Academic medicine : journal of the Association of American Medical Colleges
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Many U. S. residency graduates will practice in various types of managed care organizations, where they will be expected to arrive skilled in managed care activities such as prescribing with formularies and adhering to preauthorization processes for procedures, referrals, and hospital admissions. Residency programs must prepare their trainees to negotiate for their patients' needs within such systems. ⋯ S. residency programs. Given that most graduates of residency programs will have their health care management decisions scrutinized while in practice, the authors feel it is important that residents' first exposure to managed care be while they are still in the supportive residency environment. They believe that early exposure will not only give residents the confidence to overcome the intimidation of colleague scrutiny, but may also give graduates the tools for involvement with the development of future managed care health policy.
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As a first step in testing the utility of using trained "standardized examinees" (SEs) as a quality-assurance measure for the scoring process in a standardized-patient (SP) examination, to test whether medical residents could simulate students in an SP examination and perform consistently to specified levels under test conditions. ⋯ This study suggests that SEs can be trained to specific performance levels and may be an effective internal control for a high-stakes SP examination. They may also provide a mechanism for refining scoring checklists and for exploring the validity of SP examinations.
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When faculty have tenure, are their salaries protected? If so, what portion and in what circumstances? In the era of managed care and shrinking resources, these questions are becoming particularly important at medical schools because salaries there tend to be higher than salaries elsewhere in academia and because those salaries are more commonly dependent on outside funding. A fundamental question that will increasingly be asked is whether reductions in the salaries of tenured faculty are legally permissible. To a large extent, the answer is a matter of interpreting what each medical school has contractually obligated itself to do regarding tenure; generally, schools' tenure rules support the legal right to impose a salary reduction. ⋯ Although the main historical purpose of tenure was the protection of academic freedom, can the protection of salary be encompassed within this purpose? Usually not; the current situation is almost always one in which cost concerns, not political ones, motivate medical schools to reduce the salaries of faculty with reduced funding or practice incomes. The author concludes that although there are few precedents and many unexplored issues, it is clear that tenure was not intended to protect full salaries at most medical schools. His view is that in appropriate circumstances, reductions in the salaries of tenured faculty are legally achievable.