Medical Studies

Big Changes Ahead in Medical Education

The U.S. should be prepared for massive changes in the next few years in the way physicians are trained, experts said here Thursday.

Change will have to start with inter professional education, George Thibault, MD, president of the Josiah Macy Jr. Foundation in New York, said at an event sponsored by Health Affairs to promote its theme issue on medical education. “We know all health professionals are going to work together in formal and informal teams, yet we educate them separately and then are surprised when they don’t work together well.” Instead, professionals should be educated together so they are prepared to work together as teams, he said.

In addition, a new model of clinical education is needed, Thibault continued. “The [current] model is very fragmented and still too hospital-based to take care of a population with chronic illnesses who are largely outside the hospital. The model needs to be more longitudinal and community-based.”

Then there is the content of the curriculum. “Since [the Flexner report], biological sciences have been the basis for medical education,” he noted. “We need to add social sciences, systems management, economics, and medical professionalism.”

Thibault also suggested that medical schools move away from time-based education and toward education based on development of competencies, “so learners move through as they are ready to move through. We cannot continue to have a locked-up approach determined by everybody doing the same thing or determined by just time and place. This can lead to a more efficient system … and to professionals who are specifically prepared for the careers they’re going to take on.”

Several speakers lamented the lack of medical students willing to go into primary care. “Part of that is the culture of medical school — what’s conveyed to students plays a major role,” said Uwe Reinhardt of Princeton University in New Jersey.

“You come home and you say, ‘I’m a pediatrician,’ or you say you’re like Sanjay Gupta — a neurosurgeon. What gets you the date?” he said.

Although people often point to medical education debt as a barrier to pursuing the lesser-paid primary care specialties rather than the more well-paid specialties, Reinhardt disagreed that it’s a major problem. “Look at medical school indebtedness — on average it’s about $220,000,” he said. “I always tell physicians who bellyache, ‘you know that guy who just opened a restaurant — what do you think they pay on a mortgage?’ It’s probably close to your [loan], and somehow they make do.”

“Debt is a nuisance, but not prohibitive,” he added, noting that the Association of American Medical Colleges is trumpeting record medical school enrollment despite students’ debt problems.

For the primary care situation to change, “we need accountability,” said David Goodman, MD, of the Dartmouth Institute for Health Policy and Clinical Practice in New Hampshire and a co-principal investigator of the Dartmouth Atlas of Health Care. “The best way is with public guidance leading to peer review that leads to public funding,” with priorities that are set annually. “That might [include] increase in primary care [residency] funding — putting a thumb on the scale allows being a priority.”

Goodman proposed a scheme in which each year, 10% of physician training programs would need to reapply for their funding. Programs that are reapplying would be competing with other established programs as well as new residency programs. Applications would be peer-reviewed, and successful applicants would get an interim review to make sure they were on track.

Under such a system — which would mean that each program would be reviewed once per decade — meritorious training programs would be able to expand, while weaker programs would lose 10% to 15% of their funding. And because the awards would be made every year, it would give the system “the ability to change priorities with each succeeding year, over time,” he said. “Sure, we’ll make mistakes, but they’ll be smaller mistakes.”

Audience members also heard from Reps. Aaron Schock (R-Ill.) and Allyson Schwartz (D-Pa.)who are co-sponsoring the “Training Tomorrow’s Doctors Today Act,” a bill that would increase the number of graduate medical education (GME) slots by 15,000 over a 5-year period. “This is an issue that’s uniting [Republicans and Democrats] on Capitol Hill,” Shock said.

Both Schock and Schwartz also expressed support for legislation that would repeal and then replace Medicare’s much-maligned sustainable growth rate (SGR) formula for physician reimbursement. Schock noted that one reason the House Energy and Commerce Committee was able to get unanimous support among its committee members for its SGR repeal proposal, which would cost an estimated $179 billion, was that “they didn’t say how they’re going to pay for it.”

