August 31, 2012
Bad science watch
This is inexcusable. If it's not real, it's not medicine and it has no place in the medical school. I'm all for understanding non-traditional health beliefs and I'm happy to call "medicine" anything that works. But it's pretty obvious that "black magic" should not be part of the curriculum.
To be clear: we need a lot more residencies. Now.
Here's a chart I made showing the number of medical school graduates in the U.S. from 2002 to 2011. I grabbed the data from the AAMC.
Where are all these new kids going to go? We need more residencies. Now. Go go H.R. 6352!
More PA's in Idaho
More PA's training in Idaho. I don't know much about the impact of PAs on the health care system but I can't imagine more PAs is a bad thing.
Plans for a new DO school in Alabama
"The Alabama Department of Public Health reports 60 of Alabama's 67 counties do not have enough primary care providers, such as general practitioners, family doctors or pediatricians, and that rural parts of the state are the most medically underserved." A new school here is a good thing.
Put the med schools where the underserved live. Admit them. Train them. They will stay and practice.
D. C. Brater agrees. We need more residencies.
August 28, 2012
AMEE 2012 in Lyon
I'm in Lyon, France right now charging the laptop battery. There's good stuff here this year. I'll post a summary post when I get home.
August 16, 2012
Targeting patient populations
I've seen lots of evidence that if you want certain people to have more doctors, accept some of them into medical school.
August 14, 2012
MiChart at UMich starts tomorrow
Tomorrow the University of Michigan Hospitals and Clinics will stop using the electronic health records system that it developed in-house and has been using for over a decade and start using a more standard commercial product (EPIC) which has been tailored to UMich and is called MiChart.
What's going to happen? I imagine tomorrow will not be a great day to end up in the hospital. But the records-sharing features (especially with patients) will definitely be a good thing (until there's a security breach, of course).
Changes afoot in residency training
Here's a good run-down of some of the changes coming in residency training. Match will go better because unfilled slots will be allowed find unmatched students and vice versa; this will be needed since residency slots are becoming scarce (Go go H.R. 6352!).
There are also some fundamental changes in how residents will be assessed though this article doesn't describe them. They are interesting: I'll post about them later.
August 13, 2012
Also, is e-stuff all that different?
Why is the student notes issue always framed as an aspect of Electronic Health Records? Why isn't it an issue concerning medical records no matter the medium? Paper-based records are also kept and students can write notes on paper. I don't quite get it.
This is a general cultural issue: I still see writers talk about the Internet like it's shiny and new and futuristic and will change our lives. Yes, that 25 year-old internet. And home computers generally: I'm 41 years old and had a home computer as a kid.
This is not a crazy new problem.
Do students' notes count?
Students have to learn to use Electronic Health Records (and I assume they are better at learning this stuff than the doctors who are training them.
I've heard other people talk about whether students should be allowed to enter notes into a patient's EHR and whether it should be flagged as a student note in the record. Certainly students' notes are not a reliable as more senior clinicians; that's demonstrable. But 1) not all students' notes are unreliable and 2) flagging students' notes casts a wide (and oddly quality-blind) net over suspicious EHR entries.
This seems like an important research topic since USMLE 2 now requires post-encounter notes; students are learning this stuff and should be assessed. Where better to assess them than in the clinic and how easier to do it than through EHRs?
Another piece of the more doctors puzzle
Let's make sure docs from other countries meet our standards.
This article says: "Each year, thousands of [International Medical Graduates] IMGs seek to practice in the U.S. These doctors make up a quarter of the U.S. physician work force and play an important role in helping to fill shortages nationwide, with many practicing in rural and other medically underserved areas."
A quarter? I knew it was a lot but I had no idea.
Update: This article about boat ambulances has a buried lead about medical training in India: "While talking about medical education, the minister said that government was considering increasing medical seats to 150 from 100 in each medical college across the state. Besides, there were plans to implement a unique policy to fill up management quota seats in medical colleges, the minister said." That's a 50% increase! This may be the shape of things to come.
August 12, 2012
More residencies means more doctors
August 10, 2012
Bullying stinks and schools and residencies need to eliminate it. But there is always going to be a frustration in a system where trainees are involved in life-and-death patient care. Plus, people are people and people are impatient and cross. Especially the people who are selected for their competitiveness and self-assuredness.
As I get older I'm more and more surprised how hard it is to remember what it was like to be less experienced. Graduate students seem unqualified to me, largely because I've forgotten how incompetent I was when I was a graduate student. This grumpy "harumph: kids today" attitude must be an intolerable frustration for attendings on a stressful hospital ward.
We need more residencies
We're going to need more doctors. We added more medical students. We did not add more residencies. This article is a good summary of the problem.
Congress could solve this problem, but they won't. Some creative thinking is in order, and quickly. There are more M4s in the pipeline right now than we've had in a while.
Another new treatment
It's a constant, battery-powered, RF computer-controlled drip of baclofen for people with muscle control problems: palsy, MS, etc. If the delivery system isn't too buggy, I assume this could become standard for all sorts of chronic, drug controlled disorders. I'm lookin' at you, Diabetes.
August 09, 2012
I like animals. I like babies, too. I think I prefer babies. Practicing neonatal intubation on kittens...that's a toughie. Thoughts?
Small, regional, targeted
A new med school in Northern Ontario. Keep 'em coming. What's the curriculum going to be like? How will they favor local applicants? We'll see how successful they are at getting more locals to become doctors and practice locally. Fingers crossed.
I hate cheaters.
August 08, 2012
Audio-Digest branches out to eReaders
More dissemination is a good thing.
August 07, 2012
Know what you're getting into
Giving new M2s at IU a taste of hospital work life is important. These students are making decisions about their eventual specialties every day of their education: they know that in 10 years they won't remember 80% of what they are learning and they have a pretty good guess about which 80% that is. Unless, of course, they didn't know about the smell, the hours, the stress-level, the type of patients, or any other aspect of their chosen specialty that would make them reconsider. Then it's a different 80%.
Expose them to real doctor work-life early. Make it a larger part of medical school.
What happens when you neglect your medical education system
August 06, 2012
New medical schools are lean and mean
The rush to add medical students to fill the upcoming doctor shortage means a bunch of new medical schools. These schools have the luxury of starting a curriculum from scratch, and complying with current meded zeitgeist, these curricula are small-group-based, light on lecture, heavy on hands-on learning. Schools like this one---Cooper Medical School near Philadelphia---are springing up. Will Cooper give UPenn---the oldest medical school in the country---a run for its money?
Pakistan asks: should non-medical PhD's teach basic science?
A dust-up between Pakistani health agencies leaves Pakistan medical schools with only a few, aging basic science teachers. How would barring non-medical basic scientists from teaching in the pre-clinical years in the U.S. impact our medical education?