Training in obstetric sonography in family medicine residency programs: results of a nationwide survey and suggestions for a teaching strategy

BACKGROUND

Obstetric sonography is a valuable diagnostic procedure for family physicians who provide obstetrics; however, physicians tend to use technology that was effectively modeled during residency. The purpose of this study was to learn how many family medicine residency program directors had an interest in and a need for training in obstetric sonography, as well as whether they were willing to commit faculty and finances for adding the technology to their programs.

METHODS

All program directors listed in the 1989 American Academy of Family Physicians (AAFP) Directory of Family Practice Residency Programs (n = 379) received a five-item questionnaire about obstetric services and use of sonograms in their programs and their desire for training in obstetric sonography.

RESULTS

More than 81 percent of respondents said their programs provided obstetrics. Sixty-eight percent of these respondents used sonograms, and 53 percent indicated a need for training in obstetric sonography. Forty-five percent of all respondents, regardless of whether their programs offered obstetrics, indicated a desire for training.

CONCLUSIONS

The high level of interest in obstetric sonography can be explained, in part, by the 81 percent of respondents whose programs provided obstetrics. These figures suggest a need to establish a training curriculum in obstetric sonography for family medicine residency programs. Our training program, designed to reach faculty, residents, and practicing physicians, is described.

Impact of President Clinton's Health Security Act on residency programs

The Clinton Health Security Act calls for a major shift in the emphasis of medical training. While family practice, general pediatrics, general internal medicine, and obstetrics and gynecology stand to benefit, other specialties will see decreases in their programs and their residency slots. In light of the present sparsity of programs in family practice and the prevalent student disinterest in the specialty, only heroic efforts will make possible achievement of the 55/50 ratio of primary care physicians to other specialists outlined by the Clinton plan. Problems inevitable in the transition are described and incentives for change suggested.

Programs for international medical graduates

Medical graduates from other countries provide health care in many regions of Canada; yet differences in training standards can cause problems. A recent survey looked at the requirements of provincial licensing bodies and the preresidency programs of Canadian faculties of medicine. Quebec, Ontario, and Manitoba provide such programs, which differ in length, content, and evaluation process. McGill has recently launched a more focused program.

Trainee interns: education and service roles

AIMS

To examine the education and service roles of trainee interns in New Zealand.

METHODS

A questionnaire was completed by 123 trainee interns from the four clinical teaching schools. Areas examined were the amount of teaching received and the groups providing teaching, service work load, debt levels and the value of electives.

RESULTS

In hospitals trainee interns are taught for 30% of their week. The rest is spent performing service work, 58% of which is unsupervised and 12% supervised. Registrars and house surgeons provide the bulk of total teaching, 33% and 32% respectively. On average, trainee interns in general practice were working 40 hours/week and while on the wards 50 hours/week. On relevant wards trainee interns performed 38% of the ward work. The position of acting house surgeon had been filled by 88% of trainee interns. A debt greater than $10,000 was carried by 40%. Without the trainee intern salary 89% would not have been able to afford their electives, 25% performed electives in New Zealand. Electives were viewed as very beneficial in a number of areas.

CONCLUSIONS

Trainee interns are working many hours, providing valuable service work in New Zealand hospitals. The majority of teaching is practical, on the wards, from registrars and house surgeons. Debt affects a substantial number. Electives are a valuable part of the trainee intern course.

Women in surgery in Scotland. A Working Party of the Royal College of Surgeons of Edinburgh

Despite the fact that 50% of medical undergraduates are female, women comprise fewer than 1% of consultant general surgeons. The possible reasons for this were addressed by a working party of the Royal College of Surgeons of Edinburgh, which now reports the results of a survey of 35 women surgeons of SHO 3 grade and above working in Scotland. Findings were compared with those of 12 anaesthetists and 10 house officers. Surgeons had had an accurate perception of the work patterns their job would entail but no preparation for the lifestyle implications. The experience of gender discrimination was similar in all three groups but perceived discrimination was much more prevalent among surgeons/ophthalmologists. In contrast to the other groups surveyed, the surgical cohort was not deterred by training length, but rather discouraged by the lack of responsibility offered. Other factors which seem to contribute to the underrepresentation of women among surgeons may be the lack (1) of time for child rearing and (2) of same-sex role models.

CPR and the RCP (2). Training of students and doctors in UK medical schools

We asked British medical schools and teaching hospitals about the training they offer to medical students and hospital doctors in cardiopulmonary resuscitation. The response rate was 96%. Training that is practical and consistent with guidelines is offered to nearly all students and house officers, often by consultants. Training for other junior doctors and consultants is much less common. The organisation of training is haphazard, and many hospitals have no resuscitation training officers. As a result, few doctors receive the frequent retraining needed to maintain competence in managing cardiopulmonary arrest.

Sports medicine electives. Are they available in Canadian family medicine programs?

Sports medicine is becoming a larger part of a family physicians' practice. We surveyed all family medicine teaching programs in Canada to determine how many offer sports medicine experiences and who teaches them. The study found that few residents have clinical training in sports medicine, though most have attended seminars. Primary care physicians, orthopedic surgeons, physiotherapists, and rheumatologists teach sports medicine.

