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Category Archives: Medical School
Entering medical school, there are a number of curricular expectations for which medical schools prepare incoming students. Still, some things are bound to catch new students off guard. Medical students and medical school faculty spoke with the AMA to cover a few key topics that may surprise aspiring medical students.
Youre bound to spend more time studying than you did in your undergraduate studies. Still, if you prioritize your time, you can meet new people and have a social life.
Often, premeds are told their life will be over for four to five years, said Lindia J. Willies-Jacobo, MD, associate dean for admissions and professor at Kaiser Permanente School of Medicine, which will welcome its first class of medical students in the fall. Thats by no means true. They can continue to socialize and build community with their peers and also have a life outside of medical school.
Avani Patel is a forthcoming graduate of the University of Mississippi School of Medicine in Jackson. Earlier on in her medical school career, she had exams every Monday. That meant that weekends were typically not her time to catch up with friends or go out. She instead started to make plans on Monday nights and attend events during the week that were put on by her school.
Its up to you if you want to be socially active, Patel said. But you are going to have to make priorities and be strategic about it to balance your commitments.
Some students say medical school is comparable to high school in some of the not-so-beneficial ways.
Im from the South, so its already cliquey down here, said Patel. Its your choice if you want to be cliquey or not. I like to have multiple friend groups and get to know people on all levels.
From day one of medical school, your colleagues are your support system but could also be seen as competitors for those ultra-competitive residency slots. That can make for some interesting social dynamics.
I thought I found a great friend group my first year, and they were wonderful people. I realized that they were very high-performing and that became unhealthy for me, Patel said. I doubted myself; I felt bad about myself. We would talk about grades and compare test scores, and that was toxic for me. It had nothing to do with them and everything to do with me. I found I needed to separate myself from them.
I ended up finding another group of friends, and we never talked about grades and supported each other, and thats really what I needed.
As much as they want you to succeed in medical school, your friends may not totally understand the time and emotional energy that goes into medical school. When you start missing marquee events such as weddings and birthdays, they may take it personally, Patel said.
Youre so busy that its really difficult to make the time, Patel said. Theres a give and take, and some friends understand, those are the people you can pick up where you left off with.
Your classmates and students in the classes ahead of you have a rare ability to relate to the daily grind you'reexperiencing. That can be a very valuable resources to cope with stress.
Its really nice to have people who are going through the same things you are to be there to provide support, Patel said. We have an M1-M2 buddy system, and I think most med schools do, so a lot of people utilize their upperclassman friends as a sound board. Its very helpful to talk to them about what you are struggling with since they have gone through the same things.
Medicine can be a career that is both challenging and highly rewarding, but figuring out a medical schools prerequisites and navigating the application process can be a challenge into itself. The AMA premed glossary guide has the answers to frequently asked questions about medical school, the application process, the MCAT and more.
Have peace of mind and get everything you need to start med school off strong with the AMA.
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6 things they don't tell you about life in medical school - American Medical Association
Evidence of the effectiveness of coaching in medical education has been mounting over the last decade, leading educators and administrators to look for resources to help them create coaching programs of their own. A survey of medical schools reveals that nearly all had a coaching program or were developing one. The majority of established programs were still young, having been implemented in the last five years.
The authors of the study published in Medical Education Online surveyed more than 30 medical schools participating in the AMA Accelerating Change in Medical Education Consortium to describe existing coaching programs and help other institutions develop their own.
The AMA offers two free handbooks, Coaching in Medical Education: A Faculty Handbook, and It Takes Two: A Guide to Being a Good Coachee, to help educators and administrators create programs for coaching medical students.
Learn more with the AMA about how medical students can benefit from coaching in medicine.
Medical schools listed the following goals for the established programs and those being implemented in the next year:
Other goals cited, in descending frequency, were well-being, community building, leadership, development of lifelong learning skills, remediation and clinical skill development.
In terms of content, 92% of programs reported academic performance, 88% cited professional development and 88% mentioned goal-setting. Other domains covered, in descending frequency, were well-being, reflection, interpersonal communication, time management, clinical performance, specialty selection, learner-driven content and decision-making abilities.
