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Can Medical Schools Provide Better Student Information to Residency Programs?
Residency programs would have more accurate and meaningful information on prospective matches if medical schools reconsidered when they deliver student assessments and what those assessments measure, according to academic leaders.
Several academic physicians discussed those topics — and offered solutions — during the American Medical Association’s ChangeMedEd 2017 national conference.
Kim Lomis, MD, associate dean for undergraduate medical education at Vanderbilt University School of Medicine, spoke in favor of offering a more honest, robust dean’s letter with student assessments.
A dean’s letter, also known as a Medical Student Performance Evaluation letter, is sent with every residency application by Oct. 1. However, the possibility of a conflict of interest exists: Schools want their students to attend the best programs possible.
Dr. Lomis said that because more students are taking earlier clerkships, schools can send a more in-depth performance assessment post-clerkship.
Helen Morgan, MD, associate professor of obstetrics and gynecology at the University of Michigan Medical School, offered another solution: Schools should submit a second, post-graduation assessment between Oct. 1 and after the match process has been completed.
“The dean’s letter is to help the student get into a good residency. What we want to send at the end of medical school is more along the lines of helping the learner succeed once they start their residency,” Dr. Morgan said.
George C. Mejicano, MD, the senior associate dean for education at Oregon Health and Science University, said his school has begun to assess students based on the Core Entrustable Professional Activities for Entering Residency (EPAs). The 13 Core EPAs focus on tasks — such as working in a team or performing a history or examination — rather than facts or lessons.
Sally Santen, MD, a professor of emergency medicine at the University of Michigan Medical School, said schools should apply the six core competencies defined by the Accreditation Council for Graduate Medical Education to undergraduates.
The core competencies are mile markers indicating how much further a resident has to go. Evaluating medical students based on those competencies will give residency programs an earlier understanding of a student’s progress, Dr. Santen said.
“Many of the medical schools had been using the competencies to begin with, so it was easy just to continue with that,” Dr. Santen said. “Program directors understood the language. So they understood what they were getting [with the supplemental letter].”
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Hippocratic Oath Revised to Reflect Changing Relationships Among Physicians, Patients, Colleagues
For the first time since 2006, physician leaders have substantially updated the international, modern-day Hippocratic Oath to reflect changes in the relationship between doctors and patients as well as among doctors and their peers, including educators.
The changes were adopted at the World Medical Association’s General Assembly meeting in October in Chicago. The WMA had sought input from member national medical associations, external experts, and the public for two years before adopting the changes.
The oath, now called “The Physician’s Pledge,” contains several key changes, including:
- A new clause to “respect the autonomy and dignity” of a patient;
- The addition of “well-being” to the clause that states the health of the patient shall be a doctor’s first priority;
- Calling for mutual respect between teachers, colleagues, and students; previously, it called for students to respect their teachers but did not include reciprocity; and
- A new clause that compels physicians to look after their own “health, well-being, and abilities.”
The changes “have enabled this pivotal document to more accurately reflect the challenges and needs of the modern medical profession,” Ramin Walter Parsa-Parsi, MD, of Germany, wrote in a JAMA Viewpoint essay.
According to medical historian Ludwig Edelstein, PhD, the original Hippocratic Oath was written in Ionic Greek, between the third and fifth centuries BC.
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Neurosurgeons: Brain Surgery Not Just For Younger Doctors
When is a neurosurgeon too old to perform brain surgery?
That’s the question the Mayo Clinic posed to almost 5,000 neurosurgeons recently for a study, “The Aging Neurosurgeon: When Is Enough, Enough? Attitudes Toward Ceasing Practice and Testing in Late Career,” published in its Proceedings journal this month.
“Appropriately assessing the aging neurosurgeon is important to protect patient safety and also maximize the capacity of an aging neurosurgical workforce,” researchers wrote.
For the study, researchers received almost 1,500 responses to a confidential online survey conducted between March 1 and May 31, 2016.
Most of the respondents — 67 percent — said there should be no absolute age cutoff to practice surgery, according to the survey. But 50 percent said neurosurgeons aged 65 and older should undergo additional testing, including cognitive assessment or a review of cases, in addition to a maintenance of certification (MOC) examination. Forty-two percent said MOC should be tailored to accommodate aging neurosurgeons, researchers found.
Most of the respondents — 938 out of 1,449 overall (65 percent) — were 50 and older, researchers said.
“Although this is a study of neurosurgeons, the implications of these findings are widely applicable across specialties, and additional research on testing for aging and competency is needed across specialties,” the study’s authors wrote.
According to the Association of American Medical Colleges’ 2016 Physician Specialty Data Report, 43.2 percent of practicing U.S. physicians in 2015 were 55 or older. At 44.5 percent, neurosurgeons were slightly older than average, but much younger as a whole than pulmonologists (85 percent were 55 or older), preventive medicine specialists (68.4 percent), pathologists (63.2 percent), and psychiatrists (60.4 percent).
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This Month in Texas Medicine
The December issue of Texas Medicine focuses on Senate Bill 507, by Sen. Kelly Hancock, which expands balance billing mediation to all physicians and other practitioners who provide out-of-network services at certain in-network facilities, and also expands mediation to out-of-network emergency care. Other articles look into a constitutional challenge to the state’s Advance Directives Act; reference pricing, which has emerged as a potential strategy for health plans to keep premiums low and address the problems that managed care plans are facing; and steps physicians can take to prepare for natural disasters and other sudden calamities.
Check out our digital edition.
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It's Academic is designed for physicians in academic settings. For more information about TMA’s efforts on behalf of medical education and academic physicians, visit the TMA Council on Medical Education’s Subcommittee for Academic Physicians page and advocacy page on the TMA website.
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