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

Purpose
Medical student mistreatment has been recognized for decades and is known to adversely impact students both personally and professionally. Similarly, burnout has been shown to negatively impact students. This study assesses the prevalence of student mistreatment across multiple medical schools and characterizes the association between mistreatment and burnout.

The prevalence of medical student mistreatment and its association with burnout.

Purpose To identify common struggles of interns, determine residency program directors’ (PDs’) views of the competencies to be gained in the fourth year of medical school, and apply this information to formulate goals of curricular reform and student advising. Method In 2007, semistructured interviews were conducted with 30 PDs in the 10 most common specialty choices of students at the University of California, San Francisco, School of Medicine to assess the PDs’ priorities for knowledge, skills, and attitudes to be acquired in the fourth year. Interviews were coded to identify major themes. Results Common struggles of interns were lack of self-reflection and improvement, poor organizational skills, underdeveloped professionalism, and lack of medical knowledge. The Accreditation Council for Graduate Medical Education competencies of patient care, practicebased learning and improvement, interpersonal and communication skills, and professionalism were deemed fundamental to fourth-year students’ development. Rotations recommended across specialties were a subinternship in a student’s future field and in internal medicine (IM), rotations in an IM subspecialty, critical care, and emergency and ambulatory medicine. PDs encouraged minimizing additional time spent in the student’s future field. Suggested coursework included an intensively coached transitional subinternship and courses to improve students’ medical knowledge. Conclusions PDs deemed the fourth year to have a critical role in the curriculum. There was consensus about expected fourth-year competencies and the common clinical experiences that best prepare students for residency training. These findings support using the fourth year to transition students to graduate medical training and highlight areas for curricular innovation. Acad Med. 2009; 84:823–829.

/pdf/what-training-is-needed-in-the-fourth-year-of-medical-school-bq0fko1u6g.pdf

What Training Is Needed in the Fourth Year of Medical School? Views of Residency Program Directors

Liz Allen, Amy Brand, Jo Scott, Micah Altman and Marjorie Hlava are trialling digital taxonomies to help researchers to identify their contributions to collaborative projects.

Publishing: Credit where credit is due

MedlinePlus是链接美国国立卫生研究所（NIH）院内各机构和美国国家生物技术信息中心的重要渠道之一。NIH涵盖的生物医学信息资源既广且深，又相互交叉，从各主要栏目页面很难全面获得所需信息。MedlinePlus汇集了美国国家医学图书馆（NLM）、NIH和其他政府机构以及医疗组织的权威信息，并为解答健康问题提供引导信息。MedlinePlus还包括Medline检索，提供医学期刊论文的快速入口，处方和非处方药物的详细信息，附有插图的医学百科全书、互动性强的指南、多媒体卫生信息、数千种临床试验的链接、以及每日更新的卫生信息。

MedlinePlus

Background
Many patient education materials (PEMs) available on the internet are written at high school or college reading levels, rendering them inaccessible to the average US resident, who reads at or below an 8th grade level. Currently, electronic health record (EHR) providers partner with companies that produce PEMs, allowing clinicians to access PEMs at the point of care.

Readability of Patient Education Materials Available at the Point of Care

BACKGROUND/OBJECTIVES: To identify major barriers to video-based telehealth use among homebound older adults. DESIGN: Cross-sectional survey. SETTING: A large home-based primary care (HBPC) program in New York City (NYC) serving 873 homebound patients living in the community. PARTICIPANTS: Sixteen primary care physicians. MEASUREMENTS: An 11-item assessment of provider perceptions of patients' experience with and barriers to telehealth. RESULTS: According to physicians in the HBPC program, more than one-third (35%) of homebound patients (mean age of 82.7; 46.6% with dementia; mean of 4 comorbidities/patient) engaged in first-time video-based telehealth encounters between April and June 2020 during the first COVID-19 surge in NYC. The majority (82%) required assistance from a family member and/or paid caregiver to complete the visit. Among patients who had not used telehealth, providers deemed 27% (n = 153) "unable to interact over video" for reasons including cognitive or sensory impairment and 14% lacked access to a caregiver to assist them with technology. Physicians were not knowledgeable of their patients' internet connectivity, ability to pay for cellular plans, or video-capable device access. CONCLUSION: The COVID-19 pandemic resulted in a large and dramatic shift to video-based telehealth use in home-based primary care. However, 4 months into the pandemic a majority of patients had not participated in a video-based telehealth encounter due to a number of barriers. Patients lacking caregiver support to assist with technology may benefit from novel approaches such as the deployment of community health workers to assist with device setup. Physicians may not be able to identify potentially modifiable barriers to telehealth use among their patients, highlighting the need for better systematic data collection before targeted interventions to increase video-based telehealth use.

Barriers to telehealth access among homebound older adults.

BackgroundWhether attending physicians, residents, nurses, and medical students agree on what constitutes medical student abuse, its severity, or influencing factors is unknown.MethodWe surveyed 237 internal medicine attending physicians, residents, medical students, and nurses at 13 medical

Do attending physicians, nurses, residents, and medical students agree on what constitutes medical student abuse?

Medical students have routinely documented patient encounters in both inpatient and outpatient care venues This hands-on experience has provided a way for students to reflect on patient encounters, learn proper documentation skills, and attain a sense of being actively involved in and responsible for the care of patients Over the last several years, the practice of student note writing has come into question Institutional disincentives to student documentation include insurance regulations that restrict student documentation from substantiating billing claims, concerns about the legal status of student notes, and implementation of electronic medical records that do not allow or restrict student access The increased scrutiny of the medical record from pay-for-performance programs and other quality measures will likely add to the pressure to exclude students from writing notes This trend in limiting medical student documentation may have wide-ranging consequences for student education, from delaying the learning of proper documentation skills to limiting training opportunities This article reviews the educational value of student note writing, the factors that have made student documentation problematic, and the potential educational impact of limiting student documentation In addition, it offers some suggestions for future research to guide policy in this area

Medical student documentation in the medical record: is it a liability?

/pdf/viewpoint-from-2-undergraduate-medical-education-deans-the-3uadm4b9kx.pdf

Peter Gliatto

Papers

Readability of Patient Education Materials Available at the Point of Care

Barriers to telehealth access among homebound older adults.

Do attending physicians, nurses, residents, and medical students agree on what constitutes medical student abuse?

Medical student documentation in the medical record: is it a liability?

Viewpoint From 2 Undergraduate Medical Education Deans The Residency Application Process: Working Well, Needs Fixing, or Broken Beyond Repair?