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: 3:00 p.m. CT, Tuesday, September 5, 2006)
JAMA NEWS RELEASES — Theme Issue on Medical Education
MEDICAL INTERNS OFTEN WORK LONGER HOURS THAN MANDATED, AT INCREASED RISK FOR INJURIES
DISTRESS FROM SELF-PERCEIVED MEDICAL ERRORS COMMON AMONG RESIDENT PHYSICIANS
PROGRAMS HELP INCREASE NUMBER OF MINORITY AND DISADVANTAGED STUDENTS ADMITTED TO MEDICAL SCHOOLS
PHYSICIANS MAY HAVE LIMITED ABILITY TO ACCURATELY SELF-ASSESS THEIR OWN CONTINUING MEDICAL EDUCATION NEEDS
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
MEDICAL INTERNS REPORT NON-COMPLIANCE WITH WORK HOUR LIMITS – EXTENDED WORK HOURS LINKED TO INCREASED RISK OF NEEDLE OR SCALPEL INJURIES
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
TV Note: This week's JAMA Report Video is on the extended work-hours of medical interns and their risk of injury. The report will be fed Tuesday, September 5, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Intelsat America 6 (formerly Telstar 6), Transponder 11 (C-Band), Downlink Freq: 3920 MHz Vertical, Audio: 6.20/6.80. For more information, 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
JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ONLINE
Go to www.jamamedia.org for more information and to apply for access.
Embargoed for Release: 3:00 p.m. CT, Tuesday, September 5, 2006
Media Advisory: To contact the corresponding author of the first study, Charles A. Czeisler, Ph.D., M.D., call Lori Shanks at 617-534-1604. To contact Christopher P. Landrigan, M.D., M.P.H., call Jessica Podlaski at 617-534-1603. To contact commentary co-author Ingrid Philibert, M.H.A., M.B.A., call Julie Jacob at 312-755-7133.
MEDICAL INTERNS OFTEN WORK LONGER HOURS THAN MANDATED, AT INCREASED RISK FOR INJURIES
CHICAGO—It is common for medical interns to work beyond the recently implemented work-hour limits and be at increased risk for job-related injuries such as needlesticks and cuts, which were associated with longer hours and fatigue, according to two studies in the September 6 issue of JAMA, a theme issue on medical education.
Exposures to contaminated fluids from percutaneous (through the skin) needlesticks and lacerations are serious hazards associated with postgraduate medical training. These injuries may result in the transmission of blood-borne pathogens, including hepatitis and human immunodeficiency viruses, and thus have significant occupational health implications, according to background information in the article. Factors contributing to the occurrence of these percutaneous injuries (PIs) in physicians have not been well studied.
Najib T. Ayas, M.D., M.P.H., of Brigham and Women’s Hospital and Harvard Medical School, Boston, and colleagues examined the contributing factors for PIs in interns and assessed their relationship to extended-duration work. The study included Web-based surveys of self-reported percutaneous exposures from 2,737 of the estimated 18,447 interns in U.S. postgraduate residency programs from 2002 to 2003. Each month, comprehensive Web-based surveys asked about work schedules and the occurrence of PIs in the previous month.
From a total of 17,003 monthly surveys, 498 PIs were reported. Of these, 294 were due to lacerations from a sharp instrument (such as a scalpel), and 204 were due to a needlestick. Rates of injuries varied significantly, depending on type of residency. Interns in surgery and obstetrics/gynecology residency programs had the greatest risk, presumably because they perform more invasive procedures than other specialties.
In 90 percent of the 498 injuries, 1 or more factors contributing to the incident were reported. The most commonly reported contributing factor was a lapse in concentration (63.8 percent of the incidents), followed by fatigue (31.0 percent of the incidents). Percutaneous injuries were more frequent during extended work compared with nonextended work. Extended work injuries occurred after an average of 29.1 consecutive work hours; nonextended work injuries occurred after an average of 6.1 consecutive work hours. The rate of PI was twice as high during the nighttime than during the daytime.
“The association of these injuries with extended work duration is likely due to the adverse cognitive effects of the sleep deprivation associated with such extended work, consistent with experimental data,” the authors write.
“Given the potentially serious consequences of such injuries, implementation of safety measures designed to reduce the risk of these occupational injuries should be undertaken. The impact of comprehensive fatigue management programs on the risk of these occupational exposures should be evaluated,” the researchers conclude.
