Korean Journal of Family Medicine

"training"

Review Article

Shared Decision-Making Training in Family Medicine Residency: A Scoping Review: Apichai Wattanapisit, Eileen Nicolle, Savithiri Ratnapalan; Korean J Fam Med 2024;45(3):134-143. Published online May 20, 2024; DOI: https://doi.org/10.4082/kjfm.23.0273

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Shared decisions, in which physicians and patients share their agendas and make clinical decisions together, are optimal for patient-centered care. Shared decision-making (SDM) training in family medicine residency is always provided, but the best training approach for improving clinical practice is unclear. This review aims to identify the scope of the literature on SDM training in family medicine residency to better understand the opportunities for training in this area. Four databases (Embase, MEDLINE, Scopus, and Web of Science) were searched from their inception to November 2022. The search was limited to English language and text words for the following four components: (1) family medicine, (2) residency, (3) SDM, and (4) training. Of the 522 unique articles, six studies were included for data extraction and synthesis. Four studies referenced three training programs that included SDM and disease- or condition-specific issues. These programs showed positive effects on family medicine residents’ knowledge, skills, and willingness to engage in SDM. Two studies outlined the requirements for SDM training in postgraduate medical education at the national level, and detailed the educational needs of family medicine residents. Purposeful SDM training during family medicine residency improves residents’ knowledge, skills, and willingness to engage in SDM. Future studies should explore the effects of SDM training on clinical practice and patient care.

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Original Articles

Effects of Module Development and Role Play Course on Clinical Practice Examination Scores during a 4th Year Clerkship: Kyong-Min Park, Kye-Yeung Park, Nam-Eun Kim, Bong-Kyung Seo, Hoon-Ki Park, Hwan-Sik Hwang; Korean J Fam Med 2018;39(1):23-28. Published online January 23, 2018; DOI: https://doi.org/10.4082/kjfm.2018.39.1.23

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Background

After introduction of clinical skills assessment in the Korean Medical Licensing Examination, medical schools have reinforced both experiential learning with real patients and preparatory programs. This study was conducted to investigate whether a clinical practice examination (CPX) preparation program improves students' CPX score in terms of case specificity.

Methods

One hundred and thirteen senior students in a medical school participated in this study. During the fourth-year clerkship, 28 students (24.8%) from three rotation groups took a 3-day CPX preparation course consisting of module development, role play, and comprehensive physical exam skills training. Eleven rotation groups (n=85) were compared as control. Both the intervention and control group took two comprehensive CPXs before and after the clerkship was completed.

Results

There was no significant difference in age, sex, and school type between the two groups. On pre-test CPX, there was no significant difference in total and sectional scores between the two groups. On post-test CPX, total scores of the intervention group were higher than those of the control groups (69.5±4.3 vs. 67.5±4.4, P<0.05). History taking scores were higher in intervention groups (70.0±6.0 vs. 66.0±6.6, P=0.01). The station scores of vaginal discharge with case similarity were higher in the intervention groups (73.0±6.3 vs. 68.9±9.3, P=0.03).

Conclusion

A short CPX preparation course improved history taking ability, but its effect was greater only in a specific case, similar to the pre-course case. Whether this effect was due to the test experience or true improvement in competency requires further investigation.

Citations

Citations to this article as recorded by

Role-play of real patients improves the clinical performance of medical students
Ling-Ju Huang, Hui-Chun Huang, Chiao-Lin Chuang, Shu-Luen Chang, Hung-Cheng Tsai, Dai-Yin Lu, Ying-Ying Yang, Ching-Chih Chang, Hui-Chi Hsu, Fa-Yauh Lee
Journal of the Chinese Medical Association.2021; 84(2): 183. CrossRef
Raising rare disease awareness using red flags, role play simulation and patient educators: results of a novel educational workshop on Raynaud phenomenon and systemic sclerosis
S. Sanges, M.-M. Farhat, M. Assaraf, J. Galland, E. Rivière, C. Roubille, M. Lambert, C. Yelnik, H. Maillard, V. Sobanski, G. Lefèvre, D. Launay, S. Morell-Dubois, E. Hachulla
Orphanet Journal of Rare Diseases.2020;[Epub] CrossRef

