scholarly journals Redefining Student Learning Objectives for the General Medicine / Primary Care Clinical Clerkship ~ The Way to Implement Community Based Medical Education

2021 ◽  
Author(s):  
Kei Miyazaki ◽  
Kenya Ie ◽  
Masaru Kitamura ◽  
Akiteru Takamura
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
General Medicine ◽  
Multidisciplinary Care ◽  
Learning Objectives ◽  
Clinical Clerkship ◽  
Structured Interviews ◽  
Community Based ◽  
Thematic Units ◽  
Student Learning Objectives

Abstract Background: Mie University is one of the first medical schools to initiate a community-based clinical clerkship in general medicine. The curriculum was developed over fifteen years ago based on the personal expertise of the general medicine faculties. The purpose of this project is to update and revise the curriculum and learning objectives by integrating the ideas of community primary care physicians and university faculties involved in clinical clerkships.Methods: We have conducted semi-structured interviews with community primary care physicians. The interviews were based on keywords extracted from the preliminary research. Two researchers independently reviewed the free-coded interview transcripts, organized them into thematic units using thematic analysis, and then discussed and merged them into one list between the two researchers. This list was shared and discussed among the four researchers to create a new curriculum and learning objectives.Results: Nine primary care physicians participated in group interviews and 11 participated in individual interviews. The following themes were identified: 1.role of primary care 2.contextual care 3.hospital-clinic collaboration 4.multidisciplinary care/inter-professional work 5.work-life balance 6.health economics 7.health promotion 8.health policy 9.common problems/common diseases. Conclusion:We have redefined the learning objectives of the general medicine clinical clerkship. The abstracts have been made more specific, which will be more helpful for both teachers and learners.

scholarly journals Understanding the clinical reasoning processes involved in the management of multimorbidity in an ambulatory setting: study protocol of a stimulated recall research

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
M.-C. Audétat ◽  
S. Cairo Notari ◽  
J. Sader ◽  
C. Ritz ◽  
T. Fassier ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Reasoning ◽  
Primary Care Physicians ◽  
Video Sequence ◽  
Structured Interview ◽  
Ambulatory Setting ◽  
Structured Interviews ◽  
Stimulated Recall ◽  
Study Results

Abstract Background Primary care physicians are at the very heart of managing patients suffering from multimorbidity. However, several studies have highlighted that some physicians feel ill-equipped to manage these kinds of complex clinical situations. Few studies are available on the clinical reasoning processes at play during the long-term management and follow-up of patients suffering from multimorbidity. This study aims to contribute to a better understanding on how the clinical reasoning of primary care physicians is affected during follow-up consultations with these patients. Methods A qualitative research project based on semi-structured interviews with primary care physicians in an ambulatory setting will be carried out, using the video stimulated recall interview method. Participants will be filmed in their work environment during a standard consultation with a patient suffering from multimorbidity using a “button camera” (small camera) which will be pinned to their white coat. The recording will be used in a following semi-structured interview with physicians and the research team to instigate a stimulated recall. Stimulated recall is a research method that allows the investigation of cognitive processes by inviting participants to recall their concurrent thinking during an event when prompted by a video sequence recall. During this interview, participants will be prompted by different video sequence and asked to discuss them; the aim will be to encourage them to make their clinical reasoning processes explicit. Fifteen to twenty interviews are planned to reach data saturation. The interviews will be transcribed verbatim and data will be analysed according to a standard content analysis, using deductive and inductive approaches. Conclusion Study results will contribute to the scientific community’s overall understanding of clinical reasoning. This will subsequently allow future generation of primary care physicians to have access to more adequate trainings to manage patients suffering from multimorbidity in their practice. As a result, this will improve the quality of the patient’s care and treatments.

scholarly journals Administrative Work and Job Role Beliefs in Primary Care Physicians: An Analysis of Semi-Structured Interviews

SAGE Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 215824401989909
Author(s):  
Eric Apaydin
Keyword(s):  
Primary Care ◽  
Los Angeles ◽  
Primary Care Physicians ◽  
Theory Approach ◽  
Structured Interviews ◽  
Job Roles ◽  
Face To Face ◽  
Administrative Work ◽  
Job Role ◽  
The Relationship

Primary care physicians face increasing amounts of administrative work (e.g., entering notes into electronic health records, managing insurance issues, delivering test results, etc.) outside of face-to-face patient visits. The objective of this study is to qualitatively describe the experience that primary care physicians have with administrative work, with an emphasis on their beliefs about their job role. I conducted semi-structured interviews with 28 family physicians and internists in Chicago, Los Angeles, and Miami and qualitatively analyzed themes from interview transcripts using the grounded theory approach. Two major themes concerning the relationship between primary care physicians and administrative work were discovered: (a) Administrative work was not central to primary care physicians’ job role beliefs, and (b) “below license” work should be delegated to nonphysicians. Job roles should be considered in future efforts to reduce physician administrative work in primary care.

