A JAMA THEME ISSUE
Edited by Robert M. Golub, MD
Medical student body diversity is thought to be important in the education of “culturally competent” physicians; however, empirical evidence to support this belief is lacking. In an analysis of data from a national survey of graduating medical students, Saha and colleagues Article assessed the association of student body racial and ethnic diversity—reflected by the proportion of underrepresented minority students—with diversity-related educational outcomes. Among the authors' findings were that white students from diverse schools were more likely to rate themselves as better prepared to care for racially and ethnically diverse patients and to express more positive attitudes about equity and access than students from less-diverse medical schools. In an editorial, Carrasquillo and Lee-Rey Article discuss the importance of increasing physician diversity and the need to critically examine medical school admission policies.
In a prospective cohort study involving medical interns at 1 academic medical center, Arora and colleagues examined the association of interns' on-call workload (new admissions and number of patients remaining on the service) with on-call sleep duration, shift duration, and participation in educational activities. The authors report that the mean sleep duration while on call was 2.8 hours (SD, 1.5 hours), the mean shift duration was 29.9 hours (SD, 1.7 hours), and the interns reported spending 11% of their time in educational activities. Higher workload was associated with less sleep while on call, longer shift duration, and less participation in educational activities.
Factors associated with the recent decline in medical students' interest in careers in internal medicine are not clear. In a 2007 cross-sectional survey of fourth-year medical students at 11 US medical schools, Hauer and colleagues found that students who reported more favorable impressions of internal medicine patients, the internal medicine practice environment, and internists' lifestyle were more likely to pursue a career in internal medicine.
A small percentage of US medical students pursue dual MD and PhD degrees. In an analysis of data reported by 2000-2006 US medical school graduates, Andriole and colleagues Article found that graduates of MD/PhD programs anticipated substantial career involvement in research, had lower educational debt, were more likely to be male and less demographically diverse, and pursued different medical specialties than graduates of other MD degree programs. In an editorial, Rosenberg Article discusses what might be learned from systematic and longitudinal assessment of MD/PhD programs and graduates.
The 1997 Balanced Budget Act limited Medicare funding for graduate medical education (GME). To examine its effects on GME programs, Salsberg and colleagues analyzed national data on the number of residents in training before and after passage of the act. The authors found that the number of residents remained relatively steady between 1997 and 2002 but then increased, for a net gain of 8% between 1997 and 2007.
“Medical acronyms and initialisms are becoming more intricate, and Y-geners have raised them to a higher level of complexity.” From “Extremities.”
Effectiveness of Internet-based instruction in the health professions
Principles to guide physician work hour regulation
Emotional intelligence and graduate medical education
Highlighting data reported in this issue on physician training and practice that contribute to a troubled health care system, Goodman discusses public investment in health profession education and national health workforce planning.
How would you manage a 60-year-old woman with mild memory impairment and white matter lesions on MRI? Go to www.jama.com, read the case, and submit your response, which may be selected for online publication. Submission deadline is September 24.
For your patients: Information about what it means to be on call.
This Week in JAMA . JAMA. 2008;300(10):1115. doi:10.1001/jama.300.10.1115