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2 Crossref

Predictive Value of the Korean Academy of Family Medicine In-Training Examination for Certifying Examination: Jung-Jin Cho, Ji-Yong Kim; Korean J Fam Med 2011;32(6):352-357. Published online September 28, 2011; DOI: https://doi.org/10.4082/kjfm.2011.32.6.352

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Background

In-training examination (ITE) is a cognitive examination similar to the written test, but it is different from the Clinical Practice Examination of the Korean Academy of Family Medicine (KAFM) Certification Examination (CE). The objective of this is to estimate the positive predictive value of the KAFM-ITE for identifying residents at risk for poor performance on the three types of KAFM-CE.

Methods

372 residents who completed the KAFM-CE in 2011 were included. We compared the mean KAFM-CE scores with ITE experience. We evaluated the correlation and the positive predictive value (PPV) of ITE for the multiple choice question (MCQ) scores of 1st written test & 2nd slide examination, the total clinical practice examination scores, and the total sum of 2nd test.

Results

275 out of 372 residents completed ITE. Those who completed ITE had significantly higher MCQ scores of 1st written test than those who did not. The correlation of ITE scores with 1st written MCQ (0.627) was found to be the highest among the other kinds of CE. The PPV of the ITE score for 1st written MCQ scores was 0.672. The PPV of the ITE score ranged from 0.376 to 0.502.

Conclusion

The score of the KAFM ITE has acceptable positive predictive value that could be used as a part of comprehensive evaluation system for residents in cognitive field.

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The Predictive Validity of the National Board of Osteopathic Medical Examiners’ COMLEX-USA Examinations With Regard to Outcomes on American Board of Family Medicine Examinations
Thomas R. O’Neill, Michael R. Peabody, Hao Song
Academic Medicine.2016; 91(11): 1568. CrossRef

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The Perception and Opinions for the 'Compulsory Clinical Training Program' of Postgraduate Medical Trainee.: Junghyoun Cho, Jaeho Lee, Seolly Jeong; Korean J Fam Med 2009;30(11):864-871. Published online November 20, 2009; DOI: https://doi.org/10.4082/kjfm.2009.30.11.864

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Background
Nowadays 2-year 'Compulsory Clinical Training Program' is on issue. The perception and opinions for the new training system of residents and interns may be essential to establish ideal postgraduate medical education. Methods: A questionnaire survey of postgraduate trainee from March to April 2008 was performed by person to person method. Gender, age, specialty, the location and the facility of the hospital, and 7 questions reflecting individual perception and opinions for the 'Compulsory Clinical Training Program' were reviewed. Results: Among in 1,314, 1,284 subjects completed the survey fully. We divided 1,284 sujects into 4 groups; Intern; Resident of Family Medicine; Resident of Internal Medicine or Pediatrics; Resident of other than Family Medicine, Internal Medicine and Pediatrics. About the vision for independent clinical skills through the 'Compulsory Clinical Training Program', most were negative. They were afraid of 'prolongation of current Internship' or 'unclear quality of the training course'. In case of setting the 'Compulsory Clinical Training Program', most chose additional resident courses for specialty. The main opinion about the ideal model of a primary physician was medical doctors who obtained primary care specialty. Conclusion: Most of the residents and interns think that the specialists of family medicine, internal medicine or pediatrics are suitable for primary care. And on wishing the additional residency course even after 'Compulsory Clinical Training Program', they doubt about the effi cacy of the new training system.

