Edited by Charlene Breedlove, MA
The ratio of the total number of full-time medical school faculty members
to the total number of medical students has increased markedly since the beginning
of this century.
Despite the substantial morbidity and mortality associated with tobacco
use and 1992 national recommendations for mandatory inclusion of smoking cessation
and intervention techniques in US undergraduate medical education, Ferry and
coworkers report that in a survey conducted between 1996 and 1998, 83 (69.2%)
of 120 schools did not require clinical training in smoking cessation techniques.
In the basic science curriculum, 63 (54.8%) of 115 schools included all of
6 content areas derived from the Agency for Health Care Policy and Research
and the National Cancer Institute, but only 5 (4.4%) of 115 schools reported
covering all 6 clinical science topics.
How professionalization of medical students is addressed by undergraduate
medical schools varies widely. In a survey of US medical schools conducted
in academic year 1998-1999, Swick and colleagues foundArticle that 104 of 116 responding
schools reported offering some formal curriculum content related to professionalization
of medical students. Most responding schools reported that professionalism
was addressed during orientation or a white-coat ceremony. Fewer than one
third of schools reported that professionalism was taught as a single course
or as an integrated sequence of courses. Epstein, in another article Article , asserts
that becoming a mindful practitioner, ethically and technically self-aware,
is a process that requires more than formal courses; it requires explicit
modeling by clinician-mentors. In an editorialArticle, Ludmerer emphasizes that the
internal culture of the academic medical center, including formal teaching
and faculty mentoring, is the dominant influence on the professionalization
process of medical students.
Clinical simulators provide self-learning opportunities for mastering
diagnostic and therapeutic skills that complement didactic and beside teaching
as well as a method for skill evaluation. Issenberg and coworkers describe
simulation technologies that have been used in surgery, cardiology, and anesthesia
and review studies of the effectiveness of these techniques.
In a systematic review of 14 randomized controlled trials on the effect
of formal continuing medical education (CME) activities on physician performance
and patient outcomes, Davis and colleagues found that more than half of the
didactic, interactive, and mixed CME interventions were associated with changes
in 1 or more measures of professional behavior, and 3 of 4 interactive and
mixed interventions were associated with effects on health care outcomes.
None of the interventions that used didactic measures alone were associated
with a change in physician performance. In a meta-analysis of the results
of 7 of the trials included in the review, the overall benefit of formal CME
was not significant, although a significant positive effect was associated
with CME sessions that included an interactive element.
Information on multicultural education in medical school curricula is
limited. In a search of several English-language databases of biomedical literature
published since 1993 and of online data sets, Loudon and coworkers identified
only 17 studies that described specific educational programs for medical students
on racial and ethnic diversity. Thirteen of the 17 programs were conducted
in North America and most occurred during the first 2 years of medical school.
Dimensions of the patient-physician relationship and the winning poems
of the 17th Annual William Carlos Williams Poetry Competition.
Educational Programs and Finances Analysis
of the results of the 1998-1999 Annual Medical School Questionnaire of the
Liaison Committee on Medical Education Part II on medical students, faculty,
and programs, and of Part I-A on financial data, from the 1997-1998 survey.
See Article and Article
Report of the 1998-1999 American Medical Association Annual Survey of
Graduate Medical Education (GME) Programs on resident physicians, residency
programs, and specialty and subspecialty enrollment.
For your patients: A primer on smoking cessation.
This Week in JAMA. JAMA. 1999;282(9):811. doi:10.1001/jama.282.9.811