Medical errors: Preliminary results of a study among Turkish family medicine residents

Abstract

Background: Regular use of evidence-based medicine (EBM) among general practitioners (GP) is insufficient.

Objective: To analyse whether knowledge and attitudes about EBM can be improved among mentors in general practice by involving sixth-year medical students as academic detailers.

Methods: An interventional non-randomized before-and-after study included 98 GPs (49 in the intervention group of mentors and 49 controls) and 174 medical students attending family medicine clinical rotations. A telephone survey on knowledge and attitudes towards EBM was conducted among participating physicians before, and six months after the rotation. During the rotation, each mentor chose two cases from real life, and the students’ task was to form an answerable clinical question, find the evidence-based answer and to write a brief report. The mentor reviewed the report and discussed it with the student.

Results: Students’ EBM detailing intervention led to significant improvement in knowledge and attitudes about EBM in the intervention group of mentors in general practice compared to control GPs (relative increase in knowledge was 20 ± 46.9% vs 6 ± 12.1%, respectively; P = 0.042). Among participants with Ph.D. or specialization in family medicine, the observed effects of the intervention were similar as in the total sample, and statistically significant, but not in the group of participants with neither scientific degree nor specialization in family medicine.

Conclusion: Knowledge and attitudes of GP mentors towards EBM can be improved by involving medical students as academic detailers. Further studies should explore the effectiveness of this method among GPs that are not mentors, and who do not have a specialization or research degree.     

At what stage in the undergraduate curriculum is it best to train in family medicine? A study from two medical schools in Spain

Background: A course in family medicine (FM) could dispel the possibility of negative stereotyping about this speciality, and instil in students a greater interest. However, when is it preferable: at the beginning or at the end of undergraduate training?

Objectives: To determine changes in knowledge and attitudes towards FM by medical students completing a course in primary care at the beginning or the end of the undergraduate training and whether those changes anticipate the choice of speciality.

Methods: Students from Albacete and Seville medical schools (primary care course in second and sixth years, respectively) were asked to respond to the ‘valuation of attitudes towards and knowledge of family medicine questionnaire’ (CAMF). Students from Albacete answered before and after the course, and in Seville second-year students answered at the end of the first trimester. All students were invited to respond again at the end of their undergraduate training. Afterwards, we investigated the score on the speciality exam (order for the election from highest to lowest score) and their choice of speciality. The outcome measures were the MIR exam score, the number in the ranking, the chosen speciality and the result of the CAMF.

Results: In Albacete 88 and 64 and in Seville 50 and 98 students responded in their second and sixth years, respectively. In Albacete, mean CAMF scores were 15.4, 22.7 before and after the course, and 21.8 at the end while in Seville, 13.9 in the second year, and 23.5 in the sixth year. Logistic regression analysis showed an association of the choice of FM only with the score on the speciality exam (OR: 0.667; 95%CI: 0.553–0.806).

Conclusion: There were no significant differences between CAMF scores at the end of undergraduate training. Only the score on the speciality exam predicts FM choice: the higher the score, the lower the probability of choosing FM.     

The attractiveness of family medicine among Polish medical students

Background: In many developed countries tuning supply and demand of medical doctors is a continuous challenge to meet the ever changing needs of community and individual patients. The long study period for medical doctors creates the opportunity to observe the current career preferences of medical students and evolution in time.

Objectives: To investigate the career choices of Polish students in different stages of their medical education.

Methods: Medical students at five Polish medical universities were questioned about their career aspirations in the first, third and sixth year.

Results: A total of 2020 students were recruited for the survey. Among first year students 17% preferred family medicine as final career option, compared to 20% in the third year, and 30% in the sixth year (significant trend, P < 0.0001). In particular, female students prefer family medicine: 71% women versus 62% women in the group with a preference for a non-family medicine orientation (P = 0.008). Medical students rejecting a career as a family doctor stated that the impossibility to work in a hospital environment was the determining factor.

Conclusion: The opportunity for professional development seems to be an important determining factor in the choice of a medical specialty in Poland. The proportion of Polish students choosing family medicine increases during their progress in medical education, with one third of students interested in a career in family medicine by year six.     

¿Qué características de los estudiantes de medicina se relacionan con mejores conocimientos y actitudes hacia la medicina de familia?