Rep. Dave Camp (R-Mich.), chair of the House Ways and Means Committee — which is charged with coming up with ways to pay for legislation such as an SGR fix — has been briefing committee members on possible “pay-fors,” said Schock, who is a member of the committee. “So stay tuned” to see what happens, he added.

Schwartz said she hopes that GME reform may eventually be included in an SGR fix bill should one be passed. “When we do something about the SGR, there might be a moment when we could slip this [GME] legislation into our discussion,” she said.

Source: Med Page today

 

Medical student study: sickly schools, healthy results

Medical student study

Students with the same entry grades perform better at medical school if they hail from poor-performing schools.

This is one of the conclusions of a study of nearly 5,000 students from 12 UK medical schools published last week in the journal BMC Medicine.

The research, titled The UKCAT-12 Study, finds that the average A-level scores of students’ schools is the only piece of contextual data with significant power to predict performance in medical school.

The finding complements a study by the Higher Education Funding Council for England in 2003, which came up with a similar result for UK universities in general, and the early findings of a follow-up, expected to be published next year.

The UKCAT-12 Study, authored by Chris McManus, professor of psychology and medical education at University College London, and colleagues from UCL and Birkbeck, University of London, says the reason for the phenomenon may be that high-performing schools give pupils’ work “extra polish”that is not available when they leave. Another possibility is the “big fish, little pond effect”, so students from lesser academic environments have higher ambitions.

“That the effect found by [Hefce] is now found in medical students suggests that there is a strong argument for using the contextual measure of average A-level attainment at a secondary school in making admission decisions,” the authors say.

The paper also lends support to the widespread use in medical school admissions of the UK Clinical Aptitude Test (UKCAT), which tests numerical, verbal and abstract reasoning, decision-making and situational judgement. It was introduced in 2006 to help distinguish between high-achieving applicants.

Based on their analysis of students who took the test between 2006 and 2008, the authors conclude that A-level grades remain the strongest predictors of medical school success. But used in conjunction with A-level and GCSE results, the UKCAT offers a small but significant boost to predictability, particularly for mature students, who often have “unusual combinations of academic qualifications”, and female students, who tend to outperform males at medical school but get worse UKCAT scores.

The paper also notes evidence that the test has widened participation and concludes that its use in admissions is “in many ways more justifiable than the use of Ucas personal statements, which…are open to criticism for difficulty in scoring consistently, are subject to a range of influences, including social opportunity, and have not been shown to predict success in medical school”.

Source: Times Higher Education

Affordable medical education will bring down healthcare costs

One way to make healthcare affordable is by ensuring that medical education becomes inexpensive, Sri Jayadeva Institute of Cardiovascular Sciences and Research (SJICSR) Director Dr C N Manjunath said.

Delivering the  keynote address at the inaugural of a two-day workshop titled ‘Affordable Healthcare and Access to Clean Water’ at the Indian Institute of Management, he said,”Because of expensive medical education, doctors are constantly thinking about how much they’ve spent on their training, and patients are made to bear the costs. To make clinical service affordable, medical education has to become affordable.”

Dr Manjunath said affordable medical education would also make 25-30 per cent doctors follow an evidence-based medical approach.

“We need to strengthen the basics of medicine. Doctors seem to be taking pride in conducting investigations (tests), most of which may be unnecessary. It is wrong to make patients undergo so many tests. In more than 50 per cent of the cases, lending a good ear to patients will give us the diagnosis,” he said.

“The basic cost of treatment will be decided by the managements in private hospitals, which are mostly looking only at a revenue model. They need to adopt a volume-cum-revenue model instead,” Dr Manjunath suggested.

He referred to how SJICSR did close to 80 angiogram procedures every day.

“With such volume, I can easily perform at least 7-8 free of cost,” he added.

Dr Manjunath said hospitals in the public sector were unable to win the trust of patients due to lack of uniformity in high standard healthcare.

