U.S. Medical Schools Still Underproducing Family Physicians

October 21, 2016 03:36 pm This email address is being protected from spambots. You need JavaScript enabled to view it. – AAFP staff members recently conducted a national study to tally the percentage of graduates from M.D.- and D.O.-granting medical schools who entered family medicine residency programs as first-year residents in 2015-2016.

[Team of young doctors]

It marks the 35th year of an AAFP undertaking that involves researching statistics from all residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).

Read the results of that work in an article titled "Entry of US Medical School Graduates Into Family Medicine Residencies: 2015-2016(stfm.cmail2.com)" in the October issue of Family Medicine.

Corresponding author Stan Kozakowski, M.D., director of the AAFP Division of Medical Education, told AAFP News the study provides insight into a longstanding problem in the U.S. graduate medical education system.

"This annual study is important because it represents one outcome measure of the efforts made by U.S. medical schools to produce family physicians," said Kozakowski. "It serves much like a barometer or dashboard dial to compare changes in this production over time."

The 2016 report offered a new twist that sets it apart from previous iterations.

"This is the first time that we have specifically looked at the production of family physicians by the medical schools in each state, including osteopathic medical schools," said Kozakowski.

"Our intention is to spark curiosity at a local level. We want state leaders to begin conversations about all their medical schools so they can learn from each other and try different approaches."

Healthy competition can be a positive motivator for learning and action, he added.

Key Findings

Kozakowski and his team noted in the article that the annual report is "one measure of the effectiveness of medical schools to produce a primary care workforce, a key measure of social responsibility, as measured by their production of graduates entering into family medicine."

They noted that primary care has been proven to improve patient outcomes, reduce health disparities and lower per-capita health care costs.

They pointed out that some states -- and certain medical schools -- do better when it comes to producing family physicians and can serve as models for other programs that need to implement strategies aimed at increasing the number of students who choose primary care and family medicine.

"The move toward a single graduate medical education accreditation system by 2020 presents an opportunity to facilitate the creation of an annual residency census for all U.S. family medicine residency programs," they wrote.

According to the study authors, in 2015, 3,594 medical school graduates entered ACGME-accredited family medicine residency programs as first-year residents. Of those

  • 48 percent were graduates of U.S. M.D.-granting schools,
  • 23 percent were from U.S. D.O.-granting schools and
  • 29 percent were international graduates.

Authors pointed out that the percentage of U.S. M.D. graduates in residencies accredited by the ACGME has remained steady for a decade. However, they noted a reciprocal shift in numbers for the other two groups.

D.O. graduates increased by about 1 percent each year during the 10-year span (from 16 percent in 2005 to 23 percent in 2015), and international graduates decreased by 1 percent each year (from 38 percent in 2005 to 29 percent in 2015).

When the authors looked at the production of graduates who chose family medicine, U.S. D.O.-granting medical schools racked up nearly twice the percentage (15.5 percent of 5,314 graduates) compared to their M.D.-granting counterparts (8.7 percent of 18,929 graduates).

"There are four times as many M.D.-granting medical schools (134) as D.O.-granting medical schools (32)," wrote the authors, and yet "they produce only three and a half times as many total graduates compared to the DO-granting schools."

When combined, the schools graduated 24,243 medical students from July 2014 to June 2015, and of those, they produced 2,463 family medicine residents, or 10.2 percent of total graduates.

Furthermore, among the 134 M.D.-granting schools

  • 10 schools accounted for 30 or more graduates entering family medicine,
  • 70 schools produced 80 percent of new doctors who chose a family medicine residency, and
  • six schools produced no family medicine residents.

The University of Minnesota Medical School in Minneapolis topped the list with 42 graduates choosing the specialty; the Uniformed Services University of the Health Sciences in Bethesda, Md., claimed the highest percentage at 19.8 percent.

D.O.-granting schools more than pulled their weight when it came to producing graduates pursuing family medicine. For instance,

  • 19 of 32 schools with graduates in 2015 produced 80 percent of D.O. graduates entering the specialty;
  • nine schools had 30 or more students enter family medicine;
  • five international schools each produced 40 or more graduates entering family medicine residencies, and combined to account for 73 percent of the total number of international students choosing the specialty; and
  • two of those international schools, Ross University School of Medicine in Portsmouth, Dominica, and St. George's University School of Medicine in True Blue, Grenada, each graduated more than 100 students who entered family medicine programs in 2015.

