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 9, 2008)
JAMA NEWS RELEASES—THEME ISSUE ON MEDICAL EDUCATION
RACIAL DIVERSITY AMONG MEDICAL STUDENTS APPEARS TO BETTER PREPARE THEM TO CARE FOR MINORITY PATIENTS
INCREASED ON-CALL WORKLOAD ASSOCIATED WITH VARIOUS NEGATIVE EFFECTS FOR MEDICAL INTERNS
STUDY EXAMINES REASONS FOR DECLINE BY MEDICAL STUDENTS IN CHOOSING INTERNAL MEDICINE AS CAREER CHOICE
M.D.-PH.D. GRADUATES LOOK MORE TOWARDS CAREER IN RESEARCH
NUMBER OF RESIDENTS TRAINING IN GRADUATE MEDICAL EDUCATION PROGRAMS INCREASES IN RECENT YEARS
INTERNET-BASED LEARNING FOR HEALTH PROFESSIONS ASSOCIATED WITH POSITIVE EFFECT
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
STUDY FINDS DIVERSITY WITHIN U.S. MEDICAL SCHOOLS HELPS TO TREAT A DIVERSE POPULATION
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 effect of having racial diversity among medical students on diversity-related outcomes. The report will be fed Tuesday, September 9, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Galaxy 28 (C-Band), Transponder 19, downlink frequency: 4080 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, September 9, 2008
Media Advisory: To contact Somnath Saha, M.D., M.P.H., call Christine Decker at 503-494-8231. To contact editorial co-author Olveen Carrasquillo, M.D., M.P.H., call Alex Lyda at 212-305-0820.
RACIAL DIVERSITY AMONG MEDICAL STUDENTS APPEARS TO BETTER PREPARE THEM TO CARE FOR MINORITY PATIENTS
CHICAGO—White medical students who attend schools with greater racial and ethnic diversity among the student body are more likely to rate themselves as highly prepared to care for minority populations, according to a study in the September 10 issue of JAMA, a theme issue on medical education.
Most medical schools in the United States explicitly seek to create diversity within their student bodies, believing it exposes students to a broad array of ideas, experiences, and perspectives, and better prepares them to meet the needs of a multicultural American population, according to background information in the article. There has been little evidence, however, that racial and ethnic diversity in medical schools produces educational benefits.
Somnath Saha, M.D., M.P.H., of Oregon Health and Science University, Portland, and colleagues conducted a study to assess whether the proportion of minority students within medical schools is associated with students’ perceived preparedness to care for diverse patient populations. A Web-based survey was administered by the Association of American Medical Colleges to 20,112 graduating medical students (64 percent of all graduating students in 2003 and 2004) from 118 allopathic medical schools in the United States. Historically black and Puerto Rican medical schools were excluded.
The researchers found that white students within the highest quintile (one-fifth) for student body racial and ethnic diversity, measured by the proportion of underrepresented minority (URM) students, were 33 percent more likely to rate themselves as highly prepared to care for minority patients than those in the lowest diversity quintile (61.1 percent vs. 53.9 percent, respectively). This association was strongest in schools in which students perceived a positive climate for interracial interaction. White students in the highest URM quintile were 42 percent more likely to have strong attitudes endorsing equitable access to care (54.8 percent vs. 44.2 percent, respectively). These associations became apparent as the proportion of minority students increased above the 60th percentile.
Underrepresented minority students were substantially more likely than both white and nonwhite/non-URM students to plan to practice in underserved areas (48.7 percent vs. 18.8 percent vs. 16.2 percent, respectively). For nonwhite students, there were no significant associations between student body URM proportions and diversity-related outcomes.
“Our study lends empirical support for the Supreme Court’s rationale (i.e., that student body racial diversity is associated with measurable, positive, student outcomes). It also indicates that a diverse student body is likely to be necessary but not sufficient. Medical schools may need to actively foster positive interaction among individuals from different backgrounds to derive the benefits of diversity. Additionally, our analysis supports the concept of ‘critical mass,’ whereby a certain proportion of minority students is considered necessary to realize the benefits of diversity. These results can guide medical schools in shaping policies for recruiting, admitting, and retaining URM students as one component of achieving diversity to help them fulfill their educational missions," the authors conclude.