“There is a need to cut red tape. Also, a corporate culture should come in the public sector. Otherwise, patients will be forced to go to the private hospitals.” With 70 per cent of clinical services today being provided by the private sector, “there is a need for better synchronisation between public and private institutions,” he said.  Dr Manjunath urged the government to reduce duties on costly medical equipment.

Source: New Indian Express

 

Dangerous Fungus Makes A Surprise Appearance In Montana

What life-threatening illness can you get from repotting plants, attending a rodeo or going spelunking? If you didn’t guess histoplasmosis, you’re not alone.

 This week’s Morbidity and Mortality Weekly Report, chronicle of all things infectious, reports on the surprising appearance of histoplasmosis, a lung infection caused by a fungus, in four people in Montana.

The fungus in question, Histoplasma capsulatum, is common in the Midwest and Midatlantic, according to the researchers at the Centers for Disease Control and Prevention and in Montana who penned the report. That was news to us. So we talked with John Bennett, chief of the clinical mycology section at the National Institutes of Health, to get up to speed.

“There are huge areas of the country where this is relatively common, including here in Washington, D.C.,” said Bennett, who wasn’t involved in the study. “The thing that made this unusual is that Montana is outside the usual area.”

Uh, exactly how common in Washington? This is suddenly starting to strike uncomfortably close to home.

Skin tests have found that a sizable number of people in the Mid-Atlantic have been infected with histoplasmosis, Bennett says. When infected you might get a cough or feel a bit fluish. But most people shake it off and never get really sick.

Indeed, histoplasmosis and other fungal infections typically are lethal only in people whose immune systems are weak. The four people in the MMWR report had other health issues that could have made them more vulnerable, ranging from chemotherapy for colon cancer to mononucleosis.

The four people who fell ill in Montana in 2012 and 2013 ranged from a 17-year-old boy who liked caving, camping and had worked as a landscaper to a 79-year-old retired rancher. The boy had had mono; the rancher had colon cancer. All recovered from their infections, though some were sick for months with pneumonia and other health problems.

Histoplasmosis, sometimes called histo, is spread by the droppings of birds and bats. It’s common in soil, so common that AIDS patients and other people with compromised immune systems are warned to have someone else repot the plants.

It’s possible that birds and bats are spreading the fungus from South Dakota and North Dakota, where it’s been known for years. Or it could be that some of these people had been exposed years earlier.

“The problem about this fungal infection, you can get infected now and not get sick until years later,” Bennett says. “The older gentleman, did he really get it in Montana? Or did he get it somewhere else and it reactivates 20 years later?”

Only one of the patients, the retired rancher, had a confirmed case of histoplasmosis, Bennett cautions. So this may not signal a looming fungal invasion of Montana.

But Dr. Henry Masur, chief of critical care at the NIH Clinical Center and an infectious disease researcher, says he wouldn’t be surprised to see histo and other infectious diseases cropping up where you wouldn’t expect to see them.

“We’re a more and more mobile society, both in terms of people and in terms of pathogens,” Masur told Shots.

OK, so you don’t live in Montana, or the Midwest or in D.C. Think you don’t have to contend with fungus? Think again.

Farmers and others in the Midwest have to contend with the fungus Blastomyces dermatitidis, which also lives in soil.

And the Pacific Northwest has been dealing with a particularly dangerous strain of Cryptococcus gatti for several years now. It has caused at least 40 deaths.

Source:

 

In pain? Listen to music, says pharmacy

A high street pharmacy is advising customers seeking pain relief to listen to music after a study found it can ease their symptoms.

Four in ten people living with persistent pain (41 per cent) told researchers their favourite songs helped them relax and feel better.

Pop music was found to be the most effective for 21 per cent of patients, followed by classical (17 per cent) and rock or indie (16 per cent).

The most effective songs were “Bridge Over Troubled Water” by Simon and Garfunkel, “Angels” by Robbie Williams, and “Albatross” by Fleetwood Mac.

