This post courtesy of Anne Taylor-Vaisey: Journal of Continuing Education in the Health Professions Volume 25, Volume 1, Winter 2005

EDITORIAL The Journal, Policy, and Education in Health Care Paul E. Mazmanian, PhD

OVERVIEW Physician Migration, Education, and Health Care John J. Norcini, PhD, and Paul E. Mazmanian, PhD

Physician migration is a complex and multifaceted phenomenon that is intimately intertwined with medical education. Imbalances in the production of physicians lead to workforce shortages and surpluses that compromise the ability to deliver adequate and equitable health care to large parts of the world s population. In this overview, we address a special section of the journal and briefly describe the current state of! affairs in physician migration and its effects on donor and recipient countries. Global forms of practice and education, based on initiatives such as telemedicine and the International Virtual Medical School, hold promise of redressing some of these imbalances without requiring physicians to leave their countries. Other initiatives, such as those to raise the standards of medical education across the continuum, will improve the quality of care locally and permit the movement of physicians, resulting in better distribution of the workforce. All of these actions require a uniquely global perspective that places a premium on the long-term benefits to humankind while respecting the rights of patients and physicians.

ORIGINAL ARTICLES

Physician Migration: A Challenge for America, a Challenge for the World Richard A. Cooper, MD

Physician Migration: Donor Country Impact A.P.R. Aluwihare, MA, MChir(Cantab), FRCS (Eng)

Physician Migration to and from Canada: The Challenge of Finding the Ethical and Political Balance Between the Individual’s Right to Mobility and Recruitment to Underserved Communities W. Dale Dauphinee, MD, FRCPC

The Medical Passport Sue Ineson, Stephen S. Seeling, JD

Telemedicine for Access to Quality Care on Medical Practice and Continuing Medical Education in a Global Arena Azhar Rafiq, MD, EMBA, Ronald C. Merrell, MD, FACS

A New Vision for Distance Learning and Continuing Medical Education Ronald M. Harden, MD

Central Asian Republics: A Case Study for Medical Education Reform Kathleen A. Conaboy, Zhamilya Nugmanova, MD, PhD, Saltanat Yeguebaeva, MD, Frances Jaeger, DrPH, Robert M. Daugherty, MD, PhD

This post courtesy of Anne Taylor-Vaisey: Journal of Continuing Education in the Health Professions Volume 25, Volume 1, Winter 2005

EDITORIAL The Journal, Policy, and Education in Health Care Paul E. Mazmanian, PhD

OVERVIEW Physician Migration, Education, and Health Care John J. Norcini, PhD, and Paul E. Mazmanian, PhD

Physician migration is a complex and multifaceted phenomenon that is intimately intertwined with medical education. Imbalances in the production of physicians lead to workforce shortages and surpluses that compromise the ability to deliver adequate and equitable health care to large parts of the world s population. In this overview, we address a special section of the journal and briefly describe the current state of! affairs in physician migration and its effects on donor and recipient countries. Global forms of practice and education, based on initiatives such as telemedicine and the International Virtual Medical School, hold promise of redressing some of these imbalances without requiring physicians to leave their countries. Other initiatives, such as those to raise the standards of medical education across the continuum, will improve the quality of care locally and permit the movement of physicians, resulting in better distribution of the workforce. All of these actions require a uniquely global perspective that places a premium on the long-term benefits to humankind while respecting the rights of patients and physicians.

ORIGINAL ARTICLES

Physician Migration: A Challenge for America, a Challenge for the World Richard A. Cooper, MD

Physician Migration: Donor Country Impact A.P.R. Aluwihare, MA, MChir(Cantab), FRCS (Eng)

Physician Migration to and from Canada: The Challenge of Finding the Ethical and Political Balance Between the Individual’s Right to Mobility and Recruitment to Underserved Communities W. Dale Dauphinee, MD, FRCPC

The Medical Passport Sue Ineson, Stephen S. Seeling, JD

Telemedicine for Access to Quality Care on Medical Practice and Continuing Medical Education in a Global Arena Azhar Rafiq, MD, EMBA, Ronald C. Merrell, MD, FACS

A New Vision for Distance Learning and Continuing Medical Education Ronald M. Harden, MD

Central Asian Republics: A Case Study for Medical Education Reform Kathleen A. Conaboy, Zhamilya Nugmanova, MD, PhD, Saltanat Yeguebaeva, MD, Frances Jaeger, DrPH, Robert M. Daugherty, MD, PhD

