Do Trainees Cause More Risk?

Medical students and residents are meant to get hands-on training so that they can become accustomed to patient care and work in their specialty. However, studies have looked into whether the presence of these students might raise the risk of complications as a result of their lack of knowledge compared to practicing physicians. A new study, however, shows that this may not be the case.

The study, conducted between 2005 and 2007, looked at 60,000 surgeries conducted during that time period. They found that in cases where residents were involved in care, the rate of severe complications was less than 6%. This mirrored that rate of severe complications during surgeries where there were no residents. This seems to show that resident involvement does not put the patient at increased risk for serious surgical complications. 

However, there is a slightly higher risk for non-serious complications. Surgery sites were marginally more likely to become infected in cases where residents were involved: 3% in resident cases versus 2.2% in non-resident cases. This may be due to the fact that resident-involved cases took a bit longer to perform (122 minutes versus 97 minutes), possibly because of the training the students were receiving and the need for the lead surgeon to go over procedures with them.

The new study seems to support the theory that residents and medical trainees do not put patients at a higher risk of serious complications and their involvement should not be seen as negative. Patients can be assured that their care is being delivered with their well-being in mind.

Hands-On With The Video Game

For the next generation of physicians, their training might not be based solely on textbooks and presentations. Instead, they are taking part in the changing face of medicine by using technological tools such as robots or video games to further their educational experience. This was a subject recently covered by the Huffington Post in Canada.

Integration of technology is meant to aid current education. While hands-on anatomy labs are great to see how the body is constructed, it's also limited to the cadaver. When a nerve is dissected or an organ removed, the act is done and the body isn't in its former state. With video games, however, the body can be "reset" and further dissection achieved in order to enforce learning. The same is true of the use of robotic mannequins. These bodies can help students learn how to deliver a baby, insert an IV, or give CPR without damaging a living human.

"This type of technology enables students to learn at a comfortable rate. Students learn more quickly because they realize it's an environment where they can practice." ~ Kim Garrison, Operations Manager Queens University School of Medicine's Simulation Centre)

By utilizing the technological tools now available, students can gain a richer understanding of how the body works and how to properly care for patients. They do not have to be limited by location or school resources in gaining that knowledge. The road ahead for medical technology is ripe with potential.

Evidence-Based Medicine

Medical students are taught how to diagnose and treat patients for a number of ailments. They go into practice with the lessons of their professors clear in their mind and base their work on this knowledge. However, reliance on this information alone may be doing a disservice to both patients and physicians alike. Instead, medical professionals should consider evidence-based medicine as a better solution.

Evidence-based medicine draws on current research to look at the best treatment option. Just because the same treatment has been used before doesn't mean it would be the best choice in all cases, or that advancements haven't been done to provide new care options. By allowing physicians to look at solutions that aren't necessarily the norm, it empowers them to go further in providing care and make a larger investment in their patient's outcome.

The need for this change in learning comes even before the physician gets into practice. When this type of learning is employed in medical school, it better prepares students to think in new and original ways, coming up with individualized solutions. The only requirement is IRB approval when utilizing patients for research purposes. Once consent is given, the ideals of evidence-based medicine can be employed and the medical field can become better able to look at patient cases as contributory to solutions.

Medical Mistakes Impair Patient Health

The medical industry seeks to provide safe patient care to everyone, but there remains the possibility of mistakes. When these occur, patients are not only put at risk, but it negatively impacts their future care. And the issue cascades. Patients may become wary of seeking further care if they have experienced medical mistakes personally, but also if they know family members or friends have experienced them.

A recent survey by Wolters Kluwer Health looked into this problem. Findings show that the issue of medical mistakes is on the minds of patients, with 73% noting concern about medical errors (45% "very" concerned), and 30% of respondents reporting that they or their friends/family members have personally experienced errors in medical care. Some issues that have occurred are receiving incorrect billing from their medical provider (45%) or misdiagnosis (20%). Cited reasons for these errors are as follows:

Reason For Mistakes	Percentage
Staff Miscommunication	35%
Medical Providers Too Rushed	26%
Staff Are Tired	14%
Staff Shortages	12%

Patients have begun to take control of their care to ensure these errors will not occur. To combat staff exhaustion, patients may delay their care until early week, when providers might be better rested. They also may seek a second opinion or confirm their diagnosis with their provider to make sure they understand what they're being treated for. Additionally, patients may write down instructions for their physician or nurse to make sure their wishes are understood.