All of the programs surveyed had multiple goals rather than a single focus.
Although this approach makes intuitive sense, literature to date has largely focused on coaching interventions with a singular goal, says the study. This finding has important implications for how institutions structure new coaching programs and select their coaches. For example, if a coaching program has multiple goals, coach-coachee dyads will need adequate time to address multiple goals and coaches will need to be well versed in multiple content areas.
The study was co-written by Maya M. Hammoud, MD, MBAthe AMA's special adviser on medical education innovation and professor of learning health sciences at University of Michigan Medical Schooland colleagues Margaret Wolff, MD, MHPE, Sally Santen, MD, PhD, Nicole Deiorio, MD, and Megan Fix, MD, from the University of Michigan Medical School, Virginia Commonwealth University School of Medicine and University of Utah School of Medicine, respectively. All these medical schools are members of the AMA consortium.
These results do not suggest one particular approach to coaching in undergraduate medical education but rather highlight variables each school can carefully consider when developing a coaching program, the study says.
Read more from the AMA about how medical students can make the most of an academic coaching relationship.
"The cornerstone of coaching is the coach-coachee relationship, the authors wrote, noting that the relationship is different from mentoring and advising. In this study, the majority of respondents correctly identified the coaching relationship as one in which the coach helps the student find a strategy through asking clarifying questions.
Most programs surveyed, 80%, made use of attending physicians as coaches, but residents and fellows and non-physicians were also utilized. In addition, while the number of students assigned to each coach varied, the majority of coaches, 64%, received 525% full-time equivalent effort to support their role.
The authors also provided insights on program development, implementation and evaluation, advising a six-step approach.
This process should begin with problem identification and a needs assessment to determine if there are unmet student needs that may be filled by a coaching program, the study says.
Limitations of the study include respondents being biased toward early adoption of education innovations, heavy representation of large academic medical centers and variability in how coaching is defined.
Graduate medical education is critical to the training of physicians. Residencies are where most new medical school graduates train for the specialties they have chosen.
By the time a residency is completed, a physician should be ready to practice without supervision and lead a team in taking care of patients. It isnt easy 80-hour weeks are often the norm but often a residency is the last step in making their career dream come true. For some, the road doesnt end there. Because of the complexity of some areas of medicine, additional graduate medical education (GME) in the form of fellowships is required.
At the UNLV School of Medicine, Dr. Kate Martin, associate dean of graduate medical education, currently oversees 20 post-graduate training programs with 321 residents/fellows. The overall program is accredited by the Accreditation Council for Graduate Medical Education (ACGME). Dr. Martin and her staff do everything from helping keep residents/fellows healthy to dealing with funding mechanisms for post-graduate education.
She previously served as afamily medicine residency program director and director of community engagement in the school. A graduate of the UNR School of Medicine, where she also completed her family medicine residency, Martin went on to complete a teaching and learning fellowship with the USC Keck School of Medicine and as well as aNational Institute for Program Director Development fellowship with the Association of Family Medicine Residency Directors.
A 2002 UNLV summa cum laude graduate who earned her bachelors degree in biology, Martin was UNLV's 2016 Honors College Alumna of the Year.
Today, she says because of her staffs two-year team effort, two more fellowships were added by the ACGME in 2019 one in pediatric emergency medicine and another in geriatrics. This means we can recruit new fellows to start in July 2020, she said. We are also currently applying for accreditation to start a fellowship program in forensic psychiatry and adult endocrinology.
How important are new fellowships to the people of Southern Nevada? According to a recent report by the Nevada Health Workforce, they are critical, given that many physicians stay to practice where they finish their GME training. The authors wrote:
One key finding of this report is that 35 of the 43 physicians pursuing additional training (81.4%) are leaving the state for fellowship and subspecialty training that does not exist or is in short supply in Nevada. This finding suggests that the development of fellowship programs in Nevada holds the potential for increasing the number and percent of GME graduates who ultimately remain in Nevada to begin practice.
