BIOMEDICAL RESEARCH POLICY COMMITTEE REPORT WAS PUBLISHED AS A SUPPLEMENT TO THE AUGUSTJOURNAL OF MEDICAL EDUCATION. A REPRINT IS ENCLOSED. REQUESTS FOR ADDITIONAL COPIES SHOULD BE ADDRESSED TO THISOFFICE. -COPIES ARE BEING SENT TO MEMBERS OF CONGRESS AND THE KEY MEMBERS OF THE ADMINISTRATION. CALLING UPON-YOUR SENATORSAND CONGRESSMEN TO TELL THE STORY OF THE ROLE. OF MEDICAL SCHOOLS IN BIOMEDICAL RESEARCH AND HEALTH CARE IS IMPORTANT.I STRONGLY URGE THAT YOU MAKE AN 411 APPOINTMENT TO SEE YOUR CONGRESSIONAL REPRESENTATIVES WHILE YOU ARE IN WASHINGTON FOR THE COUNCIL MEETINGON OCTOBER 29. UPON REQUEST WE CAN SUPPLY THE NAMES OF APPOINTMENT SECRETARIES AND PHONE NUMBERS OF YOUR SENATORS AND CONGRESSMEN. APPROPRIATIONS COMMITTEE ACTED WITH EXTRAORDINARY ALACRITY THIS YEAR. THE-NIH APPROPRIATION WAS INCREASED BY 242 MILLION DOLLARSOVER 1971, REPRESENTING A 142 MILLION DOLLAR INCREASE OVER. THE ADMINISTRATION BUDGET, THE BLUE SHEET ASCRIBES APPROPRIATIONS OUTCOME TO THE EFFECTIVENESS OF THE COALITION FOR HEALTH FUNDING UNDER THE LEADERSHIP OF JOHN A. D. COOPER.

The Association of American Medical Colleges

Identifies factors that shape how learning proceeds in workplaces. Focuses on the dual bases of how workplaces afford opportunities for learning and how individuals elect to engage in work activities and with the guidance provided by the workplace. Together, these dual bases for participation (co‐participation) at work, and the relations between them, are central to understanding the kinds of learning that workplaces are able to provide and how improving the quality of that learning might proceed. The readiness of the workplace to afford opportunities for individuals to engage in work activities and access direct and indirect support is a key determinant of the quality of learning in workplaces. This readiness can promote individuals’ engagement. However, this engagement remains dependent on the degree by which individuals wish to engage purposefully in the workplace.

/pdf/learning-through-work-workplace-affordances-and-individual-2q0q2p0ha7.pdf

Learning through work: workplace affordances and individual engagement

Objective
To summarise articles reporting on burnout among medical students and residents (trainees) in a narrative review.

Methods
MEDLINE was searched for peer-reviewed, English language articles published between 1990 and 2015 reporting on burnout among trainees. The search used combinations of Medical Subject Heading terms medical student, resident, internship and residency, and burnout, professional. Reference lists of articles were reviewed to identify additional studies. A subset of high-quality studies was selected.

Results
Studies suggest a high prevalence of burnout among trainees, with levels higher than in the general population. Burnout can undermine trainees’ professional development, place patients at risk, and contribute to a variety of personal consequences, including suicidal ideation. Factors within the learning and work environment, rather than individual attributes, are the major drivers of burnout. Limited data are available regarding how to best address trainee burnout, but multi-pronged efforts, with attention to culture, the learning and work environment and individual behaviours, are needed to promote trainees’ wellness and to help those in distress.

Conclusion
Medical training is a stressful time. Large, prospective studies are needed to identify cause‒effect relationships and the best approaches for improving the trainee experience.