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Perception and Experience of CAM Education for Family Practice Residents by Family Practice Training Faculty in South Korea.: Sun Myeong Ock, Chul Min Kim, Whan Seok Choi, Sang Yhun Ju, Ho Cheol Shin, Chan Hee Song; J Korean Acad Fam Med 2008;29(12):932-938. Published online December 10, 2008

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Background: Complementary and alternative medicine (CAM) use is popular and current trend suggests a demand for CAM education during residency training. Our objective was to assess perception, the need and experience of CAM education for family practice residents by training faculty. Methods: A questionnaire was administered to family physicians (n=262) who were registered in the Korean Academy of Family Medicine as residency training faculty between February and May 2006. Results: One hundred and seven (40.8%) of 262 faculty completed the questionnaires. Eighty three (77.6%) respondents recognized the need of CAM education during residency training and fifty two (46.8%) respondents have already educated some kind of CAM. Thirty nine (36.4%) respondents replied that partial CAM educational contents were given out at conferences. Seventy eight (72.9%) respondents recognized the need for educating residents on the general outlines of CAM along with education on verified CAM. Sixty six (61.7%) respondents replied that the Korean Academy of Family Medicine should host such education. Conclusion: Most family practice training faculty recognized the need for providing CAM education for family practice residents during residency training, but about an half of family practice training faculty did not have experiences of CAM education. (J Korean Acad Fam Med 2008;29:932-938)

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Geriatrics in Family Medicine Residency Program: Training Conditions and Suggestions.: Bodri Son, Chang Won Won, Il Sin Kim, Hyun Rim Choi, Byung Sung Kim; J Korean Acad Fam Med 2008;29(9):687-694. Published online September 10, 2008

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Background: With the number of geriatric population on a steep increase, the roles of family physicians broaden to give comprehensive medical care to the elderly. Therefore, geriatrics is becoming increasingly more important for the residents of family medicine. The authors have surveyed and researched on resident's current attention, actual training conditions, and future needs on geriatrics. Methods: Family medicine residents in 79 hospitals registered to Korean Family Medicine Resident Union were enrolled. By means of electronic and postage mail surveys, informations were gathered; including demographics, the order of importance of nine training curricula, the necessity of training itself, the facility and academic conference of geriatrics training. Results: A total of 173 residents in 45 hospitals replied with return rates of 51.9%. Among the total, 169 (97.7%) of the answered agreed on the necessity of geriatrics training. Of the nine curricula, geriatrics was considered the most important. And residents considered family medicine outpatient department and inpatient ward to be the most important place for geriatrics training. Furthermore, the residents considered elderly's diseases or symptoms as more important conference title, but the parameters such as the quality of life, physiology of aging, care in nursing home were considered less important. Conclusion: The geriatrics training program is not up to the standards of residents' satisfaction. This is considered to be due to the absence of a formal training program. To provide a better care for the elderly, it is compulsory to gain broad knowledge of geriatrics and actual experience out in the field. (J Korean Acad Fam Med 2008;29:687-694)

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Curriculum and Training Difficulties of Family Medicine Residency Programs in Korea.: Yu Jin Paek, Ho Cheol Shin, Cheol Hawn Kim, Youn Seon Choi, Hang Lee, Ae Kyung Cho, Eon Sook Lee, Jin Ho Park, Yoon Jung Chang, Min Jung Kim; J Korean Acad Fam Med 2007;28(5):367-374. Published online May 10, 2007

