JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3 p.m. CT, Tuesday, September 6, 2005)
JAMA NEWS RELEASES—THEME ISSUE ON MEDICAL EDUCATION
LONG MEDICAL RESIDENCY HOURS ASSOCIATED WITH IMPAIRED PERFORMANCE SIMILAR TO EFFECTS OF DRINKING ALCOHOL
MEDICAL STUDENTS AT RISK FOR INFLUENCE FROM PHARMACEUTICAL COMPANIES' MARKETING EFFORTS
RESIDENT PHYSICIANS REPORT THAT TRAINING OFTEN NOT ADEQUATE TO TREAT PATIENTS FROM OTHER CULTURES
NUMBER OF STUDENTS IN U.S. MEDICAL SCHOOLS REMAINS CONSTANT OVER 10 YEARS
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
VIDEO: Windows Media | Quicktime
MEDICAL STUDENTS AT RISK FOR INFLUENCE BY PHARMACEUTICAL INDUSTRY
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
TV Note: This week's JAMA video news release is on medical students' exposure to and attitudes about drug companies' marketing efforts. The release will be fed Tuesday, September 6, from 9:00 - 9:30 a.m. ET on Intelsat America 6 (formerly Telstar 6), Transponder 11 (C-Band) and from 2:00 - 2:30 p.m. ET on Intelsat America 6, Transponder 11 (C-Band). For more information, call 312/464-JAMA (5262).
JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ONLINE
Go to www.jamamedia.org for more information and to apply for access.
Save the Dates:
September 16-18, Chicago
JAMA and BMJ will host the 5th International Congress on Peer Review and Biomedical Publication. New research will be released on topics including clinical trial registries, conflict of interest, scientific misconduct, bias in funding and sponsorship, and reporting clinical trials. For more information, go to www.jama-peer.org. To register, go to www.jamamedia.org and click on Events; email mediarelations{at}jama-archives.org; or call 312-464-JAMA (5262).
September 20, New York
JAMA will release new studies on the future of Biomedical Research at Rockefeller University in New York on Tuesday, September 20, from 10 a.m. to Noon. A program will be included in a future email. To register, go to www.jamamedia.org and click on Events; email mediarelations{at}jama-archives.org; or call 312-464-JAMA (5262).
Please Note: The FOR THE MEDIA Web site now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org
Embargoed for Release: 3 p.m. CT, Tuesday, September 6, 2005
Media Advisory: To contact J. Todd Arnedt, Ph.D., call Kara Gavin at 734-647-2220.
To contact editorial co-author Phyllis Zee, M.D., Ph.D., call Elizabeth Crown at 312-503-8928.
LONG MEDICAL RESIDENCY HOURS ASSOCIATED WITH IMPAIRED PERFORMANCE SIMILAR TO EFFECTS OF DRINKING ALCOHOL
CHICAGO—During heavy call rotation and long hours, effects on residents' neurobehavioral performance are comparable to the impairment associated with a 0.04 to 0.05 grams percent blood alcohol concentration, according to an article in the September 7 issue of JAMA, a theme issue on medical education.
"Work-related sleep loss and fatigue in medical training has become a source of increasing concern," according to background information in the article. One study found that interns got 5.8 hours less sleep, had 50 percent more attentional mistakes, and made 22 percent more serious errors on critical care units while working a traditional schedule compared with a schedule with less hours. Also, self-reported lifetime rates of motor vehicle crashes and near-miss crashes among residents are 3 and 2.5 times those of nonresident drivers, respectively.
J. Todd Arnedt, Ph.D., from the University of Michigan, Ann Arbor, and colleagues compared post-call neurobehavioral performance of 34 medical residents (18 women, 16 men) after their rotations to examine the effect of extended work hours. The residents were tested after light call rotation (four-week rotations averaging 44 hours per week), light call with alcohol, heavy call (an average of 90 hours per week, every fourth or fifth night, 80 hours after July 2003), and heavy call with placebo. In the light call with alcohol condition, participants' blood alcohol concentrations were raised to 0.05 grams percent. Average age of residents was 28.7 years.
