briefly traces the evolution of medicinal ideas in ancient India. PMID:27843823

  12. Beyond compassion fatigue: the transactional model of physician compassion.

    PubMed

    Fernando, Antonio T; Consedine, Nathan S

    2014-08-01

    Physician compassion is expected by both patients and the medical profession and is central to effective clinical practice. Yet, despite the centrality of compassion to medical practice, most compassion-related research has focused on compassion fatigue, a specific type of burnout among health providers. Although such research has highlighted the phenomenon among clinicians, the focus on compassion fatigue has neglected the study of compassion itself. In this article, we present the Transactional Model of Physician Compassion. After briefly critiquing the utility of the compassion fatigue concept, we offer a view in which physician compassion stems from the dynamic but interrelated influences of physician, patient and family, clinical situation, and environmental factors. Illuminating the specific aspects of physicians' intrapersonal, interpersonal, clinical, and professional functioning that may interfere with or enhance compassion allows for targeted interventions to promote compassion in both education and practice as well as to reduce the barriers that impede it.

  13. Physicians in literature: three portrayals.

    PubMed

    Cameron, I A

    1986-02-01

    Literature can provide an objective glimpse of how the public perceives physicians. Physicians have been recipients of the full range of human response in literature, from contempt to veneration. This article examines the impressions of three authors: Mark Twain, Sir Arthur Conan Doyle, and Arthur Hailey. Their descriptions provide insight into the complex relationship physicians have with their colleagues and patients.

  14. Physicians in Literature: Three Portrayals

    PubMed Central

    Cameron, Ian A.

    1986-01-01

    Literature can provide an objective glimpse of how the public perceives physicians. Physicians have been recipients of the full range of human response in literature, from contempt to veneration. This article examines the impressions of three authors: Mark Twain, Sir Arthur Conan Doyle, and Arthur Hailey. Their descriptions provide insight into the complex relationship physicians have with their colleagues and patients. PMID:21267273

  15. [Professional ethics of physicians].

    PubMed

    de Micheli-Serra, Alfredo

    2004-01-01

    Socrates is considered the great classic moralist, although he was not the first to take care of man and morality. Aristotle instituted ethics as an autonomous science and clearly defined its fields, its methods and its purposes, formulating the concept of "happy medium". In the Aristotelian methodology we find traces of Hippocrates, who believed that the physician must always consider the peculiar aspects and that the individual characteristics' determinations can be reached by sensitivity. Once these particularities have been proved, the physician must rely on the "happy medium". Only Stoics could discover, and gradually elaborate, the concept of natural law. Apparently they were the first to establish the classic distinction between the theorical or ideal morality and the practical morality, which is accessible to all people. They refused to compare wisdom, entirely turned inward, with the medical art, which does not constitute an aim by itself. Modern authors assert that, with stoicism, the notion we can denominated wisdom's humanism rised. Today it is admitted that "medicine is more than simply learning medical data.... Physicians must have a wisdom learned from human finitude. They will need this wisdom to tackle the health care policy debates in the next decades". This would be a major cultural undertaking.

  16. Physician nutrition education.

    PubMed

    Kiraly, Laszlo N; McClave, Stephen A; Neel, Dustin; Evans, David C; Martindale, Robert G; Hurt, Ryan T

    2014-06-01

    Nutrition education for physicians in the United States is limited in scope, quality, and duration due to a variety of factors. As new data and quality improvement initiatives highlight the importance of nutrition and a generation of nutrition experts retire, there is a need for new physician educators and leaders in clinical nutrition. Traditional nutrition fellowships and increased didactic lecture time in school and postgraduate training are not feasible strategies to develop the next generation of physician nutrition specialists in the current environment. One strategy is the development of short immersion courses for advanced trainees and junior attendings. The most promising courses include a combination of close mentorship and adult learning techniques such as lectures, clinical experiences, literature review, curricular development, research and writing, multidisciplinary interactions, and extensive group discussion. These courses also allow the opportunity for advanced discourse, development of long-term collaborative relationships, and continued longitudinal career development for alumni after the course ends. Despite these curricular developments, ultimately the field of nutrition will not mature until the American Board of Medical Specialties recognizes nutrition medicine with specialty board certification.

  17. Physician-industry relations. Part 1: individual physicians.

    PubMed

    Coyle, Susan L

    2002-03-05

    This is part 1 of a 2-part paper on ethics and physician-industry relationships. Part 1 offers advice to individual physicians; part 2 gives recommendations to medical education providers and medical professional societies. Physicians and industry have a shared interest in advancing medical knowledge. Nonetheless, the primary ethic of the physician is to promote the patient's best interests, while the primary ethic of industry is to promote profitability. Although partnerships between physicians and industry can result in impressive medical advances, they also create opportunities for bias and can result in unfavorable public perceptions. Many physicians and physicians-in-training think they are impervious to commercial influence. However, recent studies show that accepting industry hospitality and gifts, even drug samples, can compromise judgment about medical information and subsequent decisions about patient care. It is up to the physician to judge whether a gift is acceptable. A very general guideline is that it is ethical to accept modest gifts that advance medical practice. It is clearly unethical to accept gifts or services that obligate the physician to reciprocate. Conflicts of interest can arise from other financial ties between physicians and industry, whether to outside companies or self-owned businesses. Such ties include honorariums for speaking or writing about a company's product, payment for participating in clinic-based research, and referrals to medical resources. All of these relationships have the potential to influence a physician's attitudes and practices. This paper explores the ethical quandaries involved and offers guidelines for ethical business relationships.

  18. Physician resource databank: numbers, distribution and activities of Canada's physicians

    PubMed Central

    Woodward, Christel; Adams, Orvill

    1985-01-01

    The physician resource databank, compiled and maintained by the Canadian Medical Association (CMA), contains functional information from 41 599 of Canada's licensed physicians. The information was gathered from a 20-item questionnaire sent to 47 162 physicians. Of the total, 38 653 responses came from physicians who had completed their training and these were included in the analysis to produce a profile of the supply of physicians in Canada. The data from physicians younger than 35 years indicate some changes in the structure of the supply: 27% are women (compared with only about 9% of physicians older than 45 years). The implications of these statistics are not yet clear, but within the next decade the numbers in some specialties—surgery, anesthesia, obstetrics and gynecology, and radiology—may be too few to meet the demand as more than 20% of the current practitioners reach retirement age. Other findings are that [List: see text] PMID:3995440

  19. How Academic Is Academic Development?

    ERIC Educational Resources Information Center

    Fraser, Kym; Ling, Peter

    2014-01-01

    University provision for academic development is well established in the USA, UK and many other countries. However, arrangements for its provision and staffing vary. In Australia, there has been a trend towards professional rather than academic staff appointments. Is this appropriate? In this paper, the domains of academic development work are…

  20. Family Textbooks Twelve Years Later

    ERIC Educational Resources Information Center

    Glenn, Norval D.

    2009-01-01

    In 1996 the author conducted an intensive study of twenty current family textbooks published in the United States, the results of which appeared in an academic journal article and a nonacademic report in 1997. The study included practical "functionalist" marriage and family textbooks and more academic sociology of the family books; these…