Motivations and Barriers towards Volunteer Work among Family Medicine Residents and Primary Health Care Physicians in Qassim Region, Saudi Arabia

Introduction: Volunteering is an unpaid voluntary activity that provides some services to one or more other people or the community at large. Volunteer in the medical field is common. Physicians and medical students are participating in voluntary activities. This study assessed the motivations and barriers of Family Medicine (FM) Residents and Primary Health Care (PHC) Physicians in Qassim Region, Saudi Arabia. Methods: This is a descriptive cross-sectional study was carried out between 12th March 2021 to 31st September 2021 in Qassim Region, Saudi Arabia. 63 FM residents and 89 PHC physicians were involved. A self-administered questionnaire using Volunteer Functions Inventory (VFI) questions was distributed. A 30-item questionnaire is divided into 6 scales of 5 items each, which are scored using a 5-point Likert-type scale (where 1 strongly disagrees and 5 strongly agree). Results: Of 152 FM residents and PHC physicians, 91 (59.9%) were males, and Saudi 90 (59.2%). The mean age was 35 (±SD8.6) years. The majority of respondents 126 (85.7%) participated in different kinds of volunteer work. The highest rank of the benefits selected 137 (90.1%) was gained Allah’s pleasure. About 66 (43.4%) of respondents reported different reasons as barriers;lack of time was the dominant reason for 59 (38.8%). A strong statistical association was found between gender and facing barriers (P-value Conclusions: This study highlighted that the values motivation factor was the highest among the six motivation determinants. The main reason preventing respondents from doing voluntary work was the lack of time. Male gender and Saudi nationality physicians participated more in previous voluntary work P-value < 0.001. Further future research into studying human behaviour towards voluntary work is highly needed.

Storylines of family medicine Ⅲ:core principles—primary care,systems and family

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine,as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world.In‘Ⅲ:core principles—primary care,systems,and family’,authors address the following themes:‘Continuity of care—building therapeutic relationships over time’,‘Comprehensiveness—combining breadth and depth of scope’,‘Coordination of care—managing multiple realities’,‘Access to care—intersectional,systemic,and personal’,‘Systems theory—a core value in patient-centered care’,‘Family-oriented practice—supporting patients’health and well-being’,‘Family physician as family member’and‘Family in the exam room’.May readers develop new understandings from these essays.

Storylines of family medicine Ⅳ:perspectives on practice—lenses of appreciation

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine,as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world.In‘Ⅳ:perspectives on practice—lenses of appreciation’,authors address the following themes:‘Relational connections in the doctor–patient partnership’,‘Feminism and family medicine’,‘Positive family medicine’,‘Mindful practice’,‘The new,old ethics of family medicine’,‘Public health,prevention and populations’,‘Information mastery in family medicine’and‘Clinical courage.’May readers nurture their curiosity through these essays.

Evaluation of obstetrics procedure competency of family medicine residents

Objective:To establish a procedure evaluation system to monitor residents’improvement in obstetrics(OB)procedures performance and skills during the training period.Methods:A web-based procedure logging and evaluation system was developed using Microsoft.net technology with a SQL server as a backend database.Residents’logged OB proce-dures were captured by the system.The OB procedures logged within 7 days were evaluated by supervising faculty using three observable outcomes(procedure competency,procedure-related medical knowledge level,and patient care).Results:Between 1 July 2005 and 30 June 2008,a total of 8543 procedures were reported,of which 1263 OB procedures were evaluated by supervising faculty.There were significant varia-tions in the number of logged procedures by gender,residency track,and US versus non-US medi-cal graduates.Approximately 84%of the procedures were performed(independently or with assis-tance)by residents.Residents’procedure skills,procedure-related medical knowledge,and patient care skills improved over time,with significant variations by gender among the three outcomes.Conclusion:The benefits of specific evaluation of procedural competence in postgraduate medical education are well established.Innovative and reliable tools to assess and monitor resi-dents’procedural skills are warranted.

