Specialist training of Slovene family physicians

Family medicine in Europe started to develop in the 1960s with the introduction of obligatory specialist training. Slovenia is a country with a long tradition of family medicine specialist training, but up until 2002 this was neither elaborated on nor conducted by peers in general practice/family medicine. When the country's socialist system started to transform due to political reforms, Slovenia began to modify its system in order to meet the criteria of the European Union. One of the changes was the introduction of a new healthcare system with an influential Medical Chamber responsible for postgraduate training in all specialities. A new model for vocational training in family medicine was established in 2002, following the recommendations of the European Union of General Practitioners (UEMO). According to the new programme, which lasts 4 years, trainees spend half of their training in a hospital setting and half in general practice, where they are supervised by a trainer in practice. This article describes the legal process of introducing new forms of specialist training in Slovenia, and its content.

Conclusion: A comparison with UEMO countries shows that the new model is comparable to other countries.     

Specialist training of Slovene family physicians

Family medicine in Europe started to develop in the 1960s with the introduction of obligatory specialist training. Slovenia is a country with a long tradition of family medicine specialist training, but up until 2002 this was neither elaborated on nor conducted by peers in general practice/family medicine. When the country's socialist system started to transform due to political reforms, Slovenia began to modify its system in order to meet the criteria of the European Union. One of the changes was the introduction of a new healthcare system with an influential Medical Chamber responsible for postgraduate training in all specialities. A new model for vocational training in family medicine was established in 2002, following the recommendations of the European Union of General Practitioners (UEMO). According to the new programme, which lasts 4 years, trainees spend half of their training in a hospital setting and half in general practice, where they are supervised by a trainer in practice. This article describes the legal process of introducing new forms of specialist training in Slovenia, and its content. CONCLUSION: A comparison with UEMO countries shows that the new model is comparable to other countries.     

Community service by North Carolina family physicians

BACKGROUND: Community service is an integral part of American society. Although Family Medicine advocates community service through community medicine, few data exist on family physicians' involvement in voluntary community service activities or roles as community advocates. METHODS: A questionnaire was mailed to 489 North Carolina family physicians, including a 20% random sample of those in community practice and all statewide faculty physicians. The survey assessed types and amount of volunteer activity, attitudes toward volunteer work, and factors that support or inhibit participation in community service. RESULTS: The overall response rate was 54%. Most respondents reported strong interests in community service before medical school and residency, yet few reported any relevant training during medical education. More than 85% of faculty and community practice family physicians reported participating in volunteer service in the previous year (70.8 mean hours for faculty vs 45.5 mean hours for community practice; P = .06). Family physicians also reported a wide variety of lifetime volunteer activities (mean number of different faculty physician activities 20.8 vs mean number of different community practice physician activities 16.7, P = .00). Less than 50% of both physician groups reported that their practice or program publicly supports those performing community service. CONCLUSIONS: The great majority of family physicians in North Carolina regularly participate in one or more volunteer community service activities, frequently without organizational recognition. Data about the scope of service expected by communities and provided by physicians may assist the discipline in clarifying the place of volunteer community service in medical education, promotion guidelines and practice.     

Inpatient resource use: a comparison of family medicine and internal medicine physicians.

BACKGROUND. It is not known whether differences exist between the use of inpatient resources by family medicine and internal medicine physicians when patient demographic and complexity variables are statistically controlled. METHODS. The study population was all patients in 13 higher volume diagnosis-related groups (DRGs) discharged from the family medicine (n = 306) and internal medicine services (n = 2374) of the University of Cincinnati Hospital during 1985 and 1986. The dependent variables were length of stay and inpatient readmission within 2 weeks. Stratification by DRGs was used to control for the effects of age and case mix on these variables. RESULTS. With the exception of findings regarding one DRG, the results do not indicate that differences exist in average length of stay between patients of family medicine and internal medicine physicians after adjustment for other variables. Furthermore, almost all of the explained variance in length of stay was attributed to patient complexity and not to physician specialty or patient race or sex. For all discharges, the proportion of patients readmitted within 2 weeks was about 4% higher for the internal medicine service. However, multivariate analysis did not support the importance of physician specialty (family medicine or internal medicine) as a predictor of whether readmission occurred within 2 weeks. CONCLUSIONS. General indicators of resource use (such as length of stay or readmission occurrence) without adjustment for patient case mix, demographics, and complexity are inadequate for comparison of health care providers. Further research regarding interspecialty differences should use longitudinal data from large populations, which would permit more detailed examination of resource utilization.     

