Becoming a physician....it's all about being competant

[Goro]

http://www.nejm.org/doi/full/10.1056/NEJMp1712900

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[Sharknad0]

Competent, Goro. Looks like someone didn’t cut it.


Sent from my iPhone using SDN mobile

 

[ekmf27050]

I'm actually looking for fun-based medical education as I aim to heal through the power of laughter.

Competency-based education seems hard and less laughter-inducing.

 

[mwsapphire]

This....article is behind paywall.
Am I missing something here?

 

[libertyyne]

I'm actually looking for fun-based medical education as I aim to heal through the power of laughter.

Competency-based education seems hard and less laughter-inducing.

 

[Trollest]

This....article is behind paywall.
Am I missing something here?

In that case, i am afraid a credit card is what you are missing.

 

[Goro]

This....article is behind paywall.
Am I missing something here?

Your University should be able to let you access the article . When in doubt try talking to your friendly librarian

 

[mwsapphire]

Your University should be able to let you access the article . When in doubt try talking to your friendly librarian

That's fine lol I just thought that was the joke or something and I was wicked confused.

 

[Geo16]

Your University should be able to let you access the article . When in doubt try talking to your friendly librarian

Guess I have to connect to our school's wifi today..

 

[chemdoctor]

Guess I have to connect to our school's wifi today..

Definitely the last resort for me too xD

 

[begoood95]

This....article is behind paywall.
Am I missing something here?

Guess I have to connect to our school's wifi today..

Use sci-hub, and unlock almost any article you please, from any location.

 

[begoood95]

"We believe that UME’s longstanding goal of producing undifferentiated physicians ready to pursue specialty training requires reexamination. The alarming costs of UME and associated student debt, the increasing volume and complexity of the knowledge and skills expected from trainees, and concerns among GME program directors that students are unprepared for residency suggest that change is needed. CBME holds the promise of producing a better-trained workforce — and for many physicians, this training could be accomplished within a shorter time frame."


I think the implied shift is a step in the right direction. Many medical students do know from day one (of medical school) the field in which they want to practice; I would also say that a non-insignificant portion of this cohort are making informed decisions. Of course, some do not know, and would rather spend time in medical school to explore more fields; this is also fine. Yet, what they're implying here is that for those that do know which specialty they'd like, it would be cogent to allow a "faster" tract to their field of interest.

I do think that medical education should still emphasize a broad education. But their case is strong, that debt, and the "increasing volume and complexity of the knowledge and skills expected from trainees," point to a solution which allows some students to make speciality decisions earlier on in their journey.

 

[Lucca]

seems like a positive set of changes to me from an educational standpoint. Interested to hear what SDN physicians have to say about this though:

"Challenges exist for entities such as the National Resident Matching Program, which relies on a fixed schedule to match students to residency positions. Residency programs will have to adapt their curricula to trainees who enter and complete training when they are ready to do so. Training experiences will have to focus on predefined outcomes for learners, not the requirements of staffing a clinical service. Faculty and learners will have to be educated in various ways of giving and receiving focused, constructive feedback and working as educational partners. New models for funding innovative residency training will also be required. In the meantime, program leaders could consider establishing more flexible residency-to-fellowship tracks within their institutions or developing creative partnerships with community practices for transitioning trainees into independent practice."

The bold in particular implies a much more involved -- and therefore more administratively demanding -- role for residents, faculty, and the residency program in general. Can such an educational model be reproduced just as easily in the busiest community hospitals in the country as easily as in, say, the Mayo Clinic?

 

[arcus]

http://www.nejm.org/doi/full/10.1056/NEJMp1712900

Thank you for bringing this article to our attention.

a few quotes and then a few questions for Goro given that you are faculty and “in the med ed system”

“Rather than insisting that a medical school or residency class proceed through medical education en masse, CBME focuses on all trainees demonstrating the competencies required for caring for a population by means of time-variable transitions from training to practice.”

“A 1978 monograph written for the World Health Organization explained how.....

“In 1999, the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) responded to public concerns about health care quality by resurrecting CBME. They mandated a shift to outcomes-based graduate medical education (GME), which broadened the requirements for graduating residents beyond appropriate patient care skills and medical knowledge to include competencies in practice-based learning and improvement, communication, professionalism, and systems-based practice.”

“Also key to assessment in CBME is a partnership between the learner and the assessor based on the sharing of formative feedback,....