(JAMA. 2008;300[10]:1135-1145. 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: DIVERSIFYING THE MEDICAL CLASSROOM—IS MORE EVIDENCE NEEDED?
“The need for medical schools to re-examine their admission polices is further emphasized by the finding in the study by Saha et al ..." writes Olveen Carrasquillo, M.D., M.P.H., of Columbia University Medical Center, New York, and Elizabeth T. Lee-Rey, M.D., M.P.H., of the Albert Einstein Hispanic Center of Excellence, Bronx, N.Y., in an accompanying editorial.
“...while approximately half of all URM graduates plan to care for underserved populations, less than 20 percent of white and nonwhite/non-URM individuals had such plans. In addition, less than half of all students in these anonymous surveys responded that access to care was a major problem, and only 42 percent responded that everyone is entitled to adequate health care. These findings alone indicate the need to evaluate the process of admitting and training students in U.S. medical schools."
“However, even with an increasing evidence base, many medical schools are unlikely to prioritize increased URM diversity. For such schools, improvements may come only through changes in leadership or external pressure by community and political forces."
(JAMA. 2008;300[10]:1203-1205. 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.
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 9, 2008
Media Advisory: To contact Vineet M. Arora, M.D., M.A., call John Easton at 773-702-6241.
INCREASED ON-CALL WORKLOAD ASSOCIATED WITH VARIOUS NEGATIVE EFFECTS FOR MEDICAL INTERNS
CHICAGO—Medical interns who experience an increase in their on-call workload are more likely to get less sleep while on call, have longer shift durations and participate less in educational activities, according to a study in the September 10 issue of JAMA, a theme issue on medical education.
In 2003, the Accreditation Council for Graduate Medical Education (ACGME) restricted resident duty hours in an attempt to reduce resident fatigue and the likelihood of fatigue-related errors that could harm patients. Further restrictions in resident duty hours are being considered. “Yet, little attention has focused on the risks associated with work intensification. Further limitations on duty hours without any attempt to address work intensification may result in residents doing the same amount of work in less time, which could undermine resident welfare and patient safety," the authors write.
Vineet M. Arora, M.D., M.A., of the University of Chicago, and colleagues examined whether increased on-call intern workload, as measured by the number of new admissions on-call and the number of previously admitted patients remaining on the service, was associated with reductions in on-call sleep, increased total shift duration, and lower likelihood of participation in educational activities (such as lectures or bedside teaching). The study, conducted from July 2003 through June 2005, included 56 medical interns observed during 1,100 call nights.
The researchers found that average sleep duration on-call was 2.8 hours and that average shift duration was 29.9 hours. Approximately 30 percent of shifts were deemed noncompliant with duty hours (greater than 30.5 hours). Analysis indicated that each new on-call admission early in the academic year was associated with less sleep (-10.5 minutes). A significant association between admission workload and shift duration also was observed. For each new on-call admission early in the academic year, shift duration increased by 13.2 minutes. Call nights during the week and early in the academic year were associated with the most sleep loss and longest shift durations.
A higher number of previously admitted patients remaining on the service was associated with a lower odds of participation in educational activities. Interns reported spending 11 percent of their time in educational activities.
“These findings raise concerns about the possibility of future duty-hour restrictions in the absence of corresponding limits on workload," the authors write. “Our study highlights the importance of considering reductions in on-call admissions as a strategy to alleviate sleep deprivation and ensure compliance with duty hours for interns early in the academic year in a traditional extended-duty shift model."
“...our findings suggest that research is needed to understand workload effects on clinical outcomes, especially in shorter shift systems in which sleep loss is less of a concern. There is a paucity of studies exploring this area and a heightened interest in optimizing resident schedules to improve resident health and patient safety. These findings may help inform program changes and policies designed to reduce resident sleep deprivation and improve duty-hour compliance," the researchers conclude.
(JAMA. 2008;300[10]:1146-1153. 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.
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 9, 2008
Media Advisory: To contact Karen E. Hauer, M.D., call Jennifer O'Brien at 415-476-8432. To contact editorial author David C. Goodman, M.D., M.S., call Hali Wickner at 603-650-1520.
