Edited by Stephen J. Lurie, MD, PhD
Prior studies have identified deficiencies in the preparation of residents
for clinical practice. In this national survey of residents in their last
year of training at academic health centers, Blumenthal and colleaguesArticle report
that residents rated themselves as prepared to manage most of the common conditions
they would encounter in clinical practice and to perform most of the services
or procedures associated with their specialty. But more than 10% of residents
in each of 7 specialties reported that they felt unprepared to undertake 1
or more tasks relevant to their disciplines. In a commentary, JohnsArticle calls
for a reevaluation of traditional residency training programs and revisions
that would meet the needs both of trainees and society.
Clinical teaching for medical students has expanded beyond inpatient
settings of tertiary care teaching hospitals to include ambulatory sites and
community-based clinical practices. To monitor educational experiences in
diverse clinical settings, Rattner and colleagues developed a data collection
system using a pocket-sized computer-read patient-encounter card to record
information for each clinical encounter, including patient age and sex, location
of the encounter, level of involvement and supervision, diagnostic procedures
performed or observed, and primary and secondary diagnoses. Analysis of patient
encounter cards completed by third-year medical students who recorded experiences
during family medicine, pediatrics, and internal medicine clerkships showed
significant differences in students' case-mix of patients, the level of disease
severity, and the number of diagnostic procedures performed across the 3 clerkships.
Findings within each clerkship were stable across 3 academic years, and the
concordance between the students' recorded principal diagnosis in a subset
of encounter cards and the faculty's diagnosis recorded in the medical record
Despite increases in the supply of physicians in the United States,
rural communities continue to be underserved. In this study of physicians
who graduated from Jefferson Medical College from 1978 through 1993, Rabinowitz
and colleagues found that freshman-year plans for family practice, being in
the Physician Shortage Area Program (PSAP; a Jefferson Medical College program
that selectively recruits students who grew up or lived in a rural area or
small town and who express a commitment to practice family medicine in a rural
area), having a National Health Service Corps scholarship, male sex, and taking
an elective senior-year family practice rural preceptorship were independently
predictive of graduates practicing rural primary care. Participation in the
PSAP was the only independent predictor of retention for all graduates. Non-PSAP
graduates who met the key PSAP selection criteria noted above were 78% as
likely as PSAP graduates to be rural primary care physicians and 75% as likely
In 1995, based on prevailing workforce projections and policy recommendations,
a special Veterans Affairs advisory panel proposed a 3-year plan to achieve
approximately equal numbers of primary care and specialist residency training
positions in the Veterans Affairs health care system. The nationwide plan
required elimination of 1000 specialist training positions and creation of
750 primary care positions. Stevens and colleagues describe the implementation
of this plan and modifications that occurred after 1 year to better align
graduate medical education (GME) with local patient care and training needs.
Over 3 years, primary care training in the Veterans Affairs system increased
from 38% to 48% of funded residency positions.
"Some students cry because the patient reminds them of themselves, and
they may identify with and personalize an aspect of the patient's situation."
From "Crying in the Curriculum."
Annual reports describe the status of US medical education programs,
students, and faculty, and trends in graduate medical education.
Recommendations for teaching humanistic care include establishing a
climate of humanism in medical schools and hospitals and specific clinical
teaching methods—taking advantage of seminal events, role-modeling,
and using active learning skills.
Winning essays from the 2001 John Conley Ethics Contest on the role
of medical students in disclosing medical errors launches the 2001-2002 edition
For your patients: Information about academic health centers.
This Week in JAMA. JAMA. 2001;286(9):1003. doi:10.1001/jama.286.9.1003