Category Archives: Education and training
More students than ever applied to and enrolled in the nation’s medical schools this year, according to data released by the Association of American Medical Colleges (AAMC).
Compared with last year’s figures, the total number of medical school applicants grew by 6.1 percent to 48,014, surpassing the previous record, set in 1996, by 1,049 students. Another important indicator of interest in medicine is first-time applicants, and they increased by 5.8 percent to 35,727 this year. The number of students enrolled in their first year of medical school exceeded 20,000 for the first time (20,055), a 2.8 percent increase over 2012.
“At a time when the nation faces a shortage of more than 90,000 doctors by the end of the decade and millions are gaining access to health insurance, we are very glad that more students than ever want to become physicians,” AAMC President and CEO Darrell G. Kirch, MD, said in a news release. “Students are doing their part by applying to medical school in record numbers. Medical schools are doing their part by expanding enrollment.” Kirch pushed for an expansion of residency training to accommodate the greater number of students studying to become physicians.
Adejoke B. Ayoola, PhD, RN, is an assistant professor of nursing in the Department of Nursing at Calvin College and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar. Mary Molewyk Doornbos, PhD, RN, is a professor of nursing, also in the Department of Nursing at Calvin College in Grand Rapids, Michigan.
It is important to deliver high-quality care to improve health outcomes in the United States. This level of care can only be delivered by well-trained health professionals. Nurses are the single group of health professionals who have the most contact with clients, and are on the forefront of promoting delivery of high-quality care.
One means of addressing the increasing demand to deliver the high-quality care proposed by the Initiative on the Future of Nursing, supported by RWJF and the Institute of Medicine (IOM), is the recommendation to increase the percentage of nurses prepared to enter masters and doctoral level education. Graduate studies prepare nurses to produce and use the best evidence in client care, which will improve health outcomes.
Calvin College Department of Nursing (CCDON), a private liberal arts college, and Michigan State University College of Nursing (MSUCON), a public academic institution, began a partnership program in 2012 to address this initiative of the Future of Nursing. This partnership provides opportunity for eligible students from the undergraduate baccalaureate nursing program to enroll in the accelerated BSN to PhD nursing program at MSUCON.
Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of RWJF’s nursing programs, and the latest news, research, and trends relating to academic progression, leadership, and other critically important nursing issues. These are some of the stories in the October issue:
Three Years Later, Institute of Medicine Report is Fueling Innovations in Nursing Practice and Education
Three years after its release , the Future of Nursing report has become a motivational tool that is transforming nursing and improving health care across the country. Read about some of the national accomplishments and achievements of the state Action Coalitions, which are working to advance nurse education, remove barriers to practice, cultivate more nurse leaders, diversify the profession, collect better data about the nursing workforce, promote interprofessional collaboration and education, and more.
Waging War Against Drug-Resistant Bacteria
RWJF Nurse Faculty Scholar Jason Farley has traveled far on the path he set out on as a young university student, and the world is taking notice of his groundbreaking work to treat patients with HIV. His research focuses on the spread of Methicillin-Resistant Staphylococcus Aureus (MRSA) and other antibiotic resistant organisms among HIV patients. MRSA poses a major threat to patients with compromised immune systems, and is increasingly placing financial burdens on health care facilities.
With a primary care provider shortage looming, medical schools are trying a new approach to get physicians into the workforce quickly: condensing medical education from four years to three.
Mercer University (Georgia), Texas Tech University, and New York University offer three-year primary care programs, and will soon be joined by programs in Tennessee, Indiana, University of Wisconsin, East Carolina, and Kentucky, MedPage Today and Fierce Healthcare report.
Most of the schools are shortening or eliminating fourth-year clinical rotations to consolidate their programs, leaving the first three years—which often focus on medical science—untouched.
"We chose to do it on the clinical end rather than [the] basic science end because, as long as Step 1 is [and] as important as it is, our students need to be fully prepared for it,” Betsy Jones, EdD, vice chair of research in Texas Tech's Department of Family Medicine, told MedPage Today. “We didn't make any changes to the curriculum that would threaten our students' ability to do well on [the United States Medical Licensing Examination]. The changes are really at the fourth year level."
A three-year program also saves medical students tuition money, and allows them to earn money in the workforce sooner than in a conventional four-year program, according to Fierce Healthcare.
Maryjoan Ladden, PhD, RN, FAAN, is a senior program officer at the Robert Wood Johnson Foundation.
There is near-universal agreement among health care stakeholders and experts that the country needs to grow the number of primary care providers. If the health care system is to meet the growing demand for care that will result from the greying of the Baby Boomers and the influx of millions of newly insured Americans, we're going to need a bigger, better-prepared health care workforce.
That’s a point the 2010 Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, made very clearly with respect to nurses. That landmark report also pointed out that health care is becoming increasingly complex as our understanding of illness grows and as the tools and systems we have available to combat it change and evolve.
There have been some unusual cooks in the kitchen at the Johnson & Wales University culinary institute in Providence, R.I., lately: medical students.
Doctors-in-training from Tulane University have been cooking alongside Johnson & Wales students for several weeks, NPR reports, to learn about nutrition. This unique program, which debuted this year and was organized by Tulane’s Goldring Center for Culinary Medicine, aims to change the way medical students think about food and, ultimately, how they will talk to future patients about nutrition and healthy eating.