STUDY EXAMINES REASONS FOR DECLINE BY MEDICAL STUDENTS IN CHOOSING INTERNAL MEDICINE AS CAREER CHOICE
CHICAGO—Medical students express reservations about internal medicine as a career because of patient complexity, the practice environment and the lifestyle, compared with other specialties, according to a study in the September 10 issue of JAMA, a theme issue on medical education.
Internists in primary care and subspecialty practice provide a large portion of the chronic care for older and medically complex patients. However, the number of students choosing residency training in general internal medicine (IM) has declined, and young physicians are leaving general IM, suggesting that projected shortfalls may greatly underestimate the future problem, according to background information in the article. The number of older adults in the United States is expected to nearly double between the years 2005 and 2030, and one planning model predicts that the United States will have 200,000 too few physicians by 2020. Current students’ perceptions about IM careers and the factors that motivate them to choose the field are not well understood.
Karen E. Hauer, M.D., of the University of California, San Francisco, and colleagues conducted a study to understand current students’ impressions and concerns about careers in IM and to identify potentially modifiable factors in their decision making. The researchers surveyed 1,177 fourth-year medical students at 11 U.S. medical schools in the spring of 2007, who were questioned regarding their educational experiences and career choice.
Overall, 274 students (23.2 percent) reported they were most likely to enter careers in IM, including 24 (2.0 percent of the total sample) in general IM. Compared with other specialties they had chosen or considered, students perceived IM as requiring more paperwork (68.0 percent of respondents), requiring a greater breadth of knowledge (62.1 percent), and having a lower income potential (64.6 percent). Other reasons cited by students for not selecting IM careers included the attractiveness of other (non-IM) specialties and the types of patients an internist sees.
Factors cited by students for choosing IM included the intellectual challenge, teaching on the IM rotation, the continuity of care and the competence of IM residents.
“Current students recognize the increasing demands on internists, particularly primary care physicians, to accomplish large numbers of preventive and therapeutic interventions during short visits with chronically ill patients while also managing increasing administrative expectations," the authors write. “Career interest in general IM is particularly low, reflecting the challenges in the primary care practice environment. A national effort to address the factors affecting students’ career choice regarding IM is needed and should include interventions to modify the nature of work and lifestyle in the field."
(JAMA. 2008;300[10]:1154-1164. 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: IMPROVING ACCOUNTABILITY FOR THE PUBLIC INVESTMENT IN HEALTH PROFESSION EDUCATION
In an accompanying editorial, David C. Goodman, M.D., M.S., of Dartmouth Medical School, Hanover, N.H., comments on the articles in this issue of JAMA regarding the health workforce, and writes that the U.S. should establish a permanent health workforce commission that can help overcome the current limitations of health professions training.
“Five principles should guide the commission’s charter. First, the public interest in the workforce should be articulated. ...The specific aims should be to craft evidence-based policy that improves access to care, quality of care, health outcomes, and the affordability of care. Second, the membership of the commission should be broad and include experts in public health, patient-centered care, and epidemiology, as well as clinicians, consumers, innovative and efficient health systems, payers, and medical educators. Third, the commission should consider policy related to health clinicians of all types. ...Fourth, an evidence-based approach to workforce policy formulation requires a dedicated staff to develop the expertise for evaluating the workforce and the likely effect of policy recommendations. ...Fifth, Congress should provide the commission with an increasing degree of regulatory responsibility that insulates reform from the self-interests of training programs and clinicians."
“The expected argument against accountability is that it is wiser to allow market forces to decide the fundamental questions of workforce size and composition. However, doing so practically assures maintaining the status quo. It is unreasonable to expect that market forces will self-organize an effective health workforce. It is time to try public health workforce planning."
(JAMA. 2008;300[10]:1205-1207. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including 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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OTHER ARTICLES IN THIS ISSUE OF JAMA
Embargoed for Release: 3:00 p.m. CT, Tuesday, September 9, 2008
To contact Dorothy A. Andriole, M.D., call Joni Westerhouse at 314-286-0120.