A narrative review on burnout experienced by medical students and residents

This paper critically analyses the nature and state of decision support systems (DSS) research. To provide context for the analysis, a history of DSS is presented which focuses on the evolution of a number of sub-groupings of research and practice: personal DSS, group support systems, negotiation support systems, intelligent DSS, knowledge management-based DSS, executive information systems/business intelligence, and data warehousing. To understand the state of DSS research an empirical investigation of published DSS research is presented. This investigation is based on the detailed analysis of 1,020 DSS articles published in 14 major journals from 1990 to 2003. The analysis found that DSS publication has been falling steadily since its peak in 1994 and the current publication rate is at early 1990s levels. Other findings include that personal DSS and group support systems dominate research activity and data warehousing is the least published type of DSS. The journal DSS is the major publishing outlet; US ‘Other’ journals dominate DSS publishing and there is very low exposure of DSS in European journals. Around two-thirds of DSS research is empirical, a much higher proportion than general IS research. DSS empirical research is overwhelming positivist, and is more dominated by positivism than IS research in general. Design science is a major DSS research category. The decision support focus of the sample shows a well-balanced mix of development, technology, process, and outcome studies. Almost half of DSS papers did not use judgement and decision-making reference research in the design and analysis of their projects and most cited reference works are relatively old. A major omission in DSS scholarship is the poor identification of the clients and users of the various DSS applications that are the focus of investigation.

/pdf/a-critical-analysis-of-decision-support-systems-research-4mg5e9u4dm.pdf

A critical analysis of decision support systems research

A framework for clarifying the meaning of Triple Bottom-Line, Integrated, and Sustainability Assessment

Purpose Since 1995, the David Geffen School of Medicine at UCLA (DGSOM) has created policies to prevent medical student mistreatment, instituted safe mechanisms for reporting mistreatment, provided resources for discussion and resolution, and educated faculty and residents. In this study, the authors examined the incidence, severity, and sources of perceived mistreatment over the 13-year period during which these measures were implemented. Method From 1996 to 2008, medical students at DGSOM completed an anonymous survey after their third-year clerkships and reported how often they experienced physical, verbal, sexual harassment, ethnic, and power mistreatment, and who committed it. The authors analyzed these data using descriptive statistics and the students’ descriptions of these incidents qualitatively, categorizing them as “mild,” “moderate,” or “severe.” They compared the data across four periods, delineated by milestone institutional measures to eradicate mistreatment. Results

Eradicating Medical Student Mistreatment: A Longitudinal Study of One Institution’s Efforts

Preface and Introduction

Background: Despite widespread implementation of policies to address mistreatment, the proportion of medical students who experience mistreatment during clinical training is significantly higher th...

https://www.tandfonline.com/doi/pdf/10.1080/10872981.2018.1478170

Exploring medical students’ barriers to reporting mistreatment during clerkships: a qualitative study

Background: National statistics reveal that efforts to reduce medical student mistreatment have been largely ineffective. Some hypothesize that as supervisors gain skills in professionalism, medical students become more sensitive. Aims: The purpose of this study was to determine if medical student perceptions of mistreatment are correlated with mistreatment sensitivity. Method: At the end of their third year, 175 medical students completed an Abuse Sensitivity Questionnaire, focused on student assessment of hypothetical scenarios which might be perceived as abusive, and the annual Well-Being Survey, which includes measurement of incident rates of mistreatment. It was hypothesized that those students who identified the scenarios as abusive would also be more likely to perceive that they had been mistreated. Results: Student perceptions of mistreatment were not statistically correlated with individual’s responses to the scenarios or to a statistically derived abuse sensitivity variable. There were no differences in abuse sensitivity by student age or ethnicity. Women were more likely than men to consider it ‘‘harsh’’ to be called incompetent during rounds ( p5 0.0005). Conclusion: This study provides preliminary evidence that challenges the hypothesis that medical students who perceive mistreatment by their superiors are simply more sensitive.

/pdf/relationship-between-medical-student-perceptions-of-27qz4u5gj4.pdf

Relationship between medical student perceptions of mistreatment and mistreatment sensitivity

The David Geffen School of Medicine at UCLA formed the Gender and Power Abuse Committee in 1995 to address mistreatment of medical students, residents, and junior faculty.

/pdf/an-abuse-free-medical-school-environment-an-ethical-2sog9nt6vb.pdf

Joyce M Fried

Papers

Eradicating Medical Student Mistreatment: A Longitudinal Study of One Institution’s Efforts

Preface and Introduction

Exploring medical students’ barriers to reporting mistreatment during clerkships: a qualitative study

Relationship between medical student perceptions of mistreatment and mistreatment sensitivity

An abuse-free medical school environment: an ethical imperative.