Evaluation of Attitudes of Family Physicians toward Occupational Health and Occupational Diseases in Türkiye

Background/Aim: This study evaluated family physicians’ attitudes toward occupational health and disease in Türkiye. Materials and Methods: The study is cross-sectional and descriptive in a quantitative research design. The “Attitude Scale for Physicians toward Occupational Health and Occupational Diseases” developed by Kolcu et al. was used in the study (Cronbach’s α 0.94). Our study aimed to sample the entire country using the stratified sample selection based on geographical region. 349 family physicians were included in the study according to sample size (n: 349). Results: The mean age of the participants in the study was 37.77 ± 8.96 (min: 27, max: 65 years). Of the participants, 65.2% were male. Of the physicians, 33.8% were family medicine specialists, and 38.8% had occupational physician certificates. It was determined that the level of attitude of family physicians toward occupational diseases was insufficient. It was also found that awareness increased as age increased, and awareness and attitude levels did not change according to gender. No significant difference was found in the scale total scores and subdimensions of family physicians’ occupational health and occupational disease attitudes according to the regions they worked in Türkiye. Conclusion: It has been concluded that there is no difference in awareness among family physicians in regions where it is much more important to diagnose an occupational disease, especially in industrial regions. The number of family physicians with occupational physician certificates was very insufficient, and a significant number of those who had occupational physician certificates did not practice occupational medicine.

Mixed methods and survey research in family medicine and community health

Many family medicine and community health researchers use surveys as an original research methodology.Our purpose is to illustrate how survey research provides an important form of quantitative research that can be effectively combined with qualitative data to form a mixed methods study.We first provide an overview of the key principles in survey research and in mixed methods research.We review the various ways that survey can be used in mixed methods studies,citing options such as beginning a study with a survey,using a survey as the second form of data collection,or combining a survey and a form of qualitative data in a single data collection procedure.Finally,we illustrate in a specific example six steps in conducting a mixed methods study using survey research.In a mixed methods study using a survey,primary care researchers should consider six steps.Step 1.Articulate the rationale for mixed methods study.Step 2.Detail quantitative and qualitative databases.Step 3.Identify a mixed methods design.Step 4.Analyse and report the results of the quantitative and qualitative databases.Step 5.Present and show integration.Step 6.Explicate the value of using mixed methods.The ability to combine and integrate survey research into a mixed methods study provides a more rigorous approach to research than conducting only a survey or conducting just a qualitative interview.While requiring skills beyond traditional survey approaches,surveys in primary care offers an opportunity for a high level of sophistication in research methodology.

Discovering and doing family medicine and community health research

We dedicate this issue to aspiring family medicine and community health researchers.We include as our audience students,residents and fellows who are still learning the craft of clinical care,clinician educators making innovative strides in teaching,and experienced clinical practitioners who are inquisitive and want to contribute to the science of family medicine and community health.In addition,we believe this issue will appeal to senior researchers and mentors as a resource to share with mentees.We now focus on why this special issue provides a unique niche for encouraging and making primary care research more accessible in primary care around the globe.

Fundamentals of case study research in family medicine and community health

The aim of this article is to introduce family medicine researchers to case study research,a rigorous research methodology commonly used in the social and health sciences and only distantly related to clinical case reports.The article begins with an overview of case study in the social and health sciences,including its definition,potential applications,historical background and core features.This is followed by a 10-step description of the process of conducting a case study project illustrated using a case study conducted about a teaching programme executed to teach international family medicine resident learners sensitive examination skills.Steps for conducting a case study include(1)conducting a literature review;(2)formulating the research questions;(3)ensuring that a case study is appropriate;(4)determining the type of case study design;(5)defining boundaries of the case(s)and selecting the case(s);(6)preparing for data collection;(7)collecting and organising the data;(8)analysing the data;(9)writing the case study report;and(10)appraising the quality.Case study research is a highly flexible and powerful research tool available to family medicine researchers for a variety of applications.