scholarly journals Investigating information-seeking behaviors of primary care physicians who care for older depressed patients and their family caregivers: a pilot study

2005 ◽  
Vol 26 (4) ◽  
pp. 111 ◽  
Author(s):  
Mary Jo Dorsey ◽  
Ellen Detlefsen
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Information Seeking ◽  
Primary Care Physicians ◽  
Care Physician ◽  
Structured Interviews ◽  
Depressed Patients ◽  
Types Of Information ◽  
Primary Care Practices ◽  
Information Seeking Behaviors

Objective – To describe preliminary findings from a study of information-seeking behaviors of primary care physicians who care for elderly and depressed patients, and the correlation between what is sought versus what is provided to the patient and (or) caregiver. Setting – Physicians in two large ambulatory primary care practices throughout urban Pittsburgh, Pennsylvania, who take care of geriatric patients. Methods – Structured interviews, with common questions, will be conducted with 12 primary care physicians to determine patterns of information-seeking behaviors. Environmental scans of physicians' offices for evidence of their existing information behaviors will complement the information obtained from the interviews. Results – This pilot study provides an analysis of the resources primary care physicians use to seek information to provide to patients and caregivers. Analyses show types of information sought, time spent seeking information, and methods used to find information given to patients. Conclusions – With mounting evidence of the Internet being used for patient self care, it is essential to understand if primary care physicians understand the scope and breadth of information readily available to their patients. The primary care physician needs to be aware of the types of information made available to their patients and the caregivers who are inclined to obtain information for the patient.

Physicians’ accounts of frontline tensions when implementing pilot projects to improve primary care

2018 ◽  
Vol 32 (1) ◽  
pp. 39-55 ◽  
Author(s):  
Elizabeth Mansfield ◽  
Onil Bhattacharyya ◽  
Jennifer Christian ◽  
Gary Naglie ◽  
Vicky Steriopoulos ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Services ◽  
Primary Care Physicians ◽  
Pilot Project ◽  
Models Of Care ◽  
Structured Interviews ◽  
Pilot Projects ◽  
Additional Time ◽  
Content Type ◽  
The Impact

Purpose Canada’s primary care system has been described as “a culture of pilot projects” with little evidence of converting successful initiatives into funded, permanent programs or sharing project outcomes and insights across jurisdictions. Health services pilot projects are advocated as an effective strategy for identifying promising models of care and building integrated care partnerships in local settings. In the qualitative study reported here, the purpose of this paper is to investigate the strengths and challenges of this approach. Design/methodology/approach Semi-structured interviews were conducted with 34 primary care physicians who discussed their experiences as pilot project leads. Following thematic analysis methods, broad system issues were captured as well as individual project information. Findings While participants often portrayed themselves as advocates for vulnerable patients, mobilizing healthcare organizations and providers to support new models of care was discussed as challenging. Competition between local healthcare providers and initiatives could impact pilot project success. Participants also reported tensions between their clinical, project management and research roles with additional time demands and skill requirements interfering with the work of implementing and evaluating service innovations. Originality/value Study findings highlight the complexity of pilot project implementation, which encompasses physician commitment to addressing care for vulnerable populations through to the need for additional skill set requirements and the impact of local project environments. The current pilot project approach could be strengthened by including more multidisciplinary collaboration and providing infrastructure supports to enhance the design, implementation and evaluation of health services improvement initiatives.

Ethical Implications of Cultural Barriers to the Depression Diagnosis: Conversations with Primary Care Physicians

2020 ◽  
Vol 51 (9) ◽  
pp. 683-701
Author(s):  
Diana Cagliero
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Ethical Issues ◽  
Treatment Options ◽  
Cross Cultural ◽  
Cultural Barriers ◽  
Structured Interviews ◽  
Cultural Backgrounds ◽  
Ethical Implications

This article explores ethical issues raised by Primary Care Physicians (PCPs) when diagnosing depression and caring for cross-cultural patients. This study was conducted in three primary care clinics within a major metropolitan area in the Southeastern United States. The PCPs were from a variety of ethnocultural backgrounds including South Asian, Hispanic, East Asian and Caucasian. While medical education training and guidelines aim to teach physicians about the nuances of cross-cultural patient interaction, PCPs report that past experiences guide them in navigating cross-cultural conversations and patient care. In this study, semi-structured interviews were conducted with seven PCPs which were transcribed and underwent thematic analysis to explore how patients’ cultural backgrounds and understanding of depression affected PCPs’ reasoning and diagnosing of depression in patients from different cultural backgrounds. Ethical issues that arose included: limiting treatment options, expressing a patient’s mental health diagnosis in a biomedical sense to reduce stigma, and somatization of mental health symptoms. Ethical implications, such as lack of autonomy, unnecessary testing, and the possible misuse of healthcare resources are discussed.

