Academic medicine : journal of the Association of American Medical Colleges
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Comparative Study
Comparing the hospitalizations of transfer and non-transfer patients in an academic medical center.
By accepting and caring for patients transferred from other institutions, academic medical centers have been able to develop comprehensive training and research programs. Whether academic institutions can continue to do this in the future is questionable. To the extent that transfer patients are more complex and severely ill than non-transfer patients, they are likely to consume more resources, and in managed care payment systems, they could place accepting hospitals in financial jeopardy. ⋯ The transfer patients stayed longer and consumed more hospital resources than did the non-transfer patients. Age, sex, case-mix, and insurance status did not account for these differences. To limit the financial liability that transfer patients pose, academic medical centers could be forced to abandon their traditional role of caring for such patients. The consequences of this possibility should be explored.
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Although there have been a number of studies of cheating in universities, surprisingly little has appeared recently in the literature regarding academic dishonesty among medical students. ⋯ About 5% of the medical students surveyed reported cheating during the first two years of medical school. The students appeared resigned to the fact that cheating is impossible to eliminate, but they lacked any clear consensus about how to proceed when they became aware of cheating by others. The guidance students appear to need concerns not so much their own ethical behaviors as how and when to intervene to address the ethical conduct of their peers.
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This is the report of a study undertaken by the Association of America n Medical Colleges to estimate the total amount of clinical revenues that are used to support the academic mission of U. S. medical schools. The study was prompted by an awareness that recent market-driven changes in health care organization and financing threaten the structure of medical school financing that has evolved over the last half-century. ⋯ However, unravelling the complex web of subsidies and cross-subsidies that characterizes medical school-hospital relationships proved to be beyond the capability of the present investigation. There is considerable evidence that changes in health care organization and financing will make it unlikely that the current level of support from practice plans and volunteer faculty can be sustained and that in some cases it is already diminishing. The restructuring of medical school financing to absorb the impact of this decline of support, which comes on top of reductions in indirect cost recoveries and pressures to lower state appropriations, constitutes one of the major challenges medical schools will face in the years ahead.