Veterans Administration BMET certification exam.

The Veterans Administration has developed a program to evaluate the level of competency of its medical equipment repairmen and to recognize those who surpass an established level of competency. This evaluation is carried out by means of testing. A passing score of 70% on all sections of the exam results in certification while failure results in enrollment in correspondence or short courses. Periodic evaluations of the exam are carried out to determine questions to be added or deleted and those which should be reworded. Since time limits are set for completing the exam, those time limits are also evaluated.     

Ureterosigmoidostomy Long-term results

Ureterosigmoidostomy was performed on 103 patients between 1928 and 1963 at the University of Wisconsin Medical Center. The indication for urinary diversion was a benign condition in 46 patients and a malignant disease in 57 patients. The surgical (hospital) mortality rate was 10 per cent for the entire series and 3 per cent for procedures performed since 1943. In patients with exstrophy of the bladder, the ten-year survival rate was 82 per cent and the twenty-year survival rate was 61 per cent. The complications of abnormal findings on postoperative pyelogram and of recurrent acute pyelonephritis have been markedly reduced by exclusive use of the Leadbetter combined technique of ureterosigmoidostomy.     

Making fun of patients: medical students' perceptions and use of derogatory and cynical humor in clinical settings.

PURPOSE: It has long been known that medical students become more cynical as they move through their training, and at times even exhibit "ethical erosion." This study examines one dimension of this phenomenon: how medical students perceive and use derogatory and cynical humor directed at patients. METHOD: The authors conducted five voluntary focus groups over a three-month period with 58 third- and fourth-year medical students at the Northeastern Ohio Universities College of Medicine in 2005. After transcribing the taped interviews, the authors analyzed the data using qualitative methods and identified themes found across groups. RESULTS: The categories that emerged from the data were (1) categories of patients who are objects of humor, including those deemed "fair game" due to obesity or other conditions perceived as preventable or self-inflicted; (2) locations for humor; (3) the "humor game," including student, resident, and faculty interaction and initiation of humor; (4) not-funny humor; and (5) motives for humor, including coping and stress relief. CONCLUSIONS: The authors offer recommendations for addressing the use of derogatory humor directed at patients that include a more critical, open discussion of these attitudes and behaviors with medical students, residents, and attending physicians, and more vigorous attention to faculty development for residents.     

Retheorizing Sexual Harassment in Medical Education: Women Students' Perceptions at Five U.S. Medical Schools

Abstract

Background: The literature consistently reports that sexual harassment occurs with regularity in medical education, mostly in clinical settings, and most of it goes unreported. Reasons for nonreporting include the fear of retaliation, a reluctance to be viewed as a victim, a fear that one is being “too sensitive,” and the belief that nothing will be done.

Purpose: We wanted to examine with greater concentration the stories women students tell about sexual harassment, including what they count as sexual harassment, for more or different clues to their persistent nonreporting.

Methods: We used focus groups to interview 30 women students at 5 U.S. medical schools. We used systematic inductive guidelines to analyze the transcribed data, linking to and building new theoretical frameworks to provide an interpretive understanding of the lived experiences of the women in our study.

Results: Consistent with previous literature, most of the students interviewed had either witnessed or observed sexual harassment. We selected 2 theoretical lenses heretofore not used to explain responses to sexual harassment: 3rd-wave feminist theory to think about how current women students conceive sexual harassment and personality theory to explain beliefs about nonreporting.

Conclusions: Medical educators need new ways to understand how contemporary women students define and respond to sexual harassment.     

Insurgent multiculturalism: rethinking how and why we teach culture in medical education.

The author proposes a theoretical orientation for cultural competency that reorganizes common curricular responses to the study of culture in medical education. What has come to be known in medical education as cultural competency is theoretically truncated and may actually work against what educators hope to achieve. Using Giroux's concept of insurgent multiculturalism, she suggests that the critical study of culture might be a bridge to certain aspects of professional development. Insurgent multiculturalism moves inquiry away from a focus on nondominant groups to a study of how unequal distributions of power allow some groups but not others to acquire and keep resources, including the rituals, policies, attitudes, and protocols of medical institutions. This approach includes not only the doctor-patient relationship but also the social causes of inequalities and dominance. Linked to professional development efforts, insurgent multiculturalism can provide students with more opportunities to look at their biases, challenge their assumptions, know people beyond labels, confront the effects of power and privilege, and develop a far greater capacity for compassion and respect.     

The Treachery of Images: How René Magritte Informs Medical Education

Using René Magritte’s well-known painting The Treachery of Images (This is not a pipe), we argue that the current focus on competencies throughout medical education can sometimes lead educators to rely too heavily on scores, checkmarks, or other forms of assessment that come to be viewed as equivalents for the actual existence of what is being measured. Magritte insisted that the image he created on the canvas was not a pipe but rather a representation of a pipe, an important distinction for educators to remember as we seek ways to evaluate trainees’ attainment of the fundamental knowledge and skills of the profession. We also urge that the focus on broader skills, values, flexibility, reflection, and insight development should fall outside the net of a competency orientation in a supportive environment spared from traditional assessment methods, using a classroom in undergraduate medical education as an example of working toward this end.