Search

In October 2000 the family of family medicine convened the Keystone III conference at Cheyenne Mountain Resort. Keystone III participants included members of Generation I (entered practice before 1970), Generation II (entered 1970-1990), and Generation III (entered after 1990). They represented a wide range of family physicians, from medical students to founders of the discipline, and from small-town solo practice to academic medicine. During the conference, the three generations worked together and separately thinking about the past, present, and future of family medicine, our roles in it, and how the understanding of a family physician and our discipline had and would continue to evolve. After the conference, the 10 Generation III members wrote the article published here, reflecting on our experiences as new physicians and physicians in training, and the similarities and differences between our experiences and those of physicians in Generations I and II. Key similarities included commitment to whole-person care, to a wide scope of practice, to community health, and to ongoing engagement with our discipline. Key differences included our understanding of availability, the need for work-life balance, the role of technology in the physician-patient relationship, and the perceptions of the relationship between medicine and a range of outside forces such as insurance and government. This article, presented with only minor edits, thus reflects accurately our perceptions in late 2000. The accompanying editorial reflects our current perspective.

Background: Several organizations emphasize that medical education should include how to improve patient outcomes effectively using quality improvement (QI) methods. In spite of the importance of teaching QI principles, limited literature exists on the implementation and evaluation of these in residency programs., Methods: The Clinical Scholars Program was established in 1996 to provide residents an opportunity to participate in a scholarly activity. The program, fully integrated into a community-based, university-affiliated family medicine residency program, is currently structured as a longitudinal educational experience, with specific time lines in which all second- and third-year residents are required to participate in and successfully complete a project before graduation. Factors influencing project success are also presented., Results: During the five-year period evaluated, 61 residents completed 53 Scholars projects, 39.6% of which were QI projects. Residents have delivered 86 local presentations, 50 state presentations, 11 national presentations, and 8 international presentations. Nine resident projects have been published in peer-reviewed journals. Factors associated with successful interventions include focus on a topic relevant and common in primary care practice, change in the system of patient care (for example, use of group visits, providing patient education directly to the patient prior to his or her visit), use of the electronic medical record to provide relevant clinical information during office visits, and interdisciplinary team participation in the project., Conclusion: This program is an example of the successful integration of scholarly activity and QI education into a residency program. It serves as a potential model for other residency programs to meet the needs of residency training and to promote QI and research in primary care practices.

Purpose: The possible mechanisms of action of emergency contraception (EC) include preventing ovulation, fertilization, or implantation of an embryo. Differences in the use of terminology between medical personnel and the general public could be misleading to patients who would use EC. This cross-sectional survey evaluated women's beliefs regarding pregnancy and EC's possible mechanisms of actions., Methods: An anonymous questionnaire was developed and pilot tested for an appropriate reading level and ease of analysis. It collected information on demographics and beliefs about pregnancy and EC. During an 8-week period, the questionnaire was given to a convenience sample of female patients aged 18 to 50 years visiting 2 academic family medicine clinics in the southeastern United States. Descriptive statistics and logistic regression models were used for analysis., Results: A total of 178 women completed questionnaires. Nearly one-half (47%) of respondents believed that pregnancy begins with fertilization; however, less than one-third (30%) believed that life begins with fertilization. Thirty-eight percent of respondents stated that they would use EC only if they believed it worked before fertilization or implantation. Generally similar proportions thought that EC works before fertilization (24%) and before implantation (36%), or were unsure about when it works (34%). Younger age was associated with higher odds of believing that EC works before fertilization; none of the other demographic factors studied conferred either higher or lower odds., Conclusions: Many women are uninformed about the possible mechanisms of action of EC, and we found no reliable predictors for those who were better informed. This study raises questions regarding women's understanding of EC and demonstrates the need to better educate them about its possible mechanisms of action.

Background and Objectives: The effect of a research requirement on initial Match rates in family medicine has not been previously studied. This study's purpose was to examine the relationship between family medicine residency programs with a research requirement and initial Match rates for those programs in the National Resident Matching Program (NRMP)., Methods: Using information from the American Academy of Family Physicians (AAFP) and the NRMP, program characteristics were obtained, and the 2005 initial and 5-year aggregate Match rates were calculated. The relationship between the presence of a research requirement and fill rates (initial and 5-year aggregate) was analyzed using analysis of variance. To control for variables known to affect Match rates, multivariate analysis was conducted., Results: About one third of residency programs (31.4%) indicated that they have a resident research requirement. No significant difference in the initial Match rates nor the 5-year aggregate was noted between programs with or without a research requirement. The association did not change after controlling for program location, structure, and size of program., Conclusions: A research requirement in a family medicine residency program does not significantly affect Match rates in the NRMP.

Background: We wanted to determine whether variations exist in use of a chaperone during the performance of a pelvic examination by family physicians., Methods: A self-administered questionnaire was mailed to 5,000 randomly selected active members of the American Academy of Family Physicians., Results: There were 3,551 survey responses (71% response rate) and 2,748 useable questionnaires. Most respondents (75.4%) reported routinely using a chaperone in the room during the collection of a Papanicolaou (Pap) smear. Significantly (P < .00001) more male physicians (84.1%) than female physicians (31.4%) reported using a chaperone. Physicians reporting routine use of a chaperone were significantly younger (P = .01) and did fewer Pap smears per month (P < .00001). Regional reporting of chaperone use varied significantly (P < .00001), with 71.6% reporting use in the Northeast, 89.0% in the South, 65.7% in the Midwest, and 72.4% in the West., Conclusion: Family physicians vary considerably in the reported use of a chaperone during the collection of a Pap smear. The variation could reflect different regional or local norms, efficiency or resource issues in high-volume clinical settings, or other interpersonal factors. These issues need to be explored in more depth.