The researchers found that performance impairment during a heavy call rotation was comparable to impairment associated with a .04 to .05 grams percent blood alcohol concentration during a light call rotation. Compared with light call, heavy call reaction times were 7 percent slower and lane variability and speed variability during the simulated driving test were 27 percent and 71 percent greater, respectively. Speed variability was 29 percent greater in heavy call with placebo than light call with alcohol, and there were similar errors and reaction times.
"These findings have important clinical implications. Residents must be aware of post-call performance impairment and the potential risk to personal and patient safety. There should be sleep loss, fatigue and countermeasure education in residency programs. Because sleepy residents may have limited ability to recognize the degree to which they are impaired, residency programs should consider these risks when designing work schedules and develop risk management strategies for residents, such as considering alternative call schedules or providing post-call napping quarters. Additional studies should examine the impact of these operational and educational interventions on resident driving safety and on patient care and safety," the authors conclude.
(JAMA. 2005;294:1025-1033. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by a grant from American Sleep Medicine Foundation (formerly the Sleep Medicine Education and Research Foundation) from the American Academy of Sleep Medicine.
EDITORIAL: WORK HOURS AND REDUCING FATIGUE-RELATED RISK - GOOD RESEARCH VS. GOOD POLICY
In an accompanying editorial, Drew Dawson, Ph.D., from the University of South Australia, Adelaide, South Australia, and Phyllis Zee, M.D., Ph.D., from the Feinberg School of Medicine, Northwestern University, Chicago, write, "While there is little doubt that physicians-in-training work long hours and experience chronic sleep restriction over many years, the consequences remain unclear."
"Although the authors [Arnedt et al] acknowledge that these laboratory tests of performance have not been validated against medical tasks, the indirect implication is that residents working 80- to 90-hour weeks are at an equivalent or greater risk compared with an intoxicated physician. This is, without doubt, a notable finding and one that should concern those responsible for patient safety and medical training."
"Despite the appeal of restricting working hours, it is important to consider potential negative ramifications," the editorialists write. "In some scenarios, limiting working hours may increase risk to patients and physicians. For example, restricted working hours may lead to restricted access to health care practitioners through a reduction in the labor supply, insufficient clinical preparation for the 'real world,' increased sleep restriction in senior physicians, or increases in error rates due to work intensification."
They conclude by saying, "Failure to consider the broader issue carries the considerable hazard that well-intentioned policies to reduce fatigue-related risk may not lead to overall improvements in patient safety."
(JAMA. 2005;294:1104-1106. Available pre-embargo to the media at www.jamamedia.org)
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3 p.m. CT, Tuesday, September 6, 2005
Media Advisory: To contact Frederick S. Sierles, M.D., call Kathleen Peterson at 847-578-8344.
MEDICAL STUDENTS AT RISK FOR INFLUENCE FROM PHARMACEUTICAL COMPANIES' MARKETING EFFORTS
CHICAGO—Third-year medical students receive on average one gift or attend one activity sponsored by a pharmaceutical company per week, and most believe that sponsored educational events are likely to be biased, according to an article in the September 7 issue of JAMA, a theme issue on medical education.
Medical students are entering an environment with progressively fewer boundaries between medicine and the pharmaceutical industry, which spends $12 billion to $18 billion annually marketing to physicians (including residents), according to background information in the article. This includes 60 million visits annually by pharmaceutical representatives and most of the $1.54 billion spent annually on continuing medical education. Drug company-physician interaction presents information favoring the sponsor's product and increases the likelihood of prescribing that product. Prescribing may be inconsistent with evidence-based guidelines and may reflect the presence of drug samples or patient demand due to direct-to-consumer advertising, even if a drug was not the physician's first choice. While exposure to and attitudes about drug company interactions among residents have been studied extensively, relatively little is known about relationships between drug companies and medical students.
