Academic medicine : journal of the Association of American Medical Colleges
-
Comparative Study
Comparing postgraduate medical education at university and non-university hospitals in Japan.
In 1988 the authors surveyed all the teaching hospitals in Japan to evaluate the present status of postgraduate medical education (PGME); they received responses from 67 (84%) of the university and 172 (89%) of the non-university teaching hospitals. It was found that a large proportion of residents had spent two years in a residency without having had a single experience of some of the basic clinical skills. Consequently the residents' confidence in their abilities to perform these skills was low. ⋯ The lack of standard and minimum requirements for PGME in Japan may be the cause of the poor level of acquisition of clinical skills of residents during PGME. Other possible causes are the tendency in Japanese medical society to attach greater importance to academic attainment than to clinical competence and the excessive gravitation of residents toward university hospitals. The authors suggest their results show the necessity to improve the training in basic clinical skills in PGME in Japan, especially in university hospitals.
-
The prohibition against age-based mandatory retirement, codified in amendments to the Age Discrimination in Employment Act (ADEA) in 1986, remains a concern in the academic medical community. A seven-year exemption covering tenured faculty expires at the end of 1993. ⋯ Although the major studies concerning the probable course of events after the seven-year exemption expires indicate that there will not be a cataclysmic effect on institutions of higher education, it is still not certain how tenured faculty will behave and how that will affect medical schools. The author cautions that the management acumen of institutional leaders will be taxed, and that medical school deans should realize this and begin the transition into the new era by improving systems for faculty evaluation and development, clarifying the financial guarantees of tenure, implementing space utilization reviews, and developing programs to make retirement attractive.
-
The authors reviewed 136 cases of malpractice litigation involving residents or programs of graduate medical education that were reported from 1950 through 1989. Before 1970 malpractice constituted the only area of reported litigation for residents. The number of malpractice cases involving residents increased substantially after 1975, paralleling the growth of malpractice cases nationally. ⋯ Questions related to judicial procedure, immunity from liability, breach or causation, and informed consent were also litigated. Residents were on the side of the prevailing party in 44% of the cases. Malpractice continues to be the key legal issue facing programs of residency training.
-
Seventy members of the class that entered Dartmouth Medical School in 1984 responded in 1984 and again in 1988 to statements regarding their attitudes towards family medicine, their general criteria for choosing a specialty, and their concerns about lifestyle; also, the students were asked in 1984 to indicate their interest in a career in family medicine and in 1988 to indicate their long-term specialty choices. The students' attitudes towards family medicine were generally positive on entry and became even more positive by their fourth year. Of the 25 students who indicated an initial interest in family medicine, six chose residencies in this field. Because most of the students studied showed strengthening agreement with both (1) the belief that family practitioners are particularly capable of providing comprehensive care and (2) the desire to concentrate on a specialty that would enable them to feel very competent and sure of their work, the authors hypothesize that the students may have feared that their desire for competence and certainty was incompatible with the comprehensiveness of family medicine.