Shortening Medical Training by 30%

Office of the Provost and Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 03/2012; 307(11):1143-4. DOI: 10.1001/jama.2012.292
Source: PubMed
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Available from: Victor R Fuchs, May 21, 2014
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    • "In order to practice safely, it is crucial that physicians develop the capacity and habit to self-monitor their cognitive and non-cognitive expertise. This is particularly true if medical education is to become more flexible and individualized in order to better meet the health needs of society (4). "
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    ABSTRACT: Purpose Describe the relationship between medical students’ self-assessment and goal-setting (SAGS) skills and development of interviewing skills during the first-year doctoring course. Method 157 first-year medical students completed three two-case standardized patient (SP) interviews. After each of the first two, students viewed videotapes of their interview, completed a SAGS worksheet, and reviewed a selected tape segment in a seminar. SAGS was categorized into good and poor quality and interviewing skills were rated by trained raters. Results SAGS improved over time (37% good week 1 vs. 61% good week 10). Baseline SAGS and interviewing skills were not associated. Initial SAGS quality was associated with change in interviewing skills – those with poor-quality SAGS demonstrated a decrease and those with good-quality SAGS demonstrated an increase in scores by 17 weeks (ANOVA F=4.16, p=0.024). For students whose SAGS skills were good at both week 1 and 10, interviewing skills declined in weeks 1–10 and then increased significantly at week 17. For those whose SAGS remained ‘poor’ in weeks 1–10, interviewing skills declined in weeks 10–17. Conclusions In general, the quality of students’ SAGS improved over time. Poor baseline SAGS skills and failure to improve were associated with a decrease in interviewing skills at 17 weeks. For students with better SAGS, interviewing skills increased at week 17. Improvement in SAGS skills was not associated with improved interviewing skills. Understanding structured self-assessment skills helps identify student characteristics that influence progressive mastery of communication skills and therefore may inform curriculum and remediation tailoring.
    Medical Education Online 07/2014; 19:24407. DOI:10.3402/meo.v19.24407 · 1.27 Impact Factor
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    • "In the past decades of increasing medical complexity, further specialization and increasing societal demands, the requirements for trainees have changed profoundly. Meanwhile, the gross training time has been reduced as a result of intensified working hours legislation and initiatives to shorten postgraduate training (Emanuel & Fuchs 2012). These developments increase the need to further integrate and align the different phases of the medical educational continuum. "
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    ABSTRACT: Abstract Background: Postgraduate medical education training programs strive to prepare their trainees optimally for independent practice. Several studies have shown, however, that new consultants feel inadequately prepared for practice, and that this increases the risk of stress and burnout. Aim: To analyze across specialties for which tasks and themes new consultants feel inadequately prepared. And, to identify themes that need improved attention in postgraduate medical education programs or after registration. Methods: 330 New consultants from all hospital specialities with accredited training programs who completed their training in the north-eastern educational region of The Netherlands between 2004 and 2010 received a questionnaire which was based on a previously validated generic task inventory. Results: 143 respondents (43%) returned the questionnaire. They felt excellently prepared for 40 tasks, well prepared for 25 tasks, marginally sufficiently prepared for 18 tasks and insufficiently prepared for 8 tasks. Preparedness scores were lowest for tasks concerning management administration and leadership, research, end-of-life care, and patient safety-related communication. Surgical specialists felt better prepared for practice than medical specialists, which could not be explained by differences in general self-efficacy. Conclusion: Although new consultants felt well prepared for medical tasks, the scores of more generic tasks indicate that the alignment between the different phases of the medical education continuum and independent practice needs improvement.
    Medical Teacher 07/2014; 37(2):1-9. DOI:10.3109/0142159X.2014.929646 · 1.68 Impact Factor
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    • "It is thought that by fostering attention on the essential content of the programmes and forcing educational institutions to eliminate unnecessary and repetitious material in the curriculum, an average of 14 years of training (running through college to the speciality fellowship period) could significantly be reduced by approximately 4 years. Bearing in mind that the average medical student in the United States graduates with an estimated $160,000 in debt, 4 years less of medical school would be significant in lowering tuition debts of trainees [3]. "
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    ABSTRACT: The growing demands for easily accessible, cost effective and efficient health care services are hindering many medical training programs in delivering well prepared physicians, equipped with the competencies to tackle new and complex health care problems. In addition to this, many medical institutions are finding it difficult to design curricula that would prepare today's physicians adequately for the ongoing changes in health care. Targeted customer service is a growing phenomenon in health care, where healthcare institutions are operating as retail service providers, design experiences and deliver care around the convenience of consumers rather than the preferences of providers. Gradually finding its way into medical education, this concept entails investing in understanding the beliefs and values of consumers as a result of their different expectations and differences. Defined by the experiences that create common values among the members of a specific group, the discourse of generation segmentation has proven to be a helpful way of understanding consumer differences. There are four known generations currently impacting the pattern and distribution of healthcare services and in the coming decade, the future of medical education In this paper, medical education is re-examined in the light of this phenomenon of generation segmentation and whether today's physicians are being effectively prepared to practice in a fast changing world. The analysis provided in this paper presents a recommendation for the medical curriculum of a new millennium based on the changing needs and expectations of different generations of consumers.
    04/2013; 2(5-6). DOI:10.1007/s40037-013-0057-0
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