The November issue of Academic Medicine, a peer-reviewed journal dedicated to issues in medical education, contains several articles that may be of interest to you. Four of these articles are highlighted below - full-text versions of these articles are available in PDF format. Please note that this information is embargoed until 11:59 p.m., EST, Wednesday, Nov. 5. This issue will be released to the public on Nov. 6.
1. "Prospective Medicine: The Next Health Care Transformation"By Ralph Snyderman, M.D. and R. Sanders Williams, M.D.
To fix the broken U.S. healthcare system, new models of prospective health care must be created and validated. Prospective health care would determine the risk for individuals to develop specific diseases, detect the disease's earliest onset, and prevent or intervene early enough to provide maximum benefit. The authors describe the mechanisms of managing care prospectively, describe the components of a personalized health plan, and show how prospective care could relate to a community or group of covered individuals. They conclude by stressing that all interested parties, including academic health centers, insurers, and payers, will need to work together to develop innovative applications of new technologies and appropriate delivery models. Bipartisan political support will also be needed to help achieve rational reimbursement among providers and payers, so that prospective care can fulfill its promise of being the best cost-effective model to improve the nation's health.
2. "A National Survey of Residents' Self-Reported Work Hours: Thinking Beyond Specialty"By DeWitt C. Baldwin, Jr., M.D., et al.
A large sample of first- and second-year residents in a variety of specialties and hospitals was surveyed about a number of aspects of their work experience during the first two years of training, focusing on their self-reported work hours. Nearly half of residents reported working more than 80 hours per week. Total work hours were significantly correlated with reported stress and hours of sleep per week. Residents averaging more than 80 work hours per week were more likely to be involved in a personal accident or injury, in a serious conflict with other staff member, or in making a significant medical error. Cluster analysis revealed four different types of residency experience: high intensity, moderate intensity, low intensity, and moonlighters, suggesting that residents may have some choice in selecting a residency experience suited to their particular personal and professional needs. Given the variety of program and specialty requirements and demands, it seems unlikely that an arbitrary limit or a simple decrease in work hours will provide a satisfactory solution to many resident and patient care concerns.
3. "The Alchemists: A Case Study of a Failed Merger in Academic Medicine"By William T. Mallon, Ed.D.
In 1997, Pennsylvania State University's Hershey Medical Center and Geisinger Health System in Danville, PA, announced plans to merge into one large clinical enterprise. Both organizations bought into the idea that large consolidated entities were the wave of the future for Pennsylvania and predicted that there would be only "five or six surviving health care systems." The belief was "that bigger was better." The merger unwound three years later. The organizations realized that combining two large complex health care organizations into one does not necessarily produce economies of scale, organizational efficiencies, and an improved focus on patient care, education, and research. "Without an exhaustive and in-depth review of organizational culture, mores, values, and mission, perhaps such alliances are, in fact, destined to be folly."
4. "The Imperative for Quality: A Call for Action to Medical Schools and Teaching Hospitals"By the Academic Medical Center Working Group of the Institute for Healthcare Improvement
According to the Institute for Healthcare Improvement, growth in medical knowledge and technology is occurring at a faster pace than researchers' ability to translate these assets into safe and effective health care for the public. The medical community's continued reliance on individual autonomy and accountability, paper transactions, and secrecy has precipitated the current crisis of patient dissatisfaction, unsafe care, double-digit inflation, and low morale among physicians, nurses, and other health care workers. Patient safety and quality improvement have been identified as critical clinical and research endeavors supported by the federal government, accrediting bodies, regulatory agencies, and patient advocacy groups. The Boston-based Institute for Healthcare Improvement (IHI), now in its 12th year, is leading quality improvement and patient safety efforts by educating physicians, nurses, and other health professionals to improve the effectiveness and efficiency of their delivery systems. Recently, academic medical institutions have come together to improve patient outcomes by participating in IHI's IMPACT network, a year-old initiative open to all hospitals and health systems in the country. Through operational improvements and the education of future health professionals, the initiative's goal is to address essential dimensions of patient care: safety, effectiveness, efficiency, timeliness, patient-centeredness, and equity.
Challenges abound for medical schools and teaching hospitals. Academic Medicine, the journal of the Association of American Medical Colleges, presents major articles and research reports from leaders in medicine, government, and health that address these challenges. The journal is available online at (http://www.academicmedicine.org).
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