Patient Action	Percentage
Validate Diagnosis	66%
Sought Second Opinion	56%
Written Instructions For Providers	36%
Delayed Care Until Early Week	19%

"What is clear from survey findings is that there is a high level of concern among American consumers about medical mistakes, which could impact the doctor-patient relationship as well as how consumers approach their own healthcare. Clinical decision support tools can play a significant role in reducing instances of medical errors and improving communication among parties involved in a patient's care. Studies have shown that hospitals that adopt certain clinical decision support systems experience shorter hospital lengths of stay, reduced mortality rates and overall improvements in quality of care." ~ Dr. Linda Peitzman, Chief Medical Officer (Wolters Kluwer Health)

Medical Burnout

Burnout is an issue among many in the workforce. Increasing demands on time have caused workers to become stressed and unhappy with their jobs. The largest persons at risk for burnout are physicians, a recent survey found. 7,288 physicians in the United States were given a 22-item survey and asked their feelings on burnout in their jobs (which accounted for 27% of those invited to complete the survey). Compare the following:

Survey Response	Physicians	General Population
Dissatisfied with the balance between their work and social lives	40.2%	23.2%
Experienced symptoms of burnout	37.9%	27.8%

Symptoms reported included: depersonalization, emotional exhaustion, and a low sense of personal accomplishment. 45.8% of physicians reported at least one symptom. Medical professionals experiencing the largest burnout work in the emergency room, where stress levels are constantly raised.

Burnout Symptom	Physicians	General Population
High Emotional Exhaustion	37.9%	23.5%
High Depersonalization	29.4%	15%
Low Sense of Personal Accomplishment	12.4%	N/A

It's clear that burnout in the medical field must be addressed. The caregivers of our country are responsible for the population's well-being, so their dissatisfaction can have negative implications on patient health as well. By confronting the triggers and working to resolve them, the positive outcome can cascade throughout the industry.

More EHR Training Necessary

The use of EHRs is increasing in practice and medical schools are trying to keep up by allowing their students to use the technology. However, the training on the proper use of EHRs is often lacking and changes must be made in order to make sure future physicians have the best foundation possible. According to a recent Alliance for Clinical Education survey, a number of medical students are using EHRs in their education. 64% of medical schools allow their students access to this technology. However, the extent of this use varies.

• 66% can make notes in EHRs
• 41% can view/write notes without the ability to make orders
• 27% can view/write patient notes and enter patient orders for co-signing

Why such a variation? Because of the extent to which medical schools recognize and can support digital input within EHRs. Faculty may not have the ability to review student notes within the EHR system, or be untrained on how to access such notes, so mistakes are more apt to appear and go uncorrected. Faculty must be better trained on the EHR systems and how to utilize all components of the EHR in order to properly teach their students the correct usage.


"We hope that medical schools and faculty recognize that students need to be more integrated in the team and not excluded from utilizing the EHR...This can jeopardize their learning and their effectiveness as future physicians." ~ Maya Hammoud, Associate Professor of Obstetrics and Gynecology (University of Michigan Medical School)

More Personal Attention During Third Year

Medical students are expected to learn a large amount of information before they embark on their careers. Going through medical school, the third year is very important as that is the time students go through multiple rotations among the various hospital departments. This gives them a deeper understanding of each discipline and aid them in choosing or solidifying the specialty they want to pursue. However, some feel that this type of experience actually does a disservice to the students because of the limited time they get to spend with patients. Some schools are trying to change that through the use of integrated clerkships.

The idea behind integrated clerkships is to give students the ability to follow patients long-term. They can work within a specific community or with a specific patient group in order to chart their progress over time. This gives students the ability to develop deeper relationships with their patients and see the effect of treatment through weeks or months. It also helps patients maintain a level of empathy that is often lost during the quick rotations of traditional third year training.

Will these changes come into effect for more medical schools across the country? Depending on the success in the schools that are currently using the approach, it's possible that integrated clerkships might become more common. On the surface, it looks like a good change. Allowing students to practice their bedside manner and empathy skills, giving them the ability to see patients as people rather than their disease, will serve them well in their future careers.

Harassment in Medical School

Medical students have to endure long hours of training, many sleepless nights while they study, and countless days spent in the classroom or the hospital gaining as much knowledge as they can before embarking on a career. However, in the midst of that training, students may be enduring harassment as well. That is an issue that was recently discussed by the American Medical News.

In a survey of 12,195 medical students across the country, mistreatment was reported by 47% of respondents. Quite a high rate, but what's more concerning is the fact that only 17% of these students reported the incidents. That means the harassment may have continued for subsequent students as well, without any administrative intervention. Listed harassment included public humiliation, sexist remarks, or being require to perform personal tasks for physicians that were outside their job description. Being the focus of such harassment means that medical student's attitude is changed, which can negatively affect patient interactions as well.