At present, about 50 percent of those who complete residencies/fellowships in Southern Nevada stay here.
Martin pointed out that during her tenure the ob/gyn, psychiatry, critical care medicine, and critical care surgery GME programs have expanded as the result of funding provided by Nevada governors office of science, innovation and technology.
Here, Martin expands on the importance of graduate medical education.
GME is the next step after someone graduates medical school in order to become a practicing physician. Without it, you can't prescribe medications or treat patients. You need to complete a residency/additional training to obtain a medical license and be able to practice.
GME programs average three to five years in length, but sometimes are much longer, depending on the specialty and additional fellowship training pursued. For example, a cardiologist spends three years doing an internal medicine residency, then another threeyears in a cardiology fellowship, then possibly another one to two years in a second fellowship to become an interventional cardiologist who performs angiograms to open blocked arteries when someone is having a heart attack.
Sponsoring institutions that participate in GME, such as UNLVs School of Medicine, have a mission, according to the ACGME, to improve the health of the public, specifically to reduce health disparities. People from socioeconomically disadvantaged groups should have the opportunity to live long and healthy lives like everyone else. GME helps level that playing field through the vulnerable populations it reaches, elevating their quality of care, while training the next generation of physicians.
Starting a new residency or fellowship program requires funding, lead time, and community support. University Medical Center (UMC) is our primary teaching hospital, serving as the home base for nearly all of our GME programs. UMC is the largest financial supporter. GME funding is complex. Although UMC receives partial financial assistance from the Centers for Medicare and Medicaid Services (CMS), the hospital makes up the difference to pay resident and fellow salaries and benefits. We have recently increased our involvement with the Veterans Administration Health System and the U.S. Air Force to sponsor some resident and fellow positions, and we also receive support from several other community partners.
With the right funding, we could grow graduate medical education in Southern Nevada on a larger scale and bring even more specialties to the area with the goal that these new doctors would remain to practice in our community.
I should also point out that, in order to get there, it takes at least two years, as this requires a team of people to come together and submit an application to the ACGME. Faculty are needed in the chosen specialty to lead the program, including a program director, and additional physicians to teach the residents, along with administrative support for the program. These are the minimum ACGME requirements, so that is where we start from. The possibilities are really only limited by our passion to meet the communitys health care needs.
Residents take and study for yearly in-training exams throughout residency to prepare for the test they will take at the end of their training in order to become board-certified in their chosen specialty for instance internal medicine, pediatrics, psychiatry. (The in-training exam is a practice version of the board certification exam, so they study regularly for this. They also take licensure-related exams, called Step exams, to complete a series, i.e. Step 1, 2 and 3, which they start in medical school. Step 3 is the last step and that is taken during residency, so that is another exam that they study for, in addition to their clinical work.)
Residents and fellows are evaluated throughout the year based on the following six core competencies determined by the ACGME:
The evaluation system uses milestones that the residents and fellows must achieve in order to get to the next level and be promoted within their program, and ultimately graduate. All of this relies on feedback from their attending physician faculty, staff members, patients, and peers.
Most new residents and fellows are selected through the National Resident Matching Program. (Some fellowship programs do not participate in this, but nearly all residency programs and most fellowship programs do.) Medical students submit their applications in the fall of their fourth year of medical school, travel for interviews typically in the fall/winter months, then submit a rank list of where they would like to go. Programs submit a rank list of the applicants they want to recruit. The results are released in mid-March on Match Day, when everyone finds out where they are going to be for residency on July 1. On Match Day, the GME office goes to work to start on-boarding the next class of new residents and fellows.
I would like to see every specialty and subspecialty of adult and pediatric medicine offered in our GME programs in Southern Nevada. Our community has grown to deserve (and should demand) this level of care and medical expertise.
It depends on the program, but the application numbers have gone up in recent years due to increased competition. Fourth-year medical students typically apply to at least several programs (ranging from four to eight), but some can apply for many more.
