A Recipe for Medical Schools to Produce Primary Care Physicians

Warren Alpert Medical School, Brown University, Providence, RI, USA.
New England Journal of Medicine (Impact Factor: 55.87). 02/2011; 364(6):496-7. DOI: 10.1056/NEJMp1012495
Source: PubMed
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    • "The curricular reforms are directed to increasing practical work, problem solving, early contact with patients and greater bonding of students with their mentors [20,21]. The relationship between the student and the teacher should mirror patient-physician relationship: it should have the characteristics of mutual respect and build the process of shared decision-making, with the aim of promoting cooperation rather than competition [22]. "
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    ABSTRACT: Despite rapid growth and development of medical technology, personal relationship between the patient and physician remains the basis of high quality treatment. The aim of our study was to develop, implement and evaluate patient therapeutic letters written by students as a tool in teaching family medicine. The study included all 6th year students attending their rounds in family medicine, structured into two 10-day cycles, one in urban offices and one in offices on the Adriatic islands (rural). After receiving detailed instructions, students wrote letters to two patients after a consultation in the office. The letters were audited by patients and 3 family medicine experts who used a grading instrument (scale 0 -- poor, 1 -- medium, 2 -- good) for 1) adequacy and clarity of description of patients' disease/state, 2) knowledge, 3) adequacy of recommendations, 4) courtesy and respect and 5) language and style. Patients and experts were also asked to underline phrases they thought would be difficult to understand; the underlined text was subjected to content analysis. Both the patients and the experts gave high scores for the value and quality of the letters in terms of the description of the problem, adequacy of recommendations given, and courtesy and respect (mean (+/-standard deviation) 5.65 +/- 0.79 for patients vs. 4.87 +/- 0.79 for experts out of maximum score of 6). Family medicine experts were stricter than patients in their evaluation of the content of the letters (adequacy and clarity of disease description (P < 0.001) and adequacy of recommendations (P < 0.001). Both the patients and the experts seemed to like longer letters as the length of the letter showed significant positive correlation with the quality summary score (correlation r = 0.492 vs. r = 0.338, respectively, P < 0.010). Overlapping of the text underlined as difficult to understand by patients and experts was found in 10 (11.6%) out of 86 letters. The highest overlap (20 terms) was found for the category "Technical terms unclear to a lay reader". Writing of a letter to their first patients may be a useful tool for students to personally experience the practice of medicine and establish better partnership with patients in health care.
    BMC Medical Education 08/2013; 13(1):114. DOI:10.1186/1472-6920-13-114 · 1.22 Impact Factor
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    • "SRC programs have been recommended as mandatory components of medical education [32]. It has been well documented that even in a system of publicly funded care, underserved Canadians experience poorer health outcomes than the rest of the population [33]. "
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    ABSTRACT: Despite the increasing popularity of Student-Run Clinics (SRCs) in Canada, there is little existing literature exploring their role within the Canadian healthcare system. Generalizing American literature to Canadian SRCs is inappropriate, given significant differences in healthcare delivery between the two countries. Medical students at the University of Calgary started a SRC serving Calgary's homeless population at the Calgary Drop-In and Rehabilitation Centre (CDIRC). This study explored stakeholders' desired role for a SRC within Calgary's primary healthcare system and potential barriers it may face. Individual and group semi-structured interviews were undertaken with key stakeholders in the SRC project: clients (potential patients), CDIRC staff, staff from other stakeholder organizations, medical students, and faculty members. Intentional sampling was used in the recruitment of client participants. Interview transcripts were analyzed using a coding template which was derived from the literature. Participants identified factors related to the clinic and to medical students that suggest there is an important role for a SRC in Calgary. The clinic was cited as improving access to primary healthcare for individuals experiencing homelessness. It was suggested that students may be ideally suited to provide empathetic healthcare to this population. Barriers to success were identified, including continuity of care and the exclusion of some subsets of the homelesspopulation due to location. SRCs possess several unique features that may make them a potentially important primary healthcare resource for the homeless. Participants identified numerous benefits of the SRC to providing primary care for homeless individuals, as well as several important limitations that need to be accounted for when designing and implementing such a program.
    BMC Health Services Research 07/2013; 13(1):277. DOI:10.1186/1472-6963-13-277 · 1.71 Impact Factor
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    • "Factors such as the organizational culture and commitment to the mission of educating future primary care physicians [4,19] and specific curricular interventions are important [4]. The individual “institutional decisions create a meta-curriculum that frames other components of a medical school” [19]. Others have suggested changes in admission criteria to preferentially select future students predisposed to primary care [20], including those exhibiting altruistic attitudes and a greater sense of social responsibility [4]. "
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    ABSTRACT: The choice of a specialty by medical students is a complex one that has significant implications for the future supply of physician manpower. The study by Weissman et al. portrays this choice as reflecting the degree of congruence between a student's needs and values and his or her perception of the characteristics of the various specialties. The existing shortages in the supply of various specialists in Israel may be interpreted as signifying a lack of alignment of student needs and perceptions. . This commentary will extend the implications of this work to include the connection between students' choices and the physician manpower needs of society, and will focus on primary care physician shortages in the United States as but one example of the implications of these relationships.
    Israel Journal of Health Policy Research 05/2013; 2(1):18. DOI:10.1186/2045-4015-2-18
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