“Medical student cynicism has been a perpetual problem in medical education. That is one of the fallouts from medical student abuse. Many students come to school with great enthusiasm. By the time they come out, they are well-trained and certainly their knowledge base has grown, but there is no question that their attitudes have changed.” ~ Dr. Jerald Kay, Professor and Chair of Department of Psychology (Boonshoft School of Medicine)

How can medical students be encouraged to report their issues, and hopefully decrease the incidence? One obstacle to overcome is fear of repercussions. Medical students are staying silent because they're afraid to draw attention to themselves, and therefore draw the ire of their fellow classmates or their superiors. Added to this issue is the lack of anonymity. If one person out of a group of five or ten reports a problem, then it is easy to figure out who told. If students don't feel safe to report issues, they won't. Until these problems are faced, they will continue. Medical students may feel like it's just part of the process toward being a physician, but it doesn't have to be. Changing the medical school environment will improve attitudes and learning environment, in turn making better physicians entering the workforce.

Type of mistreatment	Never	Once	Occasionally	Frequently
Publicly humiliated	65.7%	16.9%	16.3%	1.0%
Threatened with physical harm	98.5%	1.1%	0.4%	0.0%
Physically harmed	97.9%	1.8%	0.2%	0.0%
Required to perform personal services	90.6%	5.7%	3.5%	0.2%
Subjected to sexist remarks	84.3%	6.4%	8.7%	0.7%
Denied opportunities for training or rewards based on gender	94.1%	2.4%	3.1%	0.4%
Received lower evaluations or grades because of gender	93.5%	4.4%	1.9%	0.3%
Subjected to unwanted sexual advances	95.4%	2.6%	1.9%	0.2%
Asked to exchange sexual favors for grades or other rewards	99.8%	0.1%	0.1%	0.0%
Denied opportunities based on race or ethnicity	97.3%	0.9%	1.3%	0.6%

Source: “Medical School Graduation Questionnaire: 2012 All Schools Summary Report,” Assn. of American Medical Colleges, July (aamc.org/download/300448/data/2012gqallschoolssummaryreport.pdf)

Medical Schools Making Apps

The mobile app market is growing for the medical industry. More physicians and medical students are using their mobile devices to access medical information, gain training, and do research on presented symptoms in order to make a proper diagnosis. Medical schools have even supported certain mobile apps, recommending their students download and use certain ones in order to foster their learning. However, some schools aren't just making suggestions, they're making apps themselves.

Why would schools, already burdened with time management, get into app development? It's all about expanding their students' education and giving them more specialized learning opportunities. While apps can be vetted for correct information before being recommended to students, they have to be constantly monitored in case misinformation in later updates. Medical schools who are in charge of that information release themselves would be assured that the information their students are receiving is accurate. Thus, medical schools become the creators.

Additionally, there arises a need to make apps that are targeted to specific populations. Medical students at one university will be abiding by curriculum that is not necessarily the same as another university. With generalized apps, the educational supplement provided might not focus on the specific needs of the curriculum. However, when universities take over that development, they can craft apps that focus on what's important to their student population.

The mobile medical industry is expanding and incoming medical students are utilizing all the latest technical developments in order to foster their learning. When medical schools get involved in that process, it means that students can get the best and most targeted learning available, turning them into prepared and successful physicians.

Opinions on Affordable Care Act

As we near the 2014 date set by the Affordable Care Act, it's interesting to know what medical students think of the changes. They will be the ones who have to carry the burden of increased patient loads and find a way to navigate the changed system. Last year, 1,232 medical students across the country were surveyed about the ACA. Here are some of those findings:

• 80.1% were in support of the Affordable Care Act
• 67.6% agreed ACA will expand access to care (6.5% disagreed)
• 53.9% understood ACA's major provisions (30.2% disagreed)
• 31.4% agreed PPACA will improve care quality (20.9% disagreed)
• 18.6% agreed ACA will contain costs (36% disagreed)

What do these findings show about medical students' reactions to the coming changes? Well, one area of concern is the lack of understanding of the ACA overall. Only half of those surveyed had an understanding of the major provisions, but far more were in support of it. How can this be? Wouldn't they need to understand what they're supporting? And if the basic understanding is not present, how can they believe that the act will expand access to care? It appears that medical students should take a closer look at the act and educate themselves about what changes will occur since they will be expected to work in the post-act system in a few years

CME Going Mobile

The days of relying on books and conference attendance to keep pace with education is long over. Today, physicians are instead using their mobile devices to keep up to date on the latest medical research or double-check reference materials when treating patients.

