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The ultimate objective of our epidemiological research is to complete a longitudinal population-based study to document the prevalence and impact of acute, recurrent, and chronic pain in children and adolescents. As the first phase of our epidemiological research, we developed a comprehensive screening instrument for identifying children with acute, recurrent, and chronic pain, the Pain Experience Interview. We designed this interview to provide information about the lifetime and point prevalence of various pains, and also to provide information about the intensity, affect, duration, and frequency of children's pain. The primary objective of this study was to validate the Pain Experience Interview using the discriminant validation procedure of group differences. The secondary objectives of our study were to obtain descriptive data on children's acute, recurrent, and chronic pain experiences and to conduct exploratory analyses on age- and gender-related differences in children's pain experiences. We interviewed 187 children from five different health groups (arthritis, cancer, enuresis, recurrent headaches, and healthy) to provide distinct subsets of children with respect to their acute, recurrent, and chronic pain experience, and from four different age groups (5-7, 8-10, 11-13, and 14-16 years) to provide distinct subgroups with respect to children's developmental level. To test the interview we determined a priori several study predictions about children's pain experiences. These included four predictions about the common response patterns that we would expect to observe for all children based on our understanding of acute pain caused by trauma/disease, and six predictions about the distinct response patterns that we would expect to observe based on the known differences among children in their experiences of headache, acute treatment-related pain, recurrent pain, and chronic pain. All study predictions were confirmed, demonstrating that the Pain Experience Interview is a valid screening instrument for differentiating children with different types of pain problems. The interview can provide estimates for the lifetime and point prevalence of various pains in children, and data on the intensity, affect, duration, and frequency of their pain experiences.

This study measures changes in clinical confidence experienced by 42 family practice residents as they progressed through a 2-year residency program. At the beginning, 20% or more of respondents reported they lacked confidence in 47 of the 177 topics. Self-assessed competence increased substantially in many areas. However, during the residency, new areas of concern emerged.

Purpose: To compare changes in self-assessed clinical confidence over a two-year residency between two groups of family practice residents, one starting in a family practice center and the other starting in a hospital., Method: All 44 entering residents at the University of Western Ontario in either 1984 or 1985 were eligible. Forty-two participated at baseline, and 24 (57%) provided completed responses after two years. Confidence regarding 177 topics in 19 general topic areas was assessed using self-completed questionnaires administered at baseline and after six, 12, and 24 months. The residents rotated every six months between sites, with approximately half starting in each site. Nonrandom assignment to starting site included consideration of the residents' stated preferences; hence self-selection bias was possible. Mean differences were evaluated using t-tests, and trends over time were assessed using repeated-measures analysis of variance., Results: There was no difference between the groups' grand means at any time. In the 19 areas, five statistically significant differences were seen, four at six months and one at 12 months; four involved greater confidence by the center-start group. No difference was seen after two years, and both groups displayed substantial increases in confidence over two years., Conclusions: The few significant differences in confidence between the two groups suggest that their training might have been deficient if it had omitted one of the settings. However, because these differences had disappeared after the groups had each experienced 12 months in each setting, the initial site of training appears not to affect learning.

Surveys conducted in five areas of Southern Ontario obtained clinical and service utilization data from 5,478 adults over 25 years of age. The two week period prevalence rates of arthritic and rheumatic (AR) complaints were 1.72 per cent and 2.14 per cent among two groups of users of primary care. In free-living general populations, the rates ranged from 6.23 per cent to 8.84 per cent. It was shown that only 25 per cent of complainants with AR symptoms sought health services. Of all adults seen by family physicians in one year, 28 per cent presented at least once with an AR complaint. While 20 per cent of all respondents reported some physical impairment, 43 per cent of those with AR complaints had impairment. The excess impairment was two per cent. Complaints with AR symptoms used health services at costs 78 per cent higher than the average expenditures in the same communities. The essential role of the primary care practitioner in the identification and control of AR disorders is strongly supported.

In a teaching family medical center a strategy was sought to improve the quality of medical record keeping. A study was undertaken to determine the usefulness of a standardized form for self-audit. Validity and reliability of the form were established and it was shown that there was a significant improvement in the study group three weeks after the exposure period, as compared to a control group. Improvements occurred particularly in the recording of drugs prescribed and in the linkage of progress notes to the problem list. Despite this improvement, linkage to the problem list was seen to occur in only half of the studied charts. With modification the self-audit form appears to be a useful stimulus to good record keeping.

