Current status of family medicine in Kenya; family physicians’ perception of their role

Background: Family medicine (FM) was introduced in Kenya in 2005. Up to date (August 2019), 42 family physicians have graduated from Kenyan Universities.Aim: The aim of the study was to establish the current state of FM in Kenya and identify areas for more research and actions to support and improve FM in Kenya.Setting: Interviews were conducted at the different work sites of the participants, four of them in hospitals, one at a University and one in a hotel where a FM conference was held.Methods: An online questionnaire (response rate = 56%) and six semi-structured interviews were conducted amongst family physicians who completed their studies in Kenya. However, the focus was on the interviews.Results: Family physicians have different ideas of how FM should look like ideally, but all agree that family physicians should be team leaders of a primary healthcare team, taking care of a defined population. Lack of policies, low numbers of family physicians and the misunderstanding of FM by all stakeholders are the major challenges. Sixty-four percent of the participants work in rural areas, and 77% perceive their current work as FM.Conclusion: Family medicine must be defined and properly promoted. Various areas have been identified that require further research: assessing required number of family physicians, reasons and solutions for the low number of family physicians, funding possibilities, and research the most suitable definition of a Kenyan family physician.

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Geographical distribution of family physicians in Japan: A nationwide cross-sectional study

10.21203/rs.2.10782/v1 ◽

2019 ◽

Author(s):

Shuhei Yoshida ◽

Masatoshi Matsumoto ◽

Saori Kashima ◽

Soichi Soichi Koike ◽

Susumu Tazuma ◽

...

Keyword(s):

Primary Care ◽

Family Medicine ◽

Rural Areas ◽

Census Data ◽

Family Physicians ◽

Cross Sectional Study ◽

Government Support ◽

Free Access ◽

Cross Sectional ◽

Physician Distribution

Abstract Background Geographical maldistribution of physicians, and their subsequent shortage in rural areas, has been a serious problem in Japan and in other countries. Family Medicine, a new board-certified specialty started 10 years ago in Japan by Japan Primary Care Association (JPCA), may be a solution to this problem. Methods We obtained the workplace information of 527 (78.4%) of the 672 JPCA-certified family physicians from an online database. From the national census data, we also obtained the workplace information of board-certified general internists, surgeons, obstetricians/gynaecologists and paediatricians and of all physicians as the same-generation comparison group (ages 30 to 49). Chi-squared test and residual analysis were conducted to compare the distribution between family physicians and other specialists. Results 519 JPCA-certified family physicians and 137,587 same-generation physicians were analysed. The distribution of family physicians was skewed to municipalities with a lower population density, which shows a sharp contrast to the urban-biased distribution of other specialists. The proportion of family physicians in non-metropolitan municipalities was significantly higher than that expected based on the distribution of all same-generation physicians (p<0.001). Conclusions Family physicians distributed in favour of rural areas much more than any other specialists in Japan. The better balance of family physician distribution reported from countries with a strong primary care orientation seems to hold even in a country where primary care orientation is weak, physician distribution is not regulated, and patients have free access to healthcare. Family physicians comprise only 0.2% of all Japanese physicians. However, if their population grows, they can potentially rectify the imbalance of physician distribution. Government support is mandatory to promote family medicine in Japan.

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Education for Sustainable Development (ESD) in China’s Local Primary Schools: A Pilot Study

European Journal of Sustainable Development ◽

10.14207/ejsd.2020.v9n4p118 ◽

2020 ◽

Vol 9 (4) ◽

pp. 118

Author(s):

Ronghui (Kevin) Zhou

Keyword(s):

Sustainable Development ◽

Pilot Study ◽

Primary Education ◽

Primary Schools ◽

Education For Sustainable Development ◽

Urban China ◽

Current Status ◽

Structured Interviews ◽

Definition Of ◽

Education Support

This study discusses the current status of ESD implementation in three primary schools and examines factors that have impacted the implementation of ESD in a district of an urban Chinese cities. Semi-structured interviews were conducted with three primary school principals and three school teachers. Thematic analysis was used to analyze the data. Three themes emerged that have impacted ESD implementation in this pilot study are discussed: the definition of ESD, lack of local education support, and exam pressures. The results suggested that ESD is underdeveloped in the selected context of urban China. Further investigation is required to capture the whole scope of ESD implementations in China’s primary education. Keywords: Education for Sustainable Development; Primary Education; Case Study; Teacher and Principal; China

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Neonatal Resuscitation Skills Among Pediatricians and Family Physicians: Is Residency Training Preparing for Postresidency Practice?