M.D.-PH.D. GRADUATES LOOK MORE TOWARDS CAREER IN RESEARCH
Dorothy A. Andriole, M.D., of Washington University School of Medicine, St. Louis, and colleagues conducted a study to identify factors associated with M.D.-Ph.D. program graduation among recent medical graduates. The researchers analyzed data from a nationally representative sample of 88,575 U.S. medical graduates who completed the national Association of American Medical Colleges Graduation Questionnaire from 2000-2006.
Variables associated with greater likelihood of M.D.-Ph.D. program graduation included planned substantial career involvement in research; lower educational debt and receipt of medical school scholarships or grants. Variables associated with lower likelihood of M.D.-Ph.D. graduation included female sex; race/ethnicity underrepresented in medicine; and, compared with internal medicine, planned training in emergency medicine or surgery.
“The results of this study could inform a research agenda to more fully explore the extent to which M.D.-Ph.D. program goals are indeed being met in the U.S. allopathic medical education system," the authors write.
(JAMA. 2008;300[10]:1165-1173. 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.
Embargoed for Release: 3:00 p.m. CT, Tuesday, September 9, 2008
To contact Edward Salsberg, M.P.A., call Retha Sherrod at 202-828-0975.
NUMBER OF RESIDENTS TRAINING IN GRADUATE MEDICAL EDUCATION PROGRAMS INCREASES IN RECENT YEARS
Edward Salsberg, M.P.A., of the Association of American Medical Colleges, Washington, D.C., and colleagues examined the number of residents in training before and after the 1997 Balanced Budget Act (BBA). There has been concern that because Medicare is the primary source of graduate medical education (GME) funding, the BBA would discourage growth in GME.
The researchers found that the number of residents remained relatively steady between 1997 and 2002 but then increased, for a net gain of eight percent between 1997 and 2007. The annual number of new entrants into GME increased by 7.6 percent, primarily because of increasing international medical graduates (IMGs). United States medical school graduates (M.D.’s) comprised 44.0 percent of the overall growth from 2002 to 2007, followed by IMGs (39.2 percent) and osteopathic school graduates (18.8 percent). Increasing subspecialization rates have led to fewer physicians entering generalist careers.
“Based on the change in the number of residents and fellows in ACGME-accredited programs over 5-year intervals before and after the BBA, it appears that the cap on Medicare-supported GME positions was associated with at least a temporary decrease in the growth in GME positions."
(JAMA. 2008;300[10]:1174-1180. 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.
Embargoed for Release: 3:00 p.m. CT, Tuesday, September 9, 2008
To contact David A. Cook, M.D., M.H.P.E., call John Murphy at 507-284-5005.
INTERNET-BASED LEARNING FOR HEALTH PROFESSIONS ASSOCIATED WITH POSITIVE EFFECT
David A. Cook, M.D., M.H.P.E., of Mayo Clinic, Rochester, Minn., and colleagues conducted a meta-analyses of 201 studies to summarize the effect of Internet-based instruction for health professions learners compared with no intervention and non-Internet interventions.
“...the synthesized evidence demonstrates that Internet-based instruction is associated with favorable outcomes across a wide variety of learners, learning contexts, clinical topics, and learning outcomes. Internet-based instruction appears to have a large effect compared with no intervention and appears to have an effectiveness similar to traditional methods," the authors write. “Future research should directly compare different Internet-based interventions."
(JAMA. 2008;300[10]:1181-1196. 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.
COMMENTARIES IN THIS ISSUE OF JAMA:
BUILDING PHYSICIAN WORK HOUR REGULATIONS FROM FIRST PRINCIPLES AND BEST EVIDENCE
EMOTIONAL INTELLIGENCE AND GRADUATE MEDICAL EDUCATION
MEDICAL SCHOOLS AND GRADUATE MEDICAL EDUCATION INFORMATION
The latest data on medical schools and graduate medical education, including information on enrollment, programs, specialties, etc., are available in the appendices of this issue.
JAMA REPORTS
VIDEO:
Windows Media |
Quicktime
STUDY FINDS DIVERSITY WITHIN U.S. MEDICAL SCHOOLS HELPS TO TREAT A DIVERSE POPULATION
INTRO:
As the population in the United States grows more and more diverse studies show some minorities are not receiving adequate, quality health care. Some academic leaders believe diversity within medical schools can help to better prepare doctors to treat these underserved populations. A new study finds their theory may be right. Jennifer Mitchell explains in this week's JAMA Report.