ObjectiveTo find out what sociodemographic and academic variables are associated with better knowledge and attitudes towards family medicine, before and after carrying out an assignment in primary care.Design“Before-after” study.SettingFaculty of Medicine.ParticipantsStudents enrolled in a primary health care assignment.Main measurementsKnowledge and attitudes on family medicine have been evalaluated as dependent variables, using an ad hoc designed questionnaire, consisting of 34 questions with 5 response options on a Likert type scale. The questionnaire, which also included questions on the sociodemographic and academic characteristics of the students was administered the day before classes started and at the end of the course. The scores on knlwledge and attitudes have been evaluated according to the different values of the sociodemographic and academic variable using multiple linear regression analysis.ResultsA total of 44 students filled in both questionnaires (54.3% of those enrolled). Sex was the only variable that was associated with the questionnaire total score before starting the classess (P=0.004). However, when age was was included in the model as a dichotomic variable (19 years vs. 20 years or more) and the sex-age interaction, these were also significant (P=0.011 and P=0.031, respectively). At the end of the course, only sex showed a significant association (P=0.013).ConclusionsFemales and younger student are the ones who demonstrate more favourable attitudes towards family medicine and primary health care.     

Admission factors predicting family medicine specialty choice: a literature review and exploratory study among students in the Rural Medical Scholars Program

Purpose: The Rural Medical Scholars Program (RMSP) was created to increase production of rural family physicians in Alabama. Literature review reveals reasons medical students choose careers in family medicine, and these reasons can be categorized into domains that medical schools can address through admission, curriculum, and structural interventions. We examine whether admission factors can predict family medicine specialty choice among students recruited from rural Alabama. Methods: We developed a questionnaire to study the ability of admission factors to predict family medicine specialty choice among Rural Medical Scholars (RMS). Eighty RMS graduates were surveyed by mail and 64 (80%) responded. Findings: Student characteristics of humanitarian outlook with commitment to rural or underserved populations, family medicine decision or intention made before or at medical school admission, and community influence were positive associations with RMS choosing family medicine residencies; shadowing in an urban hospital was a negative association. Conclusions: Statements of interest, intentions, plans, and decisions regarding family medicine should be elicited at the time of RMSP admission interview. Strong attachment to home community and commitment to serving and living in a rural area are also important. Students whose introduction to medicine was informed through shadowing or observing in urban hospitals should be considered less likely to become family physicians. Larger sample size studies are needed to assess the role of gender, race, marital status, size of rural town, and MCAT score of candidates in affecting residency choices of students selected for this rural medical education track.     

Who goes into family medicine?

A study was designed to identify criteria that could help select applicants to medical school with a lasting commitment to family medicine and to test the application of such criteria to predict career choice. The sample included 43 residents and physicians who chose family medicine when they entered medical school and five residents who decided on family medicine later. From the initial group, 19 remained stable in their choice of family medicine, and 24 switched to another specialty. Medical school folders and telephone interviews were used as data sources. The characteristics of stable family physicians and those who became specialists were identified, and the predictive power of these criteria was tested with 30 graduates selected at random. Based only on their entrance records, 25 of the 30 graduates were correctly identified as future family physicians or specialists. The use of these criteria in the admission process is discussed in terms of increasing the number of students who will become stable family physicians.     

Attitudes of Medical Students Towards Psychiatry

Objective: The attitudes of medical students towards psychiatry and psychotherapy were examined considering the extent of their education, previous psychiatry experience, the evaluation of the course, their career intentions and socio-demographic variables. Methods: Five hundred and eight medical students in their second, fifth, ninth and tenth semester completed a questionnaire on “Attitudes Towards Psychiatry” (ATP-30). Results: With 508 participants (return quota: 88%), the study showed no overall change in attitude in the ATP-30 during the course of the study. No general change in attitude following practical training in psychiatry was found. The more positive the psychiatry course was rated the more positive attitudes towards psychiatry were. Female students and students with psychiatry/psychotherapy experience had a significantly more positive attitude towards psychiatry as a subject. Overall 5.8% of all students showed a very positive attitude towards psychiatry. Conclusion: A positive education experience as well as personal experience increases the probability of a positive student attitude towards psychiatry. In order to assure adequate care for the mentally ill, it should be a fundamental aim of medical education to promote positive attitudes towards the mentally ill and psychiatry. It remains to be investigated, however, whether an improvement in the attitudes of students towards the psychiatry discipline is sufficient to increase the number of students who would like to become psychiatrists or whether other factors are more deciding such as career opportunities, conditions of further education, or income potential.     

