Interest in Family Medicine Among US Medical Students and Its Association With a Community College Academic Pathway

BACKGROUND AND OBJECTIVES

One-third of all medical students attend a community college (CC) on their path to medical school. The objective of this study was to examine the association between CC participation and initial specialty of interest among US allopathic medical students.

METHODS

We performed a national cross-sectional study of allopathic medical students who completed the 2012 Association of American Medical Colleges' Matriculating Student Questionnaire. Bivariate and logistic regression analyses were conducted.

RESULTS

A total of 9,885 medical student respondents were included in the study sample, consisting of 7,035 (71%) non-CC pathway, and 2,850 (29%) CC pathway participants. CC pathway participants were more likely to express intent to specialize in family medicine (272/2,850 [10%] vs 463/7,035 [7%], P<.001), compared to those on the non-CC path. CC pathway participants had higher odds of intent to specialize in family medicine (adjusted odds ratio [AOR]=1.32; 95% CI 1.13-1.56, P<0.001), compared to those on the non-CC path. Women, independent of college pathway, were nearly two times more likely to express an intention to specialize in family medicine, and three times more likely to express an intention to specialize in pediatrics than men.

CONCLUSIONS

Medical students who used a CC pathway are more likely to have intentions to specialize in family medicine, compared to those on the non-CC path.

Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States: A Systematic Literature Review

PURPOSE

The authors conducted a systematic review of the medical literature to determine the factors most strongly associated with localizing primary care physicians (PCPs) in underserved urban or rural areas of the United States.

METHOD

In November 2015, the authors searched databases (MEDLINE, ERIC, SCOPUS) and Google Scholar to identify published peer-reviewed studies that focused on PCPs and reported practice location outcomes that included U.S. underserved urban or rural areas. Studies focusing on practice intentions, nonphysicians, patient panel composition, or retention/turnover were excluded. They screened 4,130 titles and reviewed 284 full-text articles.

RESULTS

Seventy-two observational or case-control studies met inclusion criteria. These were categorized into four broad themes aligned with prior literature: 19 studies focused on physician characteristics, 13 on financial factors, 20 on medical school curricula/programs, and 20 on graduate medical education (GME) programs. Studies found significant relationships between physician race/ethnicity and language and practice in underserved areas. Multiple studies demonstrated significant associations between financial factors (e.g., debt or incentives) and underserved or rural practice, independent of preexisting trainee characteristics. There was also evidence that medical school and GME programs were effective in training PCPs who locate in underserved areas.

CONCLUSIONS

Both financial incentives and special training programs could be used to support trainees with the personal characteristics associated with practicing in underserved or rural areas. Expanding and replicating medical school curricula and programs proven to produce clinicians who practice in underserved urban or rural areas should be a strategic investment for medical education and future research.

What physicians from diverse specialties know and support in health care reform

BACKGROUND AND OBJECTIVES

The United States is in an unprecedented era of health care reform that is pushing medical professionals and medical educators to evaluate the future of their patients, careers, and the field of medicine. Our objectives were to describe physician familiarity and knowledge with the Patient Protection and Affordable Care Act (ACA) and to determine if knowledge is associated with support and endorsement of the ACA.

METHODS

We used a cross-sectional Internet-based survey of 559 physicians practicing in California. Primary outcomes were physician support and endorsement of ACA: (1) overall impact on the country (one item) and (2) perceived impact on physician's medical practice (one item). The primary predictor was knowledge of the ACA as measured with 10 questions. Other measures included age, gender, race-ethnicity, specialty, political views, provision of direct care, satisfaction with the practice of medicine, and compensation type. Descriptive statistics and multiple variable regression models were calculated.

RESULTS

Respondents were 65% females, and the mean age was 54 years (+/- 9.7). Seventy-seven percent of physicians understood the ACA somewhat well/very well, and 59% endorsed the ACA, but 36% of physicians believed that health care reform will most likely hurt their practice. Primary care physicians were more likely to perceive that the new law will help their practice, compared to procedural specialties. Satisfaction with the practice of medicine, political affiliation, compensation type, and more knowledge of the health care law were independently associated with endorsement of the ACA.

