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INTRODUCTION Measurement of family medicine research productivity has lacked the replicable methodology needed to document progress. AIM In this study, we compared three methods: (1) faculty-to-publications; (2) publications-to-faculty; and (3) department-reported publications. METHODS In this cross-sectional analysis, publications in peer-reviewed, indexed journals for faculty in 13 US family medicine departments in 2015 were assessed. In the faculty-to-publications method, department websites to identify faculty and Web of Science to identify publications were used. For the publications-to-faculty method, PubMed's author affiliation field were used to identify publications, which were linked to faculty members. In the department-reported method, chairs provided lists of faculty and their publications. For each method, descriptive statistics to compare faculty and publication counts were calculated. RESULTS Overall, 750 faculty members with 1052 unique publications, using all three methods combined as the reference standard, were identified. The department-reported method revealed 878 publications (84%), compared to 616 (59%) for the faculty-to-publications method and 412 (39%) for the publication-to-faculty method. Across all departments, 32% of faculty had any publications, and the mean number of publications per faculty was 1.4 (mean of 4.4 per faculty among those who had published). Assistant Professors, Associate Professors, Professors and Chairs accounted for 92% of all publications. DISCUSSION Online searches capture a fraction of publications, but also capture publications missed through self-report. The ideal methodology includes all three. Tracking publications is important for quantifying the return on our discipline's research investment.

INTRODUCTION Since 1991 the University of Otago, Dunedin, New Zealand has offered postgraduate qualifications specifically designed to educate general practitioners (GPs) about their unique work environment. AIM To determine motivations and impacts of postgraduate education for practising GPs. METHODS Survey of the 100 graduates of the University of Otago, Dunedin postgraduate general practice programme. Ninety five living graduates were approached and 70 (73.7%) responded. Quantitative data about disposition of respondents before enrolling and after completion of the programme were analysed using chi-square and paired t-tests. Free text responses about motivations, impacts and outcomes of the program were thematically analysed. RESULTS 64 GPs graduated with a postgraduate diploma and 36 with a masters degree in general practice. Although the mean number of graduates was 3.5 and 2.0 (respectively), annual enrolments averaged 25.1. Most graduates (60.9%) were aged in their 40s when they started studying and most (94.3%) had a spouse and/or children at home. DISCUSSION This voluntary postgraduate medical education complements traditional medical training but has low external value despite personal, practising and professional benefits. Graduates valued engagement above completion of a qualification. KEYWORDS Medical education; general practitioners; scholarship; professionalism.

Aim: To measure changes in the health status of 840 Type 1 and 9998 Type 2 diabetes patients who had completed three free annual diabetes reviews by December 2005., Method: We evaluated changes in clinical measures and differences in proportions of patients achieving guideline targets between the first and third reviews. Logistic regression analysis examined variables associated with an absolute decrease in HbA1c level of at least 1% from the first to the third review., Results: The proportion of patients achieving guideline targets for glycaemic control fell from 17.1% to 12.2% for Type 1 diabetes (p=0.004) and from 56.1% to 50.2% for Type 2 diabetes (p<0.001). There were significant improvements in mean albumin:creatinine ratio, total cholesterol, and high density lipoprotein levels in both diabetes cohorts and mean blood pressure and triglyceride levels in Type 2 patients. Adjusted odds of improved glycaemic control were higher for Type 2 diabetics treated with oral medication only (OR=4.27 (95%CI: 3.45-5.14)), insulin only (OR=7.10 [95%CI: 5.58-9.04]), and insulin and oral therapy (OR=10.05 [95%CI: 7.72-13.09])., Conclusion: The introduction of a structured and systematic general practice review process aimed at improving diabetes care and patient outcomes resulted in significant improvements in mean blood pressure, cholesterol levels, and albumin:creatinine ratio. There was, however, no overall improvement in glycaemic control

