Transcendent professionalism: keeping promises and living the questions.

Wynia and colleagues propose a definition of professionalism as a belief system by which to shape health care rather than a list of values and behaviors. The belief that professionalism is the best way to organize and deliver health care constitutes a promise to society. The notion that the medical profession as a whole as well as its individual members should be held accountable to standards of competence, ethical values, and interpersonal attributes developed, declared, and enforced by the profession itself is also a promise to society.

Institutional attributes associated with innovation and improvement: results of a multisite study.

Background: To date, no studies have explored why some teaching hospitals and health systems appear to offer a more fertile environment for innovation and improvement in the learning environment. As a consequence, little is known about the role of organizational attributes and culture in fostering innovation and improvements in settings where residents learn and participate in care, though these have been studied extensively in the general literature on organizations.

Aims: The goals of our study entailed (1) gathering ground-level observations on processes and common attributes; (2) disseminating this information for adoption and adaptation; and (3) exploring whether the current accreditation model may present barriers to institution- and program-level innovation.

Perspectives on continuing education in the health professions: improving health care through lifelong learning.

In November 2007, the Josiah Macy, Jr. Foundation convened a conference to address a number of complex issues concerning continuing education (CE) in the health professions. Participants concluded that CE, as currently practiced, does not focus adequately on improving clinician performance and patient care, is too dependent on lectures and too removed from the daily practice of clinicians, does not encourage or emphasize newer technologies and point-of-care learning, is poorly integrated across disciplines, and is inappropriately financed.

Competencies: from deconstruction to reconstruction and back again, lessons learned.

I address the potential impact of the Association of Schools of Public Health's development of a competency model for the graduate Master of Public Health. I reflect on the model in relation to the Accreditation Council for Graduate Medical Education's adoption of a competency-based model for medical education. Six lessons learned by the Accreditation Council for Graduate Medical Education that the Association of Schools of Public Health might consider in moving forward are how learning outcomes can be enhanced by using competency models, the effect of competency development processes in "creating a common language" among educators, the benefits and challenges of numerous competencies within a model, the usefulness of the Dreyfus model for progressive competency development, the need for multiple assessment tools used over time, and the value of learning portfolios.

Preparing the personal physician for practice (P(4)): redesigning family medicine residencies: new wine, new wineskins, learning, unlearning, and a journey to authenticity.

The family medicine community has come together in the Future of Family Medicine Project in an attempt to be clear about its work and values and to address the frustrations of both its own practitioners and the public. A new model has been proposed, offering several attractive features for both patients and practitioners. The project has generated momentum around the notion that it is really possible to redesign family medicine residency programs.

Patient safety curriculum for surgical residency programs: results of a national consensus conference.

Background: The American College of Surgeons (ACS) and the Accreditation Council for Graduate Medical Education (ACGME) are committed to promoting patient safety through education. In view of the critical role of residents in the delivery of safe patient care, the ACS and ACGME sponsored jointly a national consensus conference to initiate the development of a curriculum on patient safety that may be used across all surgical residency programs.

Conclusions: National leaders in surgery with expertise in surgical care and surgical education, patient safety experts, medical educators, key stakeholders from national organizations, and surgical residents were invited to participate in the conference.

Professionalism: identifying current themes.

Purpose Of Review: This review analyzes the literature on medical professionalism in order to inform further study, educational activity, and reflective practice for all phases of a physician's professional development from medical school through practice.

Recent Findings: Several themes emerged from an analysis of the writing about medical professionalism during the past year. A number of authors attempted to identify concrete behaviors associated with attributes and characteristics used to define professionalism.

In search of coherence: a view from the Accreditation Council for Graduate Medical Education.

The Conjoint Committee on Continuing Medical Education has developed a position paper, a set of recommendations, and next steps in the reform of continuing medical education (CME). The Accreditation Council for Graduate Medical Education (ACGME) sets standards for and accredits residency programs in graduate medical education and is not directly involved with CME. This article offers a perspective about the Conjoint Committee's recommendations from the executive director of the ACGME.

Short and versatile route to a key intermediate for lactacystin synthesis.

[reaction: see text] A key intermediate 14 for the synthesis of lactacystin 1 has been constructed in four steps and 33% overall yield. The key steps involve cyclization of a suitably functionalized glutamic acid derivative and concomitant alkylation of the resulting beta,beta-diketoester system, C-acylation of the cyclic alpha-amidoketone 9, and decarboxylbenzylation of 12. Alkylation of a related beta,beta-diketoester 5 was additionally achieved with several electrophiles.

Building and assessing competence: the potential for evidence-based graduate medical education.

The Accreditation Council for Graduate Medical Education (ACGME) has recently begun to use educational outcome measures as an accreditation tool. This long-term initiative offers the potential for building knowledge about effective educational interventions and ultimately for using time-variable educational models. This article reviews the progress of the ACGME initiative and plans of the initiative and explores the broader implications of competency.