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This Week in JAMA |

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JAMA. 2004;292(9):1007. doi:10.1001/jama.292.9.1007.
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MEDICAL EDUCATION

Edited by Catherine D. DeAngelis, MD, MPH

US MEDICAL EDUCATION, 2003-2004

Data from annual surveys of undergraduate and graduate medical education programs conducted by the Liaison Committee on Medical Education, the American Medical Association, and the Association of American Medical Colleges are summarized in this issue of JAMA. First, Barzansky and EtzelArticlereport that in comparison with data from 1993-1994, medical school enrollment is similar while the number of full-time faculty has increased and appointment of a senior administrator with broad responsibilities for medical education is commonplace. In the second article, Brotherton and colleaguesArticlereport trends in residency training and career choices, with a particular focus on women, and programs addressing cultural competence and complementary/alternative medicine.

SPECIALTY CERTIFICATION AND QUALITY IMPROVEMENT

Efforts to improve the quality of medical care are often systems-based and few have considered the role of physician certification in quality improvement. Brennan and colleagues review the evidence and theory relating to physician board certification status and measures of physician competence, clinical outcomes, and error prevention and find support for the hypothesis that certification and maintenance of certification will improve quality. They also report results of a national poll assessing public views on physician certification, which found that certification and frequent reevaluation of skills and competencies to maintain certification are highly valued by the public.

ASSESSING EDUCATIONAL PROGRAM EFFECTIVENESS

Clinical medicine is becoming increasingly evidence-based, but rigorous and generalizable data to substantiate the effectiveness of medical education programs are limited. Carney and colleagues review the application of standard, population-based epidemiologic research designs to test hypotheses about medical education outcomes. They also outline 3 essential elements—an existing infrastructure, institutional motivation, and a national commitment that includes increased funding—necessary for a strong educational epidemiologic research endeavor.

DETECTION AND RISK OF BREAST CANCER RECURRENCE

Studies of prognosis following breast cancer suggest that women whose cancer was found by mammography screening have a better prognosis than women whose tumors were found outside of screening or between mammography screening rounds. However, the mode of detection is not currently a factor in determining the need for systemic adjuvant therapy. Joensuu and colleaguesArticleexamined the risk of recurrence and survival among Finnish women whose breast tumors were detected by mammography screening compared with women whose tumors were found by other methods. They found a significantly increased risk of recurrence in women whose tumors were found other than by mammography screening, and method of detection was found to be an independent predictor of distant disease-free survival and overall survival. In an editorial,ArticleO'Regan discusses the potential value of these results to identify women who will benefit most from systemic adjuvant therapy.

A PIECE OF MY MIND

"Diseases are easy. Life in a refugee camp is not." From "Clinic."

LIABILITY ISSUES IN GME

On Call: Issues in Graduate Medical Education
Current and emerging professional liability issues relevant to resident and attending physicians and institutions involved in graduate medical education (GME) are reviewed.

COMMENTARY

Education in ambulatory chronic disease management needs emphasis and improvement.

EDITORIAL

The importance of "professors who profess" and the challenges they face are discussed by DeAngelis.

CLINICIAN'S CORNER

Clinical Review
Clinical management of systolic hypertension in older persons.

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