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GME e-Letter, November 2008
From the Editor: Multiple health care challenges facing US
1. Top 10 ways to fix handoffs
2. Post positions on AMA-RFS Web site
3. How to file a duty-hour violation complaint
4. Virtual Mentor: Ethics of preventive medicine under scrutiny
5. Updates on new/planned medical schools in Pennsylvania, Florida, Michigan
6. Residency coordinators needed for AMA Insurance survey
7. New for AMA members: Succeeding from Medical School to Practice
8. MedPAC panel addresses medical education training
9. Medical education in the news: Duty hours, valor, fear, and burnout
10. AMA seeking vice president for medical education
11. International medical workforce meeting held in Scotland
12. Primary care shortages a continuing concern
13. News from the Association for Hospital Medical Education (AHME)
14. Medical Students: Apply to The CDC Experience Applied Epidemiology Fellowship
15. Blast injuries: What clinicians need to know
16. Research opportunities for physicians in training
17. Seeking the leaders in medicine
Dear colleague,
The presidential election is finally behind us. We now face the reality of finding solutions to multiple pressing problems. Universal access to health care is near the top.*
Young doctors entering practice in the US face a dysfunctional, profit-driven, and fragmented health care system. In addition to the 46 million Americans without insurance, there is a tsunami of baby boomers approaching Medicare with high expectations. With our economy in a ditch, it's unlikely we can sustain the hypertrophic health-care sector, currently at $2 trillion and 16% of our nation's GDP—especially when our health outcomes trail Canada, the UK and most European nations, who spend much less.
Medical students are no less altruistic today than in the past, but they will enter GME with enormous debts and a desire for work-life balance. They know the specialties that offer better compensation and controllable hours and are flocking to them. We shouldn't blame them. Instead, we should accept some responsibility for this mess. Where were we when we ceded so much control to insurance companies, government bureaucrats and hospital executives? When physician compensation diverged so greatly?
Many of us see medical injustice in our communities; we should not tolerate it. Most of us recognize medical waste and inefficiency too; we should not contribute to it.
We should not wait for politicians to call on us for solutions. It is time for physician leadership to reclaim the high ground. What better place to start than in our GME programs?
* Through its Voice for the Uninsured campaign, the AMA is committed to expanding coverage and choices for all Americans.
As always, we welcome your comments on these or other issues at gme@ama-assn.org
Paul H. Rockey, MD, MPH, Director
AMA Division of Graduate Medical Education
Reminder: Order your Green Book now
To receive an order form for the 2008-2009 edition of the Graduate Medical Education Directory, 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.
1. Top 10 ways to fix handoffs
As described in the October Archives of Surgery, (abstract) a group of surgery interns at The Johns Hopkins Hospital have developed a list of 10 ways to perform a successful sign-out. These include:
1. Ensure enough time
2. Make sign-out an active process
3. Emphasize sick patients
The study was covered in the Wall Street Journal Health Blog (October 20).
In related news, a study in the October Joint Commission Journal on Quality and Patient Safety found that problem handoffs are common and may cause as much patient harm as medication-related events (Washington Post, Sept. 26).
2. Post positions on AMA-RFS Web site
Do you have an open residency position to fill? Promote your position by posting your vacancy on the AMA Resident and Fellow Section's (AMA-RFS) Web site for free. Staff of residency/fellowship programs can use the convenient online form to describe their available position, requirements, contact information, etc. See:
http://www.ama-assn.org/ama/pub/category/6920.html
and click on "Residency and Fellowship Vacancy Submission Form." Programs can post positions that are vacant after the Match process is completed and those intended for residents who have completed 1 year or more of training.
3. How to file a duty-hour violation complaint
The educational environment, quality of patient care, and personal well-being for all physicians-in-training are high-priority issues for the AMA Resident and Fellow Section.
The Section has posted an online guide (PDF, 21KB) for filing a complaint of duty-hour violations with the ACGME.
In related news, Thomas Nasca, MD, MACP, ACGME chief executive officer, distributed a special message (PDF, 21KB) to all program directors, designated institutional officials, and residents about potential duty hour violations identified in the ACGME resident survey.
The message notes, in part, that a simplified resident complaint system will be announced soon.
In addition, Nasca writes, "Harassment and intimidation does not produce humanistic physicians. Retaliation and threats of personal harm or punishment is the antithesis of professional behavior, honesty and integrity, as well as unacceptable negative role model behavior. Residents must never be told to disclose anything but the truth. The public demands no less, nor should we as professionals."