(JAMA. 2006;296:1055-1062. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
MOST MEDICAL INTERNS REPORT NON-COMPLIANCE WITH WORK-HOUR LIMITS
More than 80 percent of medical interns surveyed in 2003-2004 indicated they were working hours in excess of what is currently mandated, according to a study in the September 6 issue of JAMA.
In 2003, the Accreditation Council for Graduate Medical Education (ACGME) implemented work hour limits for all physicians-in-training (residents) in the United States, according to background information in the article. Each trainee is limited to a maximum of 30 consecutive work hours, a maximum of 80 weekly work hours, averaged over 4 weeks, and 1 day in 7 (averaged over 4 weeks) must be free of all duties. These limits were developed in response to national concern with the long work hours of residents.
Christopher P. Landrigan, M.D., M.P.H., of Brigham and Women’s Hospital and Harvard Medical School, Boston, and colleagues conducted a study to estimate the frequency with which interns (first-year residents) were compliant with the ACGME duty hour standards in the first year following implementation. The study consisted of monthly Web-based surveys to assess the work hours and sleep of 4,015 interns, conducted pre-implementation of ACGME standards (July 2002 through May 2003) and post-implementation (July 2003 through May 2004). Participants completed 29,477 reports of their work and sleep hours.
In the year following implementation of ACGME standards, 83.6 percent of participating interns reported work hours that were noncompliant during at least 1 month. Hours in violation of the duty hour standards were reported during 44.0 percent of the monthly reports received postimplementation; 61.5 percent of the months during which interns’ worked exclusively in hospital settings contained reported hours in violation of the standards. Over the year, monthly rates of noncompliance decreased from 48.8 percent to 38.0 percent. Comparing postimplementation to preimplementation, average weekly work hours decreased 5.8 percent, from 70.7 hours to 66.6 hours.
Working shifts greater than 30 consecutive hours was reported by 67.4 percent of interns. Averaged over 4 weeks, 43.0 percent reported working more than 80 hours weekly, and 43.7 percent reported not having 1 day in 7 off work duties. Postimplementation, average sleep duration increased 6.1 percent (22 minutes), however, reported average sleep during extended shifts decreased 4.5 percent.
The researchers write that there are several reasons why rates of noncompliance may have remained high. “First, the ACGME duty hour standards were unaccompanied by financial and technical support. Programs may not have the resources or expertise to redesign their schedules to the extent required. In addition, house officers are typically unwilling to depart precipitously at the scheduled change of shift when an emergent patient care situation demands their continued presence. Such situations are common in high intensity settings, yet most scheduling systems do not account for these commonplace emergencies.”
(JAMA. 2006;296:1063-1070. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
COMMENTARY: HIGH-QUALITY LEARNING FOR HIGH-QUALITY HEALTH CARE
In an accompanying commentary, David C. Leach, M.D., and Ingrid Philibert, M.H.A., M.B.A., of the Accreditation Council for Graduate Medical Education, Chicago, discuss the larger issues of medical residents’ learning environment.
“The academic community continues to contribute to the debate about resident duty hours and the broader elements of the learning environment to work toward ensuring high-quality learning for high-quality health care. Accreditation is not static; examples of programs and institutions that have successfully modified their patient care and learning environments inform the development of standards and enable the dissemination of new approaches to the problem of delivering safe and effective care in an environment that fosters good learning.”
“Professional standards suited to multidisciplinary teams, handoffs, and shift-based approaches to care are emerging and need further refinement; some of this is occurring already,” the authors write. “High-quality learning is impossible in the absence of high-quality patient care; likewise, high-quality patient care is impossible without high-quality learning. Attention to both is needed.”
(JAMA. 2006;296:1132-1134. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Financial disclosures – none reported.
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: 3:00 p.m. CT, Tuesday, September 5, 2006
Media Advisory: To contact Colin P. West, M.D., Ph.D., call John Murphy at 507-284-5005.
DISTRESS FROM SELF-PERCEIVED MEDICAL ERRORS COMMON AMONG RESIDENT PHYSICIANS
CHICAGO—About one-third of surveyed resident physicians report committing at least one major error during the study period, often associated with substantial personal distress, according to a study in the September 6 issue of JAMA, a theme issue on medical education.
Medical errors and patient safety are an important concern for patients and physicians. The proportion of hospitalized patients affected by medical errors has been estimated to be 5 percent to 10 percent, although it has approached 50 percent in some studies, according to background information in the article. The illness, death, and financial costs of these events may be great. Many reports on medical errors have focused on the rate at which errors affect patients. Less is known about the proportion of physicians who commit errors.