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Background
This study was conducted to survey the current status of family medicine residency programs and to evaluate the difficulties in training of the curriculums. Methods: Questionnaires on residency programs were sent to all the centers of residency programs by mail in April 2006. The questionnaire included detailed characteristics of residency programs, curriculum schedule, reasons for failed specific curriculum, and review and measures by the program center and the Korean Academy of Family Medicine to resolve problematic curriculums. Results: A total of 113 residency programs responded. Among the 93 residency programs except for the 20 subsidiary hospitals, inadeguate subjects were mainly dermatology (12 programs, 12.3%), psychiatry (6 programs, 7.5%), ophthalmology (5 programs, 7.1%), and otolaryngology (5 programs, 7.1%). Training rejection rate was higher in dermatology (13 programs, 14.4%), radiology (11 programs, 13.1%), gastrofibroscopy (8 programs, 9.5%), and psychiatry (5 programs, 6.2%). Emergency me-dicine in 4 programs and general surgery in 3 programs had a longer duration of training than initially planned. Difficulties in training some subjects were due to failed establishment of specific curriculums in non-university hospital. Commonly established clinics were health promotion center, obesity clinic, smoking cessation clinic, geriatric clinic, stress clinic, and clinical nutrition clinic. Family medicine center programs included gastrofibroscopy, obesity, smoking cessation, geriatrics, hospice care, and evidence-based medicine. Conclusion: There is repeated demand for taking measures to promote better curriculum in the nation-wide view of family medicine. Dermatology, radiology, psychiatry, and otolaryngology were the subjects difficult to receive training. Measures to strengthen the weak subjects are urgently needed. (J Korean Acad Fam Med 2007;28: 367-374)

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Family Physician's Knowledge, Attitude, Experience and Training on Breastfeeding.: Hai Lim Kim, Hong Soo Lee, Young A Oh, Su Yun Kim; J Korean Acad Fam Med 2006;27(2):120-127. Published online February 10, 2006

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Background
: Breastfeeding is not common in Korea despite its known benefits. The role of family physicians is important in promoting breast-feeding since they can provide prenatal and postnatal care on lifelong basis. This paper analyzed a survey of family physicians on their knowledge, attitude, experience, and training concerning breastfeeding.

Methods : The survey was carried out by e-mail enquiry to the residents and board-certified physicians registered in the Korean Academy of Family Medicine. The enquiry was developed by Gary L. Freed composed of 18 questions about knowledge, attitudes, experience, and training. The answers to the questions were analyzed to give frequency and the associations between the variables.

Results : Among the total, 64% of the residents and 76% of the physicians answered yes to whether breastfeeding was the best means of feeding an infant under 6 months of age. Also, 83% of the residents and 85% of physicians answered it was right to quit breastfeeding completely when breast abscess developed. The breastfeeding promotion was done more frequently by those who had personal experience. They had higher rate of educating patients than those who did not (28% vs. 9%, P＜0.0001). Despite its importance, 86.5% of the residents and 77.6% of the physicians answered that they did not have enough opportunity to learn about breastfeeding during their training years.

Conclusion : Although family physicians are required to play a role in promoting breastfeeding, they are insufficiently trained under the current system. Therefore, it is necessary to develop a training program to educate the residents on breastfeeding.

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Difficult Problems for Family Physicians in Clinical Practice.: Ki Heum Park, Dong Uk Lee, Nak Jin Sung; J Korean Acad Fam Med 2006;27(2):91-96. Published online February 10, 2006

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Background
: Real performance in practice is one of the criteria by which residency training program can be evaluated. We surveyed the difficult problems in which family physicians underwent in their practices after a university hospital training program to evaluate our family physician training program.

Methods : The study subjects were all physicians who fulfilled our family physician residency training program in a university hospital from February 1993 to February 1999. Data on facing difficult problems were collected via questionnaire which was distributed in advance and answered by practicing physicians. The study period was the first week of each month from March 1999 to December 1999.

Results : The participating physicians were 13 among 20. Total collected cases were 179. The reasons why family physicians faced difficulty in their practices were persistent symptoms of patients, lack of knowledge, lack of skills and facilities, vague symptoms, multiple symptoms of patients, low compliance, negative feelings, and patients' economic problems. Common difficult problems were abdominal pain (15), low back pain (14), cough (14), arthralgia and myalgia (12), skin rash (11), dyspnea (8), multiple somatic complaints (8), otitis media (7), nasal stuffiness (6), and dizziness (6) among 179 cases. Rare diseases comprised 22.2% of difficult problems.

Conclusion : The problems of difficulty that family physicians faced in their practices were persistent symptoms of chronic diseases despite active treatment, lack of knowledge and skills in differential diagnosis of acute illness, and rare diseases in the communities.