Frederick S. Sierles, M.D., of the Rosalind Franklin University of Medicine and Science, North Chicago, Ill., and colleagues measured the frequency of medical students' exposure to drug company gifts, students' attitudes about gifts, and correlates of these frequencies and attitudes. In 2003 the researchers distributed a 64-item anonymous survey to 1,143 third-year students at 8 U.S. medical schools, exploring their exposure and response to drug company interactions. The schools' characteristics included a wide spectrum of ownership types, National Institutes of Health funding, and geographic locations. In 2005, the researchers conducted a national survey of student affairs deans to measure the prevalence of school-wide policies on drug company-medical student interactions.
The overall response rate of the surveys was 72.3 percent (826/1,143). The researchers found that average exposure for each student was 1 gift or sponsored activity per week. Of respondents, 93.2 percent were asked or required by a physician to attend at least 1 sponsored lunch. Regarding attitudes, 68.8 percent believed gifts would not influence their practices and 57.7 percent believed gifts would not affect colleagues' practices. Of the students, 80.3 percent (553/604) believed that they were entitled to gifts. Of 183 students who thought a gift valued at less than $50 was inappropriate, 86.3 percent had accepted one.
Nearly 60 percent (59.6 percent) of the students simultaneously believed that sponsored grand rounds are educationally helpful and are likely to be biased. Students at one school who had attended a seminar about drug company-physician relationships were no more likely than the non-attending classmates to show skepticism. Of the respondents, 85.6 percent did not know if their school had a policy on these relationships. In a national survey of student affairs deans, among the 99 who knew their policy status, only 10.1 percent reported having school-wide policies about these interactions.
"Our study adds to previous literature by demonstrating experiences and attitudes among large numbers of students at a variety of medical schools and indicating acceptance of the value of drug company?sponsored gifts and activities. Research should focus on evaluating methods to limit these experiences and affect the development of these attitudes, with a goal of ensuring that physicians' decisions are based solely on helping the individual patient achieve the greatest possible benefit," the authors conclude.
(JAMA. 2005;294:1034-1042. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: The Alliance for Clinical Education (ACE) funded supplies (cover letter, survey form, envelopes, postage) for the 2005 student affairs survey of deans. There was no other external funding. For the financial disclosures of the authors, please see the JAMA article.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3 p.m. CT, Tuesday, September 6, 2005
Media Advisory: To contact Joel S. Weissman, Ph.D., call Donita Bodie at 617-724-5627.
RESIDENT PHYSICIANS REPORT THAT TRAINING OFTEN NOT ADEQUATE TO TREAT PATIENTS FROM OTHER CULTURES
CHICAGO—Many resident physicians report a lack of preparedness in caring for patients with specific cultural characteristics, such as those who have beliefs or practices at odds with Western medicine, according to an article in the September 7 issue of JAMA, a theme issue on medical education.
Sociocultural differences between patients and physicians influence communication and clinical decision making, and there is evidence that patient-physician communication is directly linked to patient satisfaction, adherence, and overall quality of care, according to background information in the article. Unexplored or misunderstood sociocultural differences between patients and physicians can lead to patient dissatisfaction, poor adherence to treatment, and poor health outcomes. In an effort to provide health care professionals with the knowledge and skills to effectively care for diverse populations, an educational movement in "cross-cultural care" has emerged. Little has been known about residents' educational experience in this area.
Joel S. Weissman, Ph.D., of Massachusetts General Hospital, Boston, and colleagues conducted a study to assess the self-perceived preparedness of resident physicians to provide quality care to diverse patient populations and to determine whether they reported receiving formal training and evaluation in cross-cultural care during their residency. To accomplish this, surveys were mailed in 2003 to approximately 3,500 residents in 7 specialties in their final year of training at major U.S. teaching hospitals.
