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  • Advice as graduation approaches....

    To the Class of 2013,

    Congratulations on an incredible achievement; in a few short days or weeks you will be receiving your MD/DO degree and then embarking onto residency! While you undergo this transition, the field of medicine also is facing dramatic changes, both internally and externally. There has been increasing scrutiny on the objectivity of our judgement as physicians and how our relationships with industry can affect the trust relationship that is at the heart of the doctor-patient dyad.

    Patients are skeptical of our relationships with industry and are concerned that they may compromise our ability to render effective and cost conscious care. In fact, studies have shown that when exposed to industry interactions such as gifts (even pens!), drug samples, free meals, and travel, doctors are more likely to prescribe costly name-brand medications and less likely to prescribe the cheaper generic alternatives. You might see this as a deviation from the evidence-based prescribing methods you learned over the past four years, while patients may see it as an erosion of trust and a higher bottom line cost for medical care in a world of skyrocketing healthcare costs.

    If you can appreciate that industry interactions with medical professionals have the potential to affect the patient-doctor relationship, there here is the good news: part of the Affordable Care Act called the the Physician Payment Sunshine Act (“Sunshine Act”) requires manufacturers of drugs and medical devices to report the monetary value of gifts and payments to doctors to the Centers for Medicare and Medicaid Services, all of which will be posted on a publicly accessible website. This includes the costs of gifts, consulting fees, research activities, speaking fees, meals and travel. However, payments or other “transfers of value” to residents (you) will not be required to be reported. What will this mean for you?


    Best wishes for success as you begin residency,
    The PharmFree Steering Committee

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  • New PBS Documentary Age of Champions - AMSA Members Watch Free!

    AMSA invites you to watch the new PBS documentary Age of Champions for free between April 18 - 28, at ageofchampions.org/premiere. Age of Champions tells the story of five competitors who sprint, leap, and swim for gold at the National Senior Olympics. You’ll meet a 100-year-old tennis champion, 86-year-old pole vaulter, and rough-and-tumble basketball grandmothers as they triumph over the limitations of age. 

    Age of Champions is a powerful resource for past and present medial students to learn more about seniors and inspire people of all ages to lead a healthier, happier and more active lifestyle.

    Watch the full documentary at ageofchampions.org/premiere.

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  • NEJM Survey: Work Hours Working?

    It has been almost two years since the Accreditation Council on Graduate Medical Education (ACGME) duty hour standards were released. The recommendation - note: not regulation - limits first year resident physicians to 16-hour shifts, a decrease from 24 hours.

    AMSA continues to say that the recommendations, which permit intermediate-level and senior residents to work 24-hour shifts, are not strong enough and we continue to urge the Occupational Safety and Health Administration, which is tasked with enforcing safety and health legislation, to address resident work hours.

    In last week's New England Journal of Medicine, results of a national survey conducted between December 2011 and February 2012, found that residents reported no improvement in education, total number of hours worked, or the amount of rest they were getting. In fact, many participants described the changes as detrimental, with the majority feeling less prepared to take on more-senior roles. Only quality of life for first-year residents was identified as having improved. The frequency of handoffs and workload for senior residents were both noted to have increased, whereas patient safety was deemed to be unchanged. Overall, only 22.9% of residents reported approval of the 2011 regulations. Read more here.

    What do you think? Are the recommendations strong enough? What else can be done?

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  • Does affirmative action belong in medicine?

    As the gatekeepers to the medical profession, medical schools have obligations that extend beyond their individual students to society at large. Those obligations include redressing current disparities in health care, where minority patients tend to receive less and lower quality care than others.

    This statement comes from the amicus brief that AMSA has recently signed in the case of Fisher v. the University of Texas. Last week, the Supreme Court heard oral arguments in this case.

    About the case: Abigail Fischer charged that she was denied admission to the University of Texas at Austin because they gave preferential treatment to minority students. She is white. The university argues that Ms. Fischer did not meet the admission criteria and simply was not accepted to the program. 

    In any event, the issue here is affirmative action as it pertains to medicine. We won't comment directly on the case but instead discuss how physicians need to understand diverse cultures in order to make the system work. 

    Research shows that when physicians understand more about the diverse cultures of their patients, physician decision-making is better informed, patients are more likely to follow their physicians’ advice, and medical outcomes improve.

    At the same time, we see minority populations continue to disproportionately suffer from health conditions. These disparities cannot continue. AMSA signed on to this "friend of the court" because we agree with the AAMC, the main organization on this amicus brief, that medical schools are the key to eliminating the health disparities described above is to develop a workforce of people from all backgrounds to bridge the current differences between providers and patients. 

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  • London Doctor Tells Students to Act Less "Overtly Gay"

    Dr. Una Coales, a London physician, recently told medical students to act less gay if they wanted to get further in their careers. The Royal College of General Practitioners (RCGP) is now investigating Dr. Coales.

    Dr Una Coales, a member of the RCGP council, suggested gay students speak in deeper voices and alter their body language to increase their chances of success in the RCGP Clinical Skills Assessment. She told one student to walk like a "straight" man. Read more.

    In an op-ed for The Independent, Coales says she was only trying to help students avoid being subject to existing bias.

    We would love to hear your thoughts on this topic.

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  • Social Media and Medical Professionalism

    Albert Einstein College of Medicine at Yeshiva University received a two-year $50,000 grant as part of Institute of Medicine as a Profession 2012 Education and Training to Professionalism Initiative. The grant, “Social Media and Medical Professionalism: Perfect Match or Perfect Storm?” will focus on the ethical issues behind social media.