Trauma fellowship training: the insiders' perspective

Trauma care is in a period of transition from care given by surgeons at the closest community hospital to care given by trauma specialists at trauma centers and within emergency medical systems. It has thus become increasingly important for the educational goals of trauma fellowship training to reflect the needs of the future system as well as the views of future practitioners. These views differ from those of surgical colleagues practicing trauma surgery, and the views of future trauma specialists should be considered during the formulation of training guidelines. This survey appears to be the first attempt to interpret the views of trauma fellows: 48 of the 83 fellows (57.8%) in the 1991-1992 national cohort responded. They made suggestions about their own training, including ways to increase surgical experiences and opportunities for academic pursuits, but gave no insight as to an appropriate mix of critical care training. Although critical care certification is a major attraction for fellowship training, the cohort does not want to be thought of as nonoperating surgical intensivists. A second year of fellowship training is seen as necessary for research and trauma systems-related studies.

Impact of mandatory nonoperative training on surgical critical care

Since the development of surgical critical care (SCC) as a discrete body of knowledge and its recognition by the American Board of Surgery (ABS), it has been beset by several controversies. One controversy is that the Residency Review Committee (RRC) for Surgery mandated that approved SCC training be 1 year long with no operative experience. A survey was conducted to determine the opinions and experiences on this controversy and others of 498 surgeons who regularly practice SCC. Seventy percent (349) responded and 100% of these held a Certificate of Added Qualifications in SCC. Only 35% of the respondents had completed a critical care fellowship and 61% were either the director or associate director of an ICU. An overwhelming majority (> 90%) believed that SCC should be considered one of the essentials in training surgeons and that the ABS should continue to offer a Certificate of Added Qualifications. Two thirds disagreed with the RRC's ban on operative experience during SCC fellowships and 71% believed that this prohibition limited the pool of surgical applicants to SCC programs. There were no significant differences in the responses between any of the major subgroups. Interestingly, 50% of the respondents who had completed RRC-approved SCC fellowships stated that their fellowship included operative experience.(ABSTRACT TRUNCATED AT 250 WORDS)

[Professional profile of students in specialization courses on Occupational Medicine]

The authors tied to find out a physician's professional profile who attended specialization courses in Occupational Medicine offered by the University of São Paulo Medical School. There are eight charts that show how the courses developed and the necessary changes made for their recognition in this specialty. The results also show how many jobs a physician needs to obtain a reasonable salary for his survival.

Evaluating policy change in physician manpower planning

The decade of the 1980s witnessed a revitalization of free-market interest in the use of incentives and voluntary participation to promote activities in a wide range of fields. Because of its history of decentralized control over physician residency training, the state of New Jersey found such an approach appealing when it sought to restructure its graduate medical education system. Two statewide task forces spent a year developing policy changes designed to produce voluntary changes in such areas as the size and growth of the state system. However, a 2-year follow-up survey of the directors of state residency programs revealed little perceivable change.

MD-PhDs in dermatology

A national survey was conducted to explore ways in which MD-PhDs in dermatology balance their research and clinical interests and the factors that influenced their career decisions. A questionnaire was mailed to all MD-PhDs who were affiliated with dermatology training programs as determined by a preliminary study. The survey consisted of a questionnaire about research background, career pathway, attitudes about personal and professional issues, and influence of residency training program on career decision making. From 60 MD-PhD dermatologists surveyed, 43 (72%) completed questionnaires. Eighty percent of the respondents (34 of 43) held positions in academic medicine; 76% entered dermatology with the intent to pursue academic medicine. Almost all (93%) held academic positions immediately after residency; 50% held positions with the title of assistant professor or higher as their first postresidency employment. Only 26% of the respondents received funding for their MD-PhD through the federally funded Medical Scientist Training Program. Fifty percent of the respondents completed their training with loans. Despite the long period of training and expense required for the dual career, a high percentage (80%) stayed in academic dermatology suggesting that they are an important source for supplying physician-scientists to the field of dermatology. The ability to limit patient care responsibilities and maintain protected time for research may be a factor responsible for the high percentage of MD-PhDs that stay in academic dermatology.

Infectious disease manpower in the United States--1986. 2. Changes in practice patterns over time and training needs. Manpower and Training Committee, Infectious Diseases Society of America

Infectious disease-trained internal medicine physicians responding to a questionnaire survey (n = 1802) reported minor differences in time spent in patient care versus laboratory-based research whether they subsequently became practitioners or academicians. Both practitioners and academicians ranked hospital epidemiology first, followed by knowledge of hospital antibiotic policies in order of importance for new trainees to be taught. Internists with greater than 12 months of training in infectious diseases were divided into private practice versus academically based groups, and their distribution of time spent in various professional activities was analyzed by 5-year intervals for each cohort. These studies confirmed an increasing proportion of time spent in infectious disease-related patient care for new practitioners. Over time, patient care activities decreased and administrative activities increased in all groups. These data are important for estimating future manpower needs.