Responses were obtained from 60 percent (2,047) of the sample. Virtually all (96 percent) of the residents indicated that it was moderately or very important to address cultural issues when providing care. The number of respondents who indicated that they believed they were not prepared to care for diverse cultures in a general sense was only 8 percent. However, a larger percentage of respondents believed they were not prepared to provide specific components of cross-cultural care, including caring for patients with health beliefs at odds with Western medicine (25 percent), new immigrants (25 percent), and patients whose religious beliefs affect treatment (20 percent). In addition, 24 percent indicated that they lacked the skills to identify relevant cultural customs that impact medical care. In contrast, only a small percentage of respondents (1 percent-2 percent) indicated that they were not prepared to treat clinical conditions or perform procedures common in their specialty.
Approximately one-third to half of the respondents reported receiving little or no instruction in specific areas of cross-cultural care beyond what was learned in medical school. Forty-one percent (family medicine) to 83 percent (surgery and obstetrics/gynecology) of respondents reported receiving little or no evaluation in cross-cultural care during their residencies. Barriers to delivering cross-cultural care included lack of time (58 percent) and lack of role models (31 percent).
"These findings have implications for how residency training programs prepare physicians to provide high-quality care to an increasingly diverse nation. The practice of medicine continues to be complex and it is difficult to achieve a high level of competence in all areas. Nevertheless, the views from residents indicate that a lot of additional training and the presence of good role models and mentors go a long way to ensure that they are sufficiently skilled to deliver high-quality medical care," the authors write.
"Our study is the first, to our knowledge, to obtain a national estimate of the readiness of new physicians to deliver high-quality care to culturally diverse populations. While attitudes regarding the importance of cross-cultural care seem to be positive, there appear to be relatively few opportunities for meaningful education and mentoring, and little evaluation. These findings highlight a need for significant improvement in cross-cultural education to help eliminate racial and ethnic disparities in health care," the authors conclude.
(JAMA. 2005;294:1058-1067. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This work was supported by grants from The California Endowment and The Commonwealth Fund.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3 p.m. CT, Tuesday, September 6, 2005
Media Advisory: To contact Barbara Barzansky, Ph.D., or Sarah E. Brotherton, Ph.D., call Jim Michalski at 312-464-5785.
NUMBER OF STUDENTS IN U.S. MEDICAL SCHOOLS REMAINS CONSTANT OVER 10 YEARS
CHICAGO—The enrollment at U.S. medical schools has changed very little over the last 10 years,
according to an article in the September 7 issue of JAMA, a theme issue on medical education.
Barbara Barzansky, Ph.D., and Sylvia I. Etzel, of the American Medical Association, Chicago, examined the status of a number of variables related to medical education that represent areas that recently have been in flux or have potential impact on health care delivery. The study compared selected results of the Liaison Committee on Medical Education (LCME) Annual Medical School Questionnaire between 2004-2005 and 1994-1995. The questionnaire was sent to the deans of all 125 LCME-accredited medical schools. The response rate was 100 percent in both years.
The authors found that the number of medical students in 1994-1995 and in 2004-2005 remained constant, at about 67,000. The number of full-time faculty members increased from 90,016 in 1994-1995 to 119,025 in 2004-2005 (a 32 percent increase). In 2004-2005, 68 percent of all first-year medical students were residents of the state in which the medical school is located and an average of 43 percent of 2005 graduates remained in the same state as the medical school for graduate medical education; results were similar in 1995. In 2004-2005, night call was less common in the family medicine, internal medicine, pediatrics, and psychiatry clerkships compared with 1994-1995.
"A number of factors may have contributed to this increase [in faculty size]. Some disciplines, such as genetics and emergency medicine, increased well beyond the average, perhaps indicating a newly-defined need for this expertise for patient care or research. In addition, during 2002-2003 medical schools derived 35.9 percent of their total revenue from faculty practice and 32.6 percent from grants and contracts (including direct and facilities/administrative costs). Maintaining these revenue streams requires considerable faculty effort and has provided some of the impetus to increase the size of the faculty," the authors write.