The reputation and professional identity of family medicine practice according to medical students: A Spanish case study

ObjectiveOver the last decade, family medicine has been progressively rejected by medical students as a career choice in many Western countries. Our objective is to contribute to a better understanding of this phenomenon by examining the reputation of and identification processes with family medicine by medical students.DesignA qualitative case study.MethodsFocus groups and document analysis were used for generating empirical material. Focus groups (n=6) were conducted (2008–2009). Thematic analysis was adopted as the technique for analyzing data gathered.SettingA faculty of medicine of a Spanish university.ParticipantsSecond and sixth year undergraduate medical students (N=48).ResultsFamily medicine appears to be largely devalued as a professional activity, among medical students, being viewed as a monotonous and non-technological medical practice with no intellectual challenge. Such a negative view, which already appears in early stages of medical training, leads to a lack of identification with this medical practice by students.ConclusionMisconceptions about the practice of family medicine, created and reproduced in health care system and societal contexts, encourage the practice of specialized medicine. In addition, the academic environment appears to promote organ- and disease-based medical knowledge, which goes against the holistic and patient-centered approach characteristic of the practice of family medicine. In order to improve the reputation of family medicine and for it to be considered as an attractive career path by medical students, it is recommended that family medicine is developed as an academic medical field, and that improvements are made in the conditions and status of this medical practice within the health care system.     

Mentor mother support for mothers experiencing intimate partner violence in family practice: A qualitative study of three different perspectives on the facilitators and barriers of implementation

Background: Intimate partner violence (IPV) is highly prevalent and associated with physical and mental health problems. Mentor mother support is a low threshold intervention in family practice consisting of support by non-professionals trained to support mothers experiencing IPV. A mentor mother support study showed reduced exposure to IPV and decreased symptoms of depression.

Objectives: Identify factors determining implementation success of mentor mother support in family practice.

Methods: Individual interviews were conducted with 12 family physicians, 16 abused mothers and three mentor mothers. Four mentor mothers participated in a focus group. Qualitative content analysis was used to analyse the data.

Results: The identification and discussion of abuse is hindered by family physicians’ attitudes because they considered mothers experiencing IPV as a difficult target group with a responsibility of their own to break out of their violent situation. Some family physicians doubted the partner’s violence because he was known as a patient as well. Acceptance of mentor mother support is related to the readiness for change of mothers experiencing IPV. Mentor mothers facilitate acceptance and completion of their support by connecting as a friend who is equal and less threatening than professionals.

Conclusion: To improve successful implementation of mentor mother support in primary care, we should focus on family physicians’ attitudes towards IPV. To change these attitudes, we recommend continuous training of family physicians. By being paraprofessional friends, mentor mothers offer low threshold support that is complementary to professional support and should be embedded more widely in primary care.

KEY MESSAGES

• We need to focus on family physicians’ attitudes towards IPV to improve the support for mothers experiencing IPV.

• As ‘paraprofessional friends,’ mentor mothers offer low-threshold support that is complementary to professional support.

     

Factors affecting future choice of specialty among first-year medical students of the University of the West Indies, Trinidad

BACKGROUND: This study was conducted to determine factors that influence career choice among 1st-year medical students. DESIGN AND METHODS: A cross-sectional survey of 170 1st-year medical students from the University of the West Indies, St Augustine Campus was undertaken with a questionnaire designed to assess their perceptions of careers in various specialties. Likert scales were used to quantify the reasons for their preferences. RESULTS: The response rate was 136/170 (80%). The age of respondents ranged from 16 to 36 years, mean 20.45, SD 2.88. Of the generic factors students considered important in their choice of a specialty, students ranked the ability to help patients the highest (rating of 1.44), along with the diagnosis and treatment of disease second (rating of 1.49); 38 (27.9%) cited medicine, 26 (19.1%) surgery, 13 (9.6%) paediatrics, 10 (7.4%) family practice and 4 (2.9%) psychiatry as their chosen career. Students begin their medical training with the view that a career in psychiatry is less attractive than other specialties surveyed. The average attractiveness was estimated as surgery 1.64, medicine, 1.81, paediatrics 1.95 and psychiatry 2.57. The differences between the averages were highly significant (F = 57.6, P < 0.001). CONCLUSION: The findings suggest that although 1st-year medical students rank the diagnosis and treatment of disease and the ability to help patients as the greatest influence in choosing a specialty, internal medicine was the most popular chosen career, while the surgical specialties were identified as the most attractive. Medical students have serious reservations about psychiatry as a career choice.     