VIDEO:
B-ROLL
Medical students in class
Tight faces
Tight male minority student
Classroom shots
AUDIO:
MEDICAL SCHOOLS THAT STRIVE TO ADMIT A CERTAIN NUMBER OF MINORITY STUDENTS HAVE COME UNDER INCREASED SCRUTINY FOR POSSIBLE UNFAIR AND DISCRIMINATORY POLICIES. BUT A NEW STUDY FINDS DIVERSITY IN THE CLASSROOM APPEARS TO HELP MANY NEW DOCTORS FEEL MORE PREPARED TO TREAT MINORITY PATIENTS.
VIDEO:
SOT/FULL
Super @ :19
Somnath Saha, M.D., M.P.H.
General Internist, Portland VA Medical Center
Runs: 12
AUDIO:
“The more underrepresented minority students in a specific medical school the more likely white students in those medical schools were to feel prepared to care for minority populations.”
VIDEO:
B-ROLL
Doctor teaching
Tight doctor
Medical students and teacher
Minority student
Doctor and medical students making rounds
AUDIO:
DOCTOR SOMNATH (sum-not) SAHA IS A GENERAL INTERNIST AT PORTLAND VA MEDICAL CENTER. HE AND HIS COLLEAGUES ANALYZED DATA FROM MORE THAN TWENTY THOUSAND QUESTIONNAIRES FROM GRADUATING MEDICAL STUDENTS IN THE U.S. FROM 2003 TO 2004. RESEARCHERS FOUND THAT IN A MORE DIVERSE STUDENT BODY NEW DOCTORS NOT ONLY FEEL BETTER PREPARED TO TREAT MINORITY PATIENTS BUT THEY ALSO HAVE STRONGER ATTITUDES ABOUT ENDORSING EQUITABLE ACCESS TO CARE.
VIDEO:
SOT/FULL
Somnath Saha, M.D., M.P.H.
General Internist, Portland VA Medical Center
Runs: 11
AUDIO:
“They were more likely to believe that everyone is entitled to adequate access to medical care regardless of their ability to pay.”
VIDEO:
B-ROLL
GXF/JAMA COVER
Minority students in class
AUDIO:
THE STUDY APPEARS THIS WEEK IN A THEME ISSUE OF JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, DEVOTED TO MEDICAL EDUCATION.
THE POSITIVE EFFECTS OF DIVERSITY WERE SEEN WHEN MINORITY STUDENTS INCLUDING BLACKS, LATINOS AND NATIVE AMERICANS MADE UP AT LEAST TEN PERCENT OF THE ENTIRE CLASS.
VIDEO:
SOT/FULL
Somnath Saha, M.D., M.P.H.
General Internist, Portland VA Medical Center
Runs: 09
AUDIO:
“Because it matters really we should be allowing medical schools to consider race and ethnicity when they think about what kind of class they want to have within their walls.”
VIDEO:
B-ROLL
Medical students with patient
Patient in hospital
Doctor students and patient
AUDIO:
RESEARCHERS SAY BECAUSE OF DISPARITIES IN THE DELIVERY OF CARE TO MINORITY POPULATIONS RESOLVING THOSE INEQUALITIES SHOULD BE OF NATIONAL IMPORTANCE.
VIDEO:
SOT/FULL
Somnath Saha, M.D., M.P.H.
General Internist, Portland VA Medical Center
Runs: 10
AUDIO:
“To the extent that we can help to reduce those inequalities by graduating medical students who will become doctors who feel prepared to care for those populations we’ve done the nation a great service.”
VIDEO:
B-ROLL
Medical students walk out of room
AUDIO:
JENNIFER MITCHELL, THE JAMA REPORT.
TAG:
Researchers say diversity in the classroom alone does not appear to make a difference. Medical students who feel most prepared to treat minority patients also benefitted from attending medical schools that have a positive institutional climate when it comes to race and ethnicity outside of the classroom. For more information about this study you can log on to www.jama.com.
