Family Medicine最新文献

This article reflects on the establishment of a family medicine consultant clinic at Mangochi District Hospital in rural Malawi, highlighting its significance in enhancing primary health care access and education. Founded under the Department of Family Medicine at Kamuzu University of Health Sciences, which was established in 2008, the clinic aims to address the high disease burden faced by the district's 1.3 million residents, where specialist care is often inaccessible. Since its inception in early 2020, the clinic has provided critical care for patients with complex medical needs, emphasizing a holistic, patient-centered approach to their care. The clinic facilitates continuity of care and coordinates referrals to higher-level facilities, while also functioning as a training platform for medical students and residents. Challenges such as patient overflow, inappropriate referrals, and resource limitations are discussed, alongside strategies for ongoing evaluation and improvement. Early anecdotal evidence indicates a positive impact on patient satisfaction and care quality. The article underscores the importance of integrating family medicine specialists into rural health care settings to strengthen clinical education and improve patient outcomes. This initiative exemplifies a successful model for expanding family medicine influence in other rural districts and will potentially contribute to improved health systems throughout Malawi.

Background and objectives: The University of California, Los Angeles (UCLA) International Medical Graduate (IMG) program addresses the need for more bilingual and bicultural Latino family physicians in California where Latinos are the largest racial/ethnic minority group and a large percentage of the population speaks Spanish. The objective of this descriptive study was to assess family medicine residency match, board certification, and initial practice location outcomes of the program graduates.

Methods: We conducted a cross-sectional study of program graduates (N=204) from 2007 to 2024. Data were abstracted from program administrative files and the California Medical Board. Primary outcomes were match rate into California family medicine residency programs, completion of a residency, board certification, and initial training practice location. We computed descriptive statistics for participant characteristics and outcomes.

Results: A total of 177/204 (87%) participants completed the UCLA IMG program and entered the match. The country with the most graduates was Mexico followed by Cuba. All graduates, 177/177 (100.0%), that applied and entered the National Resident Matching Program matched in a family medicine residency program. A total of 172 (97%) matched in California programs and 5 (2.8%) matched out of state. Family medicine board certification was verified for 152/159 (95.6%) of those eligible. Few completed a fellowship.

Conclusions: The UCLA IMG program was effective at preparing program graduates that were fluent in Spanish and bicultural to match in a California family medicine residency program and subsequently practice family medicine in underserved areas. Future studies will examine long-term practice outcomes, predictors of success, and participant perspectives on the program.

Over the past 2 decades, the growing need to strengthen primary care in southern Africa has fueled a rising interest in the specialty of family medicine. Given the region's heavy burden of both communicable and noncommunicable diseases, along with restricted health care resources and limited access to care, family physicians may play a key role in improving health care access and quality in these settings. The development of family medicine in Zambia began in 2013 as a working group of committed clinical and public health academics, and progressed to the launch of that country's first family medicine residency in 2019. Despite enormous challenges, the program has flourished since that time, growing rapidly from the inaugural two residents in 2019 to 45 residents and recent graduates by 2025. While this growth has allowed the residency to become a leader in family medicine education in the region, it also has brought a new set of challenges. In this narrative, we describe the health care context of Zambia, the introduction of family medicine as a specialty to a new health care landscape, and the launch of that country's first ever and rapidly growing family medicine residency, as well as unique challenges, strategies employed, and lessons learned along the way. We conclude the article by looking ahead at new challenges and recommendations for the program's continued growth. The experiences and lessons learned may be used by future family medicine residency start-ups throughout sub-Saharan Africa.

Background and objectives: Family-oriented patient care, an approach to involve the patient's family in clinical encounters, is essential to family medicine. The Pontificia Universidad Católica de Chile offers a Family-Oriented Patient Care (FOPC) course within its family medicine residency program, aiming to enhance family involvement skills among residents. We present the course and report residents' self-efficacy, satisfaction, and competencies with family-oriented care after the course.

Methods: The FOPC course is an 8-week program using a flipped-classroom model with interactive discussions, role-play with simulated patients, and clinical activities. Evaluation methods include resident-reported self-efficacy, course relevance, satisfaction, clinical supervisors' assessments of family-oriented care competencies, and Observed Structured Clinical Examination (OSCE) scores on simulated scenarios.

Results: Residents reported high self-efficacy in family-oriented practices, with mean scores above 4.0 on a 5-point scale across various domains, including conducting family-oriented clinical visits and using family assessment tools. Course relevance and satisfaction received high ratings, with average scores of 4.7±0.7 on a 1-5 scale for relevance and 6.2±0.8 on a 1-7 scale for satisfaction. Clinical supervisors' evaluations indicated integration of family-oriented skills in patient care. However, OSCE scores suggested partial application of these skills in simulated clinical encounters.

Conclusions: After participating in the FOPC course, residents reported having confidence to apply family-oriented care skills in patient encounters, but OSCE ratings did not confirm clinical translation. Results highlight the need for continued reinforcement to enhance skill application in real clinical contexts, supporting the need for longitudinal training integration throughout residency.

In this article we reflect on the state of family medicine education and training in sub-Saharan Africa; in particular, we focus on these key issues: advocacy, evidence of impact, barriers and enablers, and implementation strategies. Sub-Saharan Africa is the last region of the world to embrace family medicine, and adoption varies widely among countries. Family physicians with postgraduate training are relatively few. In the public sector, primary care is mostly offered by nurses or physician assistants, while in the private sector, it is offered by general practitioners. Family physicians work in both primary care and primary hospitals, in multidisciplinary teams; as clinicians, consultants, capacity builders, clinical trainers, leaders of clinical governance and may also have some managerial functions. Advocacy for the contribution of family physicians and training programs is needed with departments of health, regulatory bodies, higher education institutions, and other health professions. Evidence of impact in the African context is limited due to the small numbers and limited research outputs. Barriers and enablers to education and training are related to the stage of development. Key issues include a lack of academic and teaching expertise, a need to develop learning environments and clinical trainers, sufficient training posts, and appropriate deployment of new graduates. Implementation strategies to overcome these barriers can be categorized into planning, educational, financial, quality management, and policy related strategies. A South-South-North approach to support and partnerships is advocated. More attention should be given to engaging the public on the contribution of family medicine.