The ACGME specifies that faculty must be board-certified (or have equivalent qualifications) in their specialty or subspecialty field, so they are held to that standard for competency. The residency and fellowship program faculty have a passion for teaching, often years of experience in an academic setting, but all have some alignment with our mission of education, research, and clinical service in a GME setting.
Per ACGME requirements, residents may work no more than 80 hours per week with one day off in seven, averaged over a four-week period. The GME office and residency/fellowship programs monitor work hours closely and make schedule adjustments to stay in compliance.
Yes, and so we are working on bringing more fellowships online and are already expanding our current programs in psychiatry, ob/gyn, critical care medicine, and critical care surgery.
The GME team provides support through their individual roles. In addition, the GME office serves as a safe space for residents and fellows to bring concerns and have issues addressed that may be going on within their programs or the institution at-large. Our office also provides assistance with processing of loan deferment requests, acts as a liaison with HR, sponsors several subcommittees on topics important to the residents/fellows, such as well-being, space/learning environment, and policy creation/review.
We also carry out the Graduate Medical Education Committee (GMEC) meetings, which bring the core residency program directors, program coordinators, and residents together to discuss important accreditation, program, and institutional issues every other month. The GME office hosts an annual resident/fellow research day, a chief resident retreat (for the new/incoming senior-level residents), and institution-wide orientations for new residents and fellows each year. We have an annual program director retreat for the faculty as well. The GME office also funds residents and fellows to travel around the country to present their research at national conferences.
The first African-American woman to graduate from medical school in the US is buried in an unmarked grave in Hyde Park – Universal Hub
The Friends of the Hyde Park Branch Library have started raising funds for a gravestone for Rebecca Lee Crumpler, who graduated from the New England Female Medical College in Boston in 1864 and whose body currently lies in an unmarked grave in Fairview Cemetery in Hyde Park.
The Friends are hoping to raise between $3,000 and $5,000 for a tombstone for Crumpler. They've collected some info on Crumpler, of whom no known image survives: Born in Delaware in 1831, she grew up in Pennsylvania, but she eventually moved to the Boston area, where she took classes at West Newton English and Classical School and settled in Charlestown. In 1864, she earned her medical degree. After serving time following the Civil War with the Freedmen's Bureau in Richmond, VA, she moved back to the Boston area with her husband, Arthur, and eventually settled in Hyde Park - near the cemetery where she is now buried.
In 1883, she write a book of medical advice for "mothers, nurses, and all who may desire to mitigate the afflictions of the human race," A Book of Medical Discourses in Two Parts.
Donations towards a tombstone can be made to:
Friends of the Hyde Park LibraryFor: Crumpler Fund35 Harvard Avenue, Hyde Park, MA 02136
Ask the Authors: Dr. Mohammadreza Hojat Speaks on the Erosion of Empathy Exhibited by Medical Students – DocWire News
Last week, DocWire News covered a study which suggests that medical students lose empathy as they progress through medical school.
We spoke with lead researcher Mohammadreza Hojat, PhD, who detailed what prompted him to undertake this study. As a psychologist by academic training, I became interested in exploring the effects of human relationships in health and illness, said Dr. Hojat, of the Sidney Kimmel Medical College at Thomas Jefferson University.
This interest shifted to a more specific area of patient-doctor relationship when I started a career in medical education research about 40 years ago. The questions of why some health professionals are more capable than others to form empathic relationship with patients, what are the factors that contribute to the development of empathy, and what are the outcomes of empathic engagement in patient care prompted me to search for answers.
The study comprised 10,751 medical students (3,616 first-year, 2,764 second-year, 2,413 third-year, and 1,958 fourth-year students) enrolled in 41 campuses of DO-granting medical schools in the US while comparing preexisting data from students of MD-granting medical schools. All participants were asked to complete a web-based survey at the end of the 2017-2018 academic year.
The results showed a decline in empathy scores between medical students in the pre-clinical years (first-and-second year students) and medical students in the clinical years (third-and-fourth year students). Furthermore, the researchers observed that the pattern of empathy decline was similar among DO students, but the magnitude was less pronounced.
