Today's physician education system produces trained doctors with strong scientific underpinnings in biological and physical sciences as well as supervised practical experience in delivering care. Significant financial public support underlies the graduate-level training of the nation's physicians. Two federal programs--Medicare and Medicaid--distribute billions each year to support teaching hospitals and other training sites that provide graduate medical education. Graduate Medical Education That Meets the Nation's Health Needs is an independent review of the goals, governance, and financing of the graduate medical education system. This report focuses on the extent to which the current system supports or creates barriers to producing a physician workforce ready to provide high-quality, patient-centered, and affordable health care and identifies opportunities to maximize the leverage of federal funding toward these goals. Graduate Medical Education examines the residency pipeline, geographic distribution of generalist and specialist clinicians, types of training sites, and roles of teaching and academic health centers. The recommendations of Graduate Medical Education will contribute to the production of a better prepared physician workforce, innovative graduate medical education programs, transparency and accountability in programs, and stronger planning and oversight of the use of public funds to support training. Teaching hospitals, funders, policy makers, institutions, and health care organizations will use this report as a resource to assess and improve the graduate medical education system in the United States.

Graduate Medical Education That Meets the Nation's Health Needs

PurposeThe authors conducted a systematic review of the medical literature to determine the factors most strongly associated with localizing primary care physicians (PCPs) in underserved urban or rural areas of the United States.MethodIn November 2015, the authors searched databases (MEDLINE, ERIC,

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Predictors of Primary Care Physician Practice Location in Underserved Urban or Rural Areas in the United States: A Systematic Literature Review.

Background Despite concerns about recruitment to UK general practice, there has been no concerted educational intervention to address them. Aim To better understand how medical students’ perceptions of their experiences of their undergraduate curriculum may affect choosing general practice as a career. Design and setting Qualitative study comprising focus groups of a total of 58 students from a range of medical schools across the UK. Method A range of UK medical schools students were invited by email to participate in focus groups and return a questionnaire detailing their current career choice to facilitate sampling students with varied career preferences. Students late in their studies were sampled as they were likely to be considering future careers. Focus group discussions were audiotaped, transcribed, and anonymised for both school and participant, then thematically analysed. Perceived differences in medical school culture, curriculum philosophy, design, and intent were explored. Results Six focus groups (58 students) were convened. Some student participants’ career aspirations were strongly shaped by family and home, but clinical placements remained important in confirming or refuting these choices. High-quality general practice attachments are a powerful attractor to general practice and, when they reflect authentic clinical practice, promote general practice careers. GP tutors can be powerful, positive role models. Students’ comments revealed conflicting understandings about general practice. Conclusion Attracting rather than coercing students to general practice is likely to be more effective at changing their career choices. Early, high-quality, ongoing and, authentic clinical exposure promotes general practice and combats negative stereotyping. It is recommended that increasing opportunities to help students understand what it means to be a ‘good GP’ and how this can be achieved are created.

Influences on students' career decisions concerning general practice: a focus group study.

Today, most agree that the health care system in the United States is in need of reform and that existing health disparities have huge implications for both that system and society as a whole. As a result, academic medicine has come to play a central role in addressing health disparities in a pluralistic society. Today, diversity is no longer a projection; it is a reality. Yet, most diversity efforts continue to run parallel to core institutional processes, rather than as part of the mission of the institution. Researchers agree that, to promote a healthy and vital society, leaders in academic medicine must create institutions that can serve diverse populations. To do so, they must first increase their institutional capacity for diversity. This article outlines the next generation of work on diversity and inclusion, drawing on a broad body of research and practice to identify some of the key elements for building the kind of institutional capacity necessary for sustained change in academic medicine, including a deeper engagement of mission, one that considers diversity as core to excellence; an inclusive and differentiated understanding of diversity institutionally; alignment and intentionality with respect to key institutional elements; key metrics associated with success and a serious process to monitor progress; and the identification of diverse talent for leadership at all levels.

