Alan B Douglass's research while affiliated with Bethesda Family Medicine Residency and other places

Publications (35)

Article
The optimal length of family medicine training has been debated since the specialty's inception. Currently there are four residency programs in the United States that require 4 years of training for all residents through participation in the Accreditation Council for Graduate Medical Education Length of Training Pilot. Financing the additional year...
Article
Background and objectives: The In-training Examination (ITE) is a frequently used method to evaluate family medicine residents' clinical knowledge. We compared family medicine ITE scores among residents who trained in the 14 programs that participated in the Preparing the Personal Physician for Practice (P4) Project to national averages over time,...
Article
Background and objectives: Evolutions in care delivery toward the patient-centered medical home have influenced important aspects of care continuity. Primary responsibility for a panel of continuity patients is a foundational requirement in family medicine residencies. In this paper we characterize challenges in measuring continuity of care in res...
Article
Redesign in the health care delivery system creates a need to reorganize resident education. How residency programs fund these redesign efforts is not known. Family medicine residency program directors participating in the Preparing Personal Physicians for Practice (P(4)) project were surveyed between 2006 and 2011 on revenues and expenses associat...
Article
Abstract This resource on pregnancy and oral health covers topics for health care providers who take care of prenatal patients. The module covers a range of topics, including oral diseases of pregnancy, complications of these diseases on the pregnancy, safety of dental interventions in pregnancy, and how to promote oral health for pregnant women an...
Article
Abstract This resource on acute dental emergencies covers topics for health care providers who take care of ambulatory or hospitalized patients. The module covers a range of topics, including oral pain and infections such as abscesses and cellulitis. In addition, students learn about common trauma to primary and secondary dentition, including the b...
Article
Abstract This resource on geriatric oral health covers topics for health care providers who take care of older adult patients. The module covers a range of topics including oral health assessment; common oral diseases such as caries, periodontitis, and oral cancer; oral-systemic links (diabetes, arthritis, and dementia, to name a few); nursing home...
Article
Abstract Smiles for Life Module 6, Fluoride Varnish, covers topics for health care providers who take care of children and adolescents. The module is more than simply a “how-to” for varnish teeth; the module covers a range of topics including the cause of early childhood caries (ECC), how to assess risks for ECC, how to perform a proper oral exam o...
Article
Abstract This resource on oral examination addresses how to perform consistent and thorough oral examinations of children and adults. Clinicians learn to differentiate between normal and abnormal findings and develop an awareness of the needs of special populations such as the elderly or medically compromised individuals. This resource is designed...
Article
Abstract This resource is a learning module that addresses the nature, prevalence, and consequences of oral disease throughout the life cycle, with a focus on correlations between oral and systemic health. Clinicians learn their role in preventing oral disease, addressing frequently encountered oral problems, and promoting oral health among their p...
Article
Abstract This resource addresses how adult oral health is impacted by factors such as disease, aging, medication, and substance use. Clinicians review risk factors and etiologies of oral conditions, as well as appropriate treatment and referral procedures. Additionally, this module addresses how to effectively promote oral disease prevention, coord...
Article
Full-text available
The study's objective was to describe faculty development skills needed for residency redesign in 14 family medicine residencies associated with the Preparing the Personal Physician for Practice (P4) project. We used self-administered surveys to assess ratings of existing faculty development efforts and resident attitudes about faculty teaching bet...
Article
Full-text available
ORIGINAL ARTICLES T he primary care specialties of family medicine, general pe-diatrics, and general inter-nal medicine are actively engaged in residency redesign, driven by the need to transform their disciplines and adequately prepare physicians to practice in a changing health care environment. 1-3 Others have suggested that transformation in pa...
Article
Extending the residency curriculum to 4 years has been proposed as a logical innovation in response to the Future of Family Medicine Report given the increasing complexity of medical care and reduction in available training time due to duty hour restrictions. Middlesex Hospital, a participant in the P⁴ Initiative, is the first family medicine resid...
Article
Family medicine is actively engaged in residency redesign, but it is unclear how curricular innovation and restructuring of residency programs will affect their performance in the National Resident Matching Program (NRMP). The Preparing the Personal Physician for Practice (P⁴) Project is a residency redesign initiative of 14 family medicine residen...