Family medicine training in China:crisis and opportunity

Strengthening primary Care through family mediCine Primary care based in the community centres has been one of the top priorities in health-care reform in China launched in 2009.1 In order to support the reform,hospital spending has been curved to put more resources at the primary care level.2 Recent review,however,still argues slow progress in developing primary care system in China.3 Studies have pointed out that primary care has not been the first point of contact for majority of patients in China.4 Beijing ecology of care study5,for example,demonstrated fewer number of people seek primary care physicians in the community as their first contact care compared with a similar study conducted in the USA.People prefer tertiary care hospitals in urban centres for their first contact care.

Focusing on the assets in our challenges:family medicine residency programme in Chiang Rai,Thailand

BACKGROUND For more than 20 years,family medicine(FM)in Thailand is still looking for its place in our primary care healthcare system as an estab-lished specialty.Historically,primary care in Thailand was provided by the new graduates from the medical school.They were assigned to district hospitals as general practitioners(GPs)and were required to serve a 3-year period in various parts of the country.GPs have a primary medical qualification but have not undertaken a specialty in residency.They had to undergo‘on-the job’training while functioning as the first-contact medical care providers in their community.Until the inception of FM residency,GPs could apply for formal medical subspecialty training(similar to the US residency programmes)and could return to teaching hospitals only after the completion of 3 years.

Enhancing your scholarship as a family medicine junior faculty member

Family medicine faculty are often expected to produce some form of scholarship as members of academic departments.However,this can be challenging given a range of contextual factors,including limited research capacity in many departments,increased competition for funding and individual challenges around balancing multiple roles,unclear expectations and lack of mentorship,to name a few.The purpose of this reflection is to discuss seven content areas that might be addressed by faculty in order to promote scholarship,particularly among junior faculty.These include:1)knowing your academic track and its associated expectations by rank,as well as the scholarship expectations within your department;2)considering your personal goals,interests,professional development needs and the relationship between meaningful work and burnout;3)starting small and building towards a niche content area;4)finding collaborators and the benefits of collaboration;5)seeking alignment between your scholarship and work that you already are performing;6)educating yourself about available outlets for scholarship and 7)seeking mentorship.

Family medicine residency training in Ghana after 20 years:resident attitudes about their education

Objective In addition to assessing educational needs of family medicine trainees in Ghana,we sought to assess whether those entering the training programme aimed to pursue an academic career.Design A case study using an anonymous cross-sectional survey through collaboration between faculty members from the family medicine departments of Ghana and the University of Michigan.Setting The family medicine postgraduate trainees and the most recent graduates in the three training sites,Accra,Kumasi and Mampong,as well as modular residents in Ghana served as the targeted participants during data collection between October and November of 2018.Participants Second and third year family medicine residents,fellows(known as senior residents in Ghana)and recent graduates were invited to participate in this study.Thirty-five of 77 eligible subjects provided responses(46%response rate),but five records were eliminated due to incomplete data to yield a survey completion rate of 39%(30/77).Result Participants were mostly men(n=19),and the average age of respondents was 37 years old.The participants indicated the residency programmes needed more faculty 97%(n=29),supervision during outpatient care 87%(n=26)and lectures 83%(n=25).The main reason provided by respondents for entering residency programme in family medicine,which is currently not required for practising primary care in Ghana,was to obtain more education 93%(n=28).Participants who had completed the residency programme were much more likely to be interested in becoming faculty compared with those still in residency(p<0.001).Conclusion The research confirms the need for more faculty and the importance of investing in faculty development resources for ensuring a robust programme.These findings provide constructive feedback that could improve residency curricula of the local and regional family medicine training programmes and supports investing in trainees and new graduates as future faculty candidates.

