A special theme issue of JAMA released this week focuses on important topics in the continuum of medical education, including health care spending, resident duty hours and maintenance of certification (MOC).
JAMA studies examine such timely topics as:
- How the region of medical residency training may affect physicians’ future spending patterns. One study suggests that residency may imprint care-related spending behaviors. For example, physicians practicing in high-spending regions who also had been trained in high-spending regions had an average spending per Medicare beneficiary per year $1,926 higher than those trained in low-spending regions.
- The effect of duty-hours on patient outcomes or resident board examination scores. One study found that the 2011 resident duty-hour reforms haven’t had a significant effect on mortality or readmission rates for hospitalized patients. Another study determined residents’ exam scores and outcomes for surgery patients weren’t significantly affected, either.
- The effect of MOC, as implemented by the American Board of Internal Medicine, on patient care quality and cost. One study found that implementation of MOC was associated with a decreased growth in costs related to lab tests, imaging and specialty visits. Another study found no significant differences in outcomes for patients cared for by internists with time-limited or time-unlimited certification.
In an editorial accompanying the MOC studies, Thomas H. Lee, MD, chief medical officer for Press Ganey and a physician at Brigham and Women’s Hospital, wrote that physicians should work constructively to help MOC improve, much as physicians should work continuously to improve how they collaborate with colleagues and patients.
“Physicians must make the commitment to lifelong, meaningful learning to ensure that their knowledge and skills remain current and relevant,” Dr. Lee wrote in the editorial. “Patients would be disappointed by anything less. The medical profession may never fully understand the effect of MOC, but that does not mean that physicians should give up or stop trying to make it better. The MOC program is a work in progress, as are all good physicians.”
The editorial echoes new AMA policy adopted in November, which outlines principles emphasizing the need for an evidence-based MOC process that is evaluated regularly to ensure physician needs are being met and activities are relevant to clinical practice.
Other new JAMA Viewpoints and editorials in this issue examine how to interpret duty-hours study results, incorporating electronic health records into clinical education and meaningful roles for medical students in the provision of longitudinal patient care.
The JAMA special issue reflects topics that are being discussed as part of the AMA’s Accelerating Change in Medical Education initiative. A consortium of 11 grant-receiving schools is making transformative improvements to undergraduate medical education.
The consortium has spent the last year developing and implementing new ideas to change the way future physicians are trained, including competency-based assessment, incorporating systems-based practice and team-based care teachings into curriculum, and focusing on diversity and health care disparities. Now, the group is investigating how changes in medical schools will affect residency programs.
Read more about the innovations taking place and challenges being addressed as part of the Accelerating Change in Medical Education initiative at AMA Wire®.