Journal of Graduate Medical Education ◽

10.4300/jgme-d-10-00234.1 ◽

2011 ◽

Vol 3 (4) ◽

pp. 475-480 ◽

Cited By ~ 11

Author(s):

Amy M. Wood ◽

M. Douglas Jones ◽

James H. Wood ◽

Zhaoxing Pan ◽

Thomas A. Parker

Keyword(s):

Family Medicine ◽

Rural Areas ◽

Current Practice ◽

Neonatal Resuscitation ◽

Family Physicians ◽

Newborn Resuscitation ◽

Rural Physicians ◽

Resuscitation Training ◽

National Cohort ◽

Umbilical Catheters

Abstract Background Pediatricians and family physicians are responsible for providing newborn resuscitation, yet Accreditation Council for Graduate Medical Education requirements for training in this area during residency differ markedly for the two specialties. Our objectives were to determine (1) the extent to which neonatal resuscitation training differs for pediatric and family medicine residents; (2) the extent to which general pediatricians and family physicians engage in newborn resuscitation in their practice; and (3) whether use of resuscitation skills differs between urban/suburban and rural providers. Methods We surveyed a national cohort of pediatricians and family physicians who obtained board certification between 2001 and 2005. Data were analyzed based on type of physician and setting of current practice. Results Survey response rate was 22% (382 of 1736). Compared with family medicine physicians, pediatricians received more neonatal resuscitation training during residency. Most members of both groups had attended no deliveries in the year prior to the survey (75% [111 of 148] versus 74% [114 of 154]). In their current practice, the groups were equally likely to have provided a newborn bag and mask ventilation, chest compressions, and resuscitation medications. Pediatricians were more likely than family physicians to have attempted to either intubate a newborn (20% [28 of 148] versus 10% [16 of 153]; P = .0495) or insert umbilical catheters (15% [22 of 148] versus 5% [8 of 153]; P = .005). Regardless of specialty, rural physicians were much more likely to report that they attended deliveries (61% [41 of 67] versus 15% [36 of 234]; P < .001). Among rural pediatricians attending deliveries, 44% (7 of 16) reported feeling inadequately prepared for at least one delivery in the past year. Conclusions Few primary care pediatricians and family physicians provide newborn resuscitation after residency. For those who do attend deliveries, current training may provide insufficient preparation. Flexible, individualized residency curricula could target intensive resuscitation training to individuals who plan to practice in rural areas and/or attend deliveries after graduation.

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Embarking digital learning due to COVID-19: Are teachers ready?

Journal of Technology and Science Education ◽

10.3926/jotse.1109 ◽

2021 ◽

Vol 11 (1) ◽

pp. 104

Author(s):

David Sulistiawan Aditya

Keyword(s):

