Methods
A pilot survey was sent to 25 members of the Society of Teachers of Family Medicine (STFM). Minor revisions were made according to respondents’ feedback, resulting in a 24-item, structured survey that we mailed to a national random sample of physician and nonphysician active members of STFM (N = 770). The first section of the questionnaire asked respondents a series of demographic and descriptive questions, including participants’ age, sex, ethnicity, professional effort (full or part time), length of time in their current department, and the year they completed residency or a doctoral degree. Additional information was collected on a variety of topics, including type of community-based involvement, reasons for that involvement, challenges to community-based involvement, and support or resources desired from their departments. A list of community-based activities was provided on the questionnaire, as was one write-in option Table 1. Although all activities were community-oriented, not all activities were conducted in the community.
Surveys were distributed in 2 mailings over a 6-month period with the second mailing going only to nonrespondents. Descriptive statistics consisting of percentages for categorical variables and medians for continuous, non-normally distributed variables were calculated. Univariate analyses were accomplished with the chi-square test or, in the case of non-normally distributed variables (age, years in the department, percentage of professional time spent on community-based activities), with the nonparametric Wilcoxon rank sum test.
Multiple logistic regression was used to examine the relationship between binary outcome variables and multiple explanatory variables. The logistic regression outcomes we considered were the individual types of community involvement, barriers to community involvement, and support desired. The candidate explanatory variables were chosen a priori: age, sex, degree (4 categories: master’s degree [reference group], MD degree, PhD degree, and both MD and PhD degrees), and years in department. Following the structure of the survey, analyses of barriers and desired support were restricted to those who had some type of community-based involvement in the previous year. A backward selection stepwise technique was used to build the models. Explanatory variable effects are shown as odds ratios (ORs) with 95% confidence intervals (CIs). For all analyses we used the Stata 6.0 statistical software package.16
Results
A total of 446 usable surveys were returned (58% response rate). Of these, 3 were blank and therefore unusable. Demographic characteristics indicated that respondents were representative of active STFM membership and national family medicine department faculty as reported by the Association of American Medical Colleges17Table 2.
Ninety-five percent of respondents had participated in a community-based project within the previous 12 months. Projects represented a continuum of involvement with community members. Nevertheless, much of the community-based activity was traditional in nature and included precepting medical students and residents in the community, providing clinical services at community-based sites, and conducting educational presentations in the community Table 1. When we considered only activities actually taking place within the community and excluded education about the community that took place elsewhere (the second, third, and fourth items under the heading “Any Education” in Table 1), 92% of respondents had been involved in a community-based project in the previous 12 months.
Faculty participated in community projects for several reasons, the most prevalent being personal interest or satisfaction (77%). Respondents identified insufficient time as the biggest barrier to involvement in community-based activities and noted sufficient release time as the most important form of support or resources they desired from their departments Table 3. Respondents’ academic institutions were most likely to serve urban communities (60%), followed by suburban (33%), small town (20%), and rural (16%) communities.
The association between types of community involvement and respondents’ sex, age, and professional degree was examined with logistic regression analysis. Even when controlling for degree, more men than women reported educating faculty on topics regarding community-based education and how to precept medical students or residents in community sites (OR = 2.01; 95% CI, 1.20 - 3.37; P = .008) and providing clinical care at community-based sites (OR = 1.73; 95% CI, 1.14 - 2.61; P = .009). The longer a respondent had been a member of a department, the more likely he or she was to report having served as a board, committee, or council member of a community health organization, even after controlling for age (for each 5-year interval spent in their department: OR = 1.23; 95% CI, 1.03 - 1.47; P = .023). Not surprisingly, MDs were 5.27 times more likely to report that they had precepted medical students or residents at community-based sites (95% CI, 1.29 - 21.46; P = .02) and provided medical care at community-based sites (OR = 5.35; 95% CI, 1.08 - 26.47; P = .04) than non-MD respondents. MD and PhD respondents, however, were less likely than those without such degrees to work with community members to develop and implement a research project to meet a community-identified health concern (PhDs: OR = 0.17; 95% CI, 0.04-0.84; P = .03; MDs: OR = 0.28; 95% CI, 0.07-1.09; P = .07).