Aim: To examine characteristics of general practice consultations in a New Zealand primary care population of patients who died by suicide., Methods: Case control study design, with data linkage between the RNZCGP Research Unit Database, the National Mortality Database and the Hospital Separation Diagnosis Database (hospital discharges) from 1996 to 2001. The cases were suicides who had attended a general practice contributing data to the Research Unit database. Each case was matched by gender and age to three randomly selected patients from the Research Unit database., Results: There were 221 cases of suicide identified, of which 60% had a general practice consultation in the 6 months prior to death. The significant exposure variables, corrected OR (95% CI) in the multivariate analysis were: any previous hospital admission (between January 1996 and date of death) for a psychiatric condition, 23.75 (9.01 to 62.63); any notation in the general practice record of depression, suicidal ideation or self-harm, 14.97 (4.61 to 48.65); previous hospital admission with self-harm, 8.39 (1.73 to 40.65); and general practice prescription of sedatives, 4.34 (1.69 to 11.10)., Conclusions: In general, general practice patients who commit suicide have higher rates of depression, suicidal ideation, previous self harm, and sedative prescription than average.

Aim: To report tactics for avoiding and remedying medical errors observed by general practitioners in New Zealand and five other countries., Methods: The Primary Care International Study of Medical Errors collected 66 reports of medical errors in New Zealand and 363 reports from general practitioners in Australia, Canada, England, the Netherlands, and the United States. Strategies for avoiding and overcoming errors were grouped by themes, for New Zealand and the five other countries combined., Results: In all New Zealand reports and 336 (92.6%) reports from other countries, doctors offered at least one error prevention idea. The largest category of suggestions was 'more diligence' (New Zealand: 69.7% of reports, other countries: 55.3%). Other strategies were: 'provide care differently' (New Zealand 22.7%, other countries 36.4%); 'improve communication' (19.7% and 17.8% of reports); 'education' (7.8% and 11.0% of reports); and 'more resources' (12.1% and 14.0% of reports)., Conclusions: In general practitioners' medical errors reports, a culture of individual blame is more evident than recognised need for systems design. A minority of reports contained specific, pragmatic suggestions for changing healthcare systems to protect patients' safety. Error reporting systems may be a practical way to generate innovative solutions to potentially harmful problems facing general practice patients.

Background and Objectives: This study assessed the impact of the Balanced Budget Act (BBA) of 1997 on family practice residency training programs in the United States., Methods: We surveyed 453 active family practice residency programs, asking about program closures and new program starts (including rural training tracks), changes in the number of residents and faculty, and curriculum changes. Programs were classified according to their urban or rural location, university or community hospital setting, and rural and/or urban underserved mission emphasis., Results: A total of 435 (96%) of the programs responded. Overall, the impact of the BBA was relatively small. In 1998 and 1999, nationwide, there were 11 program closures, a net decrease of only 82 residents, and a net increase of 52 faculty across program settings and mission emphasis. The rate of family practice residency program closures increased from an average of 3.0 per year between 1988-1997 to 4.8 per year in the 4 years following passage of the BBA., Conclusions: The 1997 BBA did not have an immediate significant negative impact on family practice residency programs. However, there is a worrisome increase in the rate of family practice residency closures since 1997. A mechanism needs to be established to monitor all primary care program closures to give an early warning should this trend continue.

Objective: To describe and classify process errors and preventable adverse events that occur from medical care in outpatient primary care settings., Study Design: Systematic review and synthesis of the medical literature., Data Sources: We searched MEDLINE and the Cochrane Library from 1965 through March 2001 with the MESH term medical errors, modified by adding family practice, primary health care, physicians/family, or ambulatory care and limited the search to English-language publications. Published bibliographies and Web sites from patient safety and primary care organizations were also reviewed for unpublished reports, presentations, and leads to other sites, journals, or investigators with relevant work. Additional papers were identified from the references of the papers reviewed and from seminal papers in the field., Outcomes Measured: Process errors and preventable adverse events., Results: Four original research studies directly studied and described medical errors and adverse events in primary care, and 3 other studies peripherally addressed primary care medical errors. A variety of quantitative and qualitative methods were used in the studies. Extraction of results from the studies led to a classification of 3 main categories of preventable adverse events: diagnosis, treatment, and preventive services. Process errors were classified into 4 categories: clinician, communication, administration, and blunt end., Conclusions: Original research on medical errors in the primary care setting consists of a limited number of small studies that offer a rich description of medical errors and preventable adverse events primarily from the physician's viewpoint. We describe a classification derived from these studies that is based on the actual practice of primary care and provides a starting point for future epidemiologic and interventional research. Missing are studies that have patient, consumer, or other health care provider input.