"Many of the variables that we have examined, including faculty size and the geographic pipeline into medical school and residency training, may be affected by factors external to the medical school. Understanding these interrelationships will be critical in addressing important issues in medical education and health care today and in the future," the authors conclude.
(JAMA. 2005;294:1068-1074. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This research was funded solely by the American Medical Association, which employs Dr. Barzansky and Ms. Etzel.
RECORD NUMBER OF RESIDENTS AND FELLOWS IN TRAINING PROGRAMS
There are more than 100,000 physicians-in-training in the U.S., the highest recorded amount, according to an article in this issue of JAMA.
Over the last decade, the primary care specialties have experienced an ebb and flow in popularity, according to background information in the article. A description of the future primary care workforce could help plan for the health care needs of the population.
Sarah E. Brotherton, Ph.D., of the American Medical Association, Chicago, and colleagues examined graduate medical education data from the past 9 years to determine the major trends among residents in family medicine, internal medicine, pediatrics, combined internal medicine/pediatrics programs, and obstetrics/gynecology. They also examined trends in fellows training in Accreditation Council for Graduate Medical Education (ACGME)-accredited subspecialties of internal medicine and pediatrics.
The study of the National GME Census, conducted by the American Medical Association and Association of American Medical Colleges, included survey data from 8,246 allopathic graduate medical education (GME) programs during the academic year 2004-2005 about active, transferred, and graduated residents, as well as about program characteristics. Program directors confirmed the status of 97.3 percent of active residents. The accompanying program survey was completed by 7,163 (87 percent) of the program directors.
The census counted 101,291 physicians-in-training during the 2004-2005 academic year, the largest number ever recorded by this survey. The number of osteopathic medical school graduates (DOs) in allopathic GME decreased from 5,838 in 2003-2004 to 5,675, following many years of annual increases. The number of residents in primary care specialties reached a peak in the mid 1990s. The number of family medicine residents who are graduates of U.S. allopathic medical schools (USMDs) has fallen from 8,232 (77.6 percent) in 1998-1999 to 4,848 (51.7 percent) in 2004-2005. The number of primary care residents who are graduates of foreign medical schools and U.S. citizens (USIMGs) nearly doubled between 1995-1996 (n = 1,768) and 2004-2005 (n = 3,304).
The number of USIMGs training in internal medicine or pediatrics subspecialties increased by 45.7 percent between 1995-1996 (n = 622) and 2004-2005 (n = 906). The number of pediatric subspecialty fellows grew 55.7 percent, mostly because of the near doubling of USMDs, from 813 to 1,617. More than half of primary care residents are women (52.5 percent). All primary care specialties and subspecialties experienced gains in the proportion of female residents, with the greatest in obstetrics/gynecology, which increased by 28.7 percent (57.9 percent in 1995-1996 vs. 74.5 percent in 2004-2005).
"There are now more than 100,000 physicians training in ACGME-accredited programs. An increasing proportion of these physicians are pursuing subspecialty training, while the number in primary care specialties has leveled off after a period of popularity in the mid 1990s. The trends we describe suggest that the primary care medical workforce of the future will include more women, more IMGs, and more DOs, information which may inform the current discussions about physician workforce needs," the authors conclude.
(JAMA. 2005;294:1075-1082. Available pre-embargo to the media at www.jamamedia.org)
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
MEDICAL STUDENTS AT RISK FOR INFLUENCE BY PHARMACEUTICAL INDUSTRY
VIDEO:
NAT SOT UP FULL FOR :03
Close up of pen lighting up
AUDIO:
"There’s the changing color ones. Ooohh."