    According to the Institute of Medicine as a Profession, the purpose of this project is to help students understand the potential benefits and harms of using social media in medicine. Medical students will create and analyze their own “digital footprints” for evidence of online behavior that may be inconsistent with professionalism. Students will also have simulated encounters in which social media issues are raised. Third-year students will interview patients in the Bronx community in order to assess their social media usage. This will help determine whether social media use can help enhance the well-being of the patient population served by Einstein.

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  • Landmark Case Could Change Admissions Policies

    Ran Zhao 
    National Health Policy Associate Coordinator, AMSA
    University of Connecticut
    School of Public Health 2013/School of Medicine 2014

      On October 10, the issue of race in medical school admission policies will be introduced once again at the Supreme Court in Fisher v. University of Texas.

    In 2008, Abigail Fisher accused the University of denying her admission because she was Caucasian. The Association of American Medical Collages (AAMC) along with 28 other medically related organizations including the American Medical Association, and the American Medical Student Association, filed an amicus curiae (a brief filed by a group that is not a part of the case) in support of the University of Texas. 

    This case has re-surfaced previous landmark cases involving admissions and ethnicity. Historically, in the landmark case Regents of the University of California v. Bakke 1978, the Supreme Court stated that race should be a factor in the holistic review process of medical school admissions, even though schools cannot create a separate category for applicants based solely on race. In Grutter v. Bollinger 2003a, the Supreme Court again ruled 5-4 in favor of utilizing race as part of the holistic admissions process at the University of Michigan Law School. In the current case, Abigail Fischer and her supporters would like the court to declare the admission policy of University of Texas to be unlawful, and they seek to remove the factor of race entirely from the admissions process. 

    In this brief, the medical community argues that medical schools have obligations that extend beyond individual students to the society at large. Those obligations include redressing the current disparities in health care, where minority patients have limited access to care, and when they do receive care, it is often of lower quality. For this reason and many others, medical schools have adopted admission policies that evaluate applicants holistically, including personal interviews of applicants in order to train and produce future physicians that can serve diverse patient populations. Furthermore, numerous studies have shown that when physicians understand more about the diverse cultures and backgrounds of their patients, their decision making is better informed, patients are more likely to follow their advices, which in turn result in improved medical outcomes. Thus, there is no logical substitution for the holistic review process for medical school applicants. Test scores and academic prowess is but one component of a physician’s training. 

    If we reduce the admissions policy to measuring applicants strictly by their academic merits, we will rob our society and our patients of their health and well being. If we accept Fisher’s invitation to overrule the current holistic review process, the consequences will be catastrophic, because it means we will be defeating one of the fundamental tenets of the medical profession on a systemic level: Primum non nocere (First, do no harm). 

    Keep an eye out for the oral argument October 10th and see how ethnicity and our admissions process will evolve!

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  • Meet AMSA's Education & Research Team

    Meet our newest team at AMSA! Responsible for AMSA's educational programming and research activities, this team of staff and student office fellows will be busy planning quality resources and events for our members this year. Feel free to contact them for more information on their work or to share your ideas.

    AMSA recently welcomed Dr. Jeffrey Koetje as its Education and Research Director. In this essential role, Koetje will be providing day-to-day oversight, leadership and expertise in the ongoing development, planning, execution, monitoring and evaluation of educational programs, research activities and projects for AMSA and the AMSA Foundation. Email him at jkoetje@amsa.org.

    Aliye Runyan, MD is AMSA's Education & Research Fellow. She recently graduated from the University of Miami-Miller School of Medicine. Email her at erf@amsa.org. 

    Drew Lee, MD, MA is AMSA's Health Equity Fellow. He graduated from Loyola University Chicago, receiving degrees in Biology, Philosophy and International Studies, as well as delivering the commencement speech for his graduating class. Drew recently completed a MD/MA dual-degree program at Loyola University Chicago Stritch School of Medicine/Neiswanger Institute for Bioethics and Health Policy. Email him at hef@amsa.org. 

    Reshma Ramachandran is a rising fourth year medical student at the Warren Alpert School of Medicine at Brown University. Originally from Miami, FL, she migrated up north to attend Brown University where she received a Sc.B. with Honors in Physics. Email her at pff@amsa.org.

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  • One Year After ACGME Regulations Implemented, Further Adjustments Needed

    This week marks the one-year anniversary of the Accreditation Council on Graduate Medical Education (ACGME) duty hour standards that limit first year resident physicians to 16-hour shifts, a decrease from 24 hours.

    But the recommendations, which permit intermediate-level and senior residents to work 24-hour shifts, are not strong enough, says the American Medical Student Association (AMSA), the nation’s oldest and largest, independent association for physicians-in-training. AMSA continues to urge the Occupational Safety and Health Administration, which is tasked with enforcing safety and health legislation, to address resident work hours.

    “AMSA would like to see the 16-hour shift applied to all residents, not just first year interns,” says AMSA National President Dr. Elizabeth Wiley, JD, MPH. “Our hope is that policymakers will recognize that providing Americans with access to quality health care includes duty hour restrictions to keep America’s patients and resident doctors safe.”

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  • FRPAA Day of Action Tomorrow

    On April 25th, the Right to Research Coalition will host a Day of Action in support of the Federal Research Public Access Act (FRPAA), which would revolutionize students’ access to scholarly research by requiring that all federally-funded research be made openly available to the public. Students are encouraged to write op-eds and letters to the editor for publication in their local and campus newspapers, and write their legislators encouraging them to support and co-sponsor the bill. Students have already made a real impact, helping to secure a number of FRPAA’s 26 new co-sponsors, and April 25th will serve as a springboard to amplify student influence and help make FRPAA a reality.

    For additional background information on the legislation or how you can participate, see the FRPAA call to action.

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