Objectives: To develop an international taxonomy describing errors reported by general practitioners in Australia and five other countries., Design and Setting: GPs in Australia, Canada, the Netherlands, New Zealand, the United Kingdom and the United States reported errors in an observational pilot study. Anonymous reports were electronically transferred to a central database. Data were analysed by Australian and international investigators., Participants: Non-randomly selected GPs: 23 in Australia, and between 8 and 20 in the other participating countries., Main Outcome Measures: Error categories, and consequences., Results: In Australia, 17 doctors reported 134 errors, compared with 301 reports by 63 doctors in the other five countries. The final taxonomy was a five-level system encompassing 171 error types. The first-level classification was "process errors" and "knowledge and skills errors". The proportion of errors in each of these primary groups was similar in Australia (79% process; 21% knowledge and skills) and the other countries (80% process; 20% knowledge and skills). Patient harm was reported in 32% of reports from Australia and 30% from other countries. Participants considered the harm "very serious" in 9% of Australian reports and 3% of other countries' reports., Conclusions: This pilot study indicates that errors are likely to affect primary care patients in similar ways in countries with similar primary healthcare systems. Further comparative studies are required to improve our understanding of general practice error differences between Australia and other countries.

Background: Title VII predoctoral and departmental grants for departments of family medicine are intended to increase the number of family and primary care physicians in the United States and increase the number of practices in rural and underserved communities. This study assessed the relationships of Title VII funding with physicians' choices of practice specialty and location., Methods: Non-federal direct patient care physicians who graduated from US medical schools from 1981-1993 were identified in the 2000 American Medical Association Masterfile. A grant history file was used to annotate Masterfile records with Title VII funding data for the physicians' 4-year medical school enrollment. Characteristics of the county in which they practice were taken from the Area Resource File. Title VII funding variables were then related to practice specialty and location., Results: Predoctoral training and departmental development funding were strongly related to attainment of each of the Title VII program objectives evaluated., Conclusions: Title VII has been successful in achieving its stated goals and legislative intent and has had an important role in addressing US physician workforce policy issues.

Background: Family practice residency programs are based largely on a model implemented more than 30 years ago. Substantial changes in medical practice, technology, and knowledge necessitate reassessment of how family physicians are prepared for practice., Methods: We simultaneously surveyed samples of family practice residency directors, first-year residents, and family physicians due for their first board recertification examination to determine, using both quantitative and qualitative methods, their opinions about the length and content of family practice residencies in the United States., Results: Twenty-seven percent of residency directors, 32% of residents, and 28% of family physicians favored extending family practice residency to 4 years; very few favored 2- or 5-year programs. There was dispersion of opinions about possible changes within each group and among the three groups. Most in all three groups would be willing to extend residency for more training in office-based procedures and sports medicine, but many were unwilling to extend residency for more training in surgery or hospital-based care. Residents expressed more willingness than program directors or family physicians to change training. Barriers to change included disagreement about the need to change; program financing and opportunity costs, such as loss of income and delay in debt repayment; and potential negative impact on student recruitment., Conclusion: Most respondents support the current 3-year model of training. There is considerable interest in changing both the length and content of family practice training. Lack of consensus suggests that a period of elective experimentation might be needed to assure family physicians are prepared to meet the needs and expectations of their patients.