Family medicine
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Comparative Study
Exploring physician and staff perceptions of the learning environment in ambulatory residency clinics.
Investigations of teaching quality in ambulatory clinics have generally focused on faculty and medical student perspectives. We investigated the association of learning and organizational environment variables with faculty, resident, and nursing staff perceptions of quality of teaching and with a measure of resident learning in ambulatory residency clinics. ⋯ Nine learning and organizational environment scales were found internally reliable and useful to measure faculty, resident, and staff perspectives on ambulatory teaching sites. Two areas of focus for improvement were found. First, learning opportunities should be structured so that residents are oriented to the ambulatory clinic, have their knowledge assessed regularly, are helped to meet individual goals, are given appropriate levels of responsibility, and see an adequate number, mix, and continuity of patients. Second, prioritizing efforts to improve job satisfaction for all employees is important because of the association between job satisfaction and employee perceptions of quality of teaching. We recommend that research into the educational climate in ambulatory clinics include perspectives of the full range of clinic personnel who can contribute to resident learning.
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The Future of Family Medicine report advocated experimentation with 4-year residency training models. This study examines residency applicants' opinions about extending the length of residency training and seeks to determine which features of an extended program would be most desirable to applicants. ⋯ Lengthening training to 4 years would have a neutral or positive effect on applicants' interest in family medicine training in Oregon.
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Uninsured patients without a primary care home tend to use the emergency department (ED) for primary care. We examined whether an enhanced scheduling system for follow-up care from the University of New Mexico Hospital Emergency Department (UNMH-ED) that assigns patients to a family medicine home can decrease ED utilization. ⋯ Implementing an enhanced referral system to family medicine homes from the ED is associated with decreased subsequent ED utilization by uninsured patients.