These were followed by “Candle in the Wind” by Elton John, and “Easy” by “The Commodores”.

Now Lloyds Pharmacy – which commissioned the study of 1,500 people – is piloting the recommendations at selected stores across the UK.

This includes Selfridges, in Oxford Street, central London; Jubilee Crescent, Coventry; Barton Hill Road, Torquay; and Fallowfield, Manchester.

Around ten million people in the country suffer pain most days, including back and neck pain, arthritis, joint pain, and headaches or migraines.

Music has the biggest impact on younger people, with 66 per cent of those aged 16 to 24 claiming it helps with their pain management.

Pharmacist Andrew Mawhinney, from LloydsPharmacy, said: “There are lots of different ways of managing pain, not only with medicines but also with lifestyle changes such as moderate exercise and relaxation.

“After speaking to many people who are living with pain we were interested to learn just how many found music beneficial, which is why we’re now trialing the use of music within our pain service in some of our pharmacies.”

David Bradshaw, a Research Assistant Professor at The University of Utah Pain Management Centre, said: “People in pain should try to find some activity to get fully engaged in.

“Listening to favourite music is excellent for that because it can involve both thoughts and feelings.

“No matter how anxious you may feel, if you can get absorbed in the music this can help with your pain.

“Choose music you like and know well, humming or singing along can help you engage in listening and distract you from your pain.”

Of those who listen to music to help with their pain, one third (33 per cent) do so as “often as possible” and 40 per cent chose to listen in the evenings.

Source: http://truth.co.nz

 

Obese Patients with Pancreatic Cancer Have Shorter Survival

A diagnosis of pancreatic cancer usually carries with it a poor prognosis, and the news may be even worse for those who are obese: It could mean dying two to three months sooner than pancreatic cancer patients of normal weight, new research shows.

Prior studies have tied obesity to a higher chance of getting pancreatic cancer, but the new study asked whether the disease affects the tumor’s aggressiveness and the patient’s overall survival.

“[The new research] adds to the growing body of evidence that obesity is linked to cancer,” said Dr. Smitha Krishnamurthi, an associate professor of medicine at the Case Western Reserve University School of Medicine.

The study was published Oct. 21 in the Journal of Clinical Oncology. Krishnamurthi was not involved in the new study, but did write a related journal commentary.

Because it is so often asymptomatic and is detected late, pancreatic cancer remains one of the most deadly tumor types. According to the American Cancer Society, more than 45,000 people will be diagnosed with the disease this year, and it will claim over 38,000 lives.

In the new study, a team led by Dr. Brian Wolpin, an assistant professor of medicine at the Dana-Farber Cancer Institute and Harvard Medical School, collected data on more than 900 patients with pancreatic cancer who took part in either the Nurses’ Health Study or the Health Professionals Follow-Up Study. These patients were diagnosed during a 24-year period, the researchers said.

After diagnosis, the patients lived for an average of only five months. Normal-weight patients, however, lived two to three months longer than obese patients, the researchers found.

This association remained strong even after the researchers took into account factors such as age, sex, race, ethnicity, smoking and the stage of the cancer at diagnosis. The study did not, however, prove a cause-and-effect relationship between weight and length of survival.

In addition, obese patients were more likely to have more advanced cancer at the time they were diagnosed compared with normal-weight patients. Overall, the cancer had already showed signs of spreading in 72 percent of obese patients at the time of diagnosis, compared with 59 percent of normal-weight patients.

It also seemed to matter how long the patient had been obese — the association between weight and survival was strongest for the 202 patients who were obese 18 to 20 years before being diagnosed with pancreatic cancer.

Krishnamurthi said the reasons for the link aren’t clear. She said the study can’t tell us whether shorter survival in obese patients “was due to biologic changes that can occur in obesity, such as increased inflammation in the body, or whether the obesity caused other conditions that interfered with the treatment of pancreatic cancer.”

