Family medicine
-
Most outpatient treatment for depression is delivered by primary care physicians (PCPs), yet little is known about which patient variables affect PCPs' selection of high-intensity interventions, namely antidepressant medications or psychotherapy, as opposed to less-intensive treatment regimens (eg, watchful waiting, exercise). Our objective was to ascertain whether the patient's symptom severity, presenting psychosocial stress, and lifestyle habits influenced treatment recommendations. ⋯ Although vignettes depicting depressed patients with mild/moderate symptoms were more likely to elicit low-intensity treatment recommendations, the frequency was still low. Given the evidence that antidepressants and psychotherapy for mild/moderate depression may be no more effective, and likely less cost-effective, than low-intensity treatments, the findings suggest a need to disseminate knowledge of less intensive treatment options to primary care physicians.
-
Maternity care is an essential component of family medicine, yet the number of residency graduates providing this care continues to decline. Residency programs have struggled to identify strategies to increase continuation of obstetric practice among graduates. Leaders in family medicine obstetrics previously proposed a tiered model of training to ensure adequate volume for those desiring to continue maternity care upon graduation. However, whether this approach will be successful is unknown. This study aimed to identify program characteristics and teaching methods that may influence residents to continue obstetrics practice upon graduation. ⋯ This study supports a targeted approach to teaching maternity care in family medicine residency programs. Prioritizing continuity delivery experiences and fostering resident independence are strategies toward promoting increased provision of obstetric care by family medicine graduates. Further research is needed to evaluate the impact of tiered or track systems in practice.
-
Fewer medical students are choosing to work in primary care, and it is difficult to recruit and retain physicians to work in underserved communities. Positive exposures with underserved communities are known to increase a physician's likelihood of practicing in an underserved area. While a number of medical school programs are designed to address the rural physician workforce shortage, there are fewer medical school programs designed to specifically recruit and retain physicians to work in urban underserved areas. This article describes a multifaceted, longitudinal medical school curriculum at Jefferson Medical College known as the Urban Underserved Program (UUP) and a survey administered to UUP graduates exploring the association between program participation and practice outcomes. ⋯ Urban underserved communities have greater health disparities and less access to health care, and programs that promote and prepare students to enter practice in these communities can potentially impact the health of these populations.
-
Balint groups have been part of residency education for decades. This study updates our understanding of the organization, purpose, and leadership of Balint groups within US family medicine residency programs. ⋯ Balint groups are still commonly occurring, but their implementation is changing. Groups are meeting less frequently and are more likely to be larger and heterogeneous. This trend and lack of formally trained/certified leaders may be decreasing the benefit to residents involved in Balint groups.
-
Sexual health is an important aspect of overall health. Barriers to taking an adequate patient sexual history exist. Few studies have explored medical learners' comfort, knowledge, and training surrounding taking sexual histories with lesbian, gay, bisexual, transgender, questioning/queer (LGBTQ) patients specifically. ⋯ Medical students and resident/fellows reported a significantly lower level of comfort with sexual history-taking and management of sexual issues in the LGBTQ population. A comprehensive training format that not only views sexual health as an integral part of overall patient health, but also integrates LGBTQ care, is needed in medical education.