Although accurate interpretation of the standard 12-lead electrocardiogram (ECG) is fundamental to diagnosing heart disease, several prior studies report low accuracy rates among medical students, residents, and practicing physicians. The objective of this study was to determine if an online ECG Perceptual and Adaptive Learning Module (ECG PALM) is an efficient instrument to teach ECG interpretation. The ECG PALM consists of 415 unique ECG tracings with associated pretest, posttest, and delayed tests, each using 30 additional ECGs to gauge the effectiveness and durability of training.
View Article and Find Full Text PDFThe sudden, dramatic collapse of the seven-year struggle in Congress to repeal and replace the Affordable Care Act holds important lessons for all would-be reformers, including those advocating fundamental changes in medical education. In this Invited Commentary, the author draws parallels between reform initiatives in health policy and those in medical education, highlighting that, in both settings, stakeholders rarely support "repeal" in the absence of a superior replacement, even when they view the status quo as deeply flawed.For more than three decades, reformers have worked to overhaul the preclerkship medical school curriculum.
View Article and Find Full Text PDFIn this issue, Coleman and colleagues propose an ambitious strategic action framework for academic health center (AHC) department chairs seeking to expand faculty expertise in quality improvement and patient safety (QI/PS). Noting the advent of value-based payment models and that AHCs lag behind some community hospitals in QI/PS, Coleman and colleagues call for deliberate, proactive faculty development and recognition measures to build QI/PS capacity at AHCs. In this Invited Commentary, the author addresses the five challenges to strengthening QI/PS capacity identified by Coleman and colleagues: (1) the mentorship gap: the paucity of expert senior faculty who can mentor junior colleagues in QI/PS; (2) data and analytic bottlenecks: information systems and analytic requests to support QI/PS projects often get pushed to the back of long queues of prioritized queries from other departments, effectively halting QI/PS projects; (3) misalignment between existing reimbursement mechanisms and QI/PS: current fee-for-service and prospective payment mechanisms drive high utilization of costly interventions and can financially penalize organizations that keep patients well and avoid interventions; (4) limited recognition for QI/PS achievement in academic advancement decisions; and (5) pressure to invent and deploy alternative business models that reward value and results rather than the volume and pricing of services, to better align payer, provider, and patient incentives around high-value care.
View Article and Find Full Text PDFFor patients suffering from diabetes and other chronic conditions, a large body of work demonstrates income-related disparities in access to coordinated preventive care. Much less is known about associations between poverty and consequential negative health outcomes. Few studies have assessed geographic patterns that link household incomes to major preventable complications of chronic diseases.
View Article and Find Full Text PDFPurpose: To describe and report outcomes of interventions implemented in the preclerkship curriculum at the David Geffen School of Medicine at UCLA to guide students toward use of high-quality information sources and build a foundation for developing fluency in applying primary medical literature to answer clinical questions.
Method: The authors introduced three phases of change to instruction in literature searching and sourcing for beginning medical students writing learning issue essays: in phase 1 (2003-2006), students were introduced to online resources during orientation week and received a lecture on high-yield literature searching midway through their first curricular block; in phase 2 (2007-2008), the high-yield lecture shifted to orientation week, and a resource matrix and librarian-guided workshop on locating authoritative sources were added; and in phase 3 (2009), peer evaluation and collaboration were implemented. To track changes in sourcing skills, the authors analyzed 3,199 references from 665 essays written by 465 first-year students for two problem-based learning (PBL) cases during the first block of one representative year per phase (2006, 2008, 2009).
The authors describe fundamental changes that have occurred in academic health centers since the 1990 s that have caused an increasingly fragmented experience during core clerkships where medical students risk disconnection from faculty mentors, residents, and patients. Longitudinal "continuity" clinical experiences may constitute a strategy for restoring some of the historic learning conditions. In this issue, Myhre and colleagues and Woloschuk and colleagues compare the performance of students who completed a longitudinal integrated clerkship with the performance of their peers who had completed a traditional rotation-based clerkship year and find that the results are comparable in medical school and after the first year of family medicine residency training.
View Article and Find Full Text PDFIn this issue of Academic Medicine, Walling and Merando's literature review on the senior-year curriculum finds a broad consensus that this final year underperforms educationally at many U.S. medical schools, but little agreement on how to improve it.
View Article and Find Full Text PDFBackground: Because of overcrowding and cost-control efforts, emergency departments are under pressure to refer patients with nonacute conditions to other settings. However, no validated systematic methods exist for safely performing such referrals.
Objective: To determine the effects on health status and access to care of systematically referring patients with nonacute conditions to next-day primary care.