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Current State and Demand of Esophagogastroduodenoscopy Training in Family Practice Residency Programs.: Jung Han Chun, Yeong Sook Yoon, Sang Woo Oh, Eon Sook Lee, Min Gyu Kim, Young Seong Kim, Yang Hyun Kim, John Yang; J Korean Acad Fam Med 2003;24(12):1092-1098. Published online December 10, 2003

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Background
: Most recently, there is an increased use of EGD (esophagogastroduodenoscopy) for primary care among family physicians, which tends to promote EGD training programs in the course of Family Practice Residency. This study determined to survey current status of EGD training programs among residents in family medicine, identify relevant problems, and present some suggestions for their improvement.

Methods : The subjects were residents selected among family medicine training hospitals, which were registered in the KAFM (Korean Academy of Family Medicine). The residents were in their 3rd year of training or had already completed the EGD training program. Surveys were sent out to those hospitals by mail and electronic mail surveys were performed by researchers.

Results : Among 66 subject hospitals a total of 27 surveys (40.9%) were returned. Most EGD training were performed in the department of internal medicine. The mean duration of training period was 8 weeks. The averale number of hands on experience of the procedure was 62. It was found that most residents thought that EGD training period and the number of hands on experience of the procedure were insufficient. The longer period of actual experience of the procedure and the more number of EGD caseloads they had, the more they were satisfied with their EGD training programs. It was also found that there was a high demand for a follow-up learning opportunities for EGD (p＜.05), because the residents who had already had many EGD caseloads further wanted to receive continuous education even, after they acquired license. There were no relationships observation period, period of actual experience of the procedure, and number of EGD caseloads during residency with demand for follow-up learning opportunities.

Conclusion : In summary, there was insufficient EGD training period and actual experience of the EGD procedure in family practice residency. There was low satisfaction of EGD training programs and high demand for continuous education. Therefore, it is recommended to establish EGD training program, proper practice training, and regular continuing education after completing residency.

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Family Medicine Residents' Perception of Attitude Towards Request for Referral in Out-patient.: Hong Joo Yoon, Seong Hee Jin, Yoo Seock Cheong, Sun Mi Yoo, Eal Whan Park; J Korean Acad Fam Med 2003;24(3):254-259. Published online March 10, 2003

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Background
: After amendment of the national health insurance law to enforce and reform primary health care, the number of family medicine out-patients was increased. Some patients requested referral. Therefore, this study was made to reveal family medicine residents' perception of attitude towards request for referral.

Methods : The self-administered questionnaires were collected by post mailing (July 1 to July 30, 2002) and by e-mailing (July 25 to August 10, 2002). The questionnaire contained the followings: general characteristics, issues of referral request, influence of referral request in training, and influence in private family clinics.

Results : The overall response rate was 22.2% (93/418). Patients need was the most common cause of referral (62.0%). Among the total, 46.2% of respondents gave answers that increasing number of patients at the family medicine out-patient clinic was beneficial in increasing their experience. Also, 55% of respondents replied that the present state of family medicine out-patient system influenced lowering of motivation in training. Overall, 63.4% of respondents replied that the present state of family medicine out-patient system led a trend of distrust to private family clinics.

Conclusion : Patients request was the most common cause of referral in family medicine out-patient clinic. The present state of referral system in family medicine out- patient clinic influenced lowering of motivation in training and a trend of distrust to private family clinics.

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Do the family physicians having their clinic in seoul want to join in education for students and resident.: Kyung Yun Kim, Hyun Eun Kang, Seoung Wook Hwang, Jeong Hee Yang, Be Long Cho, Bong Yul Huh; J Korean Acad Fam Med 2001;22(11):1581-1588. Published online November 1, 2001

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Background
s: The education by the family physician. is important for more practical primary care medicine education. In this study, we try to know the present state of education and the future and the number of education resource and how to multiply this resource.

Methods : we have got the list of family physicians who have their clinic in Seoul by the help of the Korean Academy of Family Medicine. And we performed telephone questionary. We also asked the demographic factors.

