Chronic illness needs educated doctors: An innovative primary care training program for chronic illness education.

Background: Medical educators need proven curriculum innovations that prepare trainees for the expanding number of patients with chronic illnesses.

Purpose: We describe and evaluate the effectiveness of a chronic illness training program, Chronic Illness Needs Educated Doctors (CINED).

Method: Forty-seven trainees completed four instructional components: (1) measurements of the health-related quality of life of patients with chronic illnesses; (2) didactic sessions in which they described chronically ill patients and their care; (3) written narratives describing the trainees' reactions for these patients; and (4) portfolios offering evidence of chronic illness learning.

Trends in colorectal cancer incidence by anatomic site and disease stage in the United States from 1976 to 2005.

Objective: The objectives of the current study were to examine the trends in incidence rates of subsite-specific colorectal cancer at all stages in a large US population and to explore the impact of age and sex on colorectal cancer incidence.

Methods: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) 9 registries. Colorectal cancer incidence was divided into 3 anatomic subsite groupings: proximal colon, distal colon, and rectum.

Teaching first-year medical students to apply evidence-based practices to patient care.

Background And Objectives: Our objective was to describe and evaluate an educational intervention for teaching preclinical medical students enrolled in a family medicine preceptorship to use evidence-based medicine (EBM) techniques.

Methods: In a brief workshop, 94 preclinical students, enrolled in a 4?week family medicine preceptorship, learned an EBM approach to clinical decision making. Students were responsible for completing four patient case summaries to document that they had searched selected databases and obtained feedback from their preceptors.

Knowledge and use of academic portfolios among primary care departments in U.S. medical schools.

Background And Purpose: Portfolios are used to summarize and communicate the academic accomplishments of faculty seeking career development and promotion.

Method: We assessed knowledge and use of the portfolio in a cross sectional survey of 435 academic chairpersons of family medicine and division directors of general internal medicine and general pediatrics.

Results: Of the 241 respondents (55% response rate), 69% reported knowledge of portfolios and 55% used portfolios.

The effect of lack of insurance, poverty and paediatrician supply on immunization rates among children 19-35 months of age in the United States.

Rational, Aims And Objectives: Previous studies found that the increasing number of paediatricians in the United States was associated with improved childhood immunization coverage, while the increasing poverty level and the lack of health insurance reduced access to health care. We evaluated whether changes in the number of paediatricians, poverty level and health insurance affected national childhood immunization coverage in the state levels of the United States.

Methods: Data were collected primarily from the US National Immunization Surveys, series 4:3:1:3:3 from years 1995 and 2003.

A preclinical training model for chronic care education.

Background: Chronic illnesses are not only major health threats for half of the world's population, but these diseases are also increasing rapidly. Medical training, however, has not kept pace with this increase in chronic illness.

Methods: I describe two instructional modules whose goals were to teach preclinical medical students to (1) screen for diabetic neuropathies and provide counseling for improved diabetic foot care, and (2) screen for tobacco use and provide counseling for smoking cessation.

Changes in perceived effect of practice guidelines among primary care doctors.

Rationale, Aims And Objectives: Evidence suggests that when doctors use systematically developed clinical practice guidelines they have the potential to improve the safety, quality and value of health care. The purpose of this study was to evaluate recent changes in the perceptions of practice guidelines among US primary care doctors.

Methods: Data were collected from the Community Tracking Survey 1996-97 and 2000-01.

The impact of preclinical preceptorships on learning the fundamentals of clinical medicine and physical diagnosis skills.

Purpose: To learn whether preclinical primary care preceptorships resulted in demonstrable clinical performance benefits to medical students.

Method: This was a retrospective cohort study of 267 medical students who elected and 310 students who did not elect to take a four-week primary care preceptorship following the first year of training at the University of Texas Medical School at Houston in 2001-2003. Outcome variables were the students' performances on a written examination testing their integration of basic science and fundamentals of clinical medicine and performances on a comprehensive objective structured clinical examination (OSCE).

Assessment of competencies in physicians-in-training through the delivery of a community-based health curriculum using distance learning.

Academic physicians must master the elements of curriculum development and evaluation specific to defined competencies in postgraduate medical education. Six fellows in primary care medicine, working as a peer group with a faculty mentor, designed and evaluated a distance-learning project that included resident physicians. Professionalism, interpersonal skills and systems-based medical practice skills were measured with original instruments designed by the peer group.

Implementation of a smoking cessation counseling module in a preceptorship program.

Background: Family medicine preceptorships are underused opportunities for learning smoking cessation counseling skills. To prepare students for their future roles in preventing health problems in patients who use tobacco, we implemented a patient-centered instructional module within the elective Texas Statewide Family Practice Preceptorship Program.

Methods: Seventy-eight preclinical medical students learned to screen for tobacco use and perform smoking cessation counseling using brief motivational methods.

Evaluating the Texas Statewide Family Practice Preceptorship Program, 1992-2000.

Purpose: Since 1979, the Texas Statewide Family Practice Preceptorship Program (TSFPPP) has conducted ambulatory preceptorships to increase the number of medical students selecting family practice residencies. The authors describe the evaluation of the TSFPPP's efficacy in terms of four evaluation questions and outcome measures identified by program users from eight Texas medical schools.

Method: The authors compared the proportion of 10,081 Texas medical school students graduating from 1992-2000 who chose family practice or other primary care residencies following participation or nonparticipation in the TSFPPP's preclinical and clinical programs.

Medical treatment of women and adherence to HIV guidelines at an urban university-staffed public clinic.

Background: HIV-related morbidity and mortality have declined in recent years in the United States. Relative to their male counterparts, however, HIV-infected women tend to have less reduced morbidity and mortality. The purpose of this study was to investigate if the reported small decreases in HIV-related morbidity and mortality in women could be due to their receiving a lesser standard of care from public health clinics.

Health related quality of life in pregeriatric patients with chronic diseases at urban, public supported clinics.

Background: Understanding health-related quality of life (HRQOL) leads to more effective and focused healthcare. America's growing health disparities makes it is increasingly necessary to understand the HRQOL of pregeriatric individuals who are now 55-64 years old, i.e.

Family medicine month in a university-based program: establishing a family medicine identity.

"Family Medicine Month," a rotation forfirst-year residents, was developed to clarifyfirst-year residents'new roles as family physicians. The rotation explored the meaning and history of the specialty, as well as teaching core family medicine clinical and behavioral skills. Twenty residents who participated in the rotation in 1999 and 2000 indicated satisfaction with the rotation and endorsed its usefulness.