Delegates to the 2011 meeting of the AMA House of Delegates, June 18-22 in Chicago, turned their attention to a number of reports and resolutions that concerned medical students and residents.
Tara Boinpally, a medical student at Case Western Reserve University in Cleveland and a regional alternate delegate representing medical students in the AMA House of Delegates, testifies during an AMA reference committee hearing in favor of a resolution that asks for more longitudinal clinical training during the first two years of medical school education.
Among the various measures considered, delegates called for the AMA to examine the issue of assessing medical school applicants' personal qualities as part of the medical school admissions process. The delegates also adopted a new policy directing the AMA to encourage medical schools to provide longitudinal clinical experiences for medical students during their preclinical years and called for continued monitoring of resident physicians' and fellows' duty hour restrictions and their effects on patient safety and the learning environment.
Selecting medical school applicants based, in part, on certain personal attributes -- such as empathy and a commitment to service -- has long been championed in AAFP workforce reform and medical education policies as a way to increase the number of students most likely to go on to careers in family medicine and primary care. AMA delegates voted to follow a similar course when they adopted recommendations in a report from the Council on Medical Education(www.ama-assn.org) (see page 22) that addresses assessment of applicants' personal qualities as part of the medical school admissions process.
"Medical educators (and the public) agree that being a 'good doctor' is more than academic achievement and other measures of intellectual ability," says the report, which notes that many of these educators have called for a more "holistic assessment" of medical school applicants that would include personal qualities such as altruism, motivation, dedication and intellectual curiosity.
In fact, the report says, the top attributes required for student success in medical school -- as rated by academic affairs and admissions officers -- are integrity, cognitive ability, reliability and dependability, and motivation to pursue a medical career.
Accordingly, the final report recommendations delegates adopted call for the AMA to
- work with the Association of American Medical Colleges, or AAMC, and other organizations to encourage "improved assessment" of personal qualities when recruiting medical school applicants;
- work with the AAMC and other organizations to explore the range of measures used to assess personal qualities among applicants;
- encourage the development of innovative methodologies to assess personal qualities among those applicants;
- work with medical schools and other stakeholder groups to review the ways in which medical schools communicate the importance of personal qualities among applicants;
- encourage continued research on the personal qualities most pertinent to success as a medical student and as a physician to assist admissions committees in adequately assessing applicants; and
- encourage research on the factors that have a negative impact on humanistic and empathetic traits of medical students during medical school.
J. Mack Worthington, M.D., of Chattanooga, Tenn., an AAFP delegate to the AMA who focuses on medical education issues, told AAFP News Now that he applauds the AMA for recognizing that personal qualities, especially a desire for service, are important in the making of a good physician, particularly in primary care.
"Historically, medical schools get so many applicants that the easiest thing to do is to go for the ones with the highest MCAT (Medical College Admission Test) scores and a high grade point average. But there are people who don't do quite as well on the tests who would make good doctors.
"The AMA is coming together with the AAFP to recognize the importance of character and integrity in medical school applicants. My feeling is if there were only one test to give to applicants, a good test of character would be the best one."
Testifying in a June 19 hearing of the AMA Reference Committee on Medical Education, Carol Berkowitz, M.D., past president of the American Academy of Pediatrics, supported the idea of enhancing attention to medical school applicants' personal qualities. "Academic scores are inadequate to evaluate who will be a good doctor," she said.
Moreover, said Berkowitz, the AMA needs to study the whole issue of medical students' loss of empathy during their educational experience, which already is the subject of a growing body of research.
AMA delegates also adopted a new policy(www.ama-assn.org) (see page 7) that directs the AMA to encourage medical schools to include longitudinal clinical experiences for students during the preclinical period, or first two years, of their medical education.
In reference committee testimony, Tara Boinpally, a student at Case Western Reserve University Cleveland Clinic Lerner College of Medicine in Cleveland and a regional medical student alternate delegate from the Ohio State Medical Association, spoke for the AMA Medical Student Section, which sought the new policy.
Quoting from a 2008 AAMC report(www.aamc.org), Boinpally said that "clinical skills education best occurs as an integrated and longitudinal educational process," although most medical schools do not introduce students to clinical skills until their third year.
Yet, she said, citing a 2006 article(journals.lww.com) in Academic Medicine, students at the University of Washington felt more comfortable with clinical skills at the start of the third year after the school implemented a preclinical longitudinal clinic.
"Improving medical students' clinical and diagnostic skills will, in turn, produce better clinicians and, thus, improve patient care," said Boinpally.
According to the reference committee report, a number of medical schools have undertaken efforts to better integrate the didactic and clinical elements of education.
Worthington, who also is professor and chair of the department of family medicine at the University of Tennessee College of Medicine, which has campuses in both Memphis and Chattanooga, told AAFP News Now that early clinical experiences in medical school better prepare students for their residencies and for practice.
At his medical school, for example, first-year students immediately learn clinical skills in each of five six-week-long blocks that combine didactics with exposure to community physicians and their patients, said Worthington. And, students entering the medical school this fall will follow a curriculum that integrates even more clinical work into the first two years.
The AMA also adopted recommendations in a report on resident physicians' and fellows' duty hours.
The Council on Medical Education report, "Resident/Fellow Duty Hours, Quality of Physician Training and Patient Safety," followed up on a 2009 report from the council. The 2011 report comes as the Accreditation Council for Graduate Medical Education's, or ACGME's, new duty hour standards become effective in July.
It recommends, among other things, that the AMA
- continue to monitor the enforcement and impact of the ACGME duty hour standards on patient safety and residents' learning environments, as well as track research on duty hours, sleep, and resident and patient safety with a report back by the 2014 AMA annual meeting;
- encourage publication of studies and promote educational sessions about the impact of duty hour limits, extended work shifts, handoffs, protected sleep periods during in-house call, sleep deprivation, and fatigue on patient safety, medical errors, continuity of care, resident well-being and resident learning outcomes; and
- urge that the costs imposed by duty hour limits be borne by all health care payers.
According to the reference committee report, speakers gave strong testimony in support of the recommendations.
"Today, recognition is growing that the debate needs to move from a focus on the easily quantified metric of duty hours to developing appropriate, individualized supervision and a better learning environment," the reference committee report said.
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