Family Medicine最新文献

Background and objectives: With a projected primary care physician shortage, efforts must be made to increase the number of students choosing family medicine. Studies have explored what might influence student choice of family medicine, though questions remain about the impact of medical school policies and processes, including for admissions, as well as longitudinal tracks. This study explores some of these structural and institutional factors and how they are associated with rates of students entering into family medicine in subsequent years.

Methods: Responses from a 2016 survey of family medicine department chairs were matched to 2017-2019 institutional family medicine graduate rates to compare the rates of students entering family medicine with (a) inclusion of primary care or family medicine in the medical school's mission statement; (b) perceived support of the dean's office in increasing family medicine teaching and leadership presence in the medical school curriculum; (c) whether the admissions committee had a charge to seek out applicants interested in primary care; and (d) the presence of Liaison Committee on Medical Education designated tracks in primary care/family medicine.

Results and conclusions: Overall, schools whose admissions committees had a specific charge to seek out applicants interested in primary care were consistently more likely than their peer institutions to match more students into family medicine. Other institutional factors may play a role, particularly school mission statements and rural longitudinal tracks. The results of this study have helped to identify where departments of family medicine might focus institutional advocacy to support learners in choosing and subsequently matching into family medicine.

Following its independence from the Soviet Union in 1991, Kyrgyzstan became a pioneer in Central Asia by implementing extensive health care reforms that introduced family medicine. Beginning in the late 1990s, these reforms strengthened primary health care by introducing family medicine as a specialty and a key component of the health care system. This approach improved the quality of medical care while reducing health care costs and gradually extended to reforms in medical education and the broader health care system, including efforts to address the rural medical workforce. However, challenges remain in fully embedding family medicine into Kyrgyzstan's medical education and health care system. This paper aims to analyze the progress made since the early reforms, assess recent developments, and explore the ongoing challenges in institutionalizing family medicine within Kyrgyzstan's health care landscape. A full-text Russian translation of this article is available from author Paul Fonken (paul.fonken@gmail.com).

Background and objectives: Jordan has residency positions available for approximately 20% of graduates from Jordanian medical schools, with approximately 30 in family medicine. Most graduates never complete a residency program and instead work as outpatient general practitioners (GPs). The need for more well-trained GPs is overwhelming. To address this gap, ERASMUS+ funding provided the money and technical expertise of European family medicine faculty to create a diploma program that enhanced prior efforts. In this paper, we share the evaluation data gathered for three levels of Kirkpatrick's four-level model and discuss the additional steps taken to ensure sustainability of the diploma program.

Methods: A needs analysis consisting of a series of surveys, site visits, personal interviews, and bilateral meetings was conducted by the project consortium to identify the items most necessary in developing a sustainable project. The four levels of the Kirkpatrick evaluation model were used to evaluate the project.

Results: Trainees improved in areas of understanding primary care, ethics and values, communication skills, and patient management. Six months after diploma completion, Level 3 data showed decreases in both antibiotic prescriptions and referral rates. To increase sustainability, our program involved local stakeholders from the beginning of the project, provided training for family medicine mentors, offered incentives for program trainees, and developed a sustainable financial model.

Conclusions: Diploma programs fill an important void in the expertise of GPs. Building on prior diploma program efforts, our program added critical elements to create a successful and sustainable program.

Background and objectives: The choice of specialty by medical students is pivotal for their careers and the health care system. The shortage of trained medical providers makes this choice particularly salient in Africa. Understanding the motivations and preferences of African medical students can inform interventions to improve the distribution and retention of doctors across specialties and regions. This study aims to explore the factors influencing specialty selection among medical students across Africa using a cross-sectional, mixed-methods approach.

Methods: A survey conducted from June to October 2023 included 1,044 students from 152 medical schools. Descriptive statistics summarized sample characteristics, and linear regression models identified predictors of primary care selection. Thematic analysis was performed on qualitative data.

Results: Students interested in primary care were, on average, older and reported higher anxiety levels compared to their counterparts. Key factors influencing specialty choice across all students included personal interest, scope of practice, and intellectual stimulation, with prestige being least important for those choosing primary care. Additionally, the importance of mentorship was lower among primary care aspirants. Country-specific analysis revealed that students from Benin, Botswana, Ivory Coast, Senegal, and Sierra Leone were more likely to choose primary care.

Conclusions: This study provides an overview of the motivations behind specialty choice among African medical students, highlighting the need for tailored interventions to address regional health care needs. Understanding these preferences can help in designing strategies to enhance the distribution and retention of medical professionals in various specialties, ultimately improving health care outcomes.

Over the past 25 years, Nepal has made admirable progress not only in improving living conditions and health indices but also in training family physicians, called medical doctors in general practice (MDGPs). This article examines the evolution and contributions of family physicians, the development of their own unique residency curriculum, and their current and evolving practice scope. It also evaluates recruitment and retention challenges and suggests strategies for advancing family medicine in Nepal. Family physicians have been pioneers in health care delivery in Nepal and have had a profound impact on improving access to primary and emergent medical care for the rural population. They have contributed to the decrease in morbidity and mortality rates and improved life expectancy. Family medicine residencies and physicians have been and are evolving to meet the ever-changing needs of their country, leading primary and emergency care; but urgent reforms are needed for their recruitment and retention. Despite Nepal's uniqueness and leadership in South Asia in its recognition for and development of full-scope, well-trained family physicians, MDGP leaders need collaboration and support from both their own government and medical community, as well as from international educators, to continue to lead the country in improving health and decreasing health disparities.