Rural Areas ◽

Digital Learning ◽

Structured Interviews ◽

Learning Problem ◽

Online Questionnaire ◽

Learning Success ◽

Technology Affordances ◽

Key Aspects ◽

Voice Calls ◽

Choice Of Technology

The COVID 19 pandemic insists schools to close and embark on the digital environment to keep learning to happen. Implementing this learning in educational settings faces challenges related to human resources and infrastructure issues particularly in developing countries. This study investigated the teachers’ readiness in conducting digital learning in Yogyakarta, Indonesia. This exploratory study employed an online questionnaire and semi-structured interviews via either voice calls or video calls to safely gather both quantitative and qualitative data from 62 teachers of 27 different schools in the middle of social distancing regulation in Yogyakarta. The study revealed that the majority of teachers were psychologically, technologically, and pedagogically ready to conduct digital learning. However, the digital learning problem was mostly coming from teachers who teach in rural areas. Students’ technology affordances mainly caused a disparity of digital learning success. The findings suggest that the choice of technology adoption and methodology adjustment can be viewed as a solution to the current digital learning problem. Finally, instead of the teachers’ readiness, the students’ readiness and teachers’ technological pedagogical knowledge are other key aspects of the digital learning success. Thus, these two issues are suggestive for further studies.

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Geographical distribution of family physicians in Japan: a nationwide cross-sectional study

BMC Family Practice ◽

10.1186/s12875-019-1040-6 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Shuhei Yoshida ◽

Masatoshi Matsumoto ◽

Saori Kashima ◽

Soichi Koike ◽

Susumu Tazuma ◽

...

Keyword(s):

Primary Care ◽

Family Medicine ◽

Rural Areas ◽

Census Data ◽

Family Physicians ◽

Cross Sectional Study ◽

Government Support ◽

Free Access ◽

Cross Sectional ◽

Physician Distribution

Abstract Background Geographical maldistribution of physicians, and their subsequent shortage in rural areas, has been a serious problem in Japan and in other countries. Family Medicine, a new board-certified specialty started 10 years ago in Japan by Japan Primary Care Association (JPCA), may be a solution to this problem. Methods We obtained the workplace information of 527 (78.4%) of the 672 JPCA-certified family physicians from an online database. From the national census data, we also obtained the workplace information of board-certified general internists, surgeons, obstetricians/gynaecologists and paediatricians and of all physicians as the same-generation comparison group (ages 30 to 49). Chi-squared test and residual analysis were conducted to compare the distribution between family physicians and other specialists. Results Five hundred nineteen JPCA-certified family physicians and 137,587 same-generation physicians were analysed. The distribution of family physicians was skewed to municipalities with a lower population density, which shows a sharp contrast to the urban-biased distribution of other specialists. The proportion of family physicians in non-metropolitan municipalities was significantly higher than that expected based on the distribution of all same-generation physicians (p < 0.001). Conclusions Family physicians distributed in favour of rural areas much more than any other specialists in Japan. The better balance of family physician distribution reported from countries with a strong primary care orientation seems to hold even in a country where primary care orientation is weak, physician distribution is not regulated, and patients have free access to healthcare. Family physicians comprise only 0.2% of all Japanese physicians. However, if their population grows, they can potentially rectify the imbalance of physician distribution. Government support is mandatory to promote family medicine in Japan.

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Buying and selling the sport horse

BSAP Occasional Publication ◽

10.1017/s0263967x00042543 ◽

2006 ◽

Vol 35 ◽

pp. 1-12

Author(s):

G. K Crossman ◽

R. E. Walsh

Keyword(s):

Great Britain ◽

Research Methods ◽

Purchase Price ◽

Structured Interviews ◽

Online Questionnaire ◽

Paper Version ◽

Significant Difference ◽

Horse Industry ◽

Definition Of

AbstractThe sport horse industry in Great Britain is fragmented and serendipitous. However, there are many opportunities available for it to develop and grow. The research this paper is based upon was carried out in conjunction with British Breeding, to improve and develop the marketing of the British sport horse. The research was carried out through an online questionnaire (a paper version was also available) and semi-structured interviews. Both research methods contained questions aimed specifically at breeders or buyers, as well as general questions. Once the data had been collected it was analysed to discover where any trends, relationships or discrepancies existed between the groups. Recommendations were then formulated. Specifically, this paper considers the profiles of breeders and buyers of the sport horse, the reasons for breeding horses or ponies, the characteristics of horses valued by breeders and buyers and the methods of sale and purchase used. The significant difference between the horse purchase price of different categories of buyers, for example the leisure rider and professional rider, or eventers and show jumpers, are discussed. Profitability in relation to the reasons people breed horses or ponies is analysed. The definition of the sport horse is also examined. In conclusion, there is much work that needs to be completed to enable the sport horse industry in this country to be fully understood, from both the perspective of the breeder or producer and the buyer. However, there are opportunities available for the British sport horse industry to move forward.