Source:

 

Studies confirm colon cancer screening reduces deaths

Studies confirm colon cancer screening reduces deaths

A new analysis suggests that it’s worth it to follow screening recommendations and have the test done every 10 years (or every five for those at high risk.)

Writing in the New England Journal of Medicine on Wednesday, Harvard researcher Reiko Nishihara and co-authors assessed colonoscopy use, colorectal cancer cases and colorectal cancer deaths among participants in the multi decade Nurses’ Health Study and Health Professionals Follow-up Study.

Following 88,902 subjects over 22 years, they found that people who underwent endoscopic screenings were less likely to develop colon cancer than people who didn’t. Subjects who had clean colonoscopies, sigmoidoscopies and polypectomies were, respectively, 56%, 40%, and 43% less likely to develop the disease than subjects who were not screened.

The team estimated that 40% of the colon cancers that developed over the study period would have been prevented if all participants in the studies had went in for colonoscopies.

In a separate study in the same journal, Dr. Aasma Shaukat of the Minneapolis Veterans Affairs Heath Care System and co-authors wrote that a different screening test — the fecal occult blood test, which detects blood in a stool sample — is also effective in reducing deaths from colorectal cancer.

In that report — a 30-year follow-up on earlier work involving more than 46,000 participants — scientists who reviewed death records through 2008 found a 32% reduction in the risk of death from the disease among patients in the trial who underwent annual screening during the periods of 1976 to 1982 and from 1986 to 1992.

In an editorial also published in the New England Journal of Medicine, Dr. Theodore R. Levin and Dr. Douglas A. Corley of the Kaiser Permanente Medical Centers wrote that the studies showed that fecal occult blood tests as well as colonoscopies were effective screening measures, and suggested that current guidelines make sense for patients.

Because the data sets can’t be compared directly, they cautioned against concluding that colonoscopies are necessarily better than the blood test on the basis of the findings. Studies have found that more patients choose to get blood tests in addition to colonoscopies if they are offered — one reason why the Kaiser system in Northern California, where both co-authors work, uses a “combined approach.”

Randomized trials that are already underway may help determine what testing approach prevents the most cancers and deaths, they wrote.

Source: LasAngelestimes

Medical school program trains doctors for the future of medicine

Health care in America has changed drastically over the last decade – but the way doctors are trained has been the same for over 100 years. Now, some of the nation’s top medical schools are revamping their programs.

“Probably the single biggest reason was trying to prepare students for what health care was going to be like in a decade,” Dr. Charles Lockwood, dean of The Ohio State University (OSU) College of Medicine told FoxNews.com. “Because if you think the last 10 years have been quite a change, really when we begin to be able to sequence people’s entire DNA, and identify every conceivable illness that they’re going to have, and begin to design prevention along those lines ― it’s going to require a very different mindset for docs.”

Typically, medical students spend their first two years of medical school hitting the books, but at OSU’s College of Medicine, they’re trained as medical assistants in the first six weeks, and within eight weeks, they are seeing patients as health coaches.

“Working with patients in a service-type fashion early on in the curriculum is extremely valuable to the students ― it keeps them grounded in why they came to medical school,” Dr. Daniel Clinchot, vice dean for education at OSU’s College of Medicine said of the school’s new Lead. Serve. Inspire program. “Having your patient population that you work with over the course of 18 months is very unique, and I think really is inspiring for many of our students.”

Historically, American medicine has always centered around doctors, but a growing shift in health care delivery has put more emphasis on ensuring quality outcomes for patients.

“You have to do a lot more teaching of patients, you have to explain their illness, you have to explain all the options available for their therapy, you have to spend a lot of time talking about prevention,” said Lockwood. “Communication skills are something that are going to be critically important for the future doc, and that’s not something we’ve emphasized before in medical education.”

Advances in technology and a focus on prevention are just two of the health care changes that helped shape the new Lead. Serve. Inspire curriculum. All incoming medical students are given iPads and classes are available as traditional lectures, podcasts and e-learning modules.

