Family medicine
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The status of fourth-year chief resident (FYCR) positions in US family practice postgraduate training over the period 1987 to 1992 was assessed to better understand the role of the FYCR in family practice education. ⋯ Between 1987 and 1992, FYCRs have taken on greater administrative and clinical instructor roles, and more programs are involving FYCRs in faculty development. The position offers a unique role for the transition between trainee and faculty.
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In most medical schools and residency programs, little or no attention is given to fostering learners' reflection or self-assessment. Yet learners who do not value or who are not effective at these skills are unlikely to extract the maximum benefit from their education. They are at risk of becoming unsafe physicians. ⋯ Many learners and teachers have grown accustomed to authoritarian educational approaches in which teachers decide what the learners need and unilaterally evaluate their performance. In this review of the available literature, we summarize the compelling reasons for fostering reflection and self-assessment and for helping learners become their own coaches. Specific strategies and tools for creating programs that foster these values and activities are presented.
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Comparative Study
Trends in maternity care by graduates and the effect of an intervention.
Only 24% of family physicians in the United States deliver babies, a figure that declined remarkably during the decade of the 1980s. This study examines the content of practice, with regard to maternity care, of graduates of the University of California, Davis Family Practice Residency Network over the past 20 years, and the effectiveness of residency training intervention designed to increase maternity care activity among graduates. ⋯ This study documents the decrease in interest in providing obstetrical services by recent family practice residency graduates when compared to graduates a decade earlier. Further, it suggests that residency programs, even with very low rates of participation in maternity care, can increase the interest and participation of residents to include these services in their practices after graduation.
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The proportion of infants in the United States adequately immunized with DTP (Diphtheria, Tetanus and Pertussis) vaccine is below other industrialized nations and lowest among infants living in urban areas. At present, predictors of poor immunization are not well developed. In particular, the relationship between prenatal care utilization and childhood vaccination is not clearly defined. ⋯ Maternal demographics and health care utilization predict infant immunization rates. Use of these variables may permit early identification and case management of mothers of infants at high risk for immunization delay.
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Since abortion has become a focus of increased public attention, it is important to assess family physicians' attitudes and scope of training regarding this outpatient procedure. ⋯ If the number of family physicians providing abortions is to be increased, residency programs must offer abortion training as a more fully recognized part of the family medicine curriculum.