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Concept: Medical school

663

 To determine whether patient outcomes differ between general internists who graduated from a medical school outside the United States and those who graduated from a US medical school.

Concepts: Pathology, United States, Physician, Neurology, High school, Pediatrics, Medical school, Internal medicine

331

Surgical training has always been hard on residents. During my own residency more than 20 years ago, 100-hour workweeks and in-house call every other night were routine. A resident’s life outside the hospital was simply not a priority. Residency may be even harder on patients. A large body of research has linked sleep deprivation in resident physicians to poor performance in neurobehavioral testing and, more alarmingly, to higher rates of attention failure in patient care.(1),(2) Reacting to concerns about both resident well-being and patient safety, the Accreditation Council for Graduate Medical Education (ACGME) implemented duty-hour reforms in 2003 that . . .

Concepts: Medicine, Patient, Hospital, Sleep deprivation, Physician, Medical school, Hospital accreditation, Medical education

316

To examine patient consultation preferences for seeing or speaking to a general practitioner (GP) or nurse; to estimate associations between patient-reported experiences and the type of consultation patients actually received (phone or face-to-face, GP or nurse).

Concepts: Patient, Hospital, Physician, Doctor-patient relationship, Philosophy of science, Knowledge, General practitioner, Medical school

226

BACKGROUND: Medical schools are grappling with how best to manage industry involvement in medical education. OBJECTIVE: To describe a case study of industry-supported undergraduate medical education related to opioid analgesics. METHOD: Institutional case study. RESULTS: As part of their regular curriculum, Canadian medical students attended pain pharmacotherapy lectures that contained questionable content about the use of opioids for pain management. The lectures were supported by pharmaceutical companies that market opioid analgesics in Canada and the guest lecturer was a member of speakers bureaus of the same companies. These conflicts of interests were not fully disclosed. A reference book that reinforced some of the information in the lectures and that was paid for by a sponsoring company was made available to students. This is the first report of an association between industry sponsorship and the dissemination of potentially dangerous information to medical students. CONCLUSIONS: This case demonstrates the need for better strategies for preventing, identifying and dealing with problematic interactions between the pharmaceutical industry and undergraduate medical education. These might include the avoidance of unnecessary conflicts of interest, more disclosure of conflicts, an open process for dealing with recognised problems and internationally harmonised conflict of interest policies.

Concepts: Pharmacology, Medicine, Physician, Opioid, Pain, Pharmaceutical industry, Medical school, Conflict of interest

205

Introduction: Over the last decade, the use of medical marijuana has expanded dramatically; it is now permitted in 16 states and the District of Columbia. Our study of family physicians in Colorado is the first to gather information about physician attitudes toward this evolving practice.

Concepts: Medicine, United States, Physician, Anatomy, Pediatrics, Medical school, Specialty, Doctor of Medicine

181

Physical activity (PA) is a key component of healthy lifestyle and disease prevention. In contrast, physical inactivity accounts for a significant proportion of premature deaths worldwide. Physicians are in a critical position to help patients develop healthy lifestyles by actively counseling on PA. Sports medicine physicians, with their focus on sports and exercise medicine are uniquely trained to provide such expertise to patients, learners and colleagues. To succeed, physicians need clinical tools and processes that support PA assessment and counseling. Linking patients to community resources, and specifically to health and fitness professionals is a key strategy. Efforts should be made to expand provider education during medical school, residency and fellowship training, and continuing medical education. Lastly, physically active physicians are more likely to counsel patients to be active. A key message for the sports medicine community is the importance of serving as a positive PA role model.

