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.
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.
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.
Edited by Stephen J. Lurie, MD, PhD
"Physicians and lawyers have always had an intriguing relationship."
From "A Difference of Degrees."
Annual reports describe the status of students, faculty, and educational
programs in US medical schools, and trends in graduate medical education.
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.
For your patients: Information about medical specialties.
This Week in JAMA. JAMA. 2003;290(9):1127. doi:10.1001/jama.290.9.1127