From the Director: Duty hour regulations in place for 5 years
1. Residents/fellows: What is your experience with at-home call?
2. Have you completed the National GME Census?
3. Health professionals acting badly can threaten patient safety
4. Female residents suffer from mentoring deficit
5. Virtual Mentor: Establishing the boundaries of informed consent
6. AAMC president: Medical school expansion places burden on faculty
7. Battle for clinical rotations heating up between offshore and US schools
8. USMLE, distance learning, teaching teamwork covered at AMA meeting
9. No more pens: PhRMA announces new code of conduct
10. Physician reentry Web site updated
11. AMA adopts new medical education policies at annual meeting
12. Health care workforce planning not meeting nation’s needs
13. Sign up for AMA Medical Education Bulletin
14. Medical home needs to offer diversity, cultural competence
15. Medical education in the news: Is health care killing us?
1. Residents/fellows: What is your experience with at-home call?
2. Have you completed the National GME Census?
3. Health professionals acting badly can threaten patient safety
4. Female residents suffer from mentoring deficit
5. Virtual Mentor: Establishing the boundaries of informed consent
6. AAMC president: Medical school expansion places burden on faculty
7. Battle for clinical rotations heating up between offshore and US schools
8. USMLE, distance learning, teaching teamwork covered at AMA meeting
9. No more pens: PhRMA announces new code of conduct
10. Physician reentry Web site updated
11. AMA adopts new medical education policies at annual meeting
12. Health care workforce planning not meeting nation’s needs
13. Sign up for AMA Medical Education Bulletin
14. Medical home needs to offer diversity, cultural competence
15. Medical education in the news: Is health care killing us?
Dear colleague,
It’s been 5 years since the Accreditation Council for Graduate Medical Education (ACGME) set duty hour limits for residents/fellows (80 hours a week, and no more than 24 hours on continuous duty).
One of the reports (PDF, 59KB) approved by the AMA House of Delegates at its June meeting looks at enforcing the standards and improving resident/fellow and patient safety. It notes that teaching hospitals are "encouraged to use the challenge of duty hours compliance as an opportunity for innovation and improvement in GME and patient safety."
In honor of this anniversary, we are soliciting entries to our "Five years of duty hours" poetry contest. Simply write a poem about some aspect of duty hours; all forms accepted (haiku, tanka, limericks, sonnets). E-mail your submissions to gme@ama-assn.org. The poems will be judged on undisclosed criteria, but the winner will receive a copy of The Art of JAMA and will be published in our next issue.
Paul H. Rockey, MD, MPH, Director
AMA Division of Graduate Medical Education
Reminder: Order your copy of the 2008-2009 Graduate Medical Education Directory now: Send an e-mail to meded@ama-assn.org with the words "single copy" in the subject line, or call (800) 621-8335 and request OP416708DIB.
The AMA is drafting a report on at-home call, for consideration at the 2008 Interim meeting. There has been concern that some residency/fellowship programs have been misusing at-home call to circumvent the intent of the ACGME duty hour restrictions. For trainees in some specialties, however, increased use of at-home call has been appreciated and well accepted.
What has been your experience? Please write to us at gme@ama-assn.org and let us know. All personal information will be kept strictly confidential.
About 75 percent of GME programs have already completed their program survey on GME Track. Seventy percent completed the survey by the early FREIDA Online deadline and will have updated program information displayed on FREIDA Online by mid-August.
The next FREIDA Online deadline is September 28. Program directors who haven't yet completed their program survey should go to GME Track.
The resident survey has been open since July 16. Nearly 700 programs completed their resident survey during the first 24 hours it was available. Don't get left behind!
Need registration/login information? Call (800) 866-6793, option 1, or e-mail gmetrack@aamc.org.
Rude language and hostile behavior among physicians and other health professionals pose a serious threat to patient safety and the overall quality of care, according to a recent alert issued by the Joint Commission.
A survey of AMA Resident and Fellow Section members found that 25 percent of respondents had been threatened with nonphysical harm; 22 percent stated that they were pressured to report inaccurate duty hours; and 25 percent said that they experienced some intimidation in the workplace.
