This Week in JAMA FREE

A JAMA THEME ISSUE

Edited by Robert M. Golub, MD

Clinical protocols may improve patient outcomes but may also negatively affect medical trainees' acquisition of clinical decision-making skills. In a cohort of 553 examinees sitting for the American Board of Internal Medicine Critical Care Medicine Certification Examination, Prasad and colleagues found that training in an environment with 2 or more compared with 0 or 1 ventilation management protocols was not associated with worse performance on examination questions about mechanical ventilation management.

Unconscious (implicit) bias relating to patients' race or social class could influence clinical decision making. In a survey administered to 202 entering students (84%) at 1 US medical school, Haider and colleagues Article found that the majority of student responses were consistent with implicit preferences toward white persons and possibly those of upper social class. However, students' implicit biases were not reflected in their responses to clinical assessment vignettes. In an editorial, van Ryn and Saha Article discuss bias, disparities research, and implications for medical education.

West and colleagues analyzed data from the 2008 and 2009 Internal Medicine In-Training Examination (IM-ITE) and the 2008 IM-ITE survey and found that suboptimal quality of life and symptoms of burnout were common among the participants—who represented 74.1% of eligible internal medicine residents in the 2008-2009 academic years. Factors associated with burnout included higher educational debt and graduation from a US medical school. Low quality of life, emotional exhaustion, and educational debt were associated with lower IM-ITE examination scores.

In a cohort of 42 440 US medical school graduates (1997-2000) who were followed up through March 2009, Jeffe and Andriole found that demographic factors (race/ethnicity, age, sex, educational debt) and educational factors (including certification examination scores and withdrawal/dismissal from a graduate medical education program) were associated with eventual American Board of Medical Specialties member board certification. The contribution of these factors to board certification varied among the specialty categories.

Obedin-Maliver and colleagues Article surveyed deans at US and Canadian allopathic and osteopathic medical schools to assess dedicated teaching time and curricular content related to lesbian, gay, bisexual, and transgender (LGBT) patients and their health care needs. The authors found that the median time dedicated to LGBT-related topics was 5 hours, with wide institutional variation in quantity, content, and perceived quality of instruction. In an editorial, Curry Article discusses the evolution of medical curricula, the learning environment, and the social context of health care.

To assess the effectiveness of technology-enhanced simulation in health professions education, Cook and colleagues conducted a systematic review and meta-analysis of data from 609 research studies that evaluated technology-enhanced simulation in the training of health care professionals. The authors report that compared with no intervention, technology-enhanced simulation training was associated with better knowledge, skills, and behaviors and some improvement in patient-related outcomes.

“Technology and media are increasingly common salves for our educational woes, but where can trainees find the virtual preceptors in the digital age?” From “The Mechanics of Reasoning.”

21st-century genomics education

Conflict of interest disclosure in early medical education

Physician education: why coaches can't be judges

Orchestrating excellence in medical education

Dr Golub summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

Join Laura Mosqueda, MD, Wednesday, September 21, from 2 to 3 PM eastern time to discuss identification of and intervention for elder mistreatment. To register, go to http://www.ihi.org/authorintheroom.

Mr J is a 76-year-old with multiple medical problems and limited health literacy. How would you reduce the complexity of his medical care and help him understand his self-care needs? Read the case at www.jama.com. Submit your response by September 11 for possible online posting.

For your patients: Information about medical specialties.