Effect of BATHE interview technique on patient satisfaction in an ambulatory family medicine centre in South India

Objective The objective of the study is to determine the effect of background,affect,trouble,handling and empathy(BATHE)versus usual interview technique on patient satisfaction during regular consultation with family physicians in ambulatory care.Design The research design was a prospective,randomised control trial.Setting The trial took place in a family practice unit in South India,which was one of the clinical service units of the academic Department of Family Medicine of a tertiary hospital.Participant The eligible participants were adults above the age of 18 years,who did not have any acute presenting illness.The participants should have given consent and also not have any cognitive disability.A total of 138 participants took part in the trial,70 in BATHE group and 68 in the non-BATHE group.All participants entering the trial completed the questionnaire.Result The BATHE group had a significantly higher mean score for questions grouped under professional satisfaction.This included questions on whether the patient felt that the physician treated them as a person and also whether they felt the appropriate clinical examination was communicated to them.The questionnaire used for scoring satisfaction had 18 questions with a maximum possible score of 90.When taking a cut-off of 75%(68)from the total possible score of 90,72.9%(51)of the participants for whom the BATHE consultation technique was used were satisfied as compared with only 55.9%(30)for whom the routine consultation was carried out.This was statistically significant(χ2=11.15,p value=0.0006)Conclusion The study suggests that using BATHE in this family practice centre is beneficial in improving the perception of person centeredness in the consultation.However,further studies ruling out all possible bias are needed in our setting before the range of probable benefits of the BATHE technique can be fully gauged.

Global health training in Canadian family medicine residency programmes

Objective Canadian family medicine(FM)residency programmes are responding to the growing demand to provide global health(GH)education to their trainees;herein,we describe the various GH activities(GHAs)offered within Canadian FM programmes.Design A bilingual online survey was sent out to all 17 Canadian FM program directors(PDs)and/or an appointed GH representative.setting Online survey via Qualtrics Participants All 17 Canadian FM PDs and/or an appointed GH representative.results The response rate was 100%and represented 3250 first-year and second-year FM residents across English and French Canada.All schools stated that they participate in some form of GHAs.There was variation in the level of organisation,participation and types of GHAs offered.Overall,most GHAs are optional,and there is a large amount of variation in terms of resident participation.Approximately one third of programmes receive dedicated funding for their GHAs,and two thirds wish to increase the scope/variety of GHAs.Conclusion These results suggest nationwide interest in developing a workforce trained in GH,but show great discrepancies in training,implementation and education.

Family Planning: Choosing Contraceptive Methods in Kongo Central Province, the Democratic Republic of the Congo

Background: In developing countries, access to modern contraceptive methods remains a concern, particularly in Sub-Saharan Africa (SSA). Although satisfactory progress in increasing family planning use has been observed worldwide, demand and unmet need continue to grow. This study describes the different reasons that push women in rural and urban areas of Kongo Central province in the Democratic Republic of Congo (DRC) to choose one of the modern contraceptive methods. Methods: A cross-sectional, analytical study on the 705 clients recruited during the family planning mini-campaigns organized from January to March 2021 in 8 health zones of the Kongo Central Province in DRC. Community Contraceptive Methods Distributors (CCMD) collected the data, community health workers (CHW) trained in clinical providers’ community family planning service. The Pearson’s Chi2 test was used to compare the proportions of the methods chosen in the different study variables categories, and logistic regression was done to analyze the strength of association between the uses of long-acting reversible contraceptives (LARC) with the study variables. Results: The mean age (SD) of the clients was 25.7 years. The median number of living children was 2 children and that of pregnancies carried per client was 3. Three (3) clients under the age of 20 out of 126 (2.4%) have 3 to 4 living children and one a up to 6 living children. Out of a total of 705 clients, 11.1% aged under 20 and 39.1% of clients aged 20 to 24 requested LARC. Divorced and unmarried women chose SAC and married and common-law women chose LARC more, compared to other categories of women. Unemployed women prefer SACs more than other professional categories, and women farmers prefer LARC. The level of education has no influence on the choice of method. The use of LARC increased with the number of pregnancies carried, children alive, and children who died. The age and number of children who died did not influence the association between LARC and alive children. Conclusion: The choice of modern contraceptive methods is guided by the age of the mother and the number of children living in her life. Younger women are more likely to choose short-acting contraceptive methods in the eight health zones of Kongo Central province. The high number of living children influences the choice of LARC regardless of age.