The authors singled out Des Moines University College of Osteopathic Medicine in Iowa as having both the most graduates (68) of any of the U.S. medical schools and the largest percentage of graduates (32.7 percent) entering family medicine.

Location Matters

In aggregate, schools located east of the Mississippi River had more than double the number of total graduates than did schools west of the river; they also counted 370 more graduates who entered family medicine.

However, pointed out the authors, schools west of the Mississippi had graduating students enter family medicine at a higher rate than their counterparts east of the river (10.8 percent versus 7.7 percent).

"States were ranked by the production of all medical students entering family medicine residencies from the M.D.- and D.O.-granting schools located within the state," said the researchers. They found that

  • 51 percent of states and territories with medical schools produced 80 percent of the graduates entering ACGME-accredited family medicine programs,
  • six states produced more than 100 such graduates, and
  • seven states were below the national average of population-to-primary-care-physician ratio.

Those states -- Alabama, Florida, Georgia, Louisiana, Missouri, North Carolina and Ohio -- also claimed fewer than the national average of M.D.-medical school graduates choosing family medicine.

Iowa stood out as the only state with more than 20 percent of all graduates entering a family medicine program.

The article also sports numerous charts and graphs, including one that displays in ranked order U.S. M.D.-granting medical schools based on the past three years' average percentage of graduates who were family medicine residents.

The top five schools on that list are the University of Minnesota in Minneapolis, (19 percent) the University of Kansas in Lawrence, (17.8 percent), the University of North Dakota in Grand Forks (17.4 percent), East Carolina University in Greenville (16.7 percent), and the University of Washington in Seattle (16.6 percent).

The authors reiterated the widely known fact that most family medicine residents settle in to practice medicine within 100 miles of where they completed their residency training.

Notably, the percentage of students who graduated from M.D.-granting U.S. medical schools who remained in-state for residency ranged from a high of 68.8 percent in California to a low of 3.9 percent in Maryland.

Building the Primary Care Workforce

According to Kozakowski, "There continues to be widespread variation in the production of graduates choosing family medicine by region, state and school. In aggregate, our medical schools are failing to produce the physician workforce that this nation needs and deserves."

Moving forward, "There are opportunities to learn from those who seem to be more successful, try strategies implemented by successful schools and states, and measure the outcomes," he said.

Kozakowski would like to see the study data "activate" individuals across the country to recognize the success some schools and states have met, and then determine how to implement similar ideas in those less successful locations.

His take-home message for readers is that even though numerous studies have shown the value of family physicians in helping the country achieve the triple aim -- better health outcomes, better health care experiences and lower costs -- medical schools still lag behind in producing graduates who desire to practice family medicine.

"We need to get the right people into medical school, transform the training environment and improve the payment system," said Kozakowski.

The AAFP is doing its part to address all of these issues, but individual family physicians also have a role.

"Training the next generation of family physicians will require enthusiastic doctors who are able and willing to precept medical students in their practices," said Kozakowski. He acknowledged the demands of physicians' time and the "perceived burden" of inviting medical students into their practices.

"Students can and should add value to a practice. These students may turn out to be our future partners," he said.

Medical school can be brutal, and it’s making many of us suicidal

In August, a medical student at the Icahn School of Medicine at Mount Sinai in New York jumped out of an eighth-story window to her death.

Stories like this are too common among budding doctors across the United States. In May, a medical student at the University of Southern California took his own life. At the University of California at San Diego, a third-year medical student killed himself last year. Two years ago, when I was a medical student at Harvard, a fellow student died of suicide.

We don’t have great data on how many of the nation’s 80,000 medical students take their own lives each year. Few studies have addressed the issue, with varying results. But suicide is a major issue for medical schools. In surveys, roughly 10 percent of medical students have reported having thoughts of killing themselves within the past year.

What drives these bright young people to take their own lives?

Research has found that students may arrive at medical school feeling less burnout and depression than other people of their age. Yet once in medical school, they go on to have greater risk of mental-health problems and suicidal thoughts. According to the American Foundation for Suicide Prevention, medical students suffer from depression at rates 15 to 30 percent greater than the general population.

