June 2001 • Volume 7 • Number 6
Just do it: Involve residents in family practice research
BY SHARON DICKINSON DENT
After three years of speaking at the annual AAFP Residency Program Directors' Workshop on how to introduce research into residencies, FP Jon Temte, M.D., Ph.D., and Mark DeHaven, Ph.D., weren't sure their efforts were being translated into research.
"We realized that the best way for residents to learn about research would be for them to 'just do it,' and we would provide tools and resources," said DeHaven, a faculty member at the University of Texas Southwestern Medical Center at Dallas.
Want to join the second project?
The "Just Do It" team's second project is scheduled to kick off this month at the 2001 program directors' workshop. To join the project, call Jonathan Temte, M.D., Ph.D., at (608) 263-3111.
Also this month, an interactive Web site should open with the "Just Do It" curriculum, covering these topics:
- identifying the role of research in family medicine training,
- asking the research question,
- searching and critically appraising the literature,
- establishing the research design,
- implementing the research project and collecting data,
- using and understanding statistics,
- interpreting and synthesizing, and
- reporting, writing and presenting the research.
So he and Temte, a faculty member at the University of Wisconsin Medical School in Madison, launched "Just Do It: A Networked, Participatory Research Experience" at the 2000 program directors' workshop. They recruited family practice residencies to gather data on initial management of the febrile child 5 years old or younger.
Temte explained that the study involved residents, fellows, faculty physicians, physician assistants and nurse practitioners at 10 residencies across the country. Data collection took place over 13 weeks, wrapping up in March. Participants at the clinics entered data on pocket cards, which were returned to the project coordinators.
What emerged was the largest data set on febrile children ever to come out of family practice settings, said Temte at the AAFP research network convocation in March.
Initial returns (one residency had not yet submitted data) showed that 546 febrile children were treated in the clinics during the study period. "We have a very rich representation in terms of ethnicity," Temte said, noting that the group was about 46 percent white, 12 percent black, 37 percent Hispanic and 5 percent Asian.
The most compelling finding so far, Temte said, was the number of children treated with antibiotics. "Fifty-four percent who came in with a fever or a reported fever got an antibiotic," he said. "If you go back and add up everything that you might consider an antibiotic for -- for example, otitis media or strep throat -- if you add up all of those, it still doesn't add up to 295 kids. We're giving antibiotics to kids with upper respiratory infections, kids with bronchiolitis and respiratory syncytial virus; we're giving them to kids who probably shouldn't be on them. If you look at the literature, we probably should be way, way, way, way down from that."
Some other results:
- Eighty percent of children received no diagnostic tests. When tests were ordered, the most common one was a white blood cell count.
- The most common diagnosis by far was upper respiratory infection (about 252 cases), followed by otitis media (175 cases) and sinusitus (30 cases).
- Five percent of children were admitted to the hospital, but most children, 66 percent, were told to come back for follow-up after three days or as needed.
- Children with higher temperatures were more likely to receive antibiotics and more tests than were children with temperatures at or below 101.2 degrees Fahrenheit.
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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