Resident intimidation (see pp 16-20) was the topic of an AMA Section on Medical Schools educational session at the AMA’s 2007 Interim Meeting.
A recent study in Medical Education Online conducted at the University of Pittsburgh explores gender-specific differences in resident physicians' mentoring experiences.
Although both male and female residents in this qualitative study cited multiple barriers to finding a mentor, female residents reported fewer strategies for finding a mentor and were more passive in their approach to forming mentoring relationships compared to male residents — which could have long-term consequences for their careers in medicine.
"A Pilot Study Exploring Gender Differences in Residents' Strategies for Establishing Mentoring Relationships" (PDF, 533KB)
The right of competent adults to consent to and refuse treatment was established through a series of often high-profile court cases that also described the types of information required to ensure that consent was truly "informed."
The August issue of Virtual Mentor looks at the daily patient-physician encounters that don’t make the news. Case commentaries and articles seek to find the line between those tests and treatments for which consent is assumed and those for which explicit patient consent must be secured.
Of the many challenges facing medical school faculty, including overall career satisfaction, stress and burnout, and recruitment/retention, "the issue that perhaps is the most worrisome is the burden that medical school expansions will place on faculty teaching," said Darrell Kirch, MD, president, AAMC, in his presentation (PDF, 26KB) to the AMA Section on Medical Schools in June; the presentation slides (PDF, 1MB) are also available online.
On the plus side, noted Dr. Kirch, "Contrary to some gloomy observations that one hears, the satisfaction rate of all physicians – not just faculty – has remained markedly unchanged. A variety of surveys over the past 20 years have consistently found that roughly 70 percent to 80 percent of physicians express a positive overall satisfaction rate."
Also see the AAMC’s July Analysis in Brief (PDF, 201KB), which examines medical school faculty job satisfaction.
US educators are growing alarmed as Caribbean medical schools sign lucrative contracts with US hospitals to provide clinical rotations for their students. Meanwhile, the ongoing expansion of US medical schools has increased the need for more slots for their own students (Newsday, July 7).
The AMA Council on Medical Education is working on a report on clinical clerkships for the AMA's 2008 interim meeting in November. Also, the AMA Section on Medical Schools (AMA-SMS) presented a resolution on this topic (MS Word, 162KB), which was subsequently adopted at the AMA annual meeting in June.
In addition, Michael Reichgott, MD, PhD, Associate Dean for Clinical Affairs and GME, Albert Einstein College of Medicine, presented (PDF, 20KB) on this topic during the AMA-SMS meeting.
During the AMA annual meeting in Chicago, the AMA Section on Medical Schools brought together several speakers on leading topics of interest to medical educators, including the USMLE comprehensive review, distance learning, IT Innovations for clinical skills tests, interprofessional education, and competencies in geriatric medicine for medical students.
A revised version of the Code on Interactions with Healthcare Professionals (first issued in 2002) was recently released by the Pharmaceutical Research and Manufacturers of America (PhRMA). It goes into effect January 2009.
The new guidelines prohibit restaurant meals (but not catered meals in physicians' offices) as well as such items as pens or coffee mugs with company or product logos.
AMA Board of Trustees Chair-elect Rebecca J. Patchin, MD, commended PhRMA's new rules for providing "strong, clear guidance" (American Medical News, July 28).
Some critics, however, feel the new standards don't go far enough. One cynic, responding to the Wall Street Journal’s Health Blog (July 10) wonders whether drug detailers will switch from a pen with "tacky marketing logos" to a Mont Blanc.
In related news, Lawrence Diller, MD, writing in the July 13 San Francisco Chronicle, asks, "Are our leading pediatricians drug industry shills?"
Similarly, psychiatry is facing uncomfortable questions over close ties with the pharmaceutical industry (The New York Times, July 12).
Finally, a new report from the AAMC covers what medical students must learn to become knowledgeable, safe, and effective prescribers of medications. The report, Contemporary Issues in Medicine: Education in Safe and Effective Prescribing Practices, also examines the educational environment for learning about optimal prescribing.