Spyglass Consulting Group recently completed the "Point of Care Communications for Physicians" study and they found that smartphone use among physicians has increased 60% since 2006. Today, 94% of the medical population says they use their smartphone to manage workflow and access medical information throughout their day. Also, instead of traveling to educational conferences half-way across the country, disrupting their practice schedule, more physicians are taking advantage of the opportunity to watch these presentations on their smartphones and take assessments in order to gain credit. Future advances may include the ability to interact with the presenters and fellow attendees, rather than being a silent participant.

By using the current technology and pushing further, physicians can increase their learning opportunities and use this new knowledge for better patient interactions. Having a wealth of information at their fingertips, physicians can make any situation an opportunity to learn.

Closing the Physician Gap

With the coming healthcare reform, physicians are looking into ways to help the already-problematic system deal with the influx of new patients. The Post-Standard looked at the situation in Central New York and they noted that patients already have multiple weeks wait-time in order to see a doctor. When new patients crowd the market, that time will likely lengthen further with the gap between the number of patients and the physicians who are able to treat them widening. Rural areas have suffered from the lack of physicians as well, causing patients to drive hundreds of miles to seek care, if they can manage it. Many patients simply forego care altogether rather than deal with the hassles being created.

The Association of Medical Schools of New York is trying to counteract that problem. They are determined to fill the gap by increasing enrollment in nursing schools, medical schools, and other health professional training environments. They provide financial benefits for agreeing to work in under-served areas, including loan forgiveness and other financial aid. Additionally, steps can be taken in order to lessen the strain on physicians by spreading out the care. Patients can be treated for a variety of different ailments by other healthcare providers, which allows physicians more time in their schedules to deal with certain cases. Through the promotion of such team-oriented medicine, the industry can carry the burden of increased care. Healthcare reform is a great idea, but only if there are enough providers.

Preventative Care Through Mobile Technology

With the increase in mobile technology, there is more potential for patients to utilize preventative care tools. If they are easy to use and easy to access, patients are more likely to interact and use them to strengthen their own health outcomes. This is an area that AMedNews looked into recently.

Currently, there is a slight separation between consumer tools and physicians tools in terms of mobile technology. Apps exist for patients to try and monitor their own health, but they don't integrate with their health records. Physicians have access to alert tools, but they too give patients generalized advice. However, if tools could use personalized information, giving advice specific to patients' cases, it would help increase positive health outcomes and make physicians' jobs easier in helping their patients make a positive change. This interactive preventative health record has been piloted in eight PCP offices. Through this study, researchers "found that 25.1% of patients with access to an IPHR were up to date on preventative services." The same principle could be integrated into mobile technology. Personal health alerts could be sent to patients' devices to encourage good health practices, as well as remind patients of preventative health services. When patients receive personalized messages from their healthcare provider, they are more likely to take note and follow through.

The wealth of tools afforded to us through current technology opens the potential for better health outcomes. By pushing physicians to fully integrate patient health records with available tools and encouraging patients to take part, the overall health of the country can begin to improve. Medicine is a team effort and the utilization of technology makes the team stronger.

Coverage, But No Doctors

Healthcare reform is meant to provide coverage to many uninsured patients, helping them to get much-needed treatment. However, that is only true if there are enough doctors to cover this increased patient population. The issue was recently discussed by the New York Times.

Already, there is a growing shortage of doctors in the United States. With the influx of new patients, this problem will only grow. The Association of American Medical Colleges has noted that by 2015, there will be 62,900 less doctors than are needed in this country. Just ten years later, that number is estimated to double. Even without changes in healthcare laws, there will still be a gap between patients and providers. The population is aging, which means they'll require more physician visits, and even with current Medicaid standards those who are eligible are often left on waiting lists for appointment times. Resorting to emergency room visits to take care of routine procedures clogs up the system even more. How, then, can patients take advantage of the increased access to healthcare if there are no providers who are able to treat them?

One solution is to increase training opportunities. While it will not immediately correct the problem, since training takes a number of years, it will set the groundwork for the future. Another positive change would be to increase the recruitment to areas of need, both medically and geographically. Primary care is not increasing in numbers as quickly as other specialties, possibly because of pay discrepancies. Also, there are many under-served regions of the country because of geographic location. Physicians need to be recruited to these areas because patients often go untreated, not being able to make the long journey to their nearest healthcare professional, if they can even get an appointment. By working toward a better solution, the health of this country can become better and the overall healthcare industry can succeed.