History of chronic gastritis:How our perceptions have changed

Currently,the diagnostic strategy for chronic gastritis(CG)is aimed not just at fixing the presence of gastric mucosal inflammation,but also at gastric cancer(GC)risk stratification in a particular patient.Modern classification approach with the definition of the stage of gastritis determines the need,activities and frequency of dynamic monitoring of a patient.However,this attitude to the patient suffering from CG was far from always.The present publication is a literature review describing the key milestones in the history of CG research,from the description of the first observations of inflammation of the gastric mucosa,assessment of gastritis as a predominantly functional disease,to the advent of endoscopy of the upper digestive tract and diagnostic gastric biopsy,assessment of the role of Helicobacter pylori infection in progression of inflammatory changes to atrophy,intestinal metaplasia,dysplasia and GC.

Comparative efficacy of sodium glucose cotransporter-2 inhibitors in the management of type 2 diabetes mellitus:A real-world experience

BACKGROUND Sodium glucose cotransporter-2 inhibitors(SGLT-2i)are a class of drugs with modest antidiabetic efficacy,weight loss effect,and cardiovascular benefits as proven by multiple randomised controlled trials(RCTs).However,real-world data on the comparative efficacy and safety of individual SGLT-2i medications is sparse.AIM To study the comparative efficacy and safety of SGLT-2i using real-world clinical data.METHODS We evaluated the comparative efficacy data of 3 SGLT-2i drugs(dapagliflozin,canagliflozin,and empagliflozin)used for treating patients with type 2 diabetes mellitus.Data on the reduction of glycated hemoglobin(HbA1c),body weight,blood pressure(BP),urine albumin creatinine ratio(ACR),and adverse effects were recorded retrospectively.RESULTS Data from 467 patients with a median age of 64(14.8)years,294(62.96%)males and 375(80.5%)Caucasians were analysed.Median diabetes duration was 16.0(9.0)years,and the duration of SGLT-2i use was 3.6(2.1)years.SGLT-2i molecules used were dapagliflozin 10 mg(n=227;48.6%),canagliflozin 300 mg(n=160;34.3%),and empagliflozin 25 mg(n=80;17.1).Baseline median(interquartile range)HbA1c in mmol/mol were:dapagliflozin-78.0(25.3),canagliflozin-80.0(25.5),and empagliflozin-75.0(23.5)respectively.The respective median HbA1c reduction at 12 months and the latest review(just prior to the study)were:66.5(22.8)&69.0(24.0),67.0(16.3)&66.0(28.0),and 67.0(22.5)&66.5(25.8)respectively(P<0.001 for all comparisons from baseline).Significant improvements in body weight(in kilograms)from baseline to study end were noticed with dapagliflozin-101(29.5)to 92.2(25.6),and canagliflozin 100(28.3)to 95.3(27.5)only.Significant reductions in median systolic and diastolic BP,from 144(21)mmHg to 139(23)mmHg;(P=0.015),and from 82(16)mmHg to 78(19)mmHg;(P<0.001)respectively were also observed.A significant reduction of microalbuminuria was observed with canagliflozin only[ACR 14.6(42.6)at baseline to 8.9(23.7)at the study end;P=0.043].Adverse effects of SGLT-2i were as follows:genital thrush and urinary infection-20(8.8%)&17(7.5%)with dapagliflozin;9(5.6%)&5(3.13%)with canagliflozin;and 4(5%)&4(5%)with empagliflozin.Diabetic ketoacidosis was observed in 4(1.8%)with dapagliflozin and 1(0.63%)with canagliflozin.CONCLUSION Treatment of patients with SGLT-2i is associated with statistically significant reductions in HbA1c,body weight,and better than those reported in RCTs,with low side effect profiles.A review of large-scale real-world data is needed to inform better clinical practice decision making.