Academic competition might explain these findings. Thousands of applicants compete for spots in these schools. In 2015, the average medical school accepted just 6.9 percent of applicants, according to U.S. News and World Report; Mayo Medical School had the lowest acceptance rate at 1.8 percent. By screening for the best and the brightest, these institutions can serve as breeding grounds for competition and feelings of inadequacy.

The academic burdens at these schools can be intense. Medical students must learn a startling amount of material in a short time. For example, in our anatomy class, my classmates and I had to dissect and learn the entire human body in a matter of weeks. A well-known saying is that “medical school is like drinking water from a fire hose.” Students grapple with high-volume workloads while studying for multiple rounds of national licensing exams and preparing applications to residency programs.

Outside the classroom, medical students face additional stressors. Entering clinical settings brings students face to face with sick and dying patients, often for the first time. Immersing oneself in human suffering each day can leave its mark. Medical students spend days and nights with patients who die of cancer, who lose limbs to amputation, who depend on ventilators to breathe, who will never walk again.

Rather than receiving support in these situations, these students often suffer humiliation from senior clinicians. Doctors work in a hierarchy, with attending physicians above residents, who are above interns. At the bottom of the totem pole are medical students.

This hierarchy engenders a culture of bullying toward medical trainees. More than 80 percent of medical students report mistreatment from supervisors. I’ve seen classmates shouted at, cursed at and mocked in clinical settings. A surgeon referred to me as “Helen Keller” because I couldn’t suture fast enough.

Money can also weigh heavily on the minds of medical students, who shoulder astounding debts to finance college and medical school. According to 2015 data, 81 percent of medical students reported academic debt at graduation, with an average indebtedness of more than $180,000.

Unrelenting pressure

Amid these unrelenting pressures, many medical students descend into despair. Some turn to suicide.

No suicide is the same, just as the causes of depression and despair vary from individual to individual. But with medical students, the shared stressors of medical school are undoubtedly a common thread. In recent years, these schools have taken steps to tackle this issue.

Reducing competition in the classroom may help. The majority of medical schools have embraced pass-fail grading systems for the first one to two years when students take classes, reforms shown to enhance well-being among students without affecting academic outcomes.

Team-based learning is another emerging trend in medical education. By encouraging collaboration, educators hope to increase cohesiveness among classmates and decrease social isolation while better preparing future doctors for team-based patient care.

Universities and hospitals have sought to change the culture of medical education in other ways as well. Schools have introduced a variety of wellness programs, including counseling, group fitness activities, outdoor retreats and healthy eating seminars. Nationwide, the medical community has aimed to eradicate mistreatment of medical students in clinical settings.

But one part of medical school culture has been especially hard to overcome: the stigma of mental illness. When they need help most, medical students in anguish rarely reach out. Students attribute this reluctance to seek care to fear of stigmatization by peers and to concerns over professional ramifications, particularly during applications for residency and licensing.

Last spring, I wrote publicly about my own struggle with depression during medical school. The days leading up to the article’s publication were terrifying. I worried I might lose the residency slot I had matched into or forfeit the trust of future colleagues. Again and again, I checked the medical licensing requirements in California to make sure I wouldn’t lose the ability to care for patients.

Yet my fears have gone unfounded and, in the days that followed, I received nothing but support from colleagues and mentors. Fortunately, others are speaking up as well. In online magazines and on NPR, medical students who have lived through suicide attempts, depression and other mental-health issues are standing up against this stigma. Medical schools are now training faculty to recognize risk factors for suicide and assuring students that seeking help isn’t a sign of weakness.

Despite these efforts, too many medical students still take their lives, as the recent tragedy at Mount Sinai reminds us. In May, two physicians started a petition urging the governing bodies of medical education to do more to prevent suicide among medical trainees. As of this writing, the petition has garnered around 75,000 signatures.

Medical students spend their days learning how to help others. Can we learn to care for them, too?

Morris is a resident physician in psychiatry at the Stanford University School of Medicine.

Ethicon Announces Strategic Collaboration With Touch Surgery To Evolve Medical Education

SOMERVILLE, N.J., Aug. 24, 2016 /PRNewswire-USNewswire/ -- Ethicon, Inc., part of the Johnson & Johnson Medical Devices Companies, announces a strategic collaboration with Touch Surgery to help improve patient outcomes by delivering simulated surgical training based on the safe and efficacious use of Ethicon products in a free mobile app that can reach medical professionals in even remote regions of the world.   

