Family medicine
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Family practice in Canada is significantly different in many ways from practice in the United States and is similar in others. This article describes Canada's comprehensive, government-controlled health care system, in which patients have free access to care, and most physicians are still paid on a fee-for-service basis. ⋯ The multiple roles of the College of Family Physicians of Canada are outlined. The article concludes with a description of the nature of family practice in Canada, comparing it with the United States.
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Comparative Study
Comparisons of aged Mexican-American and non-Hispanic white nursing home residents.
The Mexican-American elderly have long been a focus of interest as a unique ethnic subgroup. A paucity of data, however, exists concerning Mexican-Americans in extended care facilities. The current retrospective study, conducted at a community based nursing facility, compared medical records of 54 Mexican-Americans to 30 non-Hispanic whites (Anglos). ⋯ Finally, investigators noted that although statistically nonsignificant, a greater percentage of Mexican-Americans (40.7%) suffered cerebrovascular attacks (CVAs) than did Anglos (23.3%, P = .11). These results indicate that Mexican-Americans are entering nursing homes more functionally and mentally impaired than their Anglo counterparts, due in part perhaps to CVAs. This study suggests that an extended family structure may help Mexican-Americans stay in the community until greater degrees of disabilities have been reached.
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Issues concerning the role of the generalist in medicine are not new. Indeed, we live in a specialty-oriented society which tends to define generalism in terms of specialism. Yet, as Gotshalk states, "Where it (the general aspect of a problem) is not satisfactorily handled, all specialization is an improvisation of temporary stopgaps on the way to ever recurrent crises."
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Family practice as a career choice has been related to a number of educational variables, including the presence of a required clinical clerkship. In order to determine whether or not the timing of the required clinical clerkship was also related to family practice residency selection, a study was undertaken to investigate the relationship between the required third-year family practice clerkship and family practice career choice. The results showed that students who attended medical schools with a required third-year clerkship in family practice were significantly more likely to enter family practice residency training (16.8%), than students who attended schools with a required fourth-year clerkship (14.5% P less than 0.05), or who attended a school with no required family practice clerkship (12.1%, P less than 0.001). These results support the recommendations of the STFM Task Force on Predoctoral Education that a required third-year clerkship in family practice is important in medical student career choice.
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This paper describes the academic roles of the 1978 through 1985 graduates of family medicine faculty development fellowship programs sponsored by the Robert Wood Johnson Foundation (RWJ) and the Division of Medicine of the U. S. Department of Health and Human Services (HHS). ⋯ Based on a 74% response rate, profiles are drawn of graduates. These profiles are compared to a review of the literature in higher education on fellowships, faculty attrition, faculty activities, tenure, and promotion. Conclusions reached from these comparisons include: (1) The retention rate of fellows in full-time faculty positions equaled or exceeded those of other fellowships found in the literature. (2) The attrition rate of alumni from faculty positions has been less than that noted of faculty in other areas of higher education. (3) On average, fellowship graduates have spent less time in research activities than recommended for productivity. (4) The emphasis on research training, particularly in RWJ fellowships, was appropriate, given increasing expectations for research productivity in tenure and promotion decisions. (5) The national trend toward development of alternatives to traditional tenure tracks matches the patterns found in family medicine fellowship alumni--31% of these alumni were serving on such tracks.