Fixing family medicine residency training

The number of US medical students entering family medicine continues to decline. Despite the increased presence of family physicians on medical school faculty and increased exposure to family medicine during training, students still cite lack of respect and excessive knowledge base to master as reasons for not choosing our specialty. Specific changes must be made to family medicine residency training to make it more attractive to students and more compatible with the realities of practice today. These changes include eliminating maternity care as a requirement, lengthening training to 4 years, and reducing the number of residency slots available. These changes will ensure that graduating family physicians will be better prepared for practice, better qualified to obtain privileges in the hospital and clinic, and more respected by their colleagues and the public.     

Disaster medicine training in family medicine: a review of the evidence

When disasters strike, local physicians are at the front lines of the response in their community. Curriculum guidelines have been developed to aid in preparation of family medicine residents to fulfill this role. Disaster responsiveness has recently been added to the Residency Review Committee Program Requirements in Community Medicine with little family medicine literature support. In this article, the evidence in support of disaster training in a variety of settings is reviewed. Published evidence of improved educational or patient-oriented outcomes as a result of disaster training in general, or of specific educational modalities, is weak. As disaster preparedness and disaster training continue to be implemented, the authors call for increased outcome-based research in disaster response training.     

Learning by contract in family medicine training

The Family Medicine Programme (FMP) of the Royal AustralianCollege of General Practitioners is a national programme ofvocational training for general/family practice. In 1981 thedecision was made to adopt ‘learning by contract’as an educational method leading to the certification of training.This paper describes the educational philosophy of the FMP andits importance in this decision. The experience of the authorsin the implementation of learning by contract is also described.     

The cost-effectiveness of training US primary care physicians to conduct colorectal cancer screening in family medicine residency programs

BackgroundDemand for a wide array of colorectal cancer screening strategies continues to outpace supply. One strategy to reduce this deficit is to dramatically increase the number of primary care physicians who are trained and supportive of performing office-based colonoscopies or flexible sigmoidoscopies. This study evaluates the clinical and economic implications of training primary care physicians via family medicine residency programs to offer colorectal cancer screening services as an in-office procedure.MethodsUsing previously established clinical and economic assumptions from existing literature and budget data from a local grant (2013), incremental cost-effectiveness ratios are calculated that incorporate the costs of a proposed national training program and subsequent improvements in patient compliance. Sensitivity analyses are also conducted.ResultsBaseline assumptions suggest that the intervention would produce 2394 newly trained residents who could perform 71,820 additional colonoscopies or 119,700 additional flexible sigmoidoscopies after ten years. Despite high costs associated with the national training program, incremental cost-effectiveness ratios remain well below standard willingness-to-pay thresholds under base case assumptions. Interestingly, the status quo hierarchy of preferred screening strategies is disrupted by the proposed intervention.ConclusionsA national overhaul of family medicine residency programs offering training for colorectal cancer screening yields satisfactory incremental cost-effectiveness ratios. However, the model places high expectations on primary care physicians to improve current compliance levels in the US.     

Hospital privileges for family physicians: documentation of family practice residents' experiences in training

This report describes a study of the content and uses of the University of Washington Affiliated Residency Network documentation system for future hospital privileges. The selected procedures and problems considered important to document for future hospital privileges were validated by means of a graduate survey conducted in 1985. Fifty percent of the 43 graduates responding used their personal documentation when applying for hospital privileges. Intermediate-sized hospitals of 50 to 199 beds were significantly more likely to require documentation than either small (fewer than 50 beds) or large (more than 200 beds) hospitals. However, 84 percent of the hospitals where graduates are located either require documentation or would find it helpful for privilege application. The three-year cumulative experiences of the 1986 cohort of graduating residents are also presented. Thirty-six of the residents (71 percent) participated actively in the voluntary network documentation system. None of the items selected as important to document for future hospital privileges were recorded by 100 percent of the residents. Obstetric procedures and problems were the items most commonly documented.