VIDEO:
B-ROLL
Students sitting around table playing with pens and other pharmaceutical company gadgets
@:09
Super: Rosalind Franklin University
North Chicago, IL
AUDIO:
THESE THIRD-YEAR MEDICAL STUDENTS SEE THESE KIND OF PHARMACEUTICAL COMPANY PENS AND GADGETS EVERY DAY IN HOSPITALS AND DOCTORS’ OFFICES. ARE THEY LIKELY TO BE INFLUENCED SO THAT WHEN THEY BECOME DOCTORS, THEY’LL WRITE MORE PRESCRIPTIONS FOR THE PRODUCTS PROMOTED HERE?
VIDEO:
SOT/FULL
@ :17
Super: Anna Litmanovich
Medical Student
Runs :03
AUDIO:
"I hope it’s not affecting me. It hasn’t so far."
VIDEO:
GFX/JAMA COVER
B-ROLL
Students with pens, etc.
AUDIO:
BUT A NEW STUDY IN A THEME ISSUE ON MEDICAL EDUCATION IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, SAYS MOST MEDICAL STUDENTS ARE AT RISK FOR BEING INFLUENCED BY PHARMACEUTICAL COMPANY MARKETING EFFORTS.
VIDEO:
SOT/FULL
@ :32
Super: Frederick Sierles, M.D.
Rosalind Franklin University
Runs :14
AUDIO:
"There’s a risk that this will influence prescribing, let’s say, or an over-emphasis on prescribing, rather than just thoughtful diagnosis, and that’s going to be less than the best possible care that patients receive."
VIDEO:
B-ROLL
Dr. Sierles and colleague at computer
Students with pens, etc.
AUDIO:
DR. FREDERICK SIERLES (rhymes with "girls") AND COLLEAGUES AT ROSALIND FRANKLIN UNIVERSITY AND EIGHT OTHER MEDICAL SCHOOLS, SURVEYED MORE THAN EIGHT-HUNDRED MEDICAL STUDENTS ACROSS THE COUNTRY TO FIND OUT HOW OFTEN THEY ENCOUNTER PHARMACEUTICAL COMPANY MARKETING, AND HOW THEY FEEL ABOUT IT.
VIDEO:
SOT/FULL
Frederick Sierles, M.D.
Rosalind Franklin University
Runs :05
AUDIO:
"It’s basically once a week they’re receiving something directly or indirectly from a drug company."
VIDEO:
B-ROLL
Drug samples on storage closet shelves
Pens, etc. on table CONTINUE COVER
AUDIO:
WHETHER IT BE THROUGH DRUG SAMPLES, GIFTS LIKE THESE, OR THROUGH A DRUG COMPANY-SPONSORED LUNCH OR EVENT.
VIDEO:
SOT/FULL
Frederick Sierles, M.D.
Rosalind Franklin University
Runs :22
AUDIO:
"The majority of them don’t think that this exposure is going to affect their eventual prescribing practices."(stop cover video here) "Every study that’s tested this shows doctors are exposed, they think that it’s not affecting them and there they go and they go out and prescribe the drug."
VIDEO:
B-ROLL
Students with marketing materials
AUDIO:
NINETY-THREE PERCENT OF THE STUDENTS HAD BEEN ASKED OR REQUIRED BY A PHYSICIAN TO ATTEND A LUNCH SPONSORED BY A DRUG COMPANY. SOME STUDENTS FEEL SUCH INTERACTIONS ARE SIMPLY PART OF THE REAL WORLD OF MEDICINE.
VIDEO:
SOT/FULL
@: 1:47
Super: Elson Lai
Medical Student
Runs :08
AUDIO:
"Without pharmaceutical companies, there wouldn’t be any drugs to prescribe. So it’s kind of like it goes both ways."
VIDEO:
B-ROLL
Students at table
Student clicking pen to make it change colors
AUDIO:
BUT DR. SIERLES SAYS MEDICAL STUDENTS SHOULD GET TRAINING TO COUNTER THE MARKETING’S EFFECTS. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
