Medical Humanities Education Research Articles

Endovascular workforce for peripheral vascular disease: current and future needs.

The current status and future needs of peripheral endovascular utilization and training have not been well defined. This topic is particularly relevant to the future of four specialties: interventional cardiology, cardiothoracic surgery, interventional radiology, and peripheral vascular surgery. We attempt to analyze the current numbers of cardiovascular patients and procedures and the numbers of treating physicians and surgeons to make predictions and recommendations for the future. The numbers of cardiovascular patients and procedures were obtained from the Healthcare Cost and Utilization Project Trend Query web site. The number of endovascular abdominal aortic aneurysm repairs was obtained with telephone or e-mail contact with the aortic endograft manufacturers. The numbers of different cardiovascular specialists were obtained with contact with different cardiovascular professional societies and the American Board of Specialists via telephone, e-mail, or web site. The numbers of accredited US cardiovascular fellowship programs and first year spots were obtained from the Graduate Medical Education Directory 2000 to 2001. Finally, the numbers of endovascular fellowship programs and first year spots were obtained with contact with the individual programs. The numbers of cardiovascular patients and procedures have risen from 1993 to 1997. This trend is expected to continue as the population ages. Despite the rapid rise of endovascular procedures, the number of open cases has continued to rise as well. However, the number of cardiovascular specialists is predicted to remain stable. Specific numbers and trends are depicted in the manuscript. Our analysis shows that a critical shortage of endovascular trained specialists will exist in the future. More surgeons need to receive endovascular training to meet these future needs.

Back to the future: history and humanism in medical education.

Medical EducationVolume 36, Issue 6 p. 506-507 Back to the future: history and humanism in medical education Mark Jackson, Mark JacksonSearch for more papers by this author Mark Jackson, Mark JacksonSearch for more papers by this author First published: 31 May 2002 https://doi.org/10.1046/j.1365-2923.2002.01237.xCitations: 14 Dr Mark Jackson, Centre for Medical History, University of Exeter, Amory Building, Rennes Drive, Exeter EX4 4RJ, UK. Tel.: 00 44 1392 263003; E-mail: m.a.jackson@exeter.ac.uk Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume36, Issue6June 2002Pages 506-507 RelatedInformation

Reflections on the humanities in medical education.

In recognition of the views advanced by the philosopher Maurice Merleau-Ponty, this paper considers some of the implications for medical practice and, hence, medical education, of recognizing the human body as an 'intertwining' of the natural (or physical) and the existential (or experiential) - something which is taken for granted in ordinary experience, but which becomes the medium through which disease can manifest itself in illness and disability. Our condition is the condition of creatures of frail flesh. Perhaps because this 'intertwining' is taken for granted, we tend to overlook the extent to which it is metaphysically astounding, even though it constitutes the daily arena and phenomena of clinical medicine. Clinical medicine is, among other things, the routine intervention in this intertwining. This fact is largely discounted by biomedical science, which concentrates on 'the natural' at the expense of neglecting 'the existential'. Such neglect arguably underlies the perceived deficiencies in medical education that the GMC sought to redress in its landmark document Tomorrow's Doctors. If the humanities disciplines concern themselves with recording and interpreting human experiences, the 'medical humanities' do so for the human experiences of illness, disability and medical intervention. This paper argues for an integrated conception of the medical humanities, and for their incorporation into the core medical curriculum. The paper concludes by outlining a proposed core module in medical humanities, based around a syllabus divided not into the characteristic enquiries of constituent disciplines, but rather into groups of topics relating to key philosophical questions prompted by the 'intertwining' in embodied human nature.

Medicare financing of graduate medical education.

The past decade has seen ongoing debate regarding federal support of graduate medical education, with numerous proposals for reform. Several critical problems with the current mechanism are evident on reviewing graduate medical education (GME) funding issues from the perspectives of key stakeholders. These problems include the following: substantial interinstitutional and interspecialty variations in per-resident payment amounts; teaching costs that have not been recalibrated since 1983; no consistent control by physician educators over direct medical education (DME) funds; and institutional DME payments unrelated to actual expenditures for resident education or to program outcomes. None of the current GME reform proposals adequately address all of these issues. Accordingly, we recommend several fundamental changes in Medicare GME support. We propose a re-analysis of the true direct costs of resident training (with appropriate adjustment for local market factors) to rectify the myriad problems with per-resident payments. We propose that Medicare DME funds go to the physician organization providing resident instruction, keeping DME payments separate from the operating revenues of teaching hospitals. To ensure financial accountability, we propose that institutions must maintain budgets and report expenditures for each GME program. To establish educational accountability, Residency Review Committees should establish objective, annually measurable standards for GME program performance; programs that consistently fail to meet these minimum standards should lose discretion over GME funds. These reforms will solve several long-standing, vexing problems in Medicare GME funding, but will also uncover the extent of undersupport of GME by most other health care payers. Ultimately, successful reform of GME financing will require "all-payer" support.