Ethicon's more than 60-year history in educating surgeons and deep expertise with surgical products, combined with Touch Surgery's technology platform and unique 3D simulations, will provide digital content that aids surgeons and students in training anytime, anywhere.

A report on global surgery, commissioned in 2015 by The Lancet, found nearly one-third of the global burden of disease can be treated surgically and that five billion people lack access to safe and affordable surgical care.1

"We're looking to improve the standards of surgical care and treatment around the world, accelerating our pace of innovation and aiding the training of more physicians through collaborations such as this agreement with Touch Surgery," says Michael del Prado, Company Group Chairman, Ethicon.  "It reflects our broad-based approach to innovation and is another important step toward developing a trusted education ecosystem that improves patient outcomes."

The Touch Surgery platform empowers and connects the global surgery community by enabling virtual surgical training on procedures in 3-D operating room simulations that are unlike other available solutions. The app currently has one million users and helps enable surgeons and other healthcare providers to practice more than 75 procedures of varying surgical specialties.

Ethicon and Johnson & Johnson Medical Device Companies are committed to expanding access to surgical procedures around the world, especially in developing countries where access to the latest training practices can be limited. The collaboration with Touch Surgery will help bolster the library of procedures to create leading educational content across a broad range of surgical specialties, helping to expand resident education and standardize procedures. 

Ethicon will begin by addressing training needs in General Surgery and will look at potential opportunities to expand over time to include other Johnson & Johnson Medical Device Companies businesses and specialties, such as orthopaedics and cardiovascular.

About Ethicon
From creating the first sutures, to revolutionizing surgery with minimally invasive procedures, Ethicon has made significant contributions to surgery for more than 60 years. Through Ethicon's surgical technologies and solutions including sutures, staplers, energy devices, trocars and hemostats and our commitment to treating serious medical conditions like obesity and cancer worldwide, we deliver innovation to make a life-changing impact. Learn more at www.ethicon.com, and follow us on Twitter @Ethicon. Ethicon represents the products and services of Ethicon, Inc. (the signing party) and certain of their affiliates.

About Johnson & Johnson Medical Devices
Having made significant contributions to surgery for more than a century, the Johnson & Johnson Medical Devices Companies are in the business of reaching more patients and restoring more lives. The group represents the most comprehensive surgical technology and specialty solutions business in the world, offering an unparalleled breadth of products, services, programs and research and development capabilities directed at advancing patient care while delivering clinical and economic value to health care systems worldwide.

1The Lancet Commission on Global Surgery, 2015, http://www.who.int/hrh/news/2015/lancet_commission_globsurgery/en/

Cautions Concerning Forward-Looking Statements
This press release contains "forward-looking statements" as defined in the Private Securities Litigation Reform Act of 1995 related to a new collaboration to expand access to digital training in surgical procedures. The reader is cautioned not to rely on these forward-looking statements. These statements are based on current expectations of future events. If underlying assumptions prove inaccurate or known or unknown risks or uncertainties materialize, actual results could vary materially from the expectations and projections of Ethicon, Inc., any of the other Johnson & Johnson Medical Devices Companies and/or Johnson & Johnson. Risks and uncertainties include, but are not limited to: the potential that the expected benefits and opportunities related to the collaboration may not be realized or may take longer to realize than expected; uncertainty of success and continued use of the app; competition, including technological advances, new products and patents attained by competitors; changes in behavior and spending patterns of purchasers of health care products and services; and global health care reforms and trends toward health care cost containment. A further list and description of these risks, uncertainties and other factors can be found in Johnson & Johnson's Annual Report on Form 10-K for the fiscal year ended January 3, 2016, including in Exhibit 99 thereto, and the company's subsequent filings with the Securities and Exchange Commission. Copies of these filings are available online at www.sec.gov, www.jnj.com or on request from Johnson & Johnson. None of the Johnson & Johnson Medical Devices Companies or Johnson & Johnson undertakes to update any forward-looking statement as a result of new information or future events or developments.

Peggy Ballman
Mobile: 908-310-7721
This email address is being protected from spambots. You need JavaScript enabled to view it.

