scholarly journals Dual Autonomies, Divergent Approaches: How Stratification in Medical Education Shapes Approaches to Patient Care

2018 ◽  
Vol 59 (2) ◽  
pp. 268-282 ◽  
Author(s):  
Tania M. Jenkins

The United States relies on international and osteopathic medical graduates (“non-USMDs”) to fill one third of residency positions because of a shortage of American MD graduates (“USMDs”). Non-USMDs are often informally excluded from top residency positions, while USMDs tend to fill the most prestigious residencies. Little is known, however, about whether the training in these different settings is comparable or how it impacts patients. Drawing on 23 months of ethnographic fieldwork and 123 interviews, I compare training at two internal medicine programs: a community hospital staffing 90% non-USMDs and a university hospital staffing 99% USMDs. The community program’s structure lent itself to a hands-off approach resulting in “inconsistent autonomy.” In contrast, the university hospital supervised its residents much more regularly, resulting in “supported autonomy.” I conclude that medicine may be stratified in unexpected ways between USMDs and non-USMDs and that stratification may matter for patients.

2021 ◽  
Vol 8 ◽  
pp. 238212052110258
Author(s):  
Haritha Pavuluri ◽  
Nicolas Poupore ◽  
William Michael Schmidt ◽  
Samantha Gabrielle Boniface ◽  
Meenu Jindal ◽  
...  

Substance Use Disorder (SUD) is a debilitating chronic illness with significant morbidity and mortality across the United States. The AAMC and LCME have supported the efforts for more effective medical education of SUD to address the existing stigma, knowledge, and treatment gaps. The Coronavirus 2019 (COVID-19) pandemic and associated social, economic, and behavioral impacts have added to this urgency. The University of South Carolina School of Medicine Greenville (USCSOMG), in collaboration with community organizations, has successfully implemented an integrated SUD education curriculum for medical students. Students learn about SUD in basic sciences, receive case-based education during clinical exercises, and are provided the opportunity to become a recovery coach and participate in the patient and family recovery meetings through this curriculum during preclinical years. During the clinical years, SUD education is enhanced with exposure to Medication for Addition Treatment (MAT). Students also partake in the care coordination of patients with SUD between the hospital and community recovery organizations. All students receive MAT waiver training in their final year and are prepared to prescribe treatment for SUD upon graduation. The experiences in this integrated curriculum integration can perhaps assist other organizations to implement similar components and empower the next generation of physicians to be competent and effective in treating patients with SUD.


2021 ◽  
Vol 29 (1) ◽  
pp. 230949902199607 ◽  
Author(s):  
Chia-Lung Shih ◽  
Peng-Ju Huang ◽  
Hsuan-Ti Huang ◽  
Chung-Hwan Chen ◽  
Tien-Ching Lee ◽  
...  

Aim: Taiwan’s response to the coronavirus disease 2019 (COVID-19) differed in that it successfully prevented the spread without having to shutdown or overburden medical services. Patients’ fear regarding the pandemic would be the only reason to reduce surgeries, so Taiwan could be the most suitable place for research on the influence of psychological factors. This study aimed to assess the impact of patients’ fear on orthopedic surgeries in Taiwan amid the peak period of the COVID-19 pandemic. Patients and Methods: The investigation period included the COVID-19 pandemic (March 2020 to April 2020) and the corresponding period in the previous year. The following data on patients with orthopedic diseases were collected: outpatient visits, hospital admission, and surgical modalities. Results: The COVID-19 pandemic led to a 22%–29% and 20%–26% reduction in outpatients, 22%–27% and 25%–37% reduction in admissions, and 26%–35% and 18%–34% reduction in surgeries, respectively, at both hospitals. The weekly mean number of patients was significantly smaller during the COVID-19 pandemic for all types of surgery and elective surgeries at the university hospital, and for all types of surgery, elective surgeries, and total knee arthroplasties at the community hospital. Further, patients visiting the community hospital during the pandemic were significantly younger, for all types of surgery, elective surgeries, and total knee arthroplasties. Conclusions: The reduction in orthopedic surgeries in Taiwan’s hospitals during COVID-19 could be attributed to patients’ fear. Even without restriction, the pandemic inevitably led to a reduction of about 20%–30% of the operation volume.


PEDIATRICS ◽  
1962 ◽  
Vol 30 (3) ◽  
pp. 497-498
Author(s):  
EDWIN D. HARRINGTON

I read Dr. Fink's letter in the April issue of Pediatric (29:678, 1962) with great interest. As we have considered this problem at a community hospital in suburban Philadelphia it has seemed to us necessary to answer two questions: (1) What is the problem? and (2) Who is responsible for the solution of the problem? Essentially, we see the problem of adequate inpatient coverage as a service problem, not a problem in medical education. I would agree with Dr. Fink that his patients "would undoubtedly receive better care with a qualified resident on duty."


2005 ◽  
Vol 5 (4) ◽  
pp. 1850076
Author(s):  
Kwame Bawuah-Edusei

An African commentary on the Doha Development Round. Kwame Bawuah-Edusei is Ambassador of Ghana to Switzerland and Austria and Permanent Representative of Ghana to the UN offices and international organizations in Geneva, including the WTO. He obtained his MD degree in 1982 at the University of Science and Technology, School of Medical Sciences, Kumasi Ghana, worked in Ghana for two years, and later studied in the United States. He specialized in Family Medicine at Howard University Hospital, Washington DC, and worked as a physician for the Dewitt Army Hospital in Fort Belvoir, Virginia. He subsequently practiced at Educe Medical Center in Alexandria, Virginia. During this period he was active in promoting business in his native Ghana and extensively involved in humanitarian work in the deprived Northern part of his country. He became a community leader in North America and was instrumental in institutionalizing democracy in Ghana. He became a Director of the EO group, an energy Company, and President of Educe Incorporated in Ghana.