Nancy Davis, PhD, CME director with the American Academy of Family Physicians, sent around this great note thanking Craig Campbell, Director of Professional Development for the Royal College of Physicians and Surgeons of Canada and out-going president of the Society of Academic CME, for all his work on the organization’s behalf. When I saw it, well, everyone should have such a tribute. Nancy gave me the OK to post it here:

For those of you who were not able to attend the SACME Business Meeting in Austin, there was a presentation of a plaque to our out-going President, Craig Campbell, which included a small inukshuk. The following explanation was read at the presentation:




Inukshuks were built by the Inuit people of northern Canada. They rise from the landscape always in human form as solid guardians, keeping the vigil to direct travelers along the best and safest path. They say, "I’ve been here before and you are on the right path." To build an inukshuk, you must find the perfect balance for each rock. No rock is more important than the other and each creation is unique.




Craig served as our inukshuk during his presidency, leading us down the right path, not favoring one rock over another, finding the perfect balance to move us forward.

Is that not a beautiful tribute? It brought tears to my eyes–would that we all could do for our organizations what it sounds like Dr. Campbell did for SACME.

This one looks like it’ll have some legs to it–it seems like I’m far from alone in being seriously disturbed by the latest revelations about drug companies asking docs to rubber-stamp pharma-written papers by letting themselves be listed as lead author without having researched or written the articles.

Now The Hoya, Georgetown University’s paper, is asking whether this might also constitute plagiarism:

 While the Medical Center doesn t have any specific policies addressing this particular type of ghostwriting, any type of ghostwriting would be an act of plagiarism, which, of course, is in violation of principles laid out in the faculty handbook, [Ken Dretchen, chair of the pharmacology department] said.

And today’s New York Times (free registration req’d) has an article that shows how this was also a part of the Vioxx mess (thanks to Health Care Renewal for the pointer):

The Advantage trial was completed in 2000, but its results were not published until 2003, when they appeared in the Annals of Internal Medicine, a well-regarded journal. Dr. Jeffrey R. Lisse, a rheumatologist at the University of Arizona who is listed as the study’s first author, said in an interview that at least two other journals had rejected the study because its results were not novel.



In the published study, Dr. Lisse reported that five patients taking Vioxx had suffered heart attacks during the trial, compared with one taking naproxen, a difference that did not reach statistical significance. But the paper never mentioned the three additional cardiac deaths of patients taking Vioxx, including the 73-year-old woman.




Dr. Lisse said that while he was listed as the paper’s first author, Merck actually wrote the report, an unusual practice.




“Merck designed the trial, paid for the trial, ran the trial,” Dr. Lisse said. “Merck came to me after the study was completed and said, ‘We want your help to work on the paper.’ The initial paper was written at Merck, and then it was sent to me for editing.”




Dr. Lisse said he had never heard of the case of the woman who died, until told of it by a reporter. “Basically, I went with the cardiovascular data that was presented to me,” he said.

Orac over at Respectful Insolence has added a second part to his field guide series (if you missed part 1, where he takes on people who go to the mikes at the Q&A, check it out–it’s hilarious). Now he beards the next wild beast species–poster presenters and those who come to graze. Here’s just one:

1. The Schmoozer. This guy (or gal) wants nothing more than to make as many contacts as possible and will do whatever it takes to achieve that aim. If you show the least bit of interest in his or her poster, the Schmoozer will sidle up to you and try to chat you up. (Characteristic quote: "Can I have your card? Here, please take mine.") Of course, once the schmoozer finds out that you’re merely junior faculty or a fellow, his or her reaction to you will be similar to what you would experience if you showed up with skin lesions characteristic of the bubonic plague or, if you’re a guy, the reaction you got the last time you tried to hit on that gorgeous model-quality beautiful chick at a bar. How do I know this one, you ask? Don’t ask.

The AAMC announces the launch of MedEdPORTAL, a web-based tool that promotes collaboration across disciplines and institutions by facilitating the exchange of peer reviewed educational materials, knowledge, and solutions. MedEdPORTAL will serve as a central repository of high quality educational materials such as PowerPoint presentations, assessment materials, virtual patient cases, and faculty development materials.
 
MedEdPORTAL will be implemented in phases through