4. Virtual Mentor: Ethics of preventive medicine under scrutiny
Preventive medicine seeks to identify and control risk factors for disease before they cause illness. Accomplishing this goal often means intervening in patient behavior or administering treatment before the onset of symptoms -- a measure viewed by some as an intrusion into personal freedom. Some even claim that medicine has begun to treat "risk factors" themselves as "diseases," so that no one is entirely healthy.
The November issue of Virtual Mentor scrutinizes the ethics of disease prevention and introduces its first podcast, "Ethics Talk," a conversation about incentives and penalties associated with corporate wellness programs.
5. Updates on new/planned medical schools in Pennsylvania, Florida, Michigan
The Commonwealth Medical College in Scranton, Pennsylvania has received "Preliminary Accreditation" from the Liaison Committee on Medical Education and plans to start classes in fall 2009.
Meanwhile, the first 40 medical school applicants accepted to the University of Central Florida College of Medicine's inaugural class will receive $20,000 for tuition and $20,000 for expenses per year for 4 years.
Thus far, the number of applicants for the 40 slots is 2,700, and counting (American Medical News, Sept. 15).
The school's dean, Deborah German, MD, will be the "host dean" at the AMA Section on Medical Schools Interim Meeting in November, where she will discuss the scholarship program as well as the challenges of starting a new medical school.
At Central Michigan University, plans are under way to establish a medical school as early as fall 2011, with an inaugural class of 100.
6. Residency coordinators needed for AMA Insurance survey
The AMA Insurance Agency is conducting a confidential research study to obtain feedback on a disability product for resident physicians.
Interviewees who qualify will receive $100 to participate in the 15- to 20-minute interview.
If you would like to see if you qualify for the interview, e-mail your name, telephone number, and hospital name to:
Larry Zimmerman
Larzimm@aol.com
7. New for AMA members: Succeeding from Medical School to Practice
Succeeding from Medical School to Practice helps medical students, residents, fellows, and young physicians handle the nonclinical demands of training and the practice environment. Developed by your physician colleagues, this easy-to-navigate resource features tips, links, and streaming video to help you prepare for a successful career in medicine.
8. MedPAC panel addresses medical education training
Three panelists, including Thomas Nasca, MD, of the ACGME, took part in an Oct. 2 meeting of the Medicare Payment Advisory Commission (MedPAC) on the topic, "Is medical education training our physicians for health care delivery in the 21st century (PDF, 960KB)?"
"The current system rates a ‘C' in terms of its proficiency in training physicians," said Nasca, who hopes that GME programs will move toward proactive, innovative approaches based on clinical outcomes data.
9. Medical education in the news: Duty hours, valor, fear, and burnout
Stephen Bergman, MD, who authored "The House of God" 30 years ago, reflects on duty hour violations and the culture of the surgical residency (Boston Globe, Oct. 13).
"The extreme physical and psychological demands placed upon residents -- demands rooted in a longstanding medical culture that is accepted as gospel -- still seem in conflict with the industry's broader push for improved quality," notes Jay Moore in "Don't Ask Me to Work 80 Hours..." (HealthLeaders Media, Oct. 9).
Accentuate the positive, eliminate the negative: Pauline Chen, MD, reflects on her own medical training and how the carrot, not the stick, may become the new residency paradigm (New York Times, Nov. 6).
Like residents, many medical students suffer from chronic sleep deprivation and experience burnout (New York Times, Oct. 30).
Narrative medicine is one way to help trainees overcome personal challenges and maintain their humanism as they become physicians (New York Times, Oct. 24).
10. AMA seeking vice president for medical education
The AMA is looking for a leader in academic medicine to serve as its vice president for medical education.
In this regard, many thanks to outgoing vice president Barbara S. Schneidman, MD, MPH, for her years of service to the AMA medical education group and best wishes for the future. She has been appointed Interim President and CEO of the Federation of State Medical Boards as of January 1, 2009.
11. International medical workforce meeting held in Scotland
The recent International Medical Workforce Collaborative Conference 2008 brought together policy makers, academics, researchers, and practitioners interested in workforce issues from the US, Canada, Australia and United Kingdom.
In other workforce news, medical educators, health care executives, and policymakers gathered in Atlanta last month for a leadership summit to develop a strategy for expanding GME in Georgia. Currently the state ranks 37th in residents and fellows per capita.
