2010 National Conference
Residents, Students Seek Action on Medical Education, Obesity, Other Topics
By Barbara Bein & Sheri Porter • Kansas City, Mo.
Future family physicians want the Academy's help in making changes to medical education, including proposals on residents' duty hours and preventing burnout among medical students and residents. They're also asking the AAFP to consider supporting efforts to allocate revenue from any tax on sugar-sweetened beverages for obesity and diabetes education, research and prevention efforts, and to investigate existing multimedia resources on obesity.
These were some of the medical education and public health issues raised in resolutions that resident and student members considered during the 2010 National Conference of Family Medicine Residents and Medical Students here July 29-31. The conference garnered 3,200 attendees, the highest attendance since 2000. That figure encompassed more than 1,000 residents, including exhibitors, and more than 800 students.
Members of the National Congress of Family Medicine Residents and the National Congress of Student Members expressed similar concerns about burnout, student debt and the obesity epidemic. Only the residents, however, engaged in spirited discussion about the latest draft proposals on residents' duty hours from the Accreditation Council for Graduate Medical Education, or ACGME.
Members of the National Congress of Family Medicine Residents and the National Congress of Student Members expressed similar concerns about burnout, student debt and the obesity epidemic. Only the residents, however, engaged in spirited discussion about the latest draft proposals on residents' duty hours from the Accreditation Council for Graduate Medical Education, or ACGME.
ACGME Duty Hours Proposals
Ben Marcum, M.D., of Pocatello, Idaho, testifies in support of a resolution he introduced during the 2010 National Conference of Family Medicine Residents and Medical Students that asks the AAFP to oppose certain changes in residents' working conditions. The changes have been proposed by the Accreditation Council on Graduate Medical Education.
Resident Ben Marcum, M.D., of Pocatello, Idaho, introduced a resolution expressing his concern about recent ACGME proposals requiring direct supervision of first-year residents, limits on moonlighting and a maximum 16-hour shift for first-year residents. His resolution asked the AAFP to oppose these proposed changes.
The resolution objected to the proposed 16-hour shifts for first-year residents, in particular, because such shifts "do not provide adequate time for PGY1 (post-graduate, year one) residents to experience the full progression of inpatient care outcomes, nor do they provide adequate home time due to the increased number of shifts at odd hours necessary to successfully prepare the resident."
Furthermore, the resolution contended, such a change would not appreciably improve resident fatigue or the ability to care for patients.
Residents were divided in their reference committee testimony. Carlos Hernandez-Torres, M.D., of Las Cruces, N.M., spoke in favor of asking the AAFP to oppose the changes, saying that "these kinds of restrictions are not compatible with a regular practice in the community."
However, Ben Schneider, M.D., of Portland, Ore., opposed that specific tack, but he emphasized that residents, program directors and accrediting bodies must discuss the duty hours issue. Otherwise, he noted, "the solution will be handed to us by the federal government."
In the end, residents asked the Academy to submit written comments to the ACGME regarding the pros and cons of the latest proposals. They also want the AAFP to share findings from a national survey of family medicine residency directors about the potential impact of some of the ACGME recommendations.
The resolution objected to the proposed 16-hour shifts for first-year residents, in particular, because such shifts "do not provide adequate time for PGY1 (post-graduate, year one) residents to experience the full progression of inpatient care outcomes, nor do they provide adequate home time due to the increased number of shifts at odd hours necessary to successfully prepare the resident."
Furthermore, the resolution contended, such a change would not appreciably improve resident fatigue or the ability to care for patients.
Residents were divided in their reference committee testimony. Carlos Hernandez-Torres, M.D., of Las Cruces, N.M., spoke in favor of asking the AAFP to oppose the changes, saying that "these kinds of restrictions are not compatible with a regular practice in the community."
However, Ben Schneider, M.D., of Portland, Ore., opposed that specific tack, but he emphasized that residents, program directors and accrediting bodies must discuss the duty hours issue. Otherwise, he noted, "the solution will be handed to us by the federal government."
In the end, residents asked the Academy to submit written comments to the ACGME regarding the pros and cons of the latest proposals. They also want the AAFP to share findings from a national survey of family medicine residency directors about the potential impact of some of the ACGME recommendations.
Burnout Among Medical Students and Residents
Both residents and students looked for remedies for burnout in graduate medical education and in medical school.
