A JAMA THEME ISSUE Edited by Robert M. Golub, MD
New duty hour regulations for residency programs accredited by the Accreditation Council for Graduate Medical Education were implemented in July 2003. In 2 observational studies, Volpp and colleaguesArticleArticle assessed the association of duty hour reform with patient mortality rates 30 days after hospital admission. The authors found no association of duty hour changes with either an improvement or worsening of mortality rates among Medicare beneficiaries. In an analysis of patients receiving care in the Veterans Affairs system, the authors found that mortality rates improved among patients with 4 common medical conditions, but no association was found for surgical patients. In an editorial, Meltzer and AroraArticle discuss the need for ongoing evaluation of the effects of duty hour changes on patients and physicians.
Poor patient-physician communication has been associated with patient complaints and malpractice claims. Tamblyn and colleaguesArticle examined the relationship between patient complaints to regulatory authorities and physician scores on the patient-physician communication portion of Canada's national licensing examination. The authors found that a low communication skill score predicted patient complaints during the physician's subsequent practice. In an editorial, Makoul and CurryArticle discuss the value of identifying and addressing deficient communication skills.
To assess whether research funding is related to the quality of medical education research, Reed and colleagues developed an instrument to measure research study quality and applied it to 210 medical education studies published in peer-reviewed journals. The authors found that quality scores were independently associated with study funding and prior medical education publications by the first author.
In a survey of internal medicine residents to determine their understanding of biostatistics and the interpretation of published research results, Windish and colleagues found that most residents lacked the statistical knowledge necessary to interpret the literature and only 25% reported confidence in understanding statistical concepts encountered in the literature.
Boonyasai and colleaguesArticle reviewed the literature to assess the effectiveness of published quality improvement (QI) curricula and the relationship of the teaching methods used for clinical outcomes. They found that many of the published curricula improved participants' knowledge about QI and used sound principles of adult learning. However, evidence of effects on clinical outcomes was weak. In an editorial, Batalden and DavidoffArticle discuss elements of experiential learning and ways to enhance instruction about QI.
In a review of undergraduate medical education research studies from 1969-2007, Baernstein and colleagues examined trends in the methods used to evaluate the efficacy of the interventions. The authors found that application of rigorous evaluation methods increased over time, and this was related to greater involvement of medical education departments or centers.
“What drew me to skiing . . . was knowing that I would get to spend the day with my 13-year-old son.” From “Balancing Acts.”
Weighing risks to individual patients vs the benefits to trainees in medical education.
Considerations if outcomes of care provided by training program alumni are used to measure program quality.
Charity Hospital, originally founded in 1736, has been a major teaching hospital in New Orleans. The present building (above) was irreparably damaged in the flooding that followed Hurricane Katrina. Krane and coauthors discuss medical education in New Orleans after Katrina, and Golub discusses the future of the city.
Photo reproduced with permission from Rudolph Matas Medical Library, Tulane University.
For your patients: Information about medical specialties.
This Week in JAMA . JAMA. 2007;298(9):953. doi:10.1001/jama.298.9.953