Family Medicine in South Africa: where are we now and where do we want to be?

Objectives: This paper outlines the development of family medicine in South Africa with special reference to the process leading to the recognition of this discipline as a medical specialty. It also examines the constraints under which the discipline has had to function, considers where the discipline should be, seeks to identify the barriers to its further development and suggests ways in which to overcome these.

Methods: A short review was carried out of the available South African literature to record the advancement of the discipline and the international literature was searched for articles supporting this direction.

Results: The situation in South Africa is complicated by the existence of many doctor groupings claiming to represent the generalist and the perception that family medicine only addresses the needs of middle-class citizens. A flawed consultative process leading up to the present stage has contributed to this perception.

Conclusions: The available literature supports the establishment of family medicine as a speciality. Developments in South Africa, such as raising the status of Family Medicine and creating a compulsory rotation through family medicine as an extended internship and the creation of registrar posts in family medicine will advance the discipline in a positive manner, whilst possibly attempting to resolve the medical migration issues that are presently destroying Sub-Saharan Africa's health services. Eur J Gen Pract 2005;11(3):127–30.     

Relationships between occupational therapy students’ understandings of disability and disability attitudes

Abstract

Background: Entering occupational therapy (OT) students have established beliefs, informed by sociocultural backgrounds. Understanding how students define and understand disability, and the relationships these understandings have to disability bias, can guide curriculum design decisions to integrate meso and macro level perspectives of disability into clinical reasoning.

Aim/Objective: This study’s aim was to explore incoming occupational therapy students’ (n?=?67) understandings of disability and their attitudes towards it.

Material and method: An online survey was used to collect data on students’ attitudes and definitions of disability. Mixed research methods were used to analyze students’ definitions of disability (content analysis) in relation to disability attitudes (Disability Attitudes Implicit Association Test).

Results/Finding: Findings reveal students enter curriculums with vast differences in understandings of people with disabilities and these may provide a basis for and contribute to differences in attitudes of disability.

Conclusions: OT students have established beliefs of disability as individualized or more socially constructed and these influence disability biases.

Significance: Students’ education has considerable influence in shaping attitudes and ways of interacting with people with disability. Understanding students’ assumptions as they enter a program is a first step to evaluate how curriculum design may influence development of student clinical reasoning strategies.     

What Do Resident Physicians Know about Nutrition? An Evaluation of Attitudes,Self-Perceived Proficiency and Knowledge

Objective: Despite the increased emphasis on obesity and diet-related diseases, nutrition education remains lacking in many internal medicine training programs. We evaluated the attitudes, self-perceived proficiency, and knowledge related to clinical nutrition among a cohort of internal medicine interns.

Methods: Nutrition attitudes and self-perceived proficiency were measured using previously validated questionnaires. Knowledge was assessed with a multiple-choice quiz. Subjects were asked whether they had prior nutrition training.

Results: Of the 114 participants, 61 (54%) completed the survey. Although 77% agreed that nutrition assessment should be included in routine primary care visits, and 94% agreed that it was their obligation to discuss nutrition with patients, only 14% felt physicians were adequately trained to provide nutrition counseling. There was no correlation among attitudes, self-perceived proficiency, or knowledge. Interns previously exposed to nutrition education reported more negative attitudes toward physician self-efficacy (p = 0.03).

Conclusions: Internal medicine interns’ perceive nutrition counseling as a priority, but lack the confidence and knowledge to effectively provide adequate nutrition education.     