SOURCE Ethicon

How India can be a world leader in medical education

(HT File Photo)

The Lok Sabha on Tuesday passed two bills aimed at putting in place a single common examination for medical and dental courses that will bring even private colleges under its ambit.

“The bill will give statutory status to the NEET. This will make the examination system fair and transparent and students won’t face multiplicity of exams. It will also stop the exploitation of students in the name of capitation fees,” health minister JP Nadda said while replying to the debate.

The National Eligibility and Entrance Test (NEET) was brought in for the first time by the Medical Council of India (MCI) in 2012 to hold a centralised examination for admissions to undergraduate and postgraduate courses in medicine. This would ensure merit-based admissions in a transparent manner and check the irregular admission processes prevalent in some of the private medical colleges.

However, NEET was set aside by the Supreme Court on petitions filed by private medical colleges. While the decision of the apex court was a setback, the court agreed to reconsider its split-decision. A few weeks ago, the court recalled its order of 2013, by which NEET had been set aside, and directed that NEET be conducted for the year 2016.

This was a welcome step. For an equal representation from states, the Government of India decided to promulgate an Ordinance, allowing the states to conduct their own medical entrance examination for the undergraduate course for this year. The Ordinance does not allow private colleges to conduct their own examinations.

NEET is urgently required in India as it will foster a sense of confidence in the admission process, and help in attracting the brightest talent to the medical profession. Moreover, students will be relieved of the burden of appearing in and paying for a number of entrance tests. However, there is criticism of NEET due to the divergence in its course content and standards. The syllabus for NEET was first based on the 10+2 level CBSE and other state boards’ course content. Issues from various quarters were examined by an expert group before finalising the course content and separate merit lists for each state were contemplated. Thus students from a particular state would compete with peers from their own state with no question of any urban-rural divide.

The ordinance does not affect NEET for postgraduate courses, which will be held in December this year. Of course, the timing of the exam could be revisited. Currently, the NEET for postgraduate courses is held at the end of the internship period. This results in students preparing for an entrance test during their internship, thereby compromising on the clinical training period. This adversely impacts the training of graduate doctors. In my view, the internship period should be properly utilised and the entrance process for postgraduate courses should include testing the students’ clinical skills.

Therefore, NEET is only the beginning. The next step should be to have a common exit examination, to ensure uniform standard of evaluation across the country. Presently the deemed or private universities conduct their own exit examinations. There have been murmurs regarding irregularities and the unfair means used in these exit examinations.

Other reform measures can include an increase in the number of postgraduate seats, adoption of a new undergraduate curriculum and adjunct faculty from basic science institutes and eminent clinicians from private hospitals. It is also necessary to review the minimum requirements required for setting up medical colleges. This would incentivise entrepreneurs whose prime interest is to create institutions of excellence providing quality education and training. Such reforms when met with the wealth of clinical material available can make India a world leader in medical education and healthcare.

First clinical study for Zika vaccine to begin in Canada

Université Laval's Infectious Disease Research Centre (IDRC) and Centre de recherche du CHU de Québec-Université Laval (CHU) are proud to announce that the first clinical study for a Zika vaccine in Canada is set to begin in Quebec City.

"We're very proud to be part of the first international team in the world to complete all of the steps in the regulatory process and to be authorized by the Food and Drug Administration (FDA) and Health Canada to develop a Zika vaccine," said Gary Kobinger, doctor of microbiology, professor in Université Laval's Faculty of Medicine, researcher with Centre de recherche du CHU, director of IDRC, and a global authority on vaccine research.

The Zika virus is transmitted primarily by mosquitoes. Although most cases are relatively mild, women who are infected while pregnant are at risk of miscarrying or giving birth to children with abnormally small heads -- a condition known as microcephaly.

"There is no existing treatment or vaccine for Zika. The vaccine currently being developed will be administered to humans for the first time as part of the clinical study. CHU de Québec-Université Laval is one of the three leading research centres involved in the vaccine study and we're very proud of that," said Gertrude Bourdon, president and CEO of CHU.

"This study under Professor Gary Kobinger's supervision is further proof of our institution's global leadership in the field of infectious disease research," said Rénald Bergeron, dean of Université Laval's Faculty of Medicine.


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