12. Primary care shortages a continuing concern
A report in the Oct. 22/29 JAMA (Full text for AMA members and JAMA subscribers) discusses the growing consensus around the primary care shortage and strategies to address it.
Because of its roots in primary care, the osteopathic medical profession can play a key role in solving this problem, writes Stephen C. Shannon, DO, MPH, President of the American Association of Colleges of Osteopathic Medicine (Inside OME, Oct. 2008).
Meanwhile, medical students from under-represented minority (URM) populations often feel pressured to choose a career in primary care, further exacerbating URM shortages in such fields as surgery and radiology as well as academic medicine (Journal for Minority Medical Students , vol. 20, no. 4) (PDF, 79KB).
13. News from the Association for Hospital Medical Education (AHME)
The Fall 2008 edition of AHME News (PDF, 1MB) includes a report from AHME's new executive director, Kim Mohn, MD, a discussion of challenges facing continuing medical education, a report of the Council of Transitional Year Program Directors' meeting in San Diego, and a discussion of the Guide to Good Medical Practice, developed by the National Alliance for Physician Competence.
Also, be sure to mark your calendars now for the 2009 Spring Institute in Savannah, Georgia, April 15-18.
14. Medical Students: Apply to The CDC Experience Applied Epidemiology Fellowship
Medical students interested in public health or in practicing medicine with a broad, analytic perspective are invited to apply for The CDC Experience Applied Epidemiology Fellowship.
Eight competitively selected fellows, selected from rising 3rd and 4th year medical students, spend 10-12 months at the Centers for Disease Control and Prevention (CDC) offices in Atlanta, where they carry out epidemiologic analyses in various areas of public health.
Examples of previous and current areas of concentration include include viral diseases, cardiovascular health, birth defects, STDs, foodborne diseases, injury prevention, and air pollution and respiratory health.
Application materials for the 2009-2010 fellowship year must be postmarked by Friday, December 5, 2008.
Questions? E-mail:
cdcexperience@cdcfoundation.gov
15. Blast injuries: What clinicians need to know
In an instant, an explosion or blast can wreak havoc, producing numerous casualties with complex, technically challenging injuries not commonly seen after natural disasters such as floods or hurricanes.
Because explosives are the weapon of choice for most terrorists, the Centers for Disease Control and Prevention (CDC) is working to reduce the impact and improve management of injuries from terrorist bombings by disseminating blast injury treatment fact sheets for health professionals.
Sixteen blast injury fact sheets are available, ranging in topics from crush injuries and burns to the treatment of children and older adults. Each fact sheet contains sections on clinical presentation, diagnostic evaluation, management, and disposition.
The fact sheets are available in multiple languages and formats.
16. Research opportunities for physicians in training
Medical students and residents/fellows are invited to apply for seed grants of $2,500 - $5,000 to conduct basic science, applied, or clinical research projects.
The AMA Foundation grants will be awarded in five research categories:
- Cardiovascular/pulmonary diseases
- HIV/AIDS
- Leukemia
- Neoplastic diseases
- Secondhand smoke
Applications are due by December 12, 2008; recipients will be announced in March 2009.
The AMA Foundation also sponsors the National and Regional Student Research Forums, which offer students/residents the opportunity to present research, receive meaningful feedback, and participate in scholarly discussions with their peers and established scientists.
Forums in 2008 will be held in California, Nebraska, Florida, and Texas. Apply now.
17. Seeking the leaders in medicine
Medical students, residents/fellows, and physicians are encouraged to apply for the 2009 AMA Foundation Leadership Awards, which aim to:
- Reward outstanding nonclinical leadership skills in community service, education, public health, and/or advocacy
- Encourage involvement in organized medicine and public service
- Help develop the country's leaders in the medical field
Award recipients receive travel expenses to the AMA Foundation Leadership Award Program and the AMA's National Advocacy Conference, March 8-11, 2009, in Washington, DC.
Deadline for applications is December 3.
Are you a member of the American Medical Association (AMA)? If so, thank you! If not, please join or renew your membership now.
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About us ...
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.
The current issue of the e-Letter is available online
Also see the Guidebook for GME Program Directors
Note: By using any external links on this page, you will be leaving the AMA's Web site. Although the sites are evaluated and reviewed, the AMA cannot guarantee the accuracy of the information that is provided by each of the links, nor does the AMA necessarily endorse the content on any of these links.
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Fred Donini-Lenhoff
Medical Education Products
American Medical Association
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(312) 464-4635
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