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The Taiwan Association of Family Medicine (TAFM) was established in 1986. At the present time Taiwan has a total of 66 residency training programs with approximately 150 first-year residents accepted per year. The TAFM realizes and values the importance of outpatient teaching for family medicine residents. Following the guidelines of outpatient training for residents set in 1989, the first-year, second-year, and third-year residents should attend the outpatient teaching at least once, twice, and three times per week, respectively, at the designated Family Medicine Clinic. Residents also receive outpatient training from qualified preceptors during their community rotations, wherein services are provided to patients in the clinics, their homes or communities where they live. In this review article, guidelines on outpatient teaching in the family medicine residency training programs made by the Taiwan Association of Family Medicine will be described, followed by my personal experiences about teaching family medicine at an outpatient clinic. Family practice is characterized by its first-contact, office-based, patient-centred, family-as-a-unit, and prevention-oriented care. Obviously, the outpatient clinic is the proper place to demonstrate and practice the characteristics of family medicine. A family physician spends approximately 90% of his/her working time on outpatient services, followed by inpatient care, institutional care and home visits. Moreover, outpatient practice at the Family Practice Center has been the most important training curriculum for family medicine residents throughout the world. Quality ambulatory teaching requires the following: 1. Preliminary class: introduction to the practice, operating procedures for the practice, communication skills, use of computer, and evidence-based medicine. 2. Teaching primer: at least two partially connected examination rooms for each learner must be provided. 3. Teaching facilities: standardized outpatient facilities, documents, and computer systems. 4. Trainers: attending staff, chief residents, and allied professionals who have received adequate preparation for both first-time teachers and continuing professional development training. 5. Evaluation system: video-taping, one-way mirror, review of medical records, clinical performance examination with standardized patients for learners, and also evaluation of the learning experience by the learners. 6. Financial arrangements: rewards and credits to the trainers, funds to support the expenses, and maintenance of teacher enthusiasm. [ABSTRACT FROM AUTHOR]

Background: Electrosurgery is one of the most commonly used energy systems in laparoscopic surgery. Two major categories of potential complications related to electrosurgery in laparoscopy are mechanical trauma and electrothermal injury. The latter can result from unrecognized energy transfer in the operational field or, less commonly, to unnoticed stray current outside the laparoscopic field of view. Stray current can result from insulation failure, direct coupling, or capacitive coupling., Methods: We reviewed the literature concerning essential biophysics of electrosurgery, including electrosurgical waveform differentiation, tissue effect, and variables that determine tissue effect. The incidence of electrosurgical injuries and possible mechanisms responsible for the injuries are discussed. Different types of injuries may result in different clinical manifestations and histopathological findings. Gross and microscopic pathological check-ups of the injury sites may distinguish between different mechanisms, and thus provide further clues postoperatively., Results: Several recommended practices are proposed to avoid electrosurgical injury laparoscopically. To achieve electrosurgical safety and to prevent electrosurgical injuries, the surgical team should have a good understanding of the biophysics of electrosurgery, the basis of equipment and general tissue effects, as well as the surgeon's spatial orientation and hand-eye coordination. Some intraoperative adjuvant procedures and newly developed safety devices have become available may aid to improve electrosurgical safety., Conclusions: Knowledge of the biophysics of electrosurgery and the mechanisms of electrosurgical injury is important in recognizing potential complications of electrosurgery in laparoscopy. Procedures for prevention, intraoperative adjuvant maneuvers, early recognition of the injury with in-time salvage treatment, and alertness to postoperative warning signs can help reduce such complications.

Almost all operations that were traditionally performed by open laparotomy operations can be done laparoscopically; however, surgeons may experience several negative health effects. A 37-year-old gynecologic laparoscopist had a herniated intervertebral disk at C5-6 level. Due to a negative trauma history, a possible explanation may be the nonergonomic posture that he held while performing laparoscopic surgery for many hours. To reduce the risk of this complication, we recommend that surgeons' spatial orientation and hand-eye coordination for laparoscopy be improved by sequential phases of training.

Background and Objectives: The Harbor-UCLA Family Practice Residency Program has offered a year-long primary care continuity clinic experience to first-year obstetrics-gynecology (OB-GYN) residents since July 1994. This paper describes the teaching programs and compares the experience of the OB-GYN residents to that of family practice (FP) residents in the same clinic site., Methods: OB-GYN residents worked in the family medicine teaching clinic for a half day each week for the entire year. The teaching program was evaluated with a questionnaire and interviews of OB-GYN residents to obtain their opinions on the value of this teaching modality. A review of clinic schedules and medical records compared the practice profiles of six OB-GYN residents with six matched FP residents., Results: Five out of six OB-GYN residents felt that the educational objective of improving primary care skills was achieved. Half of them were pleased about their relationships with the family medicine faculty; the remainder reported being treated as second-class citizens. Patient volume and the diagnosis encountered were similar between the OB-GYN residents and the FP residents., Conclusions: Evaluation of the primary care continuity clinic experience for OB-GYN residents through questionnaires, interviews, and medical records analysis revealed the acceptability, feasibility, and appropriateness of this teaching program for OB-GYN residents. However, not all OB-GYN residents were happy about their relationships with the family medicine faculty. The long-term effectiveness of the experience needs further study.

The National Health Insurance Program began in March 1995 in Taiwan. The success of the program depends largely on the operation of "Regionalization Medical Networks" which rely on family practice to provide cost-effective medical care. Instructional development activity needs to be addressed as the highest priority, to meet the impelling needs of family practice training. The acute shortage of family practice educators in Taiwan draws attention for a need of family practice faculty development programs, including short-term seminars and long-term fellowships. Continuing education programs in family practice help keep abreast the scientific as well as the social developments in familiarizing new guidelines of the National Health Insurance Program. Residency training programs that are community-based and ambulatory-oriented will prepare family practice resident physicians to make contributions for the future of "Regionalization Medical Networks". As well, the undergraduate family practice education programs will prepare future physicians with the adaptations and the challenges of the National Health Insurance Program. The allied health education programs are fundamental to build family practice teams to meet community health needs. Lastly, public education programs designed to familiarize the public with the National Health Insurance Program will help give the public an understanding and appreciation of the contributions of family practice in the health care delivery.

The concepts and principles of general practice are consistent with Chinese cultural values; the leading authorities at the General Practice Training Centre are extremely enthusiastic about the general practice movement; the Ministry of Public Health is totally supportive of the general practice training; the medical/allied health professionals are eager to participate in general practice activities; and general practice certainly is responsive to public expectations. General practice will be flourishing and prosperous in China; however, there may be times when the specialty of general practice in China experiences growing pains with obstacles. The experiences gained from the development of general practice training programmes in Taiwan and other countries to handle the obstacles are of tremendous value to the development of general practice in China. It is expected that communication and exchange between the general practice educators of Taiwan and China will play an important role in the further development of general practice in China.