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Nova Southeastern UniversityNSUWorksMedical Education Digest College of Osteopathic Medicine9-1-2013Medical Education Digest, Vol. 15 No. 5College of Osteopathic MedicineFollow this and additional works at: http://nsuworks.nova.edu/hpd_com_medPart of the Osteopathic Medicine and Osteopathy CommonsThis Magazine is brought to you for free and open access by the College of Osteopathic Medicine at NSUWorks. It has been accepted for inclusion inMedical Education Digest by an authorized administrator of NSUWorks. For more information, please contact nsuworks@nova.edu.NSUWorks CitationCollege of Osteopathic Medicine, "Medical Education Digest, Vol. 15 No. 5" (2013). Medical Education Digest. Book 7.http://nsuworks.nova.edu/hpd_com_med/7Volume 15, Number 5 • Medical Education Highlights for Primary Health Care • September/October 2013The Electronic Residency Application Service conducted a survey thatincluded 7,028 applicants in the 2006-2007 National Residency MatchingProgram to determine if they were asked potentially illegal questions dur-ing residency interviews. It was reported that 4,557 or 64.85 percent ofthe applicants were asked at least one potentially illegal question. Thetypes of inquiries deemed inappropriate included:• Marital Status• Number of Children• Practice of Family Planning• Ethnicity• Gender• Religion• Age• Sexual OrientationSpecialties included in the study were emergency medicine, generalsurgery, internal medicine, obstetrics-gynecology, and orthopedics. Maritalstatus was the most commonly asked potentially illegal question (54.3percent), followed by whether an applicant had children (27.4 percent),practiced family planning (15.3 percent), and gender (10.6 percent). Ques-tions about religion amounted to 9.3 percent, while 8.6 percent askedabout an applicant’s age.(Hern HG, Alter HJ, and Wills CP. How prevalent are potentially illegal questions during residency interviews? Academic Medicine.88:1116-1121; 2013.)Some ResidencyInterview QuestionsDeemed Potentially IllegalPromotingInterprofessional Educationin Primary Care Helps CreateBetter PhysiciansThe United States health care system needs to promote interprofessionalcollaboration, the value of primary care, and have health professionalslearn from those in practice. Preparation, training, and continuing educa-tion for multiple health professions should begin on the first day of schoolby bringing students together from these disciplines and continuingthroughout training. In an effort to demonstrate to its students the impor-tance of continuing professional development, the University of Connecti-cut in Storrs, Connecticut, provides this training to graduates for free. Ona regular basis, interprofessional grand rounds that emphasize primarycare are provided so students become comfortable with team care.  Thisexperience sometimes leads to publications, presentations, and evengrant proposals. (Van Hoof TJ and Polifroni EC. A program to promote interprofessional collaboration in primary care. Academic Medicine.88:1056;2013.)U.S. Senator LinksDysfunctional System toInsufficient Number of PrimaryCare PhysiciansSenator Bernie Sanders of Vermont, chairman of the Subcommittee on Pri-mary Health Care and Aging, remarked that health care costs twice as muchper capita in the United States than in any other major country—with worseoutcomes. Most countries have 70 percent of its physicians practicing pri-mary care and 30 percent who are specialists.In the United States, only 30 percent of physicians practice primary care.Senator Sanders suggested there is a need to substantially increase thenumber of primary care practitioners today and significantly more when theAffordable Care Act insures 30 million more people next year. Medicalschools need to do more since only 7 percent of graduates chose a primarycare career. Medicare needs to place demands on teaching hospitals to increase thenumber of primary care physicians. Reimbursement rates must create in-centives for medical school graduates to go into primary care, Sanders said.The senator also encouraged the expansion of the Federal Qualified HealthCenter program providing cost-effective affordable care to the medically un-derserved. Part of the needed revolution in primary care services is acces-sibility as well as a major expansion of the National Health Service Corps,including providing loan forgiveness and scholarships to medical studentsso they would choose to practice in underserved areas.(Sanders B. Politico. Politico.com. May 7, 2013.)Cow tongues, video games, and mannequins are being used at the Institutefor Simulation and Interprofessional Studies (ISIS) at the University of Wash-ington in Seattle, Washington. The use of the video simulations and man-nequins as well as fake body parts allows students, physicians, and otherhealth care providers to learn how to respond to emergency and nonemer-gency situations. Simulation facilitates training without jeopardizing the health and safety ofreal patients. Each year 10,000 trainees utilize the facilities of the ISIS. Theinstitute’s director, Brian Ross, met with people at the Boeing Company, anaviation manufacturer, because the first medical simulators were constructedby aviation manufacturers who had made flight simulators.There are multiple ways that simulators advance medical training. Second-and third-year residents learn laparoscopic skills by manipulating smallgraspers that move blocks while the trainees look through cameras. Anotherdevice can be used to simulate bronchoscopic examinations and colono-scopies. Cow tongues are used to simulate the repair of an episiotomy. Plastic babies lubricated with vegetable oil are delivered through a plasticpelvis with parts that move as they should. Other types of simulations areused to learn how to communicate with nurses and patients in an emer-gency situation.