Results : 134 persons were asked questionary by the telephone. 17 persons were joining in education. Trainee by the 3rd grade hospitals was the major, the next was by 2nd grade hospital, and doctors who did not have the training. 14 persons have begun education by asking of the training hospital, 3 persons wanted it, but none thought it beneficial to them. 44 persons wanted to join education in the future, and there was no difference between the 3rd and the 2nd grade hospital trainee.

Conclusion : There was no difference between the 3rd and 2nd grade hospital trainee but 2nd grade hospital trainee was less joining than the 3rd. This shows that the 2nd grade hospital trainee can be the good pool of the future education if there are adequate supply. So many adequate supply is necessary.

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The validity and reliability of self-interviewing skills evaluation protocol for residents in family medcine.: Hye Seuk Kwon, Jae Whoon Kim, Eal Whan Park, Yoo Seock Cheng, Sun Mi Yoon; J Korean Acad Fam Med 1999;20(3):241-251. Published online March 1, 1999

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Background
: Medical interviewing skills are now recognized as the most important skill to be acquired for the purpose of accurate diagnosis and treatment. Among the several evaluation methods of interviewing skills, audiovisual method has the merit of allowing the fellow residents to have discussion about the interview and of receiving feedback from the teaching faculty by replaying the real interview. In addition, it allows the resident to evaluate his or her interviewing skills. The purpose of this study is to evaluate the reliability and the validity of family residents' self-interviewing skill evaluation protocol.

Methods : A modified Arizona interview rating scale which is an interviewing skill evaluating protocol has been used after Korean version became available. Six interviews with outpatients were recorded and evaluated respectively by 10 residents. The results were compared with that of Golden Standard to assess its validity. Finally, 10 residents were divided into two groups and the results among the groups were compared to evaluate the reliability of the scale.

Results : The evaluation of interviewing skills conducted by the residents showed significant rate of correspondence with the Golden Standard(kappa=0.22), and in the comparison of 17 evaluation items, there appeared significant correspondence in 7 items. The analysis of the rate of correspondence between the two group of residents revealed significant rate of correspondence (kappa=0.43). Lastly, the comparisons between the items showed significant rate of correspondence in 11 items.

Conclusion : The residents' self interviewing skill evaluation protocol showed significant validity and reliability from which it may be concluded that the protocol can be used as an effective evaluating method.

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A Study of the core curriculum of family medicine residency Program in Korea.: Han Seung Song, Sung Il Hong, Kyung Hwan Cho, Hong Ji Song, Choon Woo Lee, Sun Mee Kim, Myung Ho Hong; J Korean Acad Fam Med 1998;19(10):820-827. Published online October 1, 1998

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Background
: In order to provide basic data which are necessary for the standard reference of residency training program in family medicine, we analysed of family practice residency program in Korea(the core curriculum) which has 313 items - diseases and problems - proposed by the Korean Academy of Family Medicine.

Methods : Each item of the core curriculum of family practice residency program in Korea was sorted according to ICD-10. They were the most compared to common 100 diseases and clinical cases in family medicine department of a tertiary hospital in one year. The most common 100 diseases were listed according to ICD-10, also. But some items which were difficult to sort were excluded. Eighty eight types of diseases were sorted. Clinical data of a tertiary hospital included 9138 cases.

Results : Comparing to clinical cases of a tertiary hospital, the core curriculum includes 93.2% cases of family medicine department of a tertiary hospital. Among the 17 fields of the core curriculum, 12 fields were found in about 50% or more among cases of the clinic and 5 fields were in less than 50%.
Among 88 diseases, the core curriculum includes 78 diseases. 10 diseases were excluded. In the most common 100 diseases, 12 diseases were related to trauma and the core curriculum did not include them.

Conclusion : Generally the core curriculum included highly prevalent diseases, but did not include some diseases which is important. Revision to make up for the weak points in the current core curriculum may be necessary.