Medical student mistreatment: understanding 'public humiliation'.

INTRODUCTION: Mistreatment in medical school is an enduring problem in medical education. Little is known about the concept of 'public humiliation,' one of the most common forms of mistreatment as identified on the AAMC Graduation Questionnaire. The objective of this study was to further investigate 'public humiliation' and to understand the underpinnings and realities of 'public humiliation' in medical education. METHOD: Focus groups of medical students on clinical rotation at the University of Washington School of Medicine were conducted over one and a half years. Qualitative analysis of responses identified emergent themes. RESULTS: Study results included responses from 28 third year and one fourth-year medical student obtained over five different focus groups. Participants defined the term 'public humiliation' as negatively, purposefully induced embarrassment. Risk factors for the experience of public humiliation in educational settings were found to include the perceived intent and tone of the teacher, as well as situations being 'public' to patients and taking place during a medical or surgical procedure. Socratic teaching or 'pimping' was not found to be a risk factor as long as learners were properly oriented to the teaching practice. DISCUSSION: This study investigated and defined 'public humiliation' in the setting of medical student mistreatment. More subtle forms of mistreatment, like public humiliation, may be amenable to interventions focused on teaching educators about the importance of orientation and clear communication of intent during the teaching process.

Empowering fourth-year medical students: the value of the senior year.

In this issue of Academic Medicine, Wolf et al explore the purposes and value of the senior year of medical school as viewed by graduating students at their institution. Using data from student focus groups and questionnaires, they report that students all found there to be significant value in but identified different purposes for the fourth year. The authors of this commentary believe that study adds to the discussion of fourth-year curriculum reform an important voice that has been lacking-that of students.Previous articles focusing on the perceived lack of clarity of educational purpose in the senior year curriculum have reflected a faculty perspective and have led some to call for increasing the structure of, decreasing the elective time in, or even completely eliminating the fourth year. In this commentary, the authors ask for a pause in this debate to consider the implications of the student perspective as well as important trends in the medical education continuum that affect the senior student (e.g., milestones that will set new expectations for first-year residents, increasing pressure associated with matching to a residency). They propose that providing students with time for career exploration and for focusing on areas of interest would allow them to individualize their preparation for residency and to be more sure of their career choices. They share the University of Washington School of Medicine's planned new fourth-year approach as an example of a flexible, individualized senior year curriculum.

Challenges and opportunities in building a sustainable rural primary care workforce in alignment with the Affordable Care Act: the WWAMI program as a case study.

The authors examine the potential impact of the Patient Protection and Affordable Care Act (ACA) on a large medical education program in the Northwest United States that builds the primary care workforce for its largely rural region. The 42-year-old Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) program, hosted by the University of Washington School of Medicine, is one of the nation's most successful models for rural health training. The program has expanded training and retention of primary care health professionals for the region through medical school education, graduate medical education, a physician assistant training program, and support for practicing health professionals.The ACA and resulting accountable care organizations (ACOs) present potential challenges for rural settings and health training programs like WWAMI that focus on building the health workforce for rural and underserved populations. As more Americans acquire health coverage, more health professionals will be needed, especially in primary care. Rural locations may face increased competition for these professionals. Medical schools are expanding their positions to meet the need, but limits on graduate medical education expansion may result in a bottleneck, with insufficient residency positions for graduating students. The development of ACOs may further challenge building a rural workforce by limiting training opportunities for health professionals because of competing demands and concerns about cost, efficiency, and safety associated with training. Medical education programs like WWAMI will need to increase efforts to train primary care physicians and increase their advocacy for student programs and additional graduate medical education for rural constituents.

The scope and variety of combined baccalaureate-MD programs in the United States.

The landscape of combined baccalaureate-MD programs has changed substantially in the last two decades but has not been documented in detail. The authors review the current state of these programs and discuss opportunities for future study of their evolving role and potential impact.In 2011, using a definition of baccalaureate-MD program built on prior research, the authors reviewed Association of American Medical Colleges sources and medical school Web sites to identify and characterize 81 active programs. In addition, they surveyed the 57 medical schools offering those programs; 31 schools with 39 programs responded. The resulting database inventories the number and distribution of programs; institutional affiliations; missions or goals; length; size; admissions criteria; curricula; and retention requirements.Since the inception of combined programs in 1961, their number and curricular length have increased. Pressures that spurred earlier programs remain evident in the goals of today's programs: attract talented high school or early college students, especially from diverse backgrounds; prepare physicians to meet societal needs; and offer an enriched premedical environment. Baccalaureate educational activities achieve program goals through special courses, medical experiences, community service, and learning communities tailored to students' needs. Admission and retention criteria are comparable to those of traditional medical schools.Combined baccalaureate-MD programs have evolved along several paths during the last half century and have enriched the baccalaureate experiences of medical students. Shifting expectations for the selection and education of future physicians warrant focused research on these programs to document their effectiveness in addressing those expectations.

Reuniting public health and medicine: the University of New Mexico School of Medicine Public Health Certificate.

The University of New Mexico School of Medicine (UNMSOM) sought to train medical students in public health concepts, knowledge, and skills as a means of improving the health of communities statewide. Faculty members from every UNMSOM department collaborated to create and integrate a public health focus into all years of the medical school curriculum. They identified key competencies and developed new courses that would synchronize students' learning public health subjects with the mainstream medical school content. New courses include: Health Equity: Principles of Public Health; Epidemiology and Biostatistics; Evidence-Based Practice; Community-Based Service Learning; and Ethics in Public Health. Students experiencing the new courses, first in pilot and then final forms, gave high quantitative ratings to all courses. Some students' qualitative comments suggest that the Public Health Certificate has had a profound transformative effect. Instituting the integrated Public Health Certificate at UNMSOM places it among the first medical schools to require all its medical students to complete medical school with public health training. The new UNMSOM Public Health Certificate courses reunite medicine and public health in a unified curriculum.

Addressing physician shortages in New Mexico through a combined BA/MD program.

The University of New Mexico School of Medicine and College of Arts and Sciences developed its combined BA/MD degree program, which will increase the medical school class from 75 students to 100 in the fall of 2010, to address the critical issue of physician shortages in underserved New Mexico. The program, which began operation at the undergraduate (i.e., college) level in 2006, expands opportunities in medical education for New Mexico students, especially those from rural and underserved minority communities, and prepares them to practice in underserved areas of New Mexico. In the BA/MD program, students will earn a bachelor of arts, a medical degree, and a proposed certificate in public health. A challenging liberal arts curriculum introduces the principles of public health. Students have unique rural medicine and public health preceptorship opportunities that begin in the undergraduate years and continue throughout medical school. Students work with a community physician mentor in summer service-learning projects during the undergraduate years, then they return for required rural medicine rotations in the first, third, and fourth years of medical school. Simultaneously, the classroom curriculum for these rural medicine experiences emphasizes the public health perspective. High priority has been placed on supporting students with academic advising and counseling, tutoring, supplemental instruction, on-campus housing, and scholarships. The program has received strong support from communities, the New Mexico state legislature, the New Mexico Medical Society, and the faculties of arts and sciences and the school of medicine. Early results on the undergraduate level demonstrate strong interest from applicants, retention of participants, and enthusiasm of students and faculty alike.