Colin P. West, M.D., Ph.D., of the Mayo Clinic College of Medicine, Rochester, Minn., and colleagues evaluated the frequency of perceived medical errors among internal medicine residents and measured the association of these medical errors with resident quality of life (QOL), burnout, symptoms of depression, and empathy. The study included data provided by 184 (84 percent) of 219 eligible internal medicine residents at Mayo Clinic Rochester. Participants began training in the 2003-2004, 2004-2005, and 2005-2006 academic years and completed surveys quarterly through May 2006. Surveys included self-assessment of medical errors and quality of life every 3 months and measures of burnout (depersonalization, emotional exhaustion, and personal accomplishment) and symptoms of depression every 6 months.
The researchers found that overall, 34 percent of study participants reported at least 1 major medical error during the study period, and 43 percent of residents completing at least 1 year of training reported errors. Of the participants, 20 percent reported 1 error, 6 percent reported 2 errors, and 8 percent reported 3 or more errors during the study period. Making a medical error in the previous 3 months was reported by an average of 14.7 percent of participants at each quarter. Self-perceived medical errors were associated with a subsequent decrease in quality of life and worsened measures in all domains of burnout.
Participants who reported self-perceived errors were about 3 times more likely to screen positive for depression. In addition, increased burnout in all domains and reduced empathy were associated with increased odds of self-perceived error in the following 3 months.
“Our results also suggest that residency programs should ensure that efforts are in place to prevent, identify, and treat burnout and to promote empathy and well-being for the welfare of residents and patients,” the authors write.
“A majority of residents discuss their errors with colleagues, supervising faculty, or friends and family, but formal programs to provide additional support for physicians who make errors appear warranted. Further investigation to identify the most effective post-error support mechanisms is needed in parallel with ongoing system efforts to reduce error rates and resident distress,” the researchers conclude.
(JAMA.2006;296:1071-1078. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This work was supported by a Medicine Innovation Development and Advancement System grant from the Mayo Clinic Department of Medicine. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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: 3:00 p.m. CT, Tuesday, September 5, 2006
Media Advisory: To contact Kevin Grumbach, M.D., call Vanessa deGier at 415-514-1592. To contact editorial co-author Jordan J. Cohen, M.D., call Nicole Buckley at 202-828-0041.
PROGRAMS HELP INCREASE NUMBER OF MINORITY AND DISADVANTAGED STUDENTS ADMITTED TO MEDICAL SCHOOLS
CHICAGO—Programs created to increase the enrollment of minority and disadvantaged students to medical schools appear to be effective, according to a study in the September 6 issue of JAMA, a theme issue on medical education.
A racially and ethnically diverse physician workforce is important for increasing access to care for underserved populations and improving the cultural competence of the workforce, according to background information in the article. However, many ethnic groups remain underrepresented among physicians in the United States. In 2000, blacks, Latinos, and Native Americans comprised more than 25 percent of the U.S. population but only 7 percent of the nation’s physicians. Students from lower-income families are also much less likely than those from higher-income families to be admitted into medical school. One strategy for increasing the diversity of the physician workforce is to implement interventions to support the academic achievement and health career aspirations of minority and low-income youth.
Among these programs are postbaccalaureate premedical programs targeting minority and disadvantaged students. These programs enroll college graduates, most of whom have previously applied unsuccessfully for admission to medical school, and provide an enrichment experience with the aim of making students more competitive medical school applicants. Currently, more than 75 academic institutions offer nondegree postbaccalaureate premedical programs, many focused on minority and disadvantaged students. However, the educational outcomes of these programs is not well known.
Kevin Grumbach, M.D., and Eric Chen, M.P.H., of the University of California, San Francisco, examined 5 University of California (UC) postbaccalaureate premedical programs to determine if they are effective in increasing medical school admission rates for program participants. The study included 265 participants in the programs in the 1999 through 2002 academic years and a control group of 396 college graduates who applied to the programs but did not participate. Of the participants, 66 percent were underrepresented minorities; for 50 percent, neither parent had attended college.
The UC programs implement a rigorous application process designed to mimic that used by the American Medical College Application Service (AMCAS). All 5 UC programs offer preparation in studying, test taking, writing personal statements, and interviewing, as well as opportunities for clinical or research experiences.
By 2005, 3 times as many program participants as controls had enrolled into medical school (67.6 percent vs. 22.5 percent). After adjusting for baseline student characteristics, students who participated in postbaccalaureate programs had a higher probability (about 6 times higher) of enrolling in medical school after controlling for grade point average and demographic characteristics.
