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This Week in JAMA
September 3, 2003

This Week in JAMA

JAMA. 2003;290(9):1127. doi:10.1001/jama.290.9.1127
Assessment of Communication, Other Clinical Skills

Several medical organizations, including the Association of American Medical Colleges and the Accreditation Council for Graduate Medical Education, are emphasizing improved training and demonstration of competency in communication skills. Yedidia and colleaguesArticle studied the outcomes of a communication skills curriculum at 3 medical schools. Using a 10-station objective structured clinical examination (OSCE) with assessment by standardized patients, they found that communication skills in a cohort of third-year medical students who received the communications curriculum were significantly improved compared with those of students who completed their third year prior to its introduction. Landon and colleaguesArticle discuss limitations of current methods to evaluate performance of physicians in clinical practice and consider the usefulness of physician clinical performance assessment, which is based on rates at which patients experience specific outcomes of care, for measuring physician competence. In an editorialArticle, Lurie discusses difficulties and possibilities in conducting high-quality research in medical education.

Outcomes of Ethics Consultations in Intensive Care Units

Ethics consultations are used to help health care professionals, patients, and surrogates come to a decision about medical treatment when value-laden conflicts are involved. In this randomized trial in adult intensive care units (ICUs) at 7 US hospitals, Schneiderman and colleaguesArticle found that the number of hospital days, days in the ICU, and days receiving mechanical ventilation were significantly lower among patients in the ethics consultation group who did not survive to hospital discharge than among nonsurvivors in the standard care group. Mortality in the 2 groups was not significantly different. In an editorialArticle, Lo discusses questions that need to be addressed by future research on ethics consultations.

Specialty Choices of US Medical Graduates

The specialty choices of graduating medical students influence the specialty mix in the physician workforce. Newton and colleaguesArticle analyzed data from 3 national databases and found that the distribution of career choices by graduates of allopathic US medical schools varied greatly from 1987 through 2002. The proportion of graduating medical students matching to primary care specialties decreased steadily from 49.2% in 1987 to a low of 43.1% in 1991, peaked at 53.2% in 1998, and declined to 44.2% in 2002. The proportion of medical students matching to general or subspecialty surgical residencies remained stable. In an analysis of data from residency matching programs, Dorsey and colleaguesArticle found that the proportion of graduating medical students ranking a specialty with a controllable lifestyle increased steadily and significantly from 1996 through 2002. Controllable lifestyle explained 55% of the variability in changes in specialty preference during this period.

Medical education

Edited by Stephen J. Lurie, MD, PhD

A Piece of My Mind

"Physicians and lawyers have always had an intriguing relationship." From "A Difference of Degrees."

US Medical Education, 2002-2003

Annual reports describe the status of students, faculty, and educational programs in US medical schools, and trends in graduate medical education.

Clinician's corner

Coverage, cost-effectiveness, and quality of home health services.


Winning essays from the 2003 John Conley Ethics Essay Contest for Medical Students consider the competing interests of a mother with Huntington disease, who does not wish to disclose her diagnosis, and her daughter, who is considering starting a family.

JAMA Patient Page

For your patients: Information about medical specialties.