Many health problems and diseases—like obesity and diabetes—could be prevented by lifestyle changes such as better eating habits.
"We basically learn how to take care of patients when things go wrong,” Neha Solanki, a fourth-year Tulane medical student, told NPR. “I think that we need to learn how to be able to make nutritious meals and to discuss diet in an educated manner."
In addition to the collaboration with Johnson & Wales, Tulane’s Goldring Center for Culinary Medicine has built relationships in its own community. Medical students help with an “edible schoolyard” program at local schools, and host hands-on cooking and nutrition education classes for community members at the nation’s first teaching kitchen affiliated with a medical school.
The Accreditation Council for Graduate Medical Education’s decision to limit the working hours of medical residents has not increased patient mortality rates, but it has decreased the time residents spend on direct patient care, according to two studies published in the August issue of the Journal of General Internal Medicine.
Researchers from the University of Pennsylvania studied 13.7 million Medicare patients admitted to hospitals between 2000 and 2008. In the first three years after the Accreditation Council enacted an 80-hour work week for residents in 2003, the researchers found no significant changes in patient mortality within 30 days of admission.
“We can reassure the public that patients did not appear to be harmed by the initial duty hour reform of 2003,” senior study author Jeffrey Silber, MD, PhD, told American Medical News. “We have published many papers prior to this looking at other outcomes [including prolonged length of stay following 2003 duty hour reform], and we have found similar results.”
A second change in resident hours came in 2011, when the Accreditation Council limited residents’ maximum shift length to 16 hours, down from 30. Researchers at Johns Hopkins University and the University of Maryland found that this change contributed to a reduction in the amount of time residents spent on direct patient care. Studies conducted in 1989 and 1993 found an average of 18 to 22 percent of residents’ time was spent on direct patient care; the new study finds residents only spent 12 percent of their time on direct patient care—or about eight minutes per patient, per day—in 2012.
Residents spent most of their time (64 percent) on indirect patient care tasks, such as talking with other health professionals, reviewing charts, and handoffs, the study concluded. Lead author Lauren Block, MD, MPH, told American Medical News that while residents aren’t spending as much time eating and sleeping at hospitals, “that time is not being made up spending time with patients, because they spend that time instead working at their computer stations.”
Richard Rieselbach, MD, is an alumnus of the Robert Wood Johnson Foundation Health Policy Fellows program and a professor emeritus and health policy consultant for the University of Wisconsin Medical Foundation.
In the last decade, the nation’s community health centers (CHCs) have doubled their capacity. They now provide care for more than 22 million underserved children and adults in every state. But they’re going to need to do it again. By 2019, some 40 million patients will be in need of care.
The United States does not have enough primary care providers to serve these new patients, and our public investment in health professions education—graduate medical education (GME)—is failing to produce the pipeline we need. Medical students are choosing specialties over primary care at an alarming rate, and a policy vacuum keeps the GME program from being held accountable.
An initiative was launched in 2011 that I think holds great promise: the Teaching Health Center Graduate Medical Education initiative. This five-year, $230 million program was funded by the Affordable Care Act and created to increase the number of primary care graduates trained in community settings.
My colleagues and I have proposed a modified and expanded version of this initiative, called “CHAMP” Teaching Health Centers (CHAMP THCs). Our teaching model would pair CHCs with academic medical centers to develop a THC track that would encourage students to graduate in primary care and practice in urban and rural underserved areas.
In the latest installment in its “Quest for Care” series that looks at the country’s shortage of health care providers, NBC News reported over the weekend on the nursing workforce. As the nation struggles to train enough nurses to care for an aging population and the influx of patients who will be newly insured because of health care reform, one thing is holding them back: a shortage of nurse faculty.
“Just as the country needs nurses the most, a shortage of professors is curbing the capacity of nursing schools to crank out graduates with advanced degrees,” the story says, citing data from the American Association of Colleges of Nursing that nursing schools are turning away tens of thousands of qualified applicants because they lack the faculty to teach them.
The College of Nursing at the University of South Carolina is turning away a few hundred students each year for that very reason, its dean, Jeanette Andrews, told NBC. Andrews, PhD, RN, is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program.
But nurse faculty are hard to find: they need advanced degrees, and leaving the field for the classroom often requires nurses to take a pay cut. Hospitals and other care settings are competing for the same skilled nurses that colleges need, experts say.
“I have five faculty positions open right now,” Andrews added. “It is really hard to find qualified, doctorally prepared faculty who are willing to relocate or to move out of a higher-paying salary in the field.”
The news media has recently covered some innovative programs that are influencing the choices and attitudes of the next generation of doctors.
American Medical News reports on the Buddy Program, which pairs first-year medical students with early-stage Alzheimer’s patients and their caregivers. The program empowers patients, and also serves as a valuable learning tool for the students, heightening “their sensitivity and empathy toward people with the disease.” The program was developed at the Northwestern University Alzheimer’s Disease Center in Chicago; Boston University, Dartmouth College, and Washington University have replicated it.
NPR reports on a program at the University of Missouri School of Medicine that is encouraging more young doctors to pursue primary care in rural areas. During the summers, the school has been sending medical students to work alongside country doctors. While school officials caution they can’t be sure about the reasons, they have discovered that students who took part in the summer program were more likely to become primary care doctors who practice family medicine. Some 46 percent of participants are choosing to work in the country after completing their medical training.