Building institutional capacity for diversity and inclusion in academic medicine.

Against the background of the recruitment crisis in general practice, we aimed to determine what United Kingdom (UK) medical students value in their future careers, how they perceive careers in general practice (GP) and what influences them. Cross-sectional survey of 280 final and penultimate year medical students at the University of Oxford, with questions relating to career choices, factors of importance when choosing a career and attitudes towards general practice as a career. Quantitative methods included cluster analysis, chi squared tests of independence and logistic regression analysis. Qualitative data were analysed thematically using the Framework method. Response rate was 89% (280/315). 40% of participants said that general practice was an attractive or very attractive career option. Respondents valued job satisfaction, work-life balance and close relationships with patients. However, fewer than 20% of respondents agreed that community-based working was important to them and many (often citing particular GPs they had observed) felt that general practice as currently structured may not be satisfying or fulfilling because of high workload, financial pressures and externally imposed directives. 63% perceived GPs to have lower status than hospital specialties and 49% thought the overall culture of their medical school had negatively influenced their views towards general practice. Some respondents considered that general practice would not be intellectually challenging or compatible with a research career; some appeared to have had limited exposure to academic primary care. With the caveat that this was a sample from a single medical school, medical students may be put off careers in general practice by three main things: low perceived value of community-based working and low status of general practice (linked to a prevailing medical school culture); observing the pressures under which GPs currently work; and lack of exposure to academic role models and primary care-based research opportunities. To improve recruitment of the next generation of GPs, medical schools must provide high quality placements in general practice, expose students to academic role models and highlight to policymakers the links between the current pressures in UK general practice and the recruitment crisis.

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UK medical students’ attitudes towards their future careers and general practice: a cross-sectional survey and qualitative analysis of an Oxford cohort

PurposeTo examine individual-level and medical-school-level factors, including the school’s primary care culture, that are associated with medical students’ likelihood of practicing primary care.MethodIn spring 2010, the Association of American Medical Colleges Center for Workforce Studies invited a

The role of medical school culture in primary care career choice.

Key Indicator in Academic Medicine: the physician workforce in the United States.

Abstract: 
Background: Postpartum Hemorrhage (PPH) is the most common reason of maternal death globally. Misoprostol and oxytocin are two first line and effective management protocols. But controversies exist in literature. For that matter, this study was conducted. 
Objectives: To compare the frequency of postpartum hemorrhage with per rectal misoprostol in relation to intramuscular oxytocin in females undergoing normal vaginal delivery at term. 
Methods: This randomized controlled trial was conducted in Department of Obstetrics & Gynaecology, Sheikh Zayed Hospital, Lahore from 01-01-2019 to 01-12-2019. Patients were divided randomly into equal halves through the lottery method. Group A received Misoprostol and group B received Oxytocin. Medications were administered within one minute of clamping and the cutting of cord. During 24 hours, soaked pads were evaluated for blood loss and total blood loss was calculated. If blood loss>500ml, then PPH was labeled. 
Results: Mean age of women in Group A and in Group-B were 29.11±6.67 and 29.23±6.70 years. The mean gestational age for Group A came as 39.60±1.78 weeks and for Group-B, it was 39.53±1.72. In Group-A 24(15.7%) and in Group-B 59(38.6%) women suffered from PPH. PPH was significantly lower in comparison to the women in Group-B. Pvalue=0.000. 
Conclusion: Results of this study showed that use of per rectal Misoprostol is more suitable and effective in the prevention of Post-partum hemorrhages compared to oxytocin in females undergoing normal vaginal delivery at term.

Sana Danish

Papers

The role of medical school culture in primary care career choice.

Key Indicator in Academic Medicine: the physician workforce in the United States.

Comparison of Sublingual & Per Rectal Misoprostol versus Oxytocin in the Prevention of Postpartum Hemorrhage