CONCLUSIONS

Endorsement of the ACA varied by specialty, knowledge, and satisfaction with the practice of medicine.

Utilizing international medical graduates in health care delivery: brain drain, brain gain, or brain waste? A win-win approach at University of California, Los Angeles

After identifying many unlicensed Hispanic international medical graduates (IMGs) legally residing in southern California, University of California, Los Angeles developed an innovative program to prepare these sidelined physicians to enter family medicine residency programs and become licensed physicians. On completion of a 3-year family medicine residency-training program, these IMGs have an obligation to practice in a federally designated underserved community in the state for 2 to 3 years. As the US health care system moves from physician-centered practices to patient-focused teams, with primary care serving as the foundation for building patient-centered medical homes, attention to educating IMGs in these concepts is crucial.

Double-blind placebo-controlled evaluation of the PROMETA™ protocol for methamphetamine dependence

AIMS

To evaluate the efficacy and safety of the PROMETA™ Protocol for treating methamphetamine dependence.

DESIGN

A double-blind, placebo-controlled 108-day study with random assignment to one of two study conditions: active medication with flumazenil (2 mg infusions on days 1, 2, 3, 22, 23), gabapentin (1200 mg to day 40) and hydroxazine (50 mg to day 10) versus placebo medication (with active hydroxazine only).

SETTING

Three substance abuse treatment clinics: two in-patient, one out-patient.

PARTICIPANTS

Treatment-seeking, methamphetamine-dependent adults (n = 120).

MEASUREMENTS

Primary outcome was percentage of urine samples testing negative for methamphetamine during the trial.

FINDINGS

No statistically significant between-group differences were detected in urine drug test results, craving, treatment retention or adverse events.

CONCLUSIONS

The PROMETA protocol, consisting of flumazenil, gabapentin and hydroxyzine, appears to be no more effective than placebo in reducing methamphetamine use, retaining patients in treatment or reducing methamphetamine craving.

Eight years of building community partnerships and trust: the UCLA family medicine community-based participatory research experience

Acknowledging the growing disparities in health and health care that exist among immigrant families and minority populations in large urban communities, the UCLA Department of Family Medicine (DFM) sought a leadership role in the development of family medicine training and community-based participatory research (CBPR). Performing CBPR requires that academic medicine departments build sustainable and long-term community partnerships. The authors describe the eight-year (2000-2008) process of building sustainable community partnerships and trust between the UCLA DFM and the Sun Valley community, located in Los Angeles County.The authors used case studies of three research areas of concentration (asthma, diabetes prevention, and establishing access to primary care) to describe how they established community trust and sustained long-term community research partnerships. In preparing each case study, they used an iterative process to review qualitative data.Many lessons were common across their research concentration areas. They included the importance of (1) having clear and concrete community benefits, (2) supporting an academic-community champion, (3) political advocacy, (4) partnering with diverse organizations, (5) long-term academic commitment, and (6) medical student involvement. The authors found that establishing a long-term relationship and trust was a prerequisite to successfully initiate CBPR activities that included an asthma school-based screening program, community walking groups, and one of the largest school-based primary care clinics in the United States.Their eight-year experience in the Sun Valley community underscores how academic-community research partnerships can result in benefits of high value to communities and academic departments.

Health care for Latino children: impact of child and parental birthplace on insurance status and access to health services

OBJECTIVES

This study sought to assess the impact of child and parental birthplace on insurance status and access to health care among Latino children in the United States.

METHODS

A cross-sectional, in-person survey of 376 random households with children aged 1 to 12 years was conducted in a predominantly Latino community. Children's insurance status and access to routine health care were compared among 3 child-parent groups: US born-US born (UU), US born-immigrant (UI), and immigrant-immigrant (II).