ACGME requirements for end-of-life training in selected residency and fellowship programs: a status report.

National recommendations have been developed for physicians' end-of-life (EOL) education. No comprehensive assessment has been done to examine postgraduate (residency and fellowship) EOL training. The authors reviewed the EOL content for 46 specialties in postgraduate training programs that affect the care of seriously ill and dying patients, using data from the 2000/2001 AMA Graduate Medical Education Directory. Internal medicine, geriatrics, and neurology contained the most comprehensive EOL requirements. Most surgical specialties contained no EOL requirement except ethics. Ethics (n = 25) and psychosocial care (n = 22) were the most common EOL domains mandated, although specific EOL content was not specified. Training in EOL communication (n = 1), personal awareness (n = 3), and EOL clinical experiences (n = 5) were the least often required instructional domains. Instruction in pain assessment and management was required in only one surgical specialty. The lack of comprehensive EOL training requirements may help explain the known problems in physicians' EOL care. Major reform in EOL requirements is needed at the level of residency review committees.

Combined internal medicine-psychiatry and family medicine-psychiatry training programs, 1999-2000: program directors' perspectives.

Despite tremendous growth in the number of combined-training residency programs, little is known about their directorships, financing, recruitment, curricula, and attrition rates, and the practice patterns of graduates. The authors surveyed residency program directors from combined internal medicine-psychiatry (IM/PSY) and family medicine-psychiatry (FP/PSY) programs to provide initial descriptive information. Programs' directors were determined from the American Medical Association's Graduate Medical Education Directory and FREIDA online database. Three mailings of a pretested questionnaire were sent to the 40 identified combined IM/PSY and FP/PSY residency programs. A total of 32 directors from 29 programs responded. Most programs were under the dual directorship of representatives from both the psychiatry department and either the internal medicine or the family medicine program. Although most directors responded that the residency program was based in psychiatry, both departments shared in administrative, recruiting, and financial responsibilities. Curricula varied widely, with limited focus on combined training experiences. Graduates (n = 41) tended to practice in academic settings (37%), where both aspects of training could be used. Others practiced in either community mental health centers or traditional private practice settings. The estimated attrition rate from combined residencies was 11%. Combined-training programs are directed by a diverse group of individuals, including dual-boarded physicians. Curricula vary widely, but most programs are within recommended guidelines. Further prospective studies are warranted to determine predictors of attrition and future practice plans.

Athletes Not Invincible When It Comes to Mental Illness

Athletes Not Invincible When It Comes to Mental Illness

Book Review Educating for Professionalism: Creating a Culture of Humanism in Medical Education Edited by Delese Wear and Janet Bickel. 215 pp. Iowa City, University of Iowa Press, 2000. $42.95. 0-87745-741-7

Book Review Educating for Professionalism: Creating a Culture of Humanism in Medical Education Edited by Delese Wear and Janet Bickel. 215 pp. Iowa City, University of Iowa Press, 2000. $42.95. 0-87745-741-7

Educating for Professionalism: Creating a Culture of Humanism in Medical Education

Educating for Professionalism: Creating a Culture of Humanism in Medical Education

Education and debate: Developing the place of medical humanities in medical education from school to the consulting room

In this issue's Education and debate section Evans and Greaves describe two educational developments in medical humanities. These initiatives appear to raise two important issues in the context of developing...

Imagination and medical education

Rival and apparently exclusive views have been canvassed about the instrumental use of the humanities in medical education. The novel is seen as offering exemplifications of moral principles on the...

Country report: Australia

The last 10 years has been an interesting time for Australian medical education despite reduced funding. There are five main workforce trends: a rural/urban maldistribution, a need for more specialists, public hospital staffing difficulties, increasing female practitioners and under-representation of indigenous practitioners. Lack of resources is a problem facing Deans, with pressure for clinical service in teaching hospitals. Entrepreneurial activities have been undertaken including the enrollment of overseas students. Medical schools have also responded to important government initiatives. Australia's 11 medical schools have undergone significant reform in the last decade. There is a mix of four (graduate), five and six year courses. AUSTRALIA'S NEW MEDICAL SCHOOL: James Cook University opened the first medical school in northern Australia in 2000. The School admits students from rural, northern Australian and indigenous backgrounds. It has a strong regional mission. RURAL AND COMMUNITY-BASED EDUCATION: Government funding to address the maldistribution of the workforce has led to the establishment of rural clubs, Departments of Rural Health and community-based programs. There have been recent moves to improve education in the two years following graduation. This includes the initiation of national projects in curriculum and assessment. Postgraduate programs in Australia are being reformed to build on the changes in undergraduate education. CME is also under review. Australian medical educators should build on the recent reforms and take on some of the new directions in medical education.