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Opportunities and barriers to enhance research capacity and outputs among academic family physicians in the Arab world

Primary Health Care Research & Development ◽

10.1017/s1463423615000377 ◽

2015 ◽

Vol 17 (01) ◽

pp. 98-104 ◽

Cited By ~ 3

Author(s):

Maya H. Romani ◽

Ghassan N. Hamadeh ◽

Dina M. Mahmassani ◽

Adel A.K. AlBeri ◽

Abdul-Munem Y. AlDabbagh ◽

...

Keyword(s):

Research Team ◽

Arab World ◽

Family Physicians ◽

Research Capacity ◽

Arab Countries ◽

Current Status ◽

Academic Institutions ◽

Online Questionnaire ◽

Family Doctors ◽

Research Activities

AimTo explore the current status of academic primary care research in Arab countries and investigate the barriers to its adequate implementation.BackgroundResearch is an essential building block that ensures the advancement of the discipline of Family Medicine (FM). FM research thus ought to be contributed to by all family physicians; nevertheless, its development is being hindered worldwide by several challenges. The amount of research conducted by academic academic family physicians and general practitioners is scant. This phenomenon is more pronounced in the Arab countries.MethodsAn online questionnaire was emailed to all academic family physicians practicing in member Arab countries of the World Organization of Family Doctors WONCA-East Mediterranean Region.FindingsSeventy-six out of 139 academic family physicians from eight Arab countries completed the questionnaire. Around 75% reported that they are required to conduct research studies, yet only 46% contributed to at least one publication. While 75% and 52.6% disclosed their interest in participating in a research team and in leading a research team respectively, 64.5% reported being currently involved in research activities. Of all, 56% have attended a research ethics course. Lack of training in research, the unavailability of a healthcare system that is supportive of research, insufficient financial resources, and the unavailability of electronic health records were perceived as major barriers in conducting FM research.ConclusionAlthough many physicians in Arab academic institutions expressed enthusiasm to conduct research projects, FM research infrastructure remains to be weak. This demonstrates the need for immense efforts from different parties particularly governments and academic institutions.

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Family Medicine and Emergency Redeployment: Unrealized Potential

Family Medicine ◽

10.22454/fammed.2022.404532 ◽

2022 ◽

Vol 54 (1) ◽

pp. 44-46

Author(s):

Hoon Byun ◽

John M. Westfall

Keyword(s):

Family Medicine ◽

Residency Training ◽

Rural Areas ◽

Family Physicians ◽

Physician Assistants ◽

Scope Of Practice ◽

Separate Analysis ◽

Medicare Beneficiaries ◽

Emergency Rooms ◽

Training Requirements

Background and Objectives: Discussions of scope of practice among family physicians has become a crucial topic amidst the COVID-19 pandemic, coupled with new attention to residency training requirements. Family medicine has seen a gradual narrowing of practice due to a host of issues, including physician choice, expanding scope of practice from physician assistants and nurses, an increased emphasis on patient volume, clinical revenue, and residency training competency requirements. We sought to demonstrate the flexibility of the family medicine workforce as shown through their scopes of practice, and argue that this is indication of their potential for redeployment during emergencies. Methods: This study computes scopes of practice for 78,416 family physicians who treat Medicare beneficiaries. We used Evaluation and Management (E/M) codes in Medicare’s 2017 Part-B public use file to calculate volumes of services done across six sites of service per physician. We aggregated counts and proportions of physicians and the E/M services they provided across sites of practice to characterize scope, and performed a separate analysis on rural physicians. Results: The study found most family physicians practicing at a single site, namely, the ambulatory clinic. However, family physicians in rural areas, where need is greater, exhibit broader scope. This suggests that a significant number of family physicians have capacity for COVID-19 deployment into other settings, such as emergency rooms or hospitals. Conclusions: Family physicians are a potential resource for emergency redeployment, however the current breadth of scope for most family physicians is not aligned with current residency training requirements and raises questions about the future of family medicine scope of practice.