“Medical education is strictly regulated in the United States, and many obstacles must be over-come if programs like EPAC are to succeed. For example, both the Liaison Committee on Medical Education and individual medical schools will need to allow learners to advance in a time-independent fashion. State licensing boards will need to adapt to the idea that medical school may be completed in less than 4 years. ACGME requirements for duration of training will need to be flexible, and specialty boards will need to allow trainees to take certification exams when they are deemed competent, rather than at a fixed time.”

“The alarming costs of UME and associated student debt, the increasing volume and complexity of the knowledge and skills expected from trainees, and concerns among GME program directors that students are unprepared for residency suggest that change is needed.”​

Questions for Goro (and any other leaders in medical education):

• How realistic is this article as to effecting any change in the present med ed paradigm?
• Given the enormous amount of revenue to be made by all those entities that comprise med ed (bolded above), what are the chances they will walk away from said revenue just to make the changes necessary as cited by the authors?
• Our med ed system is driven for revenue. How practical is it to be quoting World Health Organization since their (WHO) view is as far away from revenue making as possible?

The initial sets of words I have bolded struck me as being very far from our present med ed paradigm, as far as east is from west.

Caring? The word “caring” has been used for so long in the health care system that it lacks any credibility. No one in health care leadership roles cares about anything except them$elve$. Lets be honest.

The ACGME / ABMS responded in 1999 to public concern. What metric was used to assess what their response effected and how did the public react? Hint: it has gotten far far worse since 1999.

Partnership between learner and the assessor? Wow. That is a whopper. Third year clinical rotations has little to no evidence of partnerships and 4th year is worse. Mentoring, discipling, taking a student under a professor’s wing....all fantasy.

In summary, the med ed leaders have gotten richer, while the system has lost any semblance of caring, walked away from partnering has ceased to respond to anyone other than regulators and whatever metrics they deem necessary to grow their brand.

The article was wonderful and spot on. It will die a quiet death in the NEJM archives while the med ed system continues to consume all the revenue it can devour, health care quality be damned.

 

[Goro]

Oh please. Your typical MD school actually loses money on medical education proper. Any academic dept' can bring in more money from indirects on extramural grants than they can from an entire class of medical student tuition.

The DO schools can get away with a tuition-based model because they don't have all those annoying accreditation requirements imposed upon them by the LCMC because COCA is Ok with minimal scholarly activity (alas).

Several med school have embraced the three-year curriculum model as a means of getting more Primary Care docs out. It didn't bother them. I don't foresee a flood of people jumping into this for one year's less tuition because more people are interested in specialties.

Much to the chagrin of the hypercheivers, the move towards competency-based education includes resident training, and now it's moving to selecting students for med school.

 

[arcus]

Oh please. Your typical MD school actually loses money on medical education proper. Any academic dept' can bring in more money from indirects on extramural grants than they can from an entire class of medical student tuitionl.

No business has the luxury to work as a silo. Med ed doesnt exist simply to teach medicine. Cmon, you know this. That was last century. At my state university, large as it is, the MD school is a brand that is regularly positioned with the behemoth health system operating under the state university President. He is President of the university and the health system. The Dean of the SOM is Exec VP for the medical affairs of the health system

State university medical schools are all in it together with their own health system. This cant be new information to you.

 

[Goro]

No business has the luxury to work as a silo. Med ed doesnt exist simply to teach medicine. Cmon, you know this. That was last century. At my state university, large as it is, the MD school is a brand that is regularly positioned with the behemoth health system operating under the state university President. He is President of the university and the health system. The Dean of the SOM is Exec VP for the medical affairs of the health system

State university medical schools are all in it together with their own health system. This cant be new information to you.

And your point?

Did you even read what I wrote?

 

[begoood95]

No business has the luxury to work as a silo. Med ed doesnt exist simply to teach medicine. Cmon, you know this. That was last century. At my state university, large as it is, the MD school is a brand that is regularly positioned with the behemoth health system operating under the state university President. He is President of the university and the health system. The Dean of the SOM is Exec VP for the medical affairs of the health system

State university medical schools are all in it together with their own health system. This cant be new information to you.

I really know nothing at this point of the administrative load of leaders (presidents, VPs, etc.) within the med ed system. However, as you’ve illustrated through your posts and example, it appears that there’s a conflict of interest of sorts: if we in reality want to “care” for patients, and obtain a quality of care of which we strive to achieve, it looks as though we ought to shake up those in positions of power.