Concepts: Medicine, Obesity, Exercise, Physician, Weight loss, Pediatrics, Medical school, Medical education

175

Most American colleges and universities offer gateway biology courses to meet the needs of three undergraduate audiences: biology and related science majors, many of whom will become biomedical researchers; premedical students meeting medical school requirements and preparing for the Medical College Admissions Test (MCAT); and students completing general education (GE) graduation requirements. Biology textbooks for these three audiences present a topic scope and sequence that correlates with the topic scope and importance ratings of the biology content specifications for the MCAT regardless of the intended audience. Texts for “nonmajors,” GE courses appear derived directly from their publisher’s majors text. Topic scope and sequence of GE texts reflect those of “their” majors text and, indirectly, the MCAT. MCAT term density of GE texts equals or exceeds that of their corresponding majors text. Most American universities require a GE curriculum to promote a core level of academic understanding among their graduates. This includes civic scientific literacy, recognized as an essential competence for the development of public policies in an increasingly scientific and technological world. Deriving GE biology and related science texts from majors texts designed to meet very different learning objectives may defeat the scientific literacy goals of most schools' GE curricula.

Concepts: Medicine, Education, University, Anatomy, Medical school, College, Curriculum, Association of American Medical Colleges

167

As a component of the practice-based core competency of the Accreditation Council for Graduate Medical Education, all residents must receive training to be able to evaluate and improve their patient care practices. To further enhance our overall resident quality improvement (QI) educational experience, and to ensure resident involvement in the many aspects of a quality assurance program, we have established a resident educational leadership role and have appointed a resident as resident QI director.

Concepts: Better, Improve, Quality control, Physician, Management, Quality assurance, Medical school, Teacher

151

Psychosocial job stressors, such as low control and high demands, have been found to influence the health and wellbeing of doctors. However, past research in this area has relied on cross-sectional data, which limits causal inferences about the influence of psychosocial job stressors on health. In this study, we examine this relationship longitudinally while also assessing whether the relationship between psychosocial job stressors and health is modified by gender.

Concepts: Medicine, Health, Physician, Pediatrics, Medical school, Health science, Specialty, Cross-sectional data

150

Background Concern persists that inflexible duty-hour rules in medical residency programs may adversely affect the training of physicians. Methods We randomly assigned 63 internal medicine residency programs in the United States to be governed by standard duty-hour policies of the 2011 Accreditation Council for Graduate Medical Education (ACGME) or by more flexible policies that did not specify limits on shift length or mandatory time off between shifts. Measures of educational experience included observations of the activities of interns (first-year residents), surveys of trainees (both interns and residents) and faculty, and intern examination scores. Results There were no significant between-group differences in the mean percentages of time that interns spent in direct patient care and education nor in trainees' perceptions of an appropriate balance between clinical demands and education (primary outcome for trainee satisfaction with education; response rate, 91%) or in the assessments by program directors and faculty of whether trainees' workload exceeded their capacity (primary outcome for faculty satisfaction with education; response rate, 90%). Another survey of interns (response rate, 49%) revealed that those in flexible programs were more likely to report dissatisfaction with multiple aspects of training, including educational quality (odds ratio, 1.67; 95% confidence interval [CI], 1.02 to 2.73) and overall well-being (odds ratio, 2.47; 95% CI, 1.67 to 3.65). In contrast, directors of flexible programs were less likely to report dissatisfaction with multiple educational processes, including time for bedside teaching (response rate, 98%; odds ratio, 0.13; 95% CI, 0.03 to 0.49). Average scores (percent correct answers) on in-training examinations were 68.9% in flexible programs and 69.4% in standard programs; the difference did not meet the noninferiority margin of 2 percentage points (difference, -0.43; 95% CI, -2.38 to 1.52; P=0.06 for noninferiority). Conclusions There was no significant difference in the proportion of time that medical interns spent on direct patient care and education between programs with standard duty-hour policies and programs with more flexible policies. Interns in flexible programs were less satisfied with their educational experience than were their peers in standard programs, but program directors were more satisfied. (Funded by the National Heart, Lung, and Blood Institute and the ACGME; iCOMPARE ClinicalTrials.gov number, NCT02274818 .).

Concepts: Physician, Medical school, Percentage point, Residency, Medical education, Medical education in the United States, Intern, Internship