Article
Background: This paper presents early outcomes of three residency programs participating in Preparing the Personal Physician for Practice (P4), family medicine's innovative residency redesign initiative. The three programs allow learner-directed diversification and either allow or require extra time, up to 4 years of residency, to complete these e...
Article
Publication of Oral Health in America: A Report of the Surgeon General (SGROH) alerted the public and health professionals to the importance of oral health and the vulnerability of poor and underserved children to dental disease. In response, the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the Society...
Article
Full-text available
The Patient-centered Medical Home (PCMH) is a central concept in the evolving debate about American health care reform. We studied family medicine residency training programs' continuity clinics to assess baseline status of implementing PCMH components and to compare implementation status between community-based and university training programs. We...
Article
Oral health care in pregnancy is often avoided and misunderstood by physicians, dentists, and patients. Evidence-based practice guidelines are still being developed. Research suggests that some prenatal oral conditions may have adverse consequences for the child. Periodontitis is associated with preterm birth and low birth weight, and high levels o...
Conference Paper
Dental caries is the most common chronic disease of childhood and a disease process that can begin as soon as the first tooth erupts. Unfortunately, for many children in the 0-3 year age group, oral health is often overlooked and access to dental care often limited. These children, however, frequently interact with a pediatrician or family physicia...
Article
Full-text available
The Society of Teachers of Family Medicine Group on Oral Health released Smiles for Life: A National Oral Health Curriculum for Family Medicine in October 2005 to address a need for high-quality residency and medical school curricula in an area of documented physician knowledge deficit. This article describes the background, planning, fund-raising,...
Article
Early childhood caries is the most common chronic disease in young children and may develop as soon as teeth erupt. Bacteria, predominately mutans streptococci, metabolize simple sugars to produce acid that demineralizes teeth, resulting in cavities. Physicians should examine children's teeth for defects and cavities at every well-child visit. Any...
Article
Early childhood caries is the most common chronic disease in young children and may develop as soon as teeth erupt. Bacteria, predominately mutans streptococci, metabolize simple sugars to produce acid that demineralizes teeth, resulting in cavities. Physicians should examine children's teeth for defects and cavities at every well-child visit. Any...
Article
The purpose of this study was to investigate whether an infant oral health curriculum implemented in pediatric and family medicine residency programs could improve physicians' oral health knowledge and practice behaviors and promote the age 1 dental visit. Residents and faculty members completed a baseline current practices survey and knowledge tes...
Article
Full-text available
Almost all working adults, more than half in any given year, experience low back pain. Although the differential diagnosis is extensive, most symptoms have biomechanical causes and resolve promptly with little intervention, although recurrence is common. History and physical examination are important in distinguishing potential causes and identifyi...
Article
Neck pain is almost universal and is a common patient complaint. Although the differential diagnosis is extensive, most symptoms are from biomechanical sources, such as axial neck pain, whiplash-associated disorder (WAD), and radiculopathy. Most symptoms abate quickly with little intervention. There is relatively little high-quality treatment evide...
Article
Full-text available
Pain is a common complaint of patients who visit a family physician, and its appropriate management is a medical mandate. The fundamental principles for pain management are: placing the patient at the center of care; adequately assessing and quantifying pain; treating pain adequately; maximizing function; accounting for culture and gender differenc...
Article
Well established guidelines exist for the relief of pain at the end of life. Opioids are useful in treating a variety of painful conditions, with morphine being the gold standard. By following established protocols, opioids may be adjusted or exchanged safely. Patients with severe pain often require sustained-release opioids coupled with immediate-...
Article
Palliative care medicine is patient and family centered, unlike acute medicine, which is disease focused. Primary care providers, because of their relationships with their patients, are often best able to provide this type of care. They frequently lead teams of professionals who collaborate to meet patient needs. Practicing palliative care medicine...
Article
Dental caries, a bacterial disease of teeth characterized by destruction of enamel and dentine, is often the underlying cause of dental pain. When a carious lesion impinges on the dental pulp, pulpitis follows and, ultimately, necrosis of the pulp occurs. Untreated necrosis may lead to a localized abscess or a spreading infection into the surroundi...