(Zhang S. Medical students at UW learn practical skills with unique tools. The Seattle Times. August 18, 2013.) Simulation Institute atUniversity of WashingtonBuilds MultifacetedMedical ExperienceSince 1965 when Medicare was passed into law, graduate medical ed-ucation (GME) has been publicly funded. In 2009, this amounted to $9.5billion (about two-thirds going to 200 hospitals training the most residents)with an additional $3.18 billion from Medicaid. The funding is the largestpublic investment in U.S. health workforce development. Despite the bil-lions of dollars invested, shortages of primary care physicians, general sur-geons, and psychiatrists persist nationwide, particularly in rural andunderserved areas. As recently as 2011, advisory bodies recommended the accountabilityof GME to public health needs. The Patient Protection and Affordable CareAct mandates that the Council on Graduate Medical Education developmeasures and guidelines to longitudinally evaluate GME programs. AGeorge Washington University Department of Health Policy study has ledto the proposal of a method to measure workforce-relevant outcomes ofGME by sponsoring institutions and primary care teaching sites. The study largely excludes osteopathic medical residency programs be-cause of the separation of the accreditation process between allopathicand osteopathic medical schools in the GME system. This may change inthe future through collaboration with the American Osteopathic Associationand the American Medical Association, which maintain similar databases. Despite the major funding of GME by Medicare, physician workforceshortages continue, especially in specific specialties and locations. TheGeorge Washington study indicated that outcome measures in key work-force areas at the institution and hospital level are achievable for use indevelopment of an accountability system and in evaluating the results ofchanges in the GME system. (Chen C, Petterson S, Phillips RL, Mullan F, Bazemore A, and O’Donnell SD. Toward graduate medical education (GME) accountability:measuring the outcomes of GME institutions. Academic Medicine. 88:1-14;2013.)Improving Physician ShortageTied to Successful Outcomesat Graduate MedicalEducation InstitutionsA 2013 census performed by the American Academy of Family Physicians(AAFP) indicated that 2,938 medical graduates from allopathic and osteo-pathic medical schools entered family medicine residency programs in2013, increasing from 2,611 in the previous year. Perry Pugno, M.D., AAFPvice president for medical education,  indicated that this is part of a trendthat began four years ago with an increasing interest in a career in primarycare. However, he cautioned that this change is not happening fast enoughto meet the future demand that will be created by the introduction of theAffordable Care Act expanding insurance coverage as well as the growingpopulation of the aged.(Landen R. More residents entering family medicine, AAFP says. Modern Physician.com. August 21, 2013.)Increase in Primary CareGraduates Fails to Meet FutureDemands of Health CareMortality increases and efficiency decreases when new interns begin inJuly according to a 2011 study in the Annals of Internal Medicine. North-western Memorial Hospital in Chicago, Illinois, addresses the issue with aboot camp for its 81 new interns. Prior to commencing their internship, in-terns spend three days in June preparing for bedside assignments. The in-terns must pass a graded test in procedures and communications skillsbefore they begin their program.  The preparation involves making life-or-death decisions while treating a ro-botic patient in a simulated intensive care unit. While the procedures arecomplicated, some students displayed more difficulty with bedside com-munication skills, such as talking to an actor who simulates a dying patient.In this case, the patient had a bowel obstruction and no further chemother-apy or surgery could be done for the man’s colon cancer. The intern ac-knowledged that having a discussion with a dying patient was quite differentthan learning from a textbook.(Johnson D. Chicago’s intern “boot camp” is rehearsal for life-or-death medical issues. The New York Times. July 14, 2013.)Northwestern MemorialHospital Intern Boot CampPrepares Interns for Life- or-Death IssuesThe Medical Education Digest is published bimonthly through theNSU-COM Office of Education, Planning, and Research.EditorLeonard Levy, D.P.M., M.P.H., Associate DeanEditingNSU-COM Office of Medical Communications and Public RelationsGraphic DesignBrandee EvansACCREDITATION AND NONDISCRIMINATION Nova Southeastern University is accredited by the Southern Association ofColleges and Schools Commission on Colleges to award associate’s,baccalaureate, master’s, educational specialist, doctorate, and professionaldegrees. Contact the Commission on Colleges at 1866 Southern Lane, Decatur,Georgia 30033-4097 or call 404-679-4500 for questions about the accreditationof Nova Southeastern University. Nova Southeastern University admits students of any race, color, sex, age,nondisqualifying disability, religion or creed, sexual orientation, or national or ethnicorigin to all the rights, privileges, programs, and activities generally accorded ormade available to students at the school, and does not discriminate inadministration of its educational policies, admissions policies, scholarship andloan programs, and athletic and other school-administered programs.3200 South University Drive4th Floor, Room 1495(954) 262-1469Fort Lauderdale, FL 33328-2018http://medicine.nova.eduIn July, the Advisory Committee on Training in Primary Care Medicineand Dentistry released a report on interprofessional education it hadprepared for the Secretary of the United States Department of Healthand Human Services. The report emphasized that trainees in variousmedical professions are typically taught in isolated silos and are ofteninadequately prepared for working in interprofessional teams. Medicalprofessionals lack an understanding of each other’s roles and are nottrained for interprofessional collaboration, which results in barriers toworking together effectively, the report said.The advisory committee recommends funding for training focusingon competencies for primary care with interprofessional collaborationthat is related to population health. Care should be patient-centered,include experiences for patients and families, have a focus on patientsafety, enhance health throughout the population, and reduce costs. The committee recommends the Health Resources and Services Ad-ministration provide grants in the Bureau of Health Professions to ac-complish the goals of interprofessional education. Title VII traininggrants, as the vehicle for this support, should favor programs aimed atlearners to achieve core competencies for interprofessional educationintegrated into their training. Models developed for the programs shouldbe team-based in a variety of settings and use innovative educationaltechniques, including cutting-edge technology.(Advisory Committee on Training in Primary Care Medicine and Dentistry.Interprofessional Education. Tenth Annual Report to the Secretary of the U.S.Department of Health and Human Services. July 2013.)Advisory Committee onPrimary Care StressesImportance ofInterprofessional Education

Medical Education Digest, Vol. 15 No. 5 (September/October 2013)

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Medical Education Digest, Vol. 15 No. 5 (September/October 2013)

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