Suggested guidelines for pharmacotherapy curricula in family medicine residency training: recommendations from the Society of Teachers of Family Medicine Group on Pharmacotherapy

Rational drug use has increasingly received public policy attention in efforts to maintain quality health care at lower costs. Prescribing habits are developed during residency training, and education regarding rational drug use should be an integral part of the residency curricula. Considering that many medical errors in family medicine are related to incorrect medication management, there is need for a focused education in pharmacotherapy. This paper outlines suggested guidelines for pharmacotherapy curricula in family medicine residency training, as recommended by the Society of Teachers of Family Medicine Group on Pharmacotherapy. A pharmacotherapy curriculum should include common conditions managed in family medicine, as well as general principles of pharmacotherapy. This should allow for repeated exposure to core topics over a 3-year cycle and be delivered in various settings (didactic teaching, longitudinal active learning, point-of-care education, and rotations). The curriculum should apply and evaluate pharmacotherapy education according to the six core competencies of the Accreditation Council for Graduate Medical Education (ACGME). Although physician faculty can be responsible for pharmacotherapy education, a clinical pharmacist is uniquely qualified to provide this service. Overall, family medicine residents need comprehensive instruction in pharmacotherapy to develop rational prescribing habits. A structured pharmacotherapy curriculum may assist in achieving this goal and in meeting the ACGME core competencies for residency training.     

Family medicine in Cuba: community-oriented primary care and complementary and alternative medicine

Family physicians in Cuba and the United States operate within very different health systems. Cuba's health system is notable for achieving developed country health outcomes despite a developing country economy. The authors of this study traveled to Cuba and reviewed the literature to investigate which practices of Cuban family physicians might be applicable for US family physicians wishing to learn from the Cuban experience. We found that community-oriented primary care (COPC) and complementary and alternative medicine (CAM) are well developed within the Cuban medical system. Because COPC and CAM are already recommended by US family medicine professional bodies, US family physicians may want to learn from the Cuban experience and perhaps incorporate elements into their individual practices.     

Alternative medicine or "alternative" patients: a qualitative study of patient-oriented decision-making processes with respect to complementary and alternative medicine.

BACKGROUND: Theory and clinical practice suggest that complementary and alternative medicine (CAM) decision-making processes may differ from those used in conventional medicine. If so, understanding the differences could improve patient-provider communication around treatment options. OBJECTIVES: To examine patient-oriented decision-making processes relative to CAM use. POPULATION: Adults with chronic rheumatological disorders who utilize allopathic medicine only, CAM only, or both. METHOD: An exploratory, cross-sectional naturalistic design with thematic and content analyses. RESULTS: Three distinct decision paths were developed, differing substantially on the importance of provider trust, disease severity/prognosis, willingness to experiment, intuitive/spiritual factors, and outcomes evidence. CONCLUSIONS: These divergent decision paths indicate the possibility of "alternative patients," not just "alternative therapies." Since informed decisions, tailored to the patient, would likely lead to sustainable improvements in health care outcomes, the findings may facilitate providers' capacity to effectively advise patients about treatment alternatives and CAM use.     

Family medicine clerkship curriculum: competencies and resources

Funded by the Health Resources and Services Administration (HRSA) from 2000-2005, the Family Medicine Curriculum Resource Project (FMCRP) developed a set of resources to improve medical student education. As part of this project, the FMCRP Clerkship Workgroup created and organized resources for developing, teaching, and evaluating a family medicine clerkship. Using the Accreditation Council for Graduate Medical Education competencies as the overarching structure, the organizational scheme incorporated family medicine principles and themes in covering core topics. This curricular resource was designed to be flexible and adaptable to different medical schools and curricular settings.     

Acculturation and the use of complementary and alternative medicine

The use of complementary and alternative medicine (CAM) has been growing substantially in the US in recent years. Such a growth in CAM use coincides with an ongoing increase in the proportion of the foreign-born population in the US. The main objective of this study is to examine the relation between acculturation and the use of CAM therapies among immigrants. Data from a CAM supplement to the 2002 National Health Interview Survey were analyzed to estimate the effects of acculturation on the likelihood of using different CAM therapies over the past 12 months prior to the survey. The results suggest that the level of acculturation-as measured by nativity/length of stay in the US and language of interview-is strongly associated with CAM use. As immigrants stay longer in the US or as their use of English becomes more proficient, the likelihood that they use CAM therapies increases as well, and it gradually approaches the level of CAM use by native-born Americans. Moreover, this relation between acculturation and CAM use generally persists even after the effects of socioeconomic status, health insurance coverage, self-reported health status, and other demographic variables have all been taken into consideration. The substantially lower rates of CAM use by recent immigrants and its possible causes warrant further research.