The authors studied 46 eldest or only children under school age and their parents to determine the relationship between parents' recollections of their own childhoods and the way they use their family physician for care of their children. The parents completed a questionnaire that measured the caring and overprotection dimensions of the parenting they themselves remember. Positive correlations were found between perceptions of maternal overprotection and the frequency of children's visits. Negative correlations were found between perceptions of parental affection and children's visits and non-routine diagnoses. Neuroticism was found to be a confounding variable that slightly weakened the relationship between maternal caring and children's visits.

This paper describes the ways in which encounter data from the family practice teaching units of the Department of Family Medicine, University of Western Ontario, have been used for teaching, service, and research. The fact that family physicians may deal with several problems at one visit is emphasized, as is the need to report morbidity in terms of the population at risk, so that comparisons can be made with other work. The value of encounter data in studies of patient utilization and resident experience is noted. The validity of the data has been examined and the extent of underrecording assessed. The system has helped to encourage the spirit of inquiry in its users.

Meeting a patient for the first time, a physician must sort through an often complex, jumbled array of information. This process can be replicated in reading: literature abounds with medical examples which, when analyzed, reveal similar diagnostic challenges to those faced in practice. This article examines the poem "To An Old Jaundiced Woman" by Dr. William Carlos Williams. The conclusions of fourth year Dalhousie medical students are presented, together with the viewpoint of a practicing family physician. Readers are invited to compare their responses.

This paper describes the development of a system for recording encounter data in family practice. The system has been developed by the Department of Family Medicine, University of Western Ontario, and came about as a natural addition to a previously reported method for describing and defining a practice population. The system gathers information on each encounter and includes data concerning the patient, the provider, the location, and certain other details concerning the encounter, including all problems dealt with on that occasion. The storage and analysis of these data are carried out by a computer. The uses of such data are many, and some of them will be dealt with in the fourth and last paper in this series.

The gathering of information on the practice population is essential for practice monitoring, preventive medicine, and research. The minimum necessary information is the age and sex of individuals cared for in the practice. This allows the expression of age-sex specific morbidity rates for the at-risk population. In the Department of Family Medicine, University of Western Ontario, practice census information has been used to determine the suitable size for a teaching practice, the representativeness of our practices in terms of age, sex, residence location, and morbidity, and for the production of at-risk registers based on age and sex.

Multiple choice questions used in continuing medical education may require characteristics different from those used in tests and examinations. The questions of three continuing education exercise were assessed by 48 board certified family physicians. Each physician answered one third of the questions and then judged them on usefulness in patient management, as discriminators of quality of medical care, and on educational value. The relevance of each question was determined by a composite index based on these factors. The content of each question was independently analyzed by three physicians. Relevant questions tended to be those concerned with surgery, symptoms, and management, and those requiring more than simple factual recall. Questions on office management or concerning specific diagnoses were considered less relevant. Neither the manner of asking the question nor the severity of the illness appeared to influence relevance. This information should benefit those developing continuing education programs for family physicians, especially those designed for self-administered individual learning.

Information systems for family practice are vital in its development as an academic discipline, in the teaching and learning process which ultimately improves the quality of care, and in the planning processes which must be used to rationalize the distribution of scarce resources in the health-care field. The provision of sufficient data for these purposes demands a flexible system, generally one based on the computer as a data storing and analyzing tool. Such a system has been developed in the teaching practices of the Department of Family Medicine, University of Western Ontario; the methods employed and the uses for that system are to be described in a series of four papers. This first paper describes the methods developed for gathering demographic information on the practice population.

The Core Content Review of Family Medicine was assessed for its relevance to family practice. Three sets of questionnaires were completed and assessed by 48 experienced, certificated family physicians, of whom half were faculty members from university departments of family medicine and half were in private practice. The answers to 57% of the questions were correct. In the opinion of the panelists the answers to 62% of the questions permitted discrimination between physicians providing care of good quality and those providing care that was less than adequate. The panelists rated 78% of the questions as being educationally useful. Two thirds of the questions were deemed relevant according to a composite criterion. Examples are given of the questions considered most relevant and of those considered least relevant.

Patients with urinary symptoms are commonly seen in family practice. This study reports the rate of urinary symptoms in three teaching practices over one year. The response of the physician to such patients is described. The predictive value of urinary symptoms in the diagnosis of urinary tract infection is examined.