scholarly journals Effects of mindfulness training on perceived stress, self-compassion, and self-reflection of primary care physicians: a mixed-methods study

BJGP Open ◽  
2018 ◽  
Vol 2 (4) ◽  
pp. bjgpopen18X101621 ◽  
Author(s):  
Herman van Wietmarschen ◽  
Bram Tjaden ◽  
Marja van Vliet ◽  
Marieke Battjes-Fries ◽  
Miek Jong
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Perceived Stress ◽  
Primary Care Physicians ◽  
Mindfulness Training ◽  
Structured Interviews ◽  
Self Reflection ◽  
Self Compassion ◽  
High Workload ◽  
Compassion Scale

BackgroundPrimary care physicians are subjected to a high workload, which can lead to stress and a high incidence of burnout. A mindfulness training course was developed and implemented for primary care physicians to better cope with stress and improve job functioning.AimTo gain insight into the effects of the mindfulness training on perceived stress, self-compassion, and self-reflection of primary care physicians.Design & settingA pragmatic mixed-methods pre–post design in which physicians received 8 weeks of mindfulness training.MethodParticipants completed validated questionnaires on perceived stress (Perceived Stress Scale [PSS]), self-compassion (Self-Compassion Scale [SCS]), and self-reflection (Groningen Reflection Ability Scale [GRAS]) before the training, directly after, and 6 months later. Semi-structured interviews were conducted with six participants after the training and a content analysis was performed to gain in depth understanding of experiences.ResultsA total of 54 physicians participated in the study. PSS was reduced (mean difference [MD] -4.5, P<0.001), SCS improved (MD = 0.5, P<0.001), and GRAS improved (MD = 3.3, P<0.001), directly after the 8-week training compared with before training. Six months later, PSS was still reduced (MD = -2.9, P = 0.025) and SCS improved (MD = 0.7, P<0.001). GRAS did not remain significant (MD = 2.5, P = 0.120). Qualitative analysis revealed four themes: being more aware of their own feelings and thoughts; being better able to accept situations; experiencing more peacefulness; and having more openness to the self and others.ConclusionMindfulness training might be an effective approach for improving stress resilience, self-compassion, and self-reflection in primary care physicians.

Comparison of Processes and Outcomes of Pneumonia Care Between Hospitalists and Community-Based Primary Care Physicians

2002 ◽  
Vol 77 (10) ◽  
pp. 1053-1058 ◽  
Author(s):  
William D. Rifkin ◽  
David Conner ◽  
Alan Silver ◽  
Ann Eichorn
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Community Based

scholarly journals EKSPLORASI PERMASALAHAN DALAM IMPLEMENTASI COMMUNITY-BASED EDUCATION DI FAKULTAS KEDOKTERAN

2016 ◽  
Vol 20 (1) ◽  
pp. 90-97
Author(s):  
Vivi Meidianawaty ◽  
Widyandana Widyandana ◽  
Tri Nur Kristina
Keyword(s):  
Data Collection ◽  
Medical School ◽  
Active Participation ◽  
Qualitative Approach ◽  
Learning Objectives ◽  
Structured Interviews ◽  
Community Based ◽  
Community Based Education ◽  
Private Medical School ◽  
Implementation Problems

Penelitian ini bertujuan untuk mengeksplorasi permasalahan-permasalahan yang dapat ditemukan saat implementasi Community-based Education (CBE) di fakultas kedokteran. Pendekatan kualitatif eksplorasi dilakukan untuk mengidentifikasi permasalahan yang sering ditemui dalam implementasi program CBE. Pengumpulan data dilakukan di fakultas kedokteran negeri dan swasta dengan evaluasi dokumen, wawancara semistruktur, dan observasi. Kesimpulan dari penelitian ini adalah program CBE yang tidak menetapkan tujuan pembelajaran bersifat generik, kurang melibatkan peran aktif masyarakat dalam kegiatan pembelajaran mahasiswa, kebutuhan masyarakat yang jarang teridentifikasi, dan tidak adanya program yang berkelanjutan dapat menyebabkan kejenuhan masyarakat atau kegagalan program CBE mencapai tujuannya.Kata kunci: community-based education, implementasi, masalah, metode berkelanjutann EXPLORATION OF PROBLEMS IN COMMUNITY-BASED EDUCATION IN THE FACULTY OF MEDICINEAbstractThere were sereval problems in the implementation of Community-based Education CBE that need to be further explored. Exploratory qualitative approach was carried out to identify problems that were often encountered. Data collection was conducted in Public Medical School and Private Medical School by using document evaluation, semi-structured interviews, and observation. The conclusion of this study is CBE program that does not set the generic learning objectives, less involvement of the community active participation, the needs of community who are rarely identified, and the absence of a sustainable program can lead to saturation of the CBE program or failure to achieve its objectives.Keywords: community-based education, implementation, problems, sustainable methods

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