Transformational Medical Education Leadership: Ethics, Justice and Equity—The U. S. Public Health Service Syphilis Study at Tuskegee Provides Insight for Health Care Reform

TWO letters are presented which take opposing views of federal aid for medical education and for pediatric education in particular. The first of these is from Alan Valentine, LL.D., President, University of Rochester, N.Y. Dr. Valentine read a paper on the financing of the privately endowed medical schools before the 1948 Annual Congress on Medical Education and Licensure. (J.A.M.A. 137:1, 1948.) He is eminently qualified to discuss this subject. His extraordinarily able and realistic presentation of the current and future financial needs of medical schools concludes with an answer to the contrary view of Dr. William C. Black. (Pediatrics 1:561, April, 1948.) The second letter is from Dr. Thomas O. Gamble, Professor of Obstetrics, Albany Medical College, Albany, N.Y. Certain aspects of Dr. Gamble's letter require comment. In his third paragraph, Dr. Gamble quotes incompletely from the ICH Committee Report (Pediatrics 1:524, 1948) as follows: "It was finally agreed (Ed. note: i.e., by the ICH Committee) that neither the U. S. Children's Bureau nor the U. S. Public Health Service should be the administrative agency, but that the matter should be determined by the Federal Security Administrator, whose agency includes both the U. S. Children's Bureau and the U. S. Public Health Service. The correct quotation is: "It was finally agreed that neither the U. S. Children's Bureau nor the U. S. Public Health Service should be named the administrative agency . . . (etc.)." The position of the ICH Committee was and is that the Federal Security Agency, which already administers grants-in-aid for study and training in several fields of medicine, would be the logical administrative agency; it was not considered within the province of the ICH Committee to recommend which branch of this agency should be designated by the administrator. There was no attempt at "camouflage," as suggested by Dr. Gamble. Dr. Gamble next attacks the recommended composition of the Council on Pediatric Education. He suggests that the Academy should say to the Federal Security Administrator:

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Physician Assistants Employed by the Federal Government

Military Medicine ◽

10.1093/milmed/usaa034 ◽

2020 ◽

Vol 185 (5-6) ◽

pp. e649-e655 ◽

Cited By ~ 2

Author(s):

Noël E Smith ◽

Andrzej Kozikowski ◽

Roderick S Hooker

Keyword(s):

Public Health ◽

Health Care ◽

Health Service ◽

Federal Government ◽

Public Health Service ◽

Medical Training ◽

Physician Assistants ◽

National Commission ◽

Federal Employment ◽

The U.S

Abstract Objective Physician assistants (PAs) are health professionals who have received advance medical training and are licensed to diagnose illness, develop and manage treatment plans, prescribe medications, and serve as principal health care provider. Although the U.S. federal government is the largest single employer of PAs, at the same time little is known about them across the wide array of diverse settings and agencies. The objective of this project was to determine the census of PAs in federal employment, their location, and personal characteristics. This included approximating the number of uniformed PAs. Taking stock of a unique labor force sets the stage for more granular analyses of how and where PAs are utilized and are deployed. Methods No one central database identifies all federally employed PAs. To undertake this project, three sources were examined. Data were derived from the U.S. Office of Personnel Management and the National Commission on Certification of Physician Assistants. Uniformed PA numbers were the result of networking with senior chiefs in the military services and the U.S. Public Health Service. The data were collolated and summarized for comparison and discussion. Results As of 2018, approximately 5,200 PAs were dispersed in most branches and agencies of the government that provide health care services, including the Departments of Defense, Veterans Affairs, Health and Human Services, Justice, and Homeland Security. Federally employed PAs are civil servants or hold a commission in the uniformed services (ie, Army, Navy, Air Force, Coast Guard, and Public Health Service). Most PAs are in clinical roles, although a few hundred are in management positions. Approximately 81% of civilian PAs have had less than 15 years of federal employment. Conclusion The diverse utilization and deployment of PAs validate the importance of the role they serve as medical professionals in the federal government. From 2008 to 2019, PA employment in the federal government grew by approximately 50% supporting the forecast that substantial national PA growth is on track.

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Mobile technology to give a resource-based knowledge management advantage to community health nurses in an emerging economies context

Journal of Knowledge Management ◽

10.1108/jkm-01-2020-0018 ◽

2020 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Judith Fletcher-Brown ◽

Diane Carter ◽

Vijay Pereira ◽

Rajesh Chandwani

Keyword(s):

Public Health ◽

Breast Cancer ◽

Health Care ◽

Knowledge Management ◽

Health Service ◽

Emerging Economies ◽

Public Health Service ◽

Health Technology ◽

Content Type ◽

Knowledge Resource

Purpose Knowledge is a key success factor in achieving competitive advantage. The purpose of this paper is to examine how mobile health technology facilitates knowledge management (KM) practices to enhance a public health service in an emerging economies context. Specifically, the acceptance of a knowledge-resource application by community health workers (CHWs) to deliver breast cancer health care in India, where resources are depleted, is explored. Design/methodology/approach Fieldwork activity conducted 20 semi-structured interviews with frontline CHWs, which were analysed using an interpretive inductive approach. Findings The application generates knowledge as a resource that signals quality health care and yields a positive reputation for the public health service. The CHW’s acceptance of technology enables knowledge generation and knowledge capture. The design facilitates knowledge codification and knowledge transfer of breast cancer information to standardise quality patient care. Practical implications KM insights are provided for the implementation of mobile health technology for frontline health-care professionals in an emerging economies context. The knowledge-resource application can deliver breast cancer care, in localised areas with the potential for wider contexts. The outcomes are valuable for policymakers, health service managers and KM practitioners in an emerging economies context. Social implications The legacy of the mobile heath technology is the normalisation of breast cancer discourse and the technical up-skilling of CHWs. Originality/value First, this paper contributes three propositions to KM scholarship, in a public health care, emerging economies context. Second, via an interdisciplinary theoretical lens (signalling theory and technology acceptance model), this paper offers a novel conceptualisation to illustrate how a knowledge-resource application can shape an organisation’s KM to form a resource-based competitive advantage.

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