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This Week in JAMA
September 23 2009

This Week in JAMA

JAMA. 2009;302(12):1257. doi:10.1001/jama.2009.1400


Edited by Robert M. Golub, MD

In a retrospective analysis of hospital discharges in 2 states, Asch and colleagues assessed whether obstetrics and gynecology residency programs can be ranked by the quality of care resident physicians deliver. Maternal complications of vaginal and cesarean deliveries were defined as markers of quality, and the authors found substantial variation in complication rates across the 107 programs studied. Program rankings based on complication rates were consistent across individual types of complications and were not associated with residents' licensing examination scores.

Developing greater mindfulness—a quality of being fully present and attentive in the moment—has been proposed as an approach for addressing the psychological distress (burnout) reported by some physicians. To test this hypothesis, Krasner and colleagues Article designed and administered a continuing medical education course that included mindfulness meditation, narrative medicine, and appreciative inquiry and found that participating physicians demonstrated improvement in personal well-being, empathy, and attitudes associated with patient-centered care. In an editorial, Shanafelt Article discusses factors contributing to burnout and interventions to prevent it.

In a longitudinal cohort study of resident physicians, West and colleagues examined the association of fatigue and distress with self-perceived major medical errors. Among the 356 participants providing error data (93.7% of respondents), 139 respondents (39%) reported 1 or more self-perceived major medical errors, which were independently associated with higher levels of fatigue and distress.

Attrition rates from general surgery residencies are high and a shortage of general surgeons is predicted. To inform the response to these challenges, Yeo and colleagues assessed resident satisfaction, training experiences, and professional expectations in a national survey of general surgery residents. The authors found that a majority of residents were satisfied with their training and relationships with peers and faculty, but many acknowledged stress and concerns related to confidence, career motivation, and the need to complete specialty training.

In an anonymous survey of medical school deans of student affairs, their proxies, or their counterparts, Chretien and colleagues assessed medical school experiences with online posting of unprofessional content by students, and policies regarding online posting. Sixty percent (78 of 130) of schools responded to the survey. Among the schools represented, 60% (47 of 78) reported incidents of students posting unprofessional content online and few schools reported having policies that address student online postings.

Direct observation of medical trainees with actual patients is critical for teaching and assessing clinical and communication skills. In a systematic review of the literature, Kogan and colleagues identified 55 tools for direct observation in clinical settings but found little evidence of the tools' validity or effect on educational outcomes such as changes in knowledge, skills, or attitudes.

“I was relieved when my first interview with an assistant program director started as a friendly chat. Later, though, he abruptly asked me: ‘Why would you ever come here?’” From “Manipulation and the Match.”

Year-end transfers of outpatients

Feedback: in need of improvement

Gist memory and medical education

Caring for patients with disabilities

Simulation-based training

Join Barbara A. Slade, MD, MS, Wednesday, October 21, from 2 to 3 PM eastern time to discuss postlicensure safety surveillance for the human papillomavirus vaccine. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr DeAngelis summarizes and comments on this week's issue.


How would you manage a 52-year-old woman with disabling diabetic neuropathy? Go to www.jama.com to read the case and submit a response by October 4 for possible online publication.

For your patients: Information about continuing medical education.