Graduating medical students' exercise prescription competence as perceived by deans and directors of medical education in the United States: implications for Healthy People 2010.

This study examined perceptions of deans and directors of medical education at 128 allopathic schools of medicine in the US about the importance of physical activity and exercise topics, and their perceptions about the competence of graduating medical students to perform six fundamental skills related to exercise prescription. Healthy People 2010 recommends that clinicians counsel all patients about regular physical activity. However, in previous studies physicians identified lack of training as a barrier to physical activity counseling, and they questioned their own ability to advise patients properly. Using the 17-item Exercise and Physical Activity Competence Questionnaire, data were collected from 72 of 128 medical schools, for a response rate of 56%. While 58% of respondents indicated their typical graduate was competent in conducting a patient evaluation for the purpose of approving that patient to begin an exercise program, only 10% said their students could design an exercise prescription. Only 6% of respondents reported that their school provided a core course addressing the American College of Sports Medicine Guidelines for Exercise Testing and Prescription. Findings suggest a need for more undergraduate medical training in physical activity and exercise prescription.

Graduating medical students' exercise prescription competence as perceived by deans and directors of medical education in the United States: Implications for Healthy People 2010

Graduating medical students' exercise prescription competence as perceived by deans and directors of medical education in the United States: Implications for Healthy People 2010

American Academy of Pediatrics: Financing graduate medical education to meet pediatric workforce needs.

This statement reviews the current system of funding for graduate medical education (GME) in the United States and evaluates the potential of alternative GME funding mechanisms, including a portable authorization system, to meet future pediatric workforce needs. It addresses key issues relating to the financing of GME: Medicare direct medical education (DME) and indirect medical education adjustment (IMEA) payments, an all-payer GME trust fund, and a market mechanism to distribute GME funds for both core pediatric and pediatric subspecialty education. In a concluding series of recommendations, the statement calls for changes to the current system of GME funding to ensure the production of a pediatrician workforce that will be able to meet the future needs of infants, children, adolescents, and young adults.

The Institute on Human Values in Medicine: its role and influence in the conception and evolution of bioethics.

For ten years, 1971-1981, the Institute on Human Values in Medicine (IHVM) played a key role in the development of Bioethics as a field. We have written this history and analysis to bring to new generations of Bioethicists information about the development of their field within both the humanities disciplines and the health professions. The pioneers in medical humanities and ethics came together with medical professionals in the decade of the 1960s. By the 1980s Bioethics was a fully recognized discipline. We show the role that IHVM programs played in defining the field, training faculty and helping schools to develop programs. We review, the beginnings of the IHVM in the crucible of social and technological change that led to the establishment of the IHVM's parent organization, the Society for Health and Human Values. We then turn to the IHVM programs through which Faculty members received fellowships to explore new crossovers between the humanities and the health professions. We have not only described the Fellows Program as it existed in 1973-1980, but have completed a survey of the fellows a quarter of a century after they held their fellowships. We describe other IHVM programs designed to facilitate the initiation and development of new humanities programs, to explore conceptual issues between medicine and five humanities fields, to conduct issue driven or educational method conferences and to advance humanities programs into graduate education through the Directors of Medical Education.

Continuing medical education directory

Continuing medical education directory

Morning report: focus and methods over the past three decades.

Residents rank morning report as the most important educational activity of their residency training. Although there is a lack of documented evidence as to the educational value of morning report, the practice is ubiquitous across almost all primary care residency programs in North America. The ever-changing practice of medicine and ongoing demands for evidence in medical education force us to examine essential aspects of morning report in order to base future decisions about morning report on sound educational evidence. Thus, a systematic review of the published literature on morning report was done in order to identify the various purposes and modalities of morning report, to find evidence in support of its educational value, and to discuss possible future directions for research on morning report. The term ‘‘morning report’’ is used to describe case-based conferences where residents, attending physicians, and others meet to present and discuss clinical cases. The term includes resident reports, morning or housestaff conferences, and morning sessions but excludes work rounds or teaching rounds. In a typical morning report, the team on duty during the night presents recently admitted patients, followed by a general discussion of the cases and related topics.

The presence of hospitalists in medical education.

The presence of hospitalists in medical education.

The decline and fall of humanism in medical education.

Medical EducationVolume 34, Issue 8 p. 596-597 The decline and fall of humanism in medical education Mark Albanese, Mark Albanese Wisconsin, USASearch for more papers by this author Mark Albanese, Mark Albanese Wisconsin, USASearch for more papers by this author First published: 25 December 2001 https://doi.org/10.1046/j.1365-2923.2000.00745.xCitations: 7 Mark Albanese Dr Professor of Preventive Medicine, University of Wisconsin Medical School, Madison, Wisconsin, USA Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume34, Issue8August 2000Pages 596-597 RelatedInformation