Involvement of health maintenance organizations in graduate medical education.

Prepaid health care plans are likely to play an important part in the current transition from inpatient to ambulatory care training of physicians, because such plans enroll one in seven Americans. In the spring of 1990, the Group Health Association of America conducted a survey of health maintenance organizations (HMOs) to assess their level of involvement in graduate medical education (GME). A questionnaire was sent to the 481 HMOs in the United States that had been operational for at least four years; 58% responded. Fifteen percent (42 HMOs) indicated that they were directly involved in GME. The majority of these 42 indicated that they had an agreement with an academic medical center (AMC) or a teaching hospital to serve as an ambulatory care rotation site. About one-sixth of the 42 HMOs had been approved by the Accreditation Council for Graduate Medical Education to serve as a sponsoring organization. HMOs directly involved in GME were more likely to be staff model and group model HMOs; older plans with an enrollment of 50,000 or more; not-for-profit plans; and those owned or sponsored by an AMC.     

Perceived barriers and biases in the medical education experience by gender and race.

This study examined barriers and biases in the medical education experience by surveying fourth-year medical students. There were 270 female and 288 male respondents; their racial background was: 21% Asian, 13% underrepresented minorities, and 66% white. Women reported that the careers they were encouraged to pursue were affected by their gender (44% versus 15%) and they were often mistaken for a nonphysician (92% versus 3%). More importantly, women reported that the lack of a mentor of either gender as a large barrier (27% versus 19%). Underrepresented minorities reported that their race caused them to feel that they had to be twice as good to be treated as an equal to other students (52% versus 6%). Underrepresented minorities identified the lack of a same-race mentor (23% versus 4%) and role model (40% versus 1%) as a large barrier. Underrepresented minorities also noted an overall lack of mentors as a large barrier (25% versus 19%). Women and underrepresented minorities from the class of 1996 reported having a medical school experience characterized by similar barriers to their professional development.     

The use of simulation in medical student education on the topic of breaking bad news: A systematic review

BackgroundSimulated patients (SPs) are widely used, but the most effective way of utilising them in undergraduate breaking bad news (BBN) medical education is unknown.ObjectivesTo conduct a systematic review into SP’s use in developing BBN skills in medical students.Methods14 databases searched with the terms “Medical education”, “Patient simulation”, “Bad news”. Data was systematically extracted, and thematic analysis undertaken.ResultsOf 2117 articles screened, 29 publications met the inclusion criteria. These demonstrated a variety of SP models, including actors as patients (65.5%), peers (7.0%), and cancer survivors (3.5%). with delivery at varying times in the curricula. SPs are uniformly reported as having positive impact, but there is a lack of high-quality evidence comparing the use of differing forms of training. There was some evidence that virtual SPs were as useful as in-person SPs.ConclusionsSPs allow students to practise vital BBN communication skills without risking detriment to patient care. Despite the heterogeneity of ways in which SPs have been used, the benefits of different approaches and when and how these should be delivered remains unclear.Practice implicationsFurther educational development and research is needed about the use of SPs to support undergraduate BBN communication skills development.     

Health and medical informatics education for nurses and health service managers

Health and Medical informatics is a discipline encompassing and combining aspects of all health, medical and informatics disciplines. Consequently, the topics to be covered in any educational program can vary considerably both in depth and breadth. Given that such programs need to meet the needs of a very diverse health professional workforce, educators need to develop curricula to suit specific target groups although common topic areas need to be included. This paper presents the state of play regarding nursing informatics education. It discusses informatics education for health service managers primarily in Australia through the use of a case study and compares these with some other similar programs. It then explores some of the issues encountered which are seen as impediments to the progression of health and medical informatics education, the most significant of which is traditional University organisational structures which do not readily facilitate multidisciplinary educational programs.     

Pediatric patient education: the unanswered challenge to medical education

As many as 10-20% of pediatric patients in this country have a chronic illness. This number will likely increase. Unfortunately, there has not been a parallel growth in physicians acquiring knowledge and skills in patient education. The disparity between these high tech and high touch skills is the most logical explanation why the morbidity in some chronic illnesses like asthma has not improved despite recent advances in diagnosis and treatment. The discussion focuses on the barriers to patient education and why it has not been a more integral part of caring for chronically ill children and their families. The solutions to this problem are complex but must include the willingness of health care professionals to welcome patients and their families as partners in the process. In addition, there is a need for change in the medical education system so that patient education is taught as a continuum, beginning with principles and theory and concluding with application to patient care.     

Sharing digital teaching resources: breaking down barriers by addressing the concerns of faculty members.

PURPOSE: Regional and institutional databases have been created to improve access to educational resources and to avert unnecessary duplication. The growth and success of these databases depend upon the willingness of faculty members to contribute their materials. This qualitative study seeks to identify the barriers that block the free exchange of educational multimedia and the incentives that could be created to overcome educators' concerns. METHOD: In 2001, 34 faculty members from 13 U.S. medical schools each participated in one of five focus groups. They responded to three hypothetical scenarios depicting opportunities for sharing educational resources. Participants' responses were categorized hierarchically and sent back to them for feedback. RESULTS: Participants strongly supported multimedia databases, particularly those that serve a national audience. Obstacles for contributing materials included the lack of institutional recognition for educational innovation, confusing intellectual property policies, the hassle involved in sharing materials, and the perceived commercial potential of the materials. Peer review of educational materials was seen as an important incentive. CONCLUSIONS: Medical schools could benefit from the free exchange of high-quality educational multimedia but need to address the concerns of faculty by clarifying institutional copyright rules, streamlining the donation process, and providing assistance with cataloging assets. Removing departmental pressures to commercialize materials and recognizing peer-reviewed donations as academic achievement could foster a culture of sharing.     

Health education programs in U.S. medical schools.

To examine the status of teaching programs on health education in undergraduate medical education, the author in 1990-91 surveyed representatives of all 126 U.S. medical schools. Of the 97 institutions that responded, 63 (65%) offered instruction in patient education and 72 (74%) offered instruction in community health promotion. The responses indicated that a number of departments participated in instruction and that diverse methods of instruction and evaluation were used. Opinions of the representatives regarding the importance and adequacy of instruction in health education were quite favorable. The author concludes that more information is needed to determine the effectiveness of the instructional programs and their impact on the quality of medical care.     

Improved medical care for the elderly: intervening in medical education

It is the premise of this paper that certain instructional interventions in the medical school behavioral science curriculum will eventually improve the health care received by elderly patients. Four content areas for such intervention are reviewed: patient adherence to medication regimens, risk and management of psychosocial stress, responses to chronic illness, and doctor-patient communication patterns. The final section describes research that supports the long-term efficacy of such curricular interventions.