Factors related to the choice of family medicine: a reassessment and literature review

BACKGROUND: Recent decreases in the number of students entering family medicine has prompted reconsideration of what is known about the factors affecting specialty choice. METHODS: Thirty-six articles on family medicine specialty choice published since 1993 were reviewed and rated for quality. RESULTS: Rural background related positively and parents' socioeconomic status relates negatively to choice of family medicine. Career intentions at entry to medical school predict specialty choice. Students who believe primary care is important, have low income expectations, and do not plan a research career are more likely to choose family medicine. The school characteristic related to choice of family medicine is public ownership. Large programs to increase numbers entering primary care seem effective. Required family medicine time in clinical years is related to higher numbers selecting family medicine. Faculty role models serve both as positive and negative influences. Students rejecting family medicine are concerned about prestige, low income, and breadth of knowledge required. Students planning on a career in a disadvantaged or rural area are more likely to enter family medicine. CONCLUSIONS: Multiple factors are consistently shown to be related to the choice of the specialty of family medicine.     

Health care provider knowledge around shared clinical decision-making regarding HPV vaccination of adults aged 27–45 years in the United States

BackgroundThe Advisory Committee on Immunization Practices (ACIP) recommends shared clinical decision-making (SCDM) regarding HPV vaccination for adults aged 27–45 years who are not adequately vaccinated. The objective of this survey was to understand physician knowledge, attitudes, and practices regarding HPV vaccination in this age group.MethodsAn online survey was administered in June 2021 to physicians who reported practicing internal medicine, family medicine, or obstetrics and gynecology (targeted N = 250 in each practice specialty), selected randomly from potentially eligible physicians from a panel of 2 million U.S. health care providers.ResultsIn total, 753 physicians participated in the survey: 33.3% practiced internal medicine, 33.1% practiced family medicine, and 33.6% practiced obstetrics/gynecology; 62.5% were male and mean physician age was 52.7 years. Despite the COVID-19 pandemic, at least a third of participating physicians in each practice specialty reported having more HPV vaccine SCDM discussions with patients aged 27–45 years in the past 12 months. While a majority of physicians (79.7%) reported being aware of the SCDM recommendation for adults in this age group, only half of physicians answered an objective knowledge question about SCDM recommendations correctly.ConclusionsFindings suggest that there are physician knowledge gaps related to SCDM for HPV vaccination. To improve access to HPV vaccination for people most likely to benefit, increasing availability and use of decision aids to support SCDM discussions might help healthcare providers and patients jointly make the most informed decisions about HPV vaccination.     

Letter to the Editor: Barriers to effective asthma care in inner city general practice: Reply by the Authors

Objective: To monitor the future career preferences of medical students throughout their undergraduate years and into their postgraduate career, and to evaluate which factors may influence career choice intentions, and when this happens, over time. Design: Longitudinal study. Methods: Questionnaire to all Aberdeen, United Kingdom, Medical School entrants in 1996, and five annual follow-ups (four undergraduate, one postgraduate). Results: Response rates: year 1, 100%; year 2, 78%; year 3, 70%; year 4, 64%; year 5, 65%; pre-registration house officer (PRHO), 60%. Throughout the study, females were more positive about a career in general practice. General practice was the first choice for 13% of students in year 1; year 2, 9%; year 3, 22%; year 4, 24%; year 5, 27%; PRHO, 29%. Those choosing general practice were more likely than those choosing other specialties to be female, have their family home in Scotland, rate their academic abilities lower and their non-academic abilities as average, and have decided on their future career earlier. Reasons for general practice included: working in and being part of a community; continuity of patient contact; variety of illnesses and people encountered; undergraduate teaching experiences; dislike of or disillusionment with hospital medicine; and an increasing awareness of part-time opportunities.

Conclusion: As medical undergraduates progressed through the curriculum and became PRHOs, general practice became more popular as a career choice, particularly with females. This may be partly explained by the increased exposure to general practitioners and patients in the new community-based teaching programme and the increasing awareness of lifestyle advantages with the particular benefits of more regular hours and working part time.     