In a state-of-the-art clinical skills center on campus, students can practice virtual laparoscopy and robotic procedures. And there are four critical care simulation bays with life-like mannequins that can mimic human illnesses and medical emergencies. From a control room outside the simulation area, instructors create scenarios that test the students’ ability to treat patients under pressure in the emergency room, operating room, trauma center and labor and delivery wing.

“I think the best thing about the simulations is that it helps you practice in a lower-stress environments than when you’re actually working with patients,” Shannon Emerick, a medical student at OSU’s College of Medicine, said. “You can kind of get the jitters out, and by pretending these are real patients, you can make sure you have everything straight by the time you’re working with actual people.”

Learning the business of health care is also at the core of the Lead. Serve. Inspire program. Health care economics classes are built into the curriculum, and students also have the option to minor in business or take time off to get their MBA to help them prepare to run a successful practice in the future.

“It’s crucial that they understand the cost of health care,” said Lockwood. “Every test that they order, they need to understand exactly what that costs, every imaging procedure, every test that they do has a cost, and they need to understand what it is, and is it absolutely necessary or is there another way to get that information?”

Source: Fox News

 

Airtel Ghana funds ultra-modern medical teaching facility

Ghana President John Dramani Mahama has complimented Indian-owned mobile telecom provider Airtel Ghana for financing an ultra-modern teaching facility and clinical centre for the School of Medical Science of the University of Cape Coast that has also enabled the upgradation of the Central Regional Hospital here into a teaching facility.

The project was started two years ago after a joint sod cutting by the late president John Evans Atta Mills and the CEO (international) and joint managing director of Bharti Airtel, Manoj Kohli. The company, however, declined to state how much it had spent on the project, which it had undertaken as part of its corporate social responsibility (CSR) initiative.

President Mahama commended Airtel Ghana for funding the construction of the facility, adding that the company had been consistent with its contribution towards enhancement of education in the country.

The school runs courses in surgery, internal medicine, paediatrics and child health, and obstetrics/gynaecology. These disciplines have sub-specialties such as ENT, ophthalmology, dermatology, medical imaging, anaesthesia and pain management, psychiatry and orthopaedics.

School dean Dr Harold S Amonoo-Kuofi said the facilities funded by Airtel, together with the two-storey Diagnostics Centre, greatly helped in the decision to upgrade the Central Regional Hospital to a teaching hospital.

He also urged other corporates to follow the Airtel example and support the university in its drive to provide the human resource necessary to address the shortfall of doctors in the country, especially in the rural communities.

Airtel Ghana managing director Philip Sowah said the company decided to fund the project to fulfil one of its core values of creating a positive impact among the communities in which it operates.

“It has been our dream to be part of helping to develop the country’s human resource,” Sowah added. [IANS]

Source: India Medical Times

Five new paramedical courses started in Goa medical college

Goa chief minister Manohar Parrikar on Monday launched five paramedical courses in the Goa medical college and announced plans to set up an independent institute for these courses in the near future. Parrikar said paramedical courses are the government’s positive step in providing job-oriented education to Goan youth.

Shri Parikar was speaking after inaugurating the allied health science courses, affiliated to Goa University such as bachelor of physiotherapy, bachelor of occupational therapy, bachelor of optometry, BSc in medical imaging technology and BSc in anesthesia technology at Goa medical college and hospital, Bambolim. BSc in anesthesia technology will have 20 seats while the rest four courses have 10 seats each.

Parrikar said that better job prospects await graduates of such courses both within the country and outside, offering equal or more pay package than doctors. Paramedical personnel are very important now as doctors need to handle machinery that requires repairs at regular intervals, he said

Parrikar said he has been monitoring various problems affecting the GMC and that these problems will be sorted out within three to four months, adding that the 4-MLD effluent treatment plant will take care of the water woes of GMC.

Source: Times of India