New items have been added to the Physician Reentry into the Workforce Project Web site, including:
- New reentry policy reports from the AMA Council on Medical Education and the Texas Medical
Association - An article on physician reentry in ACOG Today
- PowerPoint slides from the Coalition for Physician Enhancement spring meeting
- Minutes of the June conference call of the project’s Assessment and Evaluation Workgroup
At its Annual Meeting in Chicago, the AMA House of Delegates (HOD) set new policies on several key medical education issues, including reports on:
- Educational Implications of the Medical Home Model (CME Report 4)
- Enforcement of Duty Hours Standards and Improving Resident, Fellow and Patient Safety
(CME Report 5) - Physician Re-entry (CME Report 6)
- Independent Regulation of Physician Licensing Exams (CME Report 10)
- Improving Parental Leave Policies for Residents and Fellows (CME Report 11)
- Observerships for International Medical Graduates (CME Report 12)
These and other medical education reports are available on the Web site of the AMA Council on Medical Education.
Also approved by the HOD were resolutions that covered:
- Support for the Epidemic Intelligence Service (EIS) Program and Preventive Medicine Residency Expansion (Resolution 301)
- Oppose Discrimination in Residency Selection Based on International Medical Graduate Status (Resolution 305)
- Credentialing Materials: Timely Submission by Residency and Fellowship Programs (Resolution 311)
- Evaluation of Increasing Resident Review Committee Requirements (Resolution 315)
- Promotion of Better Pain Care (Resolution 321)
- Eliminating Disparities in Licensure for IMG Physicians (Resolution 327)
Our "historic incremental, piecemeal approaches" to health care workforce are no longer effective. The US needs a new, collaborative, coordinated, national health workforce planning initiative that transcends geographical and professional boundaries.
A new report by the Association of Academic Health Centers (AAHC), Out of Order, Out of Time: The State of the Nation's Health Workforce, focuses attention on these challenges and offers 40 findings that document what is "out of order" with respect to the nation’s health workforce.
The AMA Medical Education Bulletin, a biannual print newsletter, is distributed to GME program directors, medical education directors at US teaching hospitals, members of the AMA Section on Medical Schools, and AMA appointees to residency review committees.
The newsletter serves as an important source of information on medical education and the AMA. Each issue includes actions of the AMA House of Delegates related to medical education.
The next issue will be published in August. E-mail us at meded@ama-assn.org if you currently do not receive the Bulletin and would like to be placed on the distribution list.
With fewer blacks and Mexican Americans going to medical school and entering primary care fields, policy changes can help ensure that the medical home is truly patient-centered and is centered on a culturally competent and diverse primary care workforce (American Family Physician, July 15).
Is the health care industry making us (and the planet) sick? A growing number of hospitals and health professionals believe it is, and are taking steps to make health care more “green” (Washington Post, July 22).
A new study finds that medical students' social networking sites (such as Facebook) include boasts about partying, boozing, and similar collegiate hijinks — information that “some faculty members believe is inappropriate for future doctors" (Palm Beach Post, July 10).
After a steep drop in medical student applicants to a military scholarship program, the Army, Navy, and Air Force now offer a $20,000 signing bonus (American Medical News, July 7).
Of the 385 medical school graduates in Georgia this year, only two chose to remain in the state to pursue a family medicine residency — and 20 students chose a family medicine residency in any state, half of what it was 5 years ago (Atlanta Journal-Constitution, July 21).
Can observing art improve physicians' diagnostic skills? Harvard medical students (and their future patients) will find out (Boston Globe, July 20).
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The GME e-Letter is produced by the Medical Education Group of the American Medical Association (AMA), publishers of the Graduate Medical Education Directory ("Green Book") and other medical education products.
Our monthly e-mail communication covers information of interest to the graduate medical education community. Readers include program directors and staff at ACGME-accredited and board-approved residency and fellowship programs, designated institution officials (DIOs), hospital administrators, professional associations, medical school deans, and governmental organizations.
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Last updated: Aug 26, 2008
Content provided by: Graduate Medical Education
Content provided by: Graduate Medical Education
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