Both congresses asked the AAFP to consider offering sessions on student and resident wellness, balance and avoidance of burnout during future national conferences. Both also want the AAFP to encourage constituent chapters to encourage programs for students and residents on individual counseling, support groups, mindfulness and other mind-body experiential learning opportunities.
"The burnout issue is important, especially in primary care," Hernandez-Torres testified before a second reference committee. "It's not just students and residents, but when we get into our practices. A healthy doctor means healthy patients."
Both congresses asked the AAFP to consider offering sessions on student and resident wellness, balance and avoidance of burnout during future national conferences. Both also want the AAFP to encourage constituent chapters to encourage programs for students and residents on individual counseling, support groups, mindfulness and other mind-body experiential learning opportunities.
"The burnout issue is important, especially in primary care," Hernandez-Torres testified before a second reference committee. "It's not just students and residents, but when we get into our practices. A healthy doctor means healthy patients."
NHSC Loan Repayment Eligibility
Both residents and students also showed their concern about student debt when they asked the AAFP to approach the National Health Service Corps, or NHSC, about its eligibility requirements.
Rachel Seltzer, a medical student at Oregon Health and Science University Medical School in Portland, testifies in support of a resolution asking the Academy to work with the National Health Service Corps, or NHSC, to eliminate any conflicts between individual state work commitments and NHSC obligations.
In their resolution, students noted that a student's outstanding service obligations -- such as state loan repayment programs, scholarship programs or conditions of medical school enrollment -- could conflict with a student's eligibility for the NHSC loan repayment program. Specifically, the NHSC states that eligible applicants "must have no outstanding service obligation for health professional service to the federal government … or other entity, unless the obligation would be completed prior to receipt of the NHSC (loan repayment program) award."
In its report, the reference committee that heard testimony on the issue said investigation of potential conflicts should be the responsibility of the individual applicant and recommended that the resolution not be adopted.
The students, however, overturned that recommendation and adopted the measure. Asit Goswami, of Huntington, W.Va., a co-author of the resolution, spoke with AAFP News Now after the vote.
According to Goswami, a clarification of NHSC language is in order, and the Academy is appropriately positioned to ask for such a clarification. "It appears that there is a conflict between the NHSC loan repayment program and state loan repayment programs," said Goswami.
"The AAFP should be working for its (student) members, especially when it comes to approaching a national organization" about a program that could have a long-term impact on medical students' ability to pay off their student loans, he added.
In its report, the reference committee that heard testimony on the issue said investigation of potential conflicts should be the responsibility of the individual applicant and recommended that the resolution not be adopted.
The students, however, overturned that recommendation and adopted the measure. Asit Goswami, of Huntington, W.Va., a co-author of the resolution, spoke with AAFP News Now after the vote.
According to Goswami, a clarification of NHSC language is in order, and the Academy is appropriately positioned to ask for such a clarification. "It appears that there is a conflict between the NHSC loan repayment program and state loan repayment programs," said Goswami.
"The AAFP should be working for its (student) members, especially when it comes to approaching a national organization" about a program that could have a long-term impact on medical students' ability to pay off their student loans, he added.
Public Health and Other Issues
Residents and students also considered a number of resolutions on public health issues, including measures on obesity and sugar-sweetened beverages.
Both groups asked the Academy to consider supporting state and national efforts to allocate revenue raised by any tax on sugar-sweetened beverages to diabetes and obesity education, research and prevention programs.
Both groups asked the Academy to consider supporting state and national efforts to allocate revenue raised by any tax on sugar-sweetened beverages to diabetes and obesity education, research and prevention programs.
Students Debate AAFP's Consumer Alliance With Coca-Cola Co.
The National Congress of Student Members entertained spirited debate regarding the Academy's Consumer Alliance partnership with The Coca-Cola Co., but in the end, did not adopt a resolution that asked the AAFP to end its monetary involvement with the company.
Sam Zager, of Jamaica Plain, Mass., spoke in favor of the resolution asking for the Academy to end that affiliation. He told the student congress, "We wouldn't be having this debate if this were a tobacco company."
Gina Miller, of Beaverton, Ore., also supported the resolution. "We as students need to speak up; we've created a giant conflict of interest."