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HIV stigma in Kenya: A family medicine led community orientated primary care approach

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v13i1.3054 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Peter M. Kioko ◽

Maureen W. Kamau ◽

Norah A. Obungu ◽

Emma A. Khabure ◽

Anne M. Simmelink ◽

...

Keyword(s):

Primary Care ◽

Family Medicine ◽

Community Health ◽

Family Physicians ◽

University Hospital ◽

Hiv Stigma ◽

Healthcare Team ◽

Short Report ◽

Care Clinic ◽

High Prevalence

The Kenyan Ministry of Health envisages that family physicians should play an important role in the implementation of community orientated primary care (COPC) in collaboration with the community health team. The Kenyan Community Health Strategy forms a solid basis for the implementation of the COPC model. Residents and faculty of the Family Medicine department at the Aga Khan University Hospital Nairobi collaborated with the Kaloleni sub-county of Kilifi County government near Mombasa in a five-step COPC process to better understand and act against the high prevalence of HIV stigma in the coastal region. Firstly, a deeper understanding of human immunodeficiency virus (HIV) stigma was acquired through community visits and work in the comprehensive care clinic. Secondly, a collaborative implementation team was formed to design a targeted and feasible intervention. In a participatory approach, a two-step intervention was employed, firstly sensitising healthcare workers and community health volunteers (CHVs) on the high prevalence of HIV stigma in their community and educating them on HIV-related issues. Secondly, the information was disseminated to the community through home visits by CHVs, health talks and the set-up of an HIV support group at the facility. This short report illustrates the important contribution of family physicians to implementation of COPC and capacity building of the primary healthcare team.

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Geographical distribution of family physicians in Japan: A nationwide cross-sectional study

10.21203/rs.2.10782/v2 ◽

2019 ◽

Author(s):

Shuhei Yoshida ◽

Masatoshi Matsumoto ◽

Saori Kashima ◽

Soichi Koike ◽

Susumu Tazuma ◽

...

Keyword(s):

Primary Care ◽

Family Medicine ◽

Rural Areas ◽

Census Data ◽

Family Physicians ◽

Cross Sectional Study ◽

Government Support ◽

Free Access ◽

Cross Sectional ◽

Physician Distribution

Abstract Background: Geographical maldistribution of physicians, and their subsequent shortage in rural areas, has been a serious problem in Japan and in other countries. Family Medicine, a new board-certified specialty started 10 years ago in Japan by Japan Primary Care Association (JPCA), may be a solution to this problem. Methods: We obtained the workplace information of 527 (78.4%) of the 672 JPCA-certified family physicians from an online database. From the national census data, we also obtained the workplace information of board-certified general internists, surgeons, obstetricians/gynaecologists and paediatricians and of all physicians as the same-generation comparison group (ages 30 to 49). Chi-squared test and residual analysis were conducted to compare the distribution between family physicians and other specialists. Results: 519 JPCA-certified family physicians and 137,587 same-generation physicians were analysed. The distribution of family physicians was skewed to municipalities with a lower population density, which shows a sharp contrast to the urban-biased distribution of other specialists. The proportion of family physicians in non-metropolitan municipalities was significantly higher than that expected based on the distribution of all same-generation physicians (p<0.001). Conclusions: Family physicians distributed in favour of rural areas much more than any other specialists in Japan. The better balance of family physician distribution reported from countries with a strong primary care orientation seems to hold even in a country where primary care orientation is weak, physician distribution is not regulated, and patients have free access to healthcare. Family physicians comprise only 0.2% of all Japanese physicians. However, if their population grows, they can potentially rectify the imbalance of physician distribution. Government support is mandatory to promote family medicine in Japan.

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