Citations

... 2,3 A resident's knowledge base may need to continually expand into a wide variety of new areas, while still including competency in the numerous existing ones expected for primary care. 3 However, a disconnect between the size of the aspirational knowledge base and what physicians actually do may exist. Some areas may never be encountered by the practicing physician, and so training in them may not be essential. ...
... To earn "submitted" points, the submission must, in the consideration of the Program Director, be a reasonable candidate for acceptance; while this has never been an issue, this caveat is added to avoid spurious submissions merely to accrue points. Adapted from Seehusen et al. 2 HSD pairwise comparison procedure was used to evaluate pairwise significance between each group where multi-group differences were found. ...
... A PubMed literature search of papers within the past 5 years relating to resident SA and ITE scores shows that research in SA focuses on identifying and overcoming barriers [4,5,[7][8][9][10], and in ITE scores focuses on using ITE to predict board passage or to compare curricular innovation [3,[11][12][13]. There are few studies that correlate standardized medical examination scores to research or SA, and each of these evaluates pre-residency exposure to Table 1. ...
... 9 The Clinic First initiative conducted site visits at 23 residency clinics, finding less than half measured continuity from the patient's perspective, and these rates varied from 21%-81%. 10 Similarly, the Length of Training Pilot, a case control study of 13 residency programs extending training to 4 years, found that defining resident continuity was challenging and needs special attention. 11 Specialty referral rates, an indirect marker of comprehensiveness, also vary widely between programs, 7%-31%. 12 Overall, there is not enough measurement to know how the majority of programs are performing, and, when areas are measured, there is wide variability. ...
... Intrinsic factors, such as gastroesophageal reflux disease and bulimia nervosa, cause demineralization and erosion of tooth enamel. The pH of endogenous acids is below the critical pH for HA dissolution, resulting in demineralized enamel surface areas [25,26]. These regions may eventually harbor acid-forming bacteria, resulting in caries formation [27,28]. ...
... Examination for signs of decay, swollen lymph glands, abscesses and cellulitis is essential. 5 Xerostomia Under normal conditions, the oral cavity yields around 500 mL of saliva every 24 hours. Xerostomia occurs when this quantity diminishes by 50%. ...
... Tooth decay is more common among pregnant women for a variety of reasons, including increased acidity in the mouth, sweet food demands, and a lack of attention to oral health. Vomiting can have a severe impact on oral hygiene and induce degradation of the mother enamel layer [13]. Due to the effect of pregnancy hormones, pregnant women bleed more easily and may postpone brushing their teeth and it leads to an increase in bacterial plaque [14]. ...
... After obtaining verbal consent to participate, a single investigator (MF) individually provided participating parents with a verbal explanation of the FV application procedure, including the potential benefit of reduced dental caries and the risk of mild enamel fluorosis, supported by a visual aid (adapted from Smiles for Life®) demonstrating the procedure ( Figure 1). [23] Following this two-to three-minute explanation, the parent completed a 19-item, paper-based survey, verbally administered by the investigator, that assessed sociodemographic variables, oral health knowledge and opinions regarding FV application by a PCP. [23] The survey instrument was adapted from a study by Hendaus et al. (2016), who evaluated parental attitudes regarding FV application in a medical setting and its impact on oral health habits. ...
... 13 For comparison, CME for oral health is readily available to PAs through the Society of Teachers of Family Medicine's Smiles for Life: A National Oral Health Curriculum. 21 To our knowledge, no similar organized CME for vision health exists for PAs. The oral health curriculum has been promoted among PAs by the PA Leadership Initiative in Oral Health following a call for the integration of oral health into primary care by the NASEM in 2011. ...
... Our finding that both top-ranked and university-based/affiliated programs displayed more elements indicating commitment to diversity and inclusion on their Web sites may represent greater availability of resources for (1) implementing diversity and inclusion initiatives and (2) developing residency Web sites to showcase initiatives. 33,34 However, since resource availability may be cross-cutting, increasing financial resources for diversity and inclusion initiatives may help to recruit more diverse applicants and address current diversity limitations. 35 Regional analysis of residency program Web sites revealed that programs in the West contained the highest average number of diversity elements on program Web sites when compared with programs in the Northeast, Midwest, and South regions, though this difference was not statistically significant. ...