RESULTS

Uninsured rates for the 3 groups of children were 10% (UU), 23% (UI), and 64% (II). Rates for lack of access to routine health care were 5% (UU), 12% (UI), and 32% (II).

CONCLUSION

Latino children of immigrant parents are more likely to lack insurance and access to routine health care than are Latino children of US-born parents.

A family medicine teaching program for obstetrics-gynecology residents

BACKGROUND AND OBJECTIVES

The Harbor-UCLA Family Practice Residency Program has offered a year-long primary care continuity clinic experience to first-year obstetrics-gynecology (OB-GYN) residents since July 1994. This paper describes the teaching programs and compares the experience of the OB-GYN residents to that of family practice (FP) residents in the same clinic site.

METHODS

OB-GYN residents worked in the family medicine teaching clinic for a half day each week for the entire year. The teaching program was evaluated with a questionnaire and interviews of OB-GYN residents to obtain their opinions on the value of this teaching modality. A review of clinic schedules and medical records compared the practice profiles of six OB-GYN residents with six matched FP residents.

RESULTS

Five out of six OB-GYN residents felt that the educational objective of improving primary care skills was achieved. Half of them were pleased about their relationships with the family medicine faculty; the remainder reported being treated as second-class citizens. Patient volume and the diagnosis encountered were similar between the OB-GYN residents and the FP residents.

CONCLUSIONS

Evaluation of the primary care continuity clinic experience for OB-GYN residents through questionnaires, interviews, and medical records analysis revealed the acceptability, feasibility, and appropriateness of this teaching program for OB-GYN residents. However, not all OB-GYN residents were happy about their relationships with the family medicine faculty. The long-term effectiveness of the experience needs further study.

A successful physician training program in cholesterol screening and management

METHOD

Thirty-six resident physicians received a blood cholesterol training program which included training in blood cholesterol screening using a fingerstick method and a desktop analyzer, diet assessment and counseling, and a management protocol for follow-up diet and drug treatment. The program also included feedback to residents about their blood cholesterol screening activity, incentives, and biweekly articles in the department newsletter.

RESULTS

Between 1986-1987 (baseline) and 1987-1988 (intervention), the percentage of the target patient population (ages 20-65 years, nonpregnant, not screened in the previous year) that was screened for hypercholesterolemia in this primary care practice increased from 16.2 to 23.2% [rate difference (RD) = 7.0; 95% confidence interval (CI) = 4.75-9.25]. The mean value of the screening tests decreased from 5.36 mmol/liter (207.2 mg/dl) to 5.08 mmol/liter (196.6 mg/dl; t = 2.98, P = 0.003) and the percentage of the population screened needing further evaluation decreased from 36.8 to 27.6% (RD 9.2; CI = 2.00-14.00). In the intervention year, compared with the baseline year, patients with a borderline blood cholesterol and cardiovascular risk factors were more likely to have a follow-up test (28.8% vs 11.9%, RD = 16.9; 95% CI = 0.80-33.00) and the low-density lipoprotein cholesterol test was used less for screening (8.2% vs 19.4%, P less than 0.0001). Conclusion. We conclude that this program was effectively integrated into a busy primary care practice, leading to improvement in blood cholesterol screening and management practices.

Return of tuberculosis: screening and preventive therapy

Approximately 25 percent of individuals exposed to Mycobacterium tuberculosis become infected. Of those, about 10 percent will develop clinically active tuberculosis at some time in their lives. The tuberculin skin test should be used to screen all patients, especially those at greatest risk of contracting the disease, such as the young and the old, and those with weakened immune systems from poor nutrition, alcohol and drug abuse, chronic illness and human immunodeficiency virus infection. Depending on the characteristics of the local population and individual medical risk factors, a reaction (induration) between 5 and 15 mm (or more) generally represents infection. Isoniazid therapy in persons with positive skin tests will decrease the risk of disease by 60 to 80 percent. Family physicians will play a critical role in efforts to eliminate tuberculosis from the United States by the year 2010.