PEDIATRICS ◽  
1991 ◽  
Vol 88 (4) ◽  
pp. 870-872
Author(s):  
ANTOINETTE PARISI EATON ◽  
SAMUEL S. FLINT

In 1986 the Council on Graduate Medical Education (COGME) was asked to advise the Congress of the supply and distribution of physicians in the United States, current and future shortages or excesses of physicians by specialty, issues relating to foreign medical graduates, and other matters relating to the financing and structure of undergraduate and graduate medical education. In 1988, the COGME Subcommittee on Physician Manpower stated to the Congress that "there appears to be an impending oversupply of pediatricians at present,"1 and the Subcommittee undertook—before making its final report to the Congress—its own independent study on manpower needs for pediatrics and six other specialties.


2018 ◽  
Vol 10 (2) ◽  
pp. 214-218 ◽  
Author(s):  
Awad A. Ahmed ◽  
Wei-Ting Hwang ◽  
Charles R. Thomas ◽  
Curtiland Deville

ABSTRACT Background  Data show that international medical graduates (IMGs), both US and foreign born, are more likely to enter primary care specialties and practice in underserved areas. Comprehensive assessments of representation trends for IMGs in the US physician workforce are limited. Objective  We reported current and historical representation trends for IMGs in the graduate medical education (GME) training pool and US practicing physician workforce. Methods  We compared representation for the total GME and active practicing physician pools with the 20 largest residency specialties. A 2-sided test was used for comparison, with P < .001 considered significant. To assess significant increases in IMG GME trainee representation for the total pool and each of the specialties from 1990–2015, the slope was estimated using simple linear regression. Results  IMGs showed significantly greater representation among active practicing physicians in 4 specialties: internal medicine (39%), neurology (31%), psychiatry (30%), and pediatrics (25%). IMGs in GME showed significantly greater representation in 5 specialties: pathology (39%), internal medicine (39%), neurology (36%), family medicine (32%), and psychiatry (31%; all P < .001). Over the past quarter century, IMG representation in GME has increased by 0.2% per year in the total GME pool, and 1.1% per year for family medicine, 0.5% for obstetrics and gynecology and general surgery, and 0.3% for internal medicine. Conclusions  IMGs make up nearly a quarter of the total GME pool and practicing physician workforce, with a disproportionate share, and larger increases over our study period in certain specialties.


2021 ◽  
Vol 7 (3) ◽  
Author(s):  
The COMEPA group

Coronavirus disease 2019 (COVID-19) has dramatically changed our lives. In the past months, hospitals were saturated of patients; therefore, it is still important to have simple and standardized prognostic factors and to evaluate the efficacy and safety of medications commonly used for COVID-19. We aimed to collect data of the patients hospitalized in Internal Medicine and Geriatrics Wards at the University Hospital (Policlinico) ‘P. Giaccone’ in Palermo, Italy (COMEPA, COVID-19 Medicina Policlinico Palermo), with the main purpose of finding prognostic tools that can be easily used in clinical practice in order to identify patients hospitalized for/with COVID-19 at higher risk of negative outcomes, such as mortality, transfer to Intensive Care Unit (ICU) and institutionalization, as well as evaluating the efficacy/safety of medications commonly used for COVID-19. For reaching these aims, the medical records of approximately 600 patients will be recorded, having data on several parameters and including as outcomes mortality, ICU placement, institutionalization. With the COMEPA study, we therefore plan to update current literature, giving new data on prognostic factors and on the efficacy/safety of some medications used for COVID-19.


2021 ◽  
Vol 8 ◽  
pp. 237428952110417
Author(s):  
Wesley Y. Naritoku ◽  
Mary A. Furlong ◽  
Barbara Knollman-Ritschel ◽  
Karen L. Kaul

The shortage of pathologists in the United States has been a topic of discussion for the past 2 decades. At the 2014 Association of Pathology Chairs (APC)/Program Directors Section (PRODS) meeting, a Pipeline Subcommittee (PSC) of the APC Advocacy Committee was formed with the charge of investigating ways to increase the number of highly qualified United States Medical Graduates entering into pathology. Several online surveys were developed to identify the strengths, weaknesses, opportunities, and threats to recruitment into pathology. Two general pipeline surveys were completed; one was issued in 2014 and is discussed in this article. In 2018, the Medical Education Working Group surveyed the Undergraduate Medical Education Directors Section on the state of undergraduate medical education for pathology; pipeline issues are included in this article from the 2018 survey. Medical schools that reported 2% to 5% or more of their graduates going into pathology were compared with schools where less than 1% went into pathology. About one-third of schools producing more pathology residents had Post-Sophomore Pathology Fellowships. Schools that had a faculty member on the curriculum committee that felt they had little or no control were more likely to have fewer graduates going into pathology. Schools having students view an autopsy as a requirement of graduation were more likely to produce graduates going into pathology. However, none of these characteristics achieved statistical significance. Continued incorporation of best practices for exposure of pathology as a medical specialty as well as outreach to students will be necessary for the future pipeline.


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