Academic medicine : journal of the Association of American Medical Colleges
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Increasingly, external forces affect and constrain physicians' clinical decision making and consequently their practice of medicine. Physicians are expected to achieve optimal patient outcomes at the lowest possible cost, which requires that they have quick and convenient access to comprehensive clinical information from different sources. ⋯ They identify critical information-related issues affecting clinicians, provide a brief overview of computer applications in medical care, and discuss studies that indicate how medical information systems can assist physicians in the delivery of cost-effective, high-quality care. Finally they discuss how individual institutions can best reap the benefits of medical information systems.
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The author maintains that the quality of medical education has been dropping for the last few decades as medical schools become less and less focused on their primary purpose of training physicians. Until the years immediately following World War II, the administration of the medical school was carried out by a small staff headed by a dean whose role was to provide leadership in educational matters. Academic departments managed the educational program, and the faculty were expected to be teachers and to participate in educational planning, preparation of teaching materials, advising of students, assessment of students' performances, admission, and all other tasks associated with having a teaching position. ⋯ The author explains why he believes these changes have come about; for example, the strong federal support of research after World War II, which encouraged a growing dependence of medical schools on research grants and consequently raised in importance those faculty who could obtain such grants. He concludes with common-sense proposals for reform (such as having the education of medical students in the hands of a small number of faculty whose prime responsibility is teaching), but admits that there are fundamental barriers to such reforms, especially vested interests and resistance to change. In the end, change will come only when those in power recognize that medical schools must be returned to their primary role of training physicians.
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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.