The findings of the study raise a red flag for medical education leaders, said Dr. Hojat. Among implications of the findings is a call for the development and implementation of targeted educational programs in medical schools to enhance and sustain empathy in physicians-in-training.
Dr. Hojat noted that the study did have a limitation its design. As a cross-sectional study, the baseline empathy at the start of medical school may be different for students in different years, thus variation in empathy in different years could be attributed to the baseline differences, and not necessarily to changes during medical school.
He feels that a more desirable study design would be a longitudinal study, in which a cohort of students is followed up (for four years) during medical school and changes in their empathy scores are compared as the cohort progresses through medical school.
Moving forward, to attenuate this limitation, Dr. Hojat is currently undertaking a five-year longitudinal study of a national cohort of osteopathic medical students from the 2019-2020 entering class. He plans to follow (the students) from matriculation to graduation to examine yearly changes in empathy, reasons for such changes, and to explore approaches to enhance and sustain their empathy.
This Project in Osteopathic Medical Education and Empathy (POMEE), according to Dr. Hojat, is sponsored by the American Association of Colleges of Osteopathic Medicine (AACOM), the American Osteopathic Association (AOA), and the Cleveland Clinic in collaboration with the Sidney Kimmel Medical College at Thomas Jefferson University.
Dr. Hojat added that: In addition to examining empathy, we plan to study changes in orientation toward holistic, integrative, and patient-centered care, attitudes toward interprofessional collaboration, lifelong learning, and burnout experiences as the cohort progresses through medical school.
Rutgers Biomedical and Health Sciences Chancellor Brian Strom made a case for the merger in a Jan. 31 letter to the executive committee of Rutgers University Senate.
A controversial proposal to merge the two Rutgers University medical schools into a single entity spread over two cities 30 miles apart may be gaining momentum, despite concerns among some faculty and staff about the process and potential risks involved.
The Rutgers University Senate is scheduled today to consider permitting leaders at Robert Wood Johnson Medical School (RWJMS) in New Brunswick and New Jersey Medical School (NJMS) in Newark to start exploring what is needed to unify these colleges under a single mission and governance structure with one educational system, research agenda and clinical practice.
Rutgers Biomedical and Health Sciences Chancellor Brian Strom, who oversees both medical schools, made a case for the merger in a Jan. 31 letter to the executive committee of the senate, a legislative body with some regulatory functions. Strom said a combined school would increase Rutgers access to research dollars and provide new opportunities for students, scientists and patients. Faculty and students at the two schools treat patients at teaching hospitals, clinics and private offices in both cities.
I believe we have the opportunity to pursue a bold and transformational change in medical education at Rutgers University that may prove to be an influential model across the United States, the RBHS chancellor wrote. He also stressed that if the schools were combined, one campus would not be a satellite or subordinate of the other.
In his letter, Strom underscored that no final decision has been made, but he asked for the senates input before faculty committees are appointed to dig into the mechanics of a merger; it is not clear how long the senate executive committee will take to make a decision. His letter does float a possible name for the combined entity Rutgers Medical School and hints that it could attract a transformational philanthropic gift.
If the Senate panel does give its go-ahead, and the faculty can find a way to make it work, the final decision would essentially be left to the Liaison Committee on Medical Education (LCME), a national committee that accredits medical schools, according to the letter. Stroms team has already been in touch with the liaison committee about the potential change, which could result in the largest medical school in the U.S. (Each program now includes more than 700 students and thousands of faculty and staff.)
Thus, my request to the Senate is to approve the merger now, with the explicit recognition that we are continuing a process where the end result may be the integration of RWJMS and NJMS into a single accredited school, the final arbiter of course being the LCME. However, an irrevocable decision to merge has not yet been made, pending that work by the faculty, he wrote.
The process outlined in Stroms letter raised concerns for some medical school faculty and staff, who believe there should be more transparency around the planning and greater input from the Rutgers community and the public. And elected officials representing Newark are particularly concerned about the impact any merger would have on clinical care there, including at the citys University Hospital, north Jerseys only Level 1 trauma center.
