Faculty Bibliography

BACKGROUND:A handful of medical schools in the U.S. are awarding medical degrees after three years. While the number of three-year pathway programs is slowly increasing there is little data on the opinions of medical education leaders on the need for shortening training. PURPOSE/OBJECTIVE:To survey deans and program directors (PDs) to understand the current status of 3-year medical degree programs and to elicit perceptions of the need for shortening medical school and the benefits and liabilities of 3-year pathway programs (3YPP). METHODS:Online surveys were emailed to the academic deans of all U.S. medical schools and to a convenience sample of residency and fellowship PDs. Frequency distributions are reported for key survey items and content analysis was used to describe open-ended responses. RESULTS:Of the respondents, 7% have a 3YPP, 4% were developing one, and 35% were considering development. In 2014, 47% of educational deans and 32% of PDs agreed that there may be a need to shorten medical school. From a list of benefits, both deans and PDs agreed that the greatest benefit to a 3YPP was debt reduction (68%). PDs and deans felt reduced readiness for independence, reduced exposure to complementary curricula regarding safety and quality improvement, premature commitment to a specialty, and burnout were all potential liabilities. From a list of concerns, PDs were concerned about depth of clinical exposure, direct patient care experience, ability to assume increased responsibility, level of maturity, and certainty regarding career choice. CONCLUSIONS:Over one-third of medical schools are considering the development of a 3YPP. While there may be benefits for a select group of students, concerns regarding maturity, depth of clinical exposure, and competency must be addressed for these programs to be well received.

Program/Project Purpose: The New York University School of Medicine (NYUSOM) has been engaging medical students in global health across their years in medical school through its' International Health Program (IHP) since 2002. All students in good academic standing are supported to participate in culturally meaningful and socially relevant research in any location that meets US State Department safe travel advisories. Students can also participate in self-funded clinical rotations. The program aims to increase the cultural competency of medical graduates as they enter the workforce to serve an increasingly diverse patient population. Our assumption was that IHP participants would have increased cultural competency, increased engagement with underserved populations, and increased incorporation of global health in their career paths. Structure/Method/Design: To understand the impact of this program we conducted a simple cross-sectional cohort study of graduates of the program from 2002 to 2012. Survey questions included demographic data as well as subjective impact of the IHP program on their residency and career choices. Outcome & Evaluation: We received 49 responses out of 213 surveys distributed by email to past participants of the IHP. Analysis of the data showed that international experiences later in medical school, rather than earlier, had a higher impact on career plans (mean of 2.70 verses mean of 2.00). Moreover, electives with both research and clinical components positively impacted career plans. Clinical rotations appeared to have slightly more impact on cultural competency than research rotations (mean of 3.82 verses mean of 3.39). Students who had not studied abroad previously (n = 24) reported that IHP had a greater impact on cultural competence, commitment to global health, and commitment to caring for the under-served than those who had previously studied abroad (n = 24). Going Forward: International heath experiences for medical students appear to have a significant impact on career paths as well as improving cultural competency. These findings can potentially benefit human resources for health by increasing US graduates long-term engagement in global public health and for working with underserved populations. We feel there is also strong argument for supporting first time international experiences for medical students

BACKGROUND: Panel Management can expand prevention and chronic illness management beyond the office visit, but there is limited evidence for its effectiveness or guidance on how best to incorporate it into practice. OBJECTIVE: We aimed to test the effectiveness of incorporating panel management into clinical practice by incorporating Panel Management Assistants (PMAs) into primary care teams with and without panel management education. DESIGN: We conducted an 8-month cluster-randomized controlled trial of panel management for improving hypertension and smoking cessation outcomes among veterans. PATRICIPANTS: Twenty primary care teams from the Veterans Affairs New York Harbor were randomized to control, panel management support, or panel management support plus education groups. Teams included 69 clinical staff serving 8,153 hypertensive and/or smoking veterans. INTERVENTIONS: Teams assigned to the intervention groups worked with non-clinical Panel Management Assistants (PMAs) who monitored care gaps and conducted proactive patient outreach, including referrals, mail reminders and motivational interviewing by telephone. MAIN MEASURES: Measurements included mean systolic and diastolic blood pressure, proportion of patients with controlled blood pressure, self-reported quit attempts, nicotine replacement therapy (NRT) prescriptions, and referrals to disease management services. KEY RESULTS: Change in mean blood pressure, blood pressure control, and smoking quit rates were similar across study groups. Patients on intervention teams were more likely to receive NRT (OR = 1.4; 95 % CI 1.2-1.6) and enroll in the disease management services MOVE! (OR = 1.2; 95 % CI 1.1-1.6) and Telehealth (OR = 1.7, 95 % CI 1.4-2.1) than patients on control teams. CONCLUSIONS: Panel Management support for primary care teams improved process, but not outcome variables among veterans with hypertension and smoking. Incorporating PMAs into teams was feasible and highly valued by the clinical staff, but clinical impact may require a longer intervention.