Orchard Sports Injury and Illness Classification System (OSIICS) Version 15

Background:Sports medicine(injury and illnesses)requires distinct coding systems because the International Classification of Diseases is insuf-ficient for sports medicine coding.The Orchard Sports Injury and Illness Classification System(OSIICS)is one of two sports medicine coding systems recommended by the International Olympic Committee.Regular updates of coding systems are required.Methods:For Version 15,updates for mental health conditions in athletes,sports cardiology,concussion sub-types,infectious diseases,and skin and eye conditions were considered particularly important.Results:Recommended codes were added from a recent International Olympic Committee consensus statement on mental health conditions in athletes.Two landmark sports cardiology papers were used to update a more comprehensive list of sports cardiology codes.Rugby union protocols on head injury assessment were used to create additional concussion codes.Conclusion:It is planned that OSIICS Version 15 will be translated into multiple new languages in a timely fashion to facilitate international accessibility.The large number of recently published sport-specific and discipline-specific consensus statements on athlete surveillance warrant regular updating of OSIICS.

Validity of fatty liver prediction scores for diagnosis of fatty liver by Fibroscan

Background:The Korea National Health and Nutrition Examination Survey nonalcoholic fatty liver disease(K-NAFLD)score was recently developed with the intent to operationally define nonalcoholic fatty liver disease(NAFLD).However,there remained an external validation that confirmed its diagnostic performance,especially in patients with alcohol consumption or hepatitis virus infection.Methods:Diagnostic accuracy of the K-NAFLD score was evaluated in a hospital-based cohort consisting of 1388 participants who received Fibroscan®.Multivariate-adjusted logistic regression models and the contrast estimation of receiver operating characteristic curves were used for validation of the K-NAFLD score,fatty liver index(FLI),and hepatic steatosis index(HSI).Results:K-NAFLD-moderate[adjusted odds ratio(aOR)=2.53,95%confidence interval(CI):1.13-5.65]and K-NAFLD-high(aOR=4.14,95%CI:1.69-10.13)groups showed higher risks of fatty liver compared to the K-NAFLD-low group after adjustments for demographic and clinical characteristics,and FLI-moderate and FLI-high groups revealed aORs of 2.05(95%CI:1.22-3.43)and 1.51(95%CI:0.78-2.90),respectively.In addition,the HSI was less predictive for Fibroscan®-defined fatty liver.Both K-NAFLD and FLI also demonstrated high accuracy in the prediction of fatty liver in patients with alcohol consumption and chronic hepatitis virus infection,and the adjusted area under curve values were comparable between K-NAFLD and FLI.Conclusions:Externally validation of the K-NAFLD and FLI showed that these scores may be a useful,noninvasive,and non-imaging modality for the identification of fatty liver.In addition,these scores also predicted fatty liver in patients with alcohol consumption and chronic hepatitis virus infection.

Integrating the health belief model into health education programs in a clinical setting

The article demonstrates that health belief model(HBM)-based health education in hypertensive patients effectively improves blood pressure control and medication adherence at 3 months and 6 months.The HBM addresses perceived barriers,benefits,susceptibility,severity,and self-efficacy,leading to better health behaviors.HBM-based education has been effective in various contexts,including managing chronic diseases,promoting cancer screenings,and preventing infectious diseases.However,the model has limitations,such as cultural applicability and addressing complex health behaviors influenced by environmental factors.Future research should integrate HBM with other theories and conduct longitudinal studies to assess long-term impacts.Despite these limitations,HBM-based education significantly improves patient outcomes,highlighting its potential in health education and promotion when appropriately adapted and implemented.This reinforces the model's value in designing effective health interventions and advancing public health.