“Among the continuum of educational pipeline programs, postbaccalaureate interventions are relatively high yield because they require only a single year of intervention, target students who have an explicit commitment to a career in medicine, and have a short timeline for achieving their payoff. The continued support and expansion of postbaccalaureate premedical programs is an important strategy for increasing the diversity of the physician workforce. Reductions enacted in the 2006 fiscal year in federal funding for Health Career Opportunities Programs, Health Careers Centers of Excellence, and related pipeline programs may threaten the continued existence of many postbaccalaureate programs that have traditionally received support from these federal programs,” the authors write.
(JAMA. 2006;296:1079-1085. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by the Bureau of Health Professions, Health Resources and Services Administration. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: BUILDING A DIVERSE PHYSICIAN WORKFORCE
In an accompanying editorial, Jordan J. Cohen, M.D., and Ann Steinecke, Ph.D., of the Association of American Medical Colleges, Washington, D.C., comment on the study concerning increasing diversity in medical schools.
“Grumbach and Chen’s finding that the University of California’s postbaccalaureate premedical programs increased minority and disadvantaged matriculants to medical school adds empirical support for the long-held belief that a sturdy scaffold of academic preparation and mentoring can offset at least some of the accumulated disadvantages experienced by many minority students interested in a career in medicine. Their findings should encourage other schools to establish postbaccalaureate programs that have special appeal to minority students.
“Given the magnitude and complexity of the obstacles to closing medicine’s diversity gap, multiple strategies must be aimed at all levels of the educational pipeline. While pursuing efforts at the early K-12 stage, students who have managed to survive the vicissitudes of their early education and who have made it through college must not be neglected. Many college graduates will require a well-designed postbaccalaureate program to be successful medical school applicants; many others might also succeed if only they were well informed about the application process and inspired to join the ranks of aspiring physicians.”
(JAMA. 2006;296:1135-1137. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Financial disclosures – none reported.
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: 3:00 p.m. CT, Tuesday, September 5, 2006
Media Advisory:To contact corresponding author Laure Perrier, M.Ed., M.L.I.S., call Sonnet L’Abbé at 416-978-6974. To contact editorial co-author F. Daniel Duffy, M.D., call Lori Bookbinder at 215-606-4122.
PHYSICIANS MAY HAVE LIMITED ABILITY TO ACCURATELY SELF-ASSESS THEIR OWN CONTINUING MEDICAL EDUCATION NEEDS
CHICAGO—Physicians appear to have a limited ability to accurately self-assess their own continuing medical education needs as compared with external observations of their competence, according to a review article in the September 6 issue of JAMA, a theme issue on medical education.
“Self-assessment and self-directed, lifelong learning have long been mainstays of the medical profession – they are activities presumed to be linked closely to the quality of care provided to patients,” the authors provide as background information in the article. “Physicians in the United States must demonstrate their engagement in lifelong learning by choosing and participating in continuing medical education (CME) activities and acquiring CME credit, which is mandated by the majority of state medical boards under the rubric [directions and rules] of states’ medical practice acts.”
David A. Davis, M.D., from the University of Toronto, and colleagues reviewed the medical literature to find studies that compared physicians’ self-rated assessments with external observations. The search yielded 725 articles, of which 17 met all inclusion criteria as outlined in the JAMA study. “Of the 20 comparisons between self- and external assessment, 13 demonstrated little, no, or an inverse relationship and 7 demonstrated positive associations,” the authors write. “A number of studies found the worst accuracy in self-assessment among physicians who were the least skilled and those who were the most confident. These results are consistent with those found in other professions.”
In conclusion the authors write, “The processes currently used to undertake professional development and evaluate competence may need to focus more on external assessment.”
(JAMA. 2006;296:1094-1102. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: PHYSICIAN KNOW THYSELF
“The systematic review of physician self-assessment by Davis and colleagues in this issue of JAMA provokes rethinking of whether it is wise to rely on unguided physician self-assessment as a cornerstone of continuous professional development,” writes F. Daniel Duffy, M.D. and Eric S. Holmboe, M.D., from the American Board of Internal Medicine, Philadelphia.
“As Davis et al recommend, the medical profession should shift CME and maintenance of certification and licensure to include processes of testing and educational methods that provide iterative feedback to supportively guide physicians in learning new concepts, as well as in changing work processes that lead to better patient care. This approach to continuous professional development combines the motivating energy provided by uncovering gaps in performance with CME, recertification, and relicensure. Physicians cannot be expected to do this in isolation; they require educational service from specialty societies and academic centers, and need the credible measurement tools and standards from certifying and licensing boards and organizations.”
