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This Week in JAMA |

This Week in JAMA FREE

JAMA. 2001;286(9):1003. doi:10.1001/jama.286.9.1003.
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Edited by Stephen J. Lurie, MD, PhD


Prior studies have identified deficiencies in the preparation of residents for clinical practice. In this national survey of residents in their last year of training at academic health centers, Blumenthal and colleaguesArticle report that residents rated themselves as prepared to manage most of the common conditions they would encounter in clinical practice and to perform most of the services or procedures associated with their specialty. But more than 10% of residents in each of 7 specialties reported that they felt unprepared to undertake 1 or more tasks relevant to their disciplines. In a commentary, JohnsArticle calls for a reevaluation of traditional residency training programs and revisions that would meet the needs both of trainees and society.


Clinical teaching for medical students has expanded beyond inpatient settings of tertiary care teaching hospitals to include ambulatory sites and community-based clinical practices. To monitor educational experiences in diverse clinical settings, Rattner and colleagues developed a data collection system using a pocket-sized computer-read patient-encounter card to record information for each clinical encounter, including patient age and sex, location of the encounter, level of involvement and supervision, diagnostic procedures performed or observed, and primary and secondary diagnoses. Analysis of patient encounter cards completed by third-year medical students who recorded experiences during family medicine, pediatrics, and internal medicine clerkships showed significant differences in students' case-mix of patients, the level of disease severity, and the number of diagnostic procedures performed across the 3 clerkships. Findings within each clerkship were stable across 3 academic years, and the concordance between the students' recorded principal diagnosis in a subset of encounter cards and the faculty's diagnosis recorded in the medical record was 77%.

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Despite increases in the supply of physicians in the United States, rural communities continue to be underserved. In this study of physicians who graduated from Jefferson Medical College from 1978 through 1993, Rabinowitz and colleagues found that freshman-year plans for family practice, being in the Physician Shortage Area Program (PSAP; a Jefferson Medical College program that selectively recruits students who grew up or lived in a rural area or small town and who express a commitment to practice family medicine in a rural area), having a National Health Service Corps scholarship, male sex, and taking an elective senior-year family practice rural preceptorship were independently predictive of graduates practicing rural primary care. Participation in the PSAP was the only independent predictor of retention for all graduates. Non-PSAP graduates who met the key PSAP selection criteria noted above were 78% as likely as PSAP graduates to be rural primary care physicians and 75% as likely to remain.

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In 1995, based on prevailing workforce projections and policy recommendations, a special Veterans Affairs advisory panel proposed a 3-year plan to achieve approximately equal numbers of primary care and specialist residency training positions in the Veterans Affairs health care system. The nationwide plan required elimination of 1000 specialist training positions and creation of 750 primary care positions. Stevens and colleagues describe the implementation of this plan and modifications that occurred after 1 year to better align graduate medical education (GME) with local patient care and training needs. Over 3 years, primary care training in the Veterans Affairs system increased from 38% to 48% of funded residency positions.

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"Some students cry because the patient reminds them of themselves, and they may identify with and personalize an aspect of the patient's situation." From "Crying in the Curriculum."

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Annual reports describe the status of US medical education programs, students, and faculty, and trends in graduate medical education.


Recommendations for teaching humanistic care include establishing a climate of humanism in medical schools and hospitals and specific clinical teaching methods—taking advantage of seminal events, role-modeling, and using active learning skills.

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Winning essays from the 2001 John Conley Ethics Contest on the role of medical students in disclosing medical errors launches the 2001-2002 edition of MSJAMA.

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For your patients: Information about academic health centers.

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