When someone has previously had a career in which their goals are profit and revinue based, it’s hard to expect the opposite—some altruism—of them. Maybe we ought to select better leaders, which will then spearhead these campaigns with genuine intent, which will bettter achieve the goal outlined in the paper.

 

[libertyyne]

There is not an adequate number of physicians or the money available to improve post graduate training in the way that it is currently funded. Reducing the patient load for Attendings and residents is just not a viable option especially considering hospitals have razor thin margins already. I dont know what the solution is but this may not be it. Plus the level of complexity this will add and administrative burden to administer something like this will be incredibly high. It is the equivalent of saying lets abandon grades in primary schooling and let each person advance as they gain competency. The problem with that is it will take more money, more one one interaction, more flexibility and administrative burden, for what seems like an untested hypothesis.

 

[arcus]

...considering hospitals have razor thin margins already.

I am surprised you of all people wrote that bolded statement.

I dont know what the solution is but this may not be it. Plus the level of complexity this will add and administrative burden to administer something like this will be incredibly high. It is the equivalent of saying lets abandon grades in primary schooling and let each person advance as they gain competency. The problem with that is it will take more money, more one one interaction, more flexibility and administrative burden, for what seems like an untested hypothesis.

The solution is to stop using medicine as an industry. Period.

Start seeing medicine as a calling, a vocation, a service, a pleasure, nay a duty, to serve others in medical need. take profits out of the service. Why hasnt America learned that our obsession with profit has broken the once wonderful American experimemt?

The answer is to return to true care, to relationships, to the physician-patient once sacred bond, and throw all the voyeurs out of the relationship. The NEJM article has the right focus but as stated earlier, it is DOA. Too many self serving interests at the expense of caring and relationships.

Will it be possible to execute the NEJM article vision? I do not think so until we change our view of medicine.
Start with medical schools

 

[libertyyne]

I am surprised you of all people wrote that bolded statement.



The solution is to stop using medicine as an industry. Period.

Start seeing medicine as a calling, a vocation, a service, a pleasure, nay a duty, to serve others in medical need. take profits out of the service. Why hasnt America learned that our obsession with profit has broken the once wonderful American experimemt?

The answer is to return to true care, to relationships, to the physician-patient once sacred bond, and throw all the voyeurs out of the relationship. The NEJM article has the right focus but as stated earlier, it is DOA. Too many self serving interests at the expense of caring and relationships.

Will it be possible to execute the NEJM article vision? I do not think so until we change our view of medicine.
Start with medical schools

oh i agree with you. I am just being realistic here. I want all Children in grade school to recieve individualized focus and one on one training as well. That sure as hell aint happening either. Oh and how about world hunger lets ger rid of that while we are at it.

 

[arcus]

oh i agree with you. I am just being realistic here. I want all Children in grade school to recieve individualized focus and one on one training as well. That sure as hell aint happening either. Oh and how about world hunger lets ger rid of that while we are at it.

you got to have dreams bubba.

if you stop dreaming, you stop living. someone famous said that but I cant recall who

 

[libertyyne]

you got to have dreams bubba.

if you stop dreaming, you stop living. someone famous said that but I cant recall who

we cant even provide every american with access to healthcare. We cant ensure that children dont go hungry or dont have food insecurity. Medical training is very low on the totem pole of dreams.

 

[arcus]

we cant even provide every american with access to healthcare. We cant ensure that children dont go hungry or dont have food insecurity. Medical training is very low on the totem pole of dreams.

Visit Venezuela, Haiti, Dominican Republic, etc

We dont have poverty in America

 

[libertyyne]

Visit Venezuela, Haiti, Dominican Republic, etc

We dont have poverty in America

have you been to detroit? Gary Indiana, heck even appalachia.

 

[arcus]

have you been to detroit? Gary Indiana, heck even appalachia.

Venezuelans, as of mid 2017, have lost on average of 19 lbs.

What is the BMI trend of USA these past 4 decades? Hint, it hasnt declined

 

[libertyyne]

Venezuelans, as of mid 2017, have lost on average of 19 lbs.

What is the BMI trend of USA these past 4 decades? Hint, it hasnt declined

so you would rather spend resources on improving gme vs aiding venezuelans?

 

[Lucca]

lets get this thread back on track pls

 

[DexDaDog]

Use sci-hub, and unlock almost any article you please, from any location.

Have never heard of Sci-Hub. Thank you!
No more driving to campus on to unlock one paper in SciFinder.

 

[Lardy Boy]

Darn. I really wanted to read the article, but need to be a subscriber.