Brooke Sciuto, M.D., of Bethesda, Md., the 2009 student member of the AAFP Board of Directors, was able to bring the added benefit of her position on the Board to the discussion.
"The Board hears your concerns, but asks that you consider the overall complexity of the issue and keep an open mind," said Sciuto. She asked the student delegates to "assume good intent" and to keep in mind that the Board had taken an "out-of-the-box approach to some funding issues."
The students did vote to reaffirm language that asks the AAFP to use the FamilyDoctor.org website to discourage consumption of sugar-sweetened beverages and soda.
Sam Zager, of Jamaica Plain, Mass., spoke in favor of the resolution asking for the Academy to end that affiliation. He told the student congress, "We wouldn't be having this debate if this were a tobacco company."
Gina Miller, of Beaverton, Ore., also supported the resolution. "We as students need to speak up; we've created a giant conflict of interest."
Brooke Sciuto, M.D., of Bethesda, Md., the 2009 student member of the AAFP Board of Directors, was able to bring the added benefit of her position on the Board to the discussion.
"The Board hears your concerns, but asks that you consider the overall complexity of the issue and keep an open mind," said Sciuto. She asked the student delegates to "assume good intent" and to keep in mind that the Board had taken an "out-of-the-box approach to some funding issues."
The students did vote to reaffirm language that asks the AAFP to use the FamilyDoctor.org website to discourage consumption of sugar-sweetened beverages and soda.
According to the residents' reference committee report, "testimony reflected that 'sugar- sweetened beverages' taxes roughly mirror taxes placed on tobacco products. As revenues from taxes on tobacco products are often used for the purposes of education and prevention of tobacco use, and illnesses that stem from tobacco use, it was believed that a similar concept should be applied to 'sugar-sweetened beverages' tax monies."
Similarly, residents asked the AAFP to join any efforts to investigate the efficacy of existing multimedia obesity education materials and to consider placing links to high-quality, evidence-based multimedia resources on its consumer website, FamilyDoctor.org.
"Obesity in the nation is about to explode, and the AAFP has to make it a priority," Heidi Meyer, M.D., of Tucson, Ariz., said in reference committee testimony. "(This resolution) won't add a fiscal note to the budget and enables us to take the lead in this horrible epidemic."
Students, for their part, asked the Academy to support national policy that educates children and adolescents about the hazards of consuming energy drinks, including popular brand name products such as Monster and Red Bull. They testified about the harmful physiological effects such drinks can have on young bodies, especially considering the drinks' high caffeine content.
In recommending adoption of the measure, the student reference committee pointed to the absence of any current Academy policy on the topic of energy drinks.
Residents also asked the AAFP to consider seeking cosponsors to launch a national media campaign to educate the public and health professionals about the scope and value of the family physician. They further asked that any potential partners be vetted by a committee of rank-and-file members and other professionals. Finally, they requested that the resolution be sent to the 2010 AAFP Congress of Delegates.
Both students and residents asked the Academy to explore collaborating with the National Center for Medical-Legal Partnerships, with the goal of creating such partnerships in family medicine residencies.
Similarly, residents asked the AAFP to join any efforts to investigate the efficacy of existing multimedia obesity education materials and to consider placing links to high-quality, evidence-based multimedia resources on its consumer website, FamilyDoctor.org.
"Obesity in the nation is about to explode, and the AAFP has to make it a priority," Heidi Meyer, M.D., of Tucson, Ariz., said in reference committee testimony. "(This resolution) won't add a fiscal note to the budget and enables us to take the lead in this horrible epidemic."
Students, for their part, asked the Academy to support national policy that educates children and adolescents about the hazards of consuming energy drinks, including popular brand name products such as Monster and Red Bull. They testified about the harmful physiological effects such drinks can have on young bodies, especially considering the drinks' high caffeine content.
In recommending adoption of the measure, the student reference committee pointed to the absence of any current Academy policy on the topic of energy drinks.
Residents also asked the AAFP to consider seeking cosponsors to launch a national media campaign to educate the public and health professionals about the scope and value of the family physician. They further asked that any potential partners be vetted by a committee of rank-and-file members and other professionals. Finally, they requested that the resolution be sent to the 2010 AAFP Congress of Delegates.
Both students and residents asked the Academy to explore collaborating with the National Center for Medical-Legal Partnerships, with the goal of creating such partnerships in family medicine residencies.
