Edited by Catherine D. DeAngelis, MD, MPH
Data from annual surveys of undergraduate and graduate medical education
programs conducted by the Liaison Committee on Medical Education, the American
Medical Association, and the Association of American Medical Colleges are
summarized in this issue of JAMA. First, Barzansky and EtzelArticlereport that in comparison with data from 1993-1994, medical school enrollment
is similar while the number of full-time faculty has increased and appointment
of a senior administrator with broad responsibilities for medical education
is commonplace. In the second article, Brotherton and colleaguesArticlereport trends in residency training and career choices, with a particular
focus on women, and programs addressing cultural competence and complementary/alternative
Efforts to improve the quality of medical care are often systems-based
and few have considered the role of physician certification in quality improvement.
Brennan and colleagues review the evidence and theory relating to physician
board certification status and measures of physician competence, clinical
outcomes, and error prevention and find support for the hypothesis that certification
and maintenance of certification will improve quality. They also report results
of a national poll assessing public views on physician certification, which
found that certification and frequent reevaluation of skills and competencies
to maintain certification are highly valued by the public.
Clinical medicine is becoming increasingly evidence-based, but rigorous
and generalizable data to substantiate the effectiveness of medical education
programs are limited. Carney and colleagues review the application of standard,
population-based epidemiologic research designs to test hypotheses about medical
education outcomes. They also outline 3 essential elements—an existing
infrastructure, institutional motivation, and a national commitment that includes
increased funding—necessary for a strong educational epidemiologic research
Studies of prognosis following breast cancer suggest that women whose
cancer was found by mammography screening have a better prognosis than women
whose tumors were found outside of screening or between mammography screening
rounds. However, the mode of detection is not currently a factor in determining
the need for systemic adjuvant therapy. Joensuu and colleaguesArticleexamined the risk of recurrence and survival among Finnish women whose breast
tumors were detected by mammography screening compared with women whose tumors
were found by other methods. They found a significantly increased risk of
recurrence in women whose tumors were found other than by mammography screening,
and method of detection was found to be an independent predictor of distant
disease-free survival and overall survival. In an editorial,ArticleO'Regan discusses the potential value of these results to identify women who
will benefit most from systemic adjuvant therapy.
"Diseases are easy. Life in a refugee camp is not." From "Clinic."
On Call: Issues in Graduate Medical Education Current
and emerging professional liability issues relevant to resident and attending
physicians and institutions involved in graduate medical education (GME) are
Education in ambulatory chronic disease management needs emphasis and
The importance of "professors who profess" and the challenges they face
are discussed by DeAngelis.
Clinical Review Clinical management
of systolic hypertension in older persons.
For your patients: Information about academic health centers.
This Week in JAMA. JAMA. 2004;292(9):1007. doi:10.1001/jama.292.9.1007