(JAMA. 2006;296:1137–1139. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Drs. Duffy and Holmboe are employees of the American Board of Internal Medicine, which uses self-assessment and self-audit in its maintenance of certification process. No other financial disclosures were reported.
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 INTERNS REPORT NON-COMPLIANCE WITH WORK HOUR LIMITS – EXTENDED WORK HOURS LINKED TO INCREASED RISK OF NEEDLE OR SCALPEL INJURIES
VIDEO:
B-ROLL
Mike “working on” dummy, listening with stethoscope
AUDIO:
MIKE WESTERHAUS (wester-house) IS AN INTERN, AS FIRST YEAR MEDICAL RESIDENTS ARE CALLED. HE’S PRACTICING ON THIS TRAINING DUMMY. BUT MOST OF HIS TRAINING IS CARING FOR REAL PATIENTS. REGULATIONS REQUIRE RESIDENTS TO WORK NO MORE THAN EIGHTY HOURS A WEEK, BUT HE UNDERSTANDS THE DESIRE TO WORK MORE.
VIDEO:
SOT/FULL
@ :16
Super: Mike Westerhaus, M.D.
Medical Intern
Runs :09
AUDIO:
“A combination of the desire to really be intimately involved in patient care and I think also to maximize learning while you’re in the hospital.”
VIDEO:
B-ROLL
GFX/JAMA COVER
Mike working on dummy
AUDIO:
BUT A NEW STUDY IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, SAYS BALANCING THOSE DESIRES WITH GETTING ENOUGH REST CAN BE TOUGH.
VIDEO:
SOT/FULL
@ :32
Super: Charles Czeisler, Ph.D., M.D.
Brigham and Women’s Hospital
Runs :10
AUDIO:
“We found that 80% of interns across the nation reported that they violated current work hour standards that have been established by the profession.”
VIDEO:
B-ROLL
Bite runs through Dr. Czeisler’s name
Exterior of Brigham and Women’s Hosp
FULL SCREEN GRAPHIC
Title: Medical Intern Work Hours
83.6% of interns violated work hour standards
67.4% worked shifts longer than 30 hours
AUDIO:
DR. CHARLES CZEISLER (SIZE-ler) OF BRIGHAM AND WOMEN’S HOSPITAL IN BOSTON IS A SLEEP EXPERT. HE WAS ONE OF THE RESEARCHERS WHO DID A NATIONWIDE SURVEY OF RESIDENTS. THE CONFIDENTIAL SURVEYS REVEALED THAT NOT ONLY DID MOST INTERNS VIOLATE WORK HOURS STANDARDS, BUT ALMOST SEVENTY PERCENT DID SO BY WORKING SHIFTS LONGER THAN THIRTY CONSECUTIVE HOURS.
VIDEO:
SOT/FULL
Charles Czeisler, Ph.D., M.D.
Brigham and Women’s Hospital
Runs :05
AUDIO:
“That’s not more than 30 hours a week, but in a single continuous shift.”
VIDEO:
B-ROLL
Mike preparing and using needle on dummy
AUDIO:
SURVEYS ALSO REVEALED THAT EVEN WORKING TWENTY-HOUR SHIFTS DOUBLED THE RISK OF INTERNS INJURING THEMSELVES, BY STICKING THEMSELVES WITH NEEDLES OR CUTTING THEMSELVES WITH SCALPELS.
VIDEO:
SOT/FULL
Charles Czeisler, Ph.D., M.D.
Brigham and Women’s Hospital
Runs :17
AUDIO:
“It’s just common sense. If you’ve been working more than 20 consecutive hours, your risk of making an error, having a lapse of attention, a lapse of concentration, is much higher than if you’re fresh and you’re within the first 8 hours of your workday.”
VIDEO:
B-ROLL
More Mike with needle
AUDIO:
HE SAYS PUTTING STRICTER LIMITS ON WORK HOURS COULD PROTECT INTERNS FROM INJURY. MEANWHILE, INTERN MIKE WESTERHAUS SAYS IT’S ALL ABOUT BALANCE.
VIDEO:
SOT/FULL
Mike Westerhaus, M.D.
Medical Intern
Runs :13
AUDIO:
“Being as involved as possible, learning as much as you can, but then also realizing that we’re humans, we have limits and that to step aside, take a break, rest up, is actually very important in providing care as well.”
VIDEO:
B-ROLL
Mike with dummy-needle
AUDIO:
THIS IS MAVIS PRALL WITH THE JAMA REPORT.