Current trends in pediatric residency training

A spreading gap has developed between available pediatric level 1 positions and those filled through the National Resident Matching Program. To define which variables enhance a program's ability to match, we surveyed program directors of all categorical pediatric training programs. An 82% response rate showed that ability to match was positively associated with larger program size and offering of shared residency positions. A negative association was found between many benefits and ability to match. The call schedule and number of call-free elective months had no measurable effect. Factors that we were unable to investigate, such as geographic location and academic reputation, may also play a role. Our results emphasize the irrelevance of enhancing benefits as a way of making programs competitive. Our energies need to be directed at attracting junior medical students to a career in pediatrics rather than competing for fourth-year students applying to pediatric programs.

Characteristics of applicants to the fellowship program in quality assurance and utilization review

This article presents the first data on the characteristics of applicants to the physician fellowship program in quality assurance (QA) and utilization review (UR). Data presented about applicants include demographic characteristics, board and national certifications, specialties, license type, practice experience, and QA and UR experience. These data were obtained from individual applications for admission to the program. They are used here to create a database for the program to generate future information on this new specialty group. Characteristics of current applications selected begin to define the members of the profession.

Graduate medical education in the United States

The annual surveys of residency programs on which this report is based have had a higher than 90% response rate for the 5 years previous to 1989. Because of a change to the new electronic data collection system in 1989, the response rate decreased to 78.3%. To adjust for the lower response rate, a regression model computed from data from previous years was developed that permitted projected estimates for 1989 data. These numbers are included in several key tables. The number of GY-1 positions seems to have decreased for 1990, although this may be an artifact of the response rate. Reported unfilled positions, including GY-1 unfilled positions, have increased each year since 1985. The number of new-entry residents (GY-1) seems to be leveling out after decreasing since 1985. Because of the lower response rate, it is difficult to determine the trend in the total number of residents on duty. While the observed number of residents is lower than in 1988, statistical projections indicate an increase of 5% over the 1988 count. Thirty-nine percent of residents were training in family practice, internal medicine, or pediatrics. The number and percent of women in residency programs has remained relatively stable despite a steady increase in the number of women graduating from US medical schools. The percentage of FMG residents has continued to decrease. The percentage of black non-Hispanic residents remains steady. The number of graduates of osteopathic medical schools in ACGME programs has increased 17% since 1987. The number of institutions involved in graduate medical education has not changed significantly during the past 3 years.

Training for general practice: a national survey

OBJECTIVES

(a) To compare current vocational training in general practice with that ascertained by a survey in 1980; (b) to compare the training of trainees in formal training schemes with that of trainees arranging their own hospital and general practice posts.

DESIGN

National questionnaire survey of United Kingdom and armed services trainees who were in a training practice on 1 April 1989. Questionnaires were distributed by course organisers.

SETTING

Research project set up after an ad hoc meeting of trainees at the 1988 national trainee conference.

SUBJECTS

2132 Of the 2281 trainees (93%) known to be in a training practice on 1 April 1989.

RESULTS

1657 Trainees returned the questionnaires, representing 73% of all trainees known to be in a training practice on 1 April 1989. Between 1980 and 1989 there were significant improvements in the trainee year, and there was also evidence of improvements in general practice study release courses. There was no evidence of improvement in other aspects of training. General practice trainees spent an average of three years in junior hospital posts, which provided very little opportunity for study related to general practice. Training received during tenure of hospital posts differed significantly between trainees in formal schemes and those arranging their own hospital posts. During the trainee year training was almost the same for those in formal schemes and those arranging their own posts. Regions varied significantly in virtually all aspects of general practice training.

CONCLUSIONS

The trainee year could be improved further by enforcing the guidelines of the Joint Committee on Postgraduate Training for General Practice. The poor training in junior hospital posts reflected the low priority that training is generally given during tenure of these posts. A higher proportion of general practice trainees should be attached to vocational training schemes. More hospital trainees could attend general practice study release courses if these were designed specifically with the needs of hospital doctors in mind.

An assessment of registrars and their training programmes at the University of Cape Town Teaching Hospitals

In order to describe the registrar population and to highlight their problems, a study using an anonymous questionnaire was conducted in August 1988 at the University of Cape Town Group of Teaching Hospitals. The average age of respondents was 32 years and the majority had family responsibilities (60% married, 41% with dependents). They had significant medical experience and postgraduate qualifications. Registrars work long hours (mean 66 +/- 13.7 h/wk), with duty shifts that can extend for up to 34 hours. Most of their time at work was devoted to patient care, with time for study and research virtually non-existent. Although the majority (61%) felt that the 'registrar experience' was worthwhile, a significant proportion of respondents (45%) had considered leaving the rotation. The study revealed several shortcomings that need to be addressed if candidates of good calibre are to be attracted, academic standards are to be maintained and sufficient specialists produced to serve the needs of our population adequately.

Osteopathic postdoctoral education

Osteopathic postdoctoral education is still in transition. With a projected modest decline in the number of graduates and continued increase in the number of intern positions, the profession can now accommodate all graduates in osteopathic internships. Changes have been made in the intern program curriculum and in procedures for approval of residency training to be more responsive to the current healthcare environment and needs of osteopathic graduates. The AOA Department of Education will continue to monitor and report on the impact of these changes.