The merger of Rutgers medical schools should not take place without input from the public, bargaining with unionized workers and oversight from New Jersey regulators, said Debbie White, a nurse and president of the Health Professionals and Allied Employees union, which represents close to 1,000 clinicians and other staff at the two schools.
New Jersey made a commitment to preserve the medical school in Newark and promote the institution as a premier teaching facility. We must hold Rutgers and the state to that commitment before allowing a merger to move the future of health care in a direction that puts Newark in the back seat, White said.
Diomedes Tsitouras, executive director of the American Association of University Professors chapter that represents some 1,500 faculty in Rutgers biomedical program, has urged the chancellor to take his time with any decision, especially given all the other changes the schools are currently experiencing. (Some of the AAUP units are engaged in contract disputes with Rutgers.)
The (university) senate should put a hold on this until details can be figured out, Tsitouras said. Theres no rush to go to the LCME.
But Strom and other Rutgers officials insist that there is now a unique opportunity for change. Our intention is to facilitate a bold transformation of medical education at Rutgers and to set a new standard for the country, said Associate Vice Chancellor Zach Hosseini, who handles marketing and communications. To do that, we are engaging with key partners, like the Rutgers University Senate and the Liaison Committee on Medical Education (LCME), to ensure we follow the necessary and appropriate steps to explore the transformation that the committee envisioned, he added, referring to a faculty panel report unveiled last week.
The current system is the result of former Gov. Chris Christies reform in 2012 that dismantled the former University of Medicine and Dentistry of New Jersey, in Newark, and restructured medical education across the state. That led to the creation of NJMS in Newark and RWJMS in New Brunswick, which were united under Rutgers umbrella biomedical program with five other health-related colleges. (The reform also shifted an osteopathic program in Camden from Rutgers to Rowan University.)
In recent years, the two Rutgers medical schools have grown closer, collaborating on a number of clinical institute programs, and they now share a single leader. In January 2019, NJMS Dean Dr. Robert L. Johnson was also appointed interim dean at the New Brunswick school RWJMS when the previous dean departed. The two schools are also combining their graduate medical education programs. In 2017, RBHS signed an agreement with RWJBarnabas Health, one of the states largest provider networks, to improve the universitys clinical practice.
Strom has suggested that integrating the two medical schools would enable the states university to attract more research funding and scientific expertise, while making the program more attractive to potential students, health care employers, and other partners. In his letter to the senate panel, he notes that Rutgers is now one of only five universities in the country with more than one medical school, and the other four are separated by hundreds not dozens of miles.
Further, this separation hurts our national rankings substantially, since our grant portfolio, a large part of the ranking, is divided between the schools, Strom wrote.
To explore the future options, Strom created a 12-member commission (six from each school) to study various scenarios, from maintaining the status quo to a full merger with two co-equal campuses. In a report distributed last week, the committee focused on two choices: remaining as two schools, but with greater collaboration, or combining into one entity. It did not endorse one option over the other, but warned that any change would be costly, complicated and require significant planning and stakeholder input.
Strom insists that no decision has been made in his letter to the senate panel, but in framing the work to come, he focuses almost exclusively on efforts needed to explore and carry out a merger. There is no mention of a process to determine if that path is preferable to more limited collaboration.
Based on the recommendations of the (12-member) Committee, our next steps are to continue and expand careful and thorough deliberations on the potential structure, governance, curriculum, research, and clinical care of a future combined Rutgers Medical School. (The final name of a combined school remains to be decided), Strom wrote. Incidentally, a worksheet provided to the senate panel included the same potential name and noted that a merger would not require additional funding, at least early on.
If this change is viewed as sufficiently transformational, we may be presented with an opportunity for a potentially transformational philanthropic gift, he wrote. No additional information on the potential gift was available Thursday afternoon.
Please consider accepting this process and with it the possibility that we will completely integrate the two medical schools into a single model school and the potential to create the brightest future for academic medicine, one that will serve our students, patients, and communities while advancing our scholarship, research, and the profession of medicine, Strom wrote.
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Another Step Toward Controversial Merger of Med Schools - NJ Spotlight