Academic medicine : journal of the Association of American Medical Colleges
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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.
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To assess the status of basic science departments in academic health centers through a survey of department chairs. ⋯ This survey reveals certain profound and disconcerting changes in the basic science departments of U.S. medical school. More studies are needed to see whether these trends continue. Further downsizing and merging of the basic sciences should be avoided in order to preserve the quality of medical education for future physicians as well as the quality of health care in the United States.
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Randomized Controlled Trial Clinical Trial
The effect of presentation order in clinical decision making.
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To investigate whether the incorporation of women's health into problem-based learning (PBL) cases affects students' tendency to identify learning issues related to women's health as they encounter patients in an ambulatory care setting. ⋯ The results suggest that PBL is an effective way to increase students' awareness of women's health issues in a primary care clinical setting. More studies are needed to define the effect of PBL on the kind of reading and learning students will do when they get to the clinical setting.
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Americans simultaneously worry about dying and about being tethered to machines that keep them alive beyond a point when life has any meaning. People living with terminal illness often feel isolated from life around them and a burden on those they love; they feel uncertain that their deaths will be relatively free of pain and suffering and that their dignity will be compromised as little as possible. These failings can be remedied. ⋯ Medicine has "colonized" death: It has transformed it into a place where progress in staving it off may appear to be unlimited, and thus it encourages forgetting that death is part of the human condition. The task before medicine, and academic medicine in particular, is to transform death back into a human scale. With all that is available to delay death--but not to make it optional--the most important task is to recover humbleness before an awesome moment and be with the patient, one human being to another, knowing that dying is not always open to solutions.