Tolerance of intimate partner violence and sexist attitudes among health sciences students from three Spanish universities

ObjectiveTo explore university health science students’ intimate partner violence tolerance and sexist attitudes and to examine their trend throughout the academic years.MethodsCross-sectional study of students of both sexes of the degrees of medicine, nursing, and psychology from three selected Spanish universities (n = 1,322). Data were collected anonymously using two validated scales: the Dating Violence Questionnaire (DVQ-R) and the Gender Role Attitudes Scale (GRAS). Logistic regressions were used to compare tolerance toward violence and sexist attitudes across the degrees. The evolution of these variables throughout different academic courses was assessed.ResultsOf the sample, 62.8% were tolerant towards intimate partner violence. The percentage of tolerant students was significantly higher in Psychology (75.9%) than in Nursing (57.7%) and Medicine Degrees (60.3%). A higher percentage of sexist students was also found in psychology students (80.8%) than in nursing (62.2%) and medicine students (62.7%). Compared to the first-year students, female medicine students of the last courses were less tolerant to intimate partner violence (p-trend <0.001), and male medicine students had less sexist attitudes (p-trend = 0.002).ConclusionsTolerance of intimate partner violence and sexist attitudes were very high, especially among psychology students. These indicators were significantly better among medicine students of higher courses, suggesting a positive effect of medical training. Intimate partner violence in the university education of the future health professionals should be addressed..     

Physical abuse – physicians knowledge and reporting attitude in Israel

The objective of this study was to assess knowledge and attitudes towards physical child abuse among pediatricians and family physicians in northern Israel. Methods: An interview consisting of multiple choice questions and vignettes were employed. A stratified sample of 107 physicians from hospitals and community clinics and of different disciplines and educational cultural backgrounds was surveyed. Results: Child abuse diagnosis was considered infrequently or not at all by 43% of the participants and a proportion of them were hesitant in their reporting intentions. A low consistency in the approach to diagnosis and management was found. Medical discipline, sex and age of the physician as well as level of knowledge and the family's socioeconomic status were not significantly related to reporting behaviors. A significant effect of medical training/cultural background (p = 0.01) and medical discipline (p = 0.04) on knowledge of child abuse were found. No relationship between knowledge and reporting behaviour was found. Conclusion: The results of this study are a reason for concern. A more active role of medical schools and health administrations in abuse- oriented education and training effort is required, particularly in societies in transition.     

Medical school entrance and career plans of Malaysian medical students

This study investigates the reasons for entry to medicine and the career perspectives of phase III medical students of the Universiti Sains Malaysia (USM). The majority of the students were Malays from low socio-economic backgrounds who entered medical school after completing a 2–year matriculation course. An interest in medicine and helping people were the two main stated reasons for entry to medical school. A group of students wishing to work in private practice was identified. In comparison to the rest of the study body, students in the group were: not well prepared to enter medical school; dissatisfied with the course; and subject to family influences. A desire for monetary gain motivated their choice of medicine as a career. Overall, 13% of the students wished to change career because they were dissatisfied with their experience of medicine as undergraduates.
The study did not find a significant difference in career intentions between female and male medical students. However, women were less likely to seek entrance into private practice or pursue formal postgraduate education. The choice of surgery as a career was confined to men. About 90% of the students had already decided on their future specialty. Four well-established specialties were their most popular choices. The gender of the students had no significant influences of the decision to continue into postgraduate education. The proportion of female students who wished to marry doctors was significantly higher than for male students.     

Using electronic surveys to gather information on physician practices during a response to a local epidemic—Rhode Island, 2011

BackgroundElectronic invitations may improve physician response rates to participate in internet surveys administered by public health agencies.MethodsFollowing an increase in reported HIV/syphilis co-infection diagnoses among men-who-have-sex-with-men in Rhode Island, we invited the state's 700 adult primary care and emergency medicine physicians via e-mail to participate in an online, multiple choice survey covering their knowledge, attitudes, and practices regarding sexually transmitted diseases and HIV testing and prevention. Survey invitations were released in three waves over 28 days, triggered by declining daily response rates.ResultsAmong 53% (n = 372) who agreed to participate, 68% (n = 252) completed all questions. Response was higher among internal medicine physicians than either family medicine or emergency medicine physicians (63% vs. 20% and 19%, respectively; P<0.0001). Daily response rates were highest in the first 48 hours after sending a reminder e-mail.ConclusionThis approach supported the Rhode Island Department of Health in rapidly gathering useful physician practice information during an outbreak. Internet-based survey tools coupled with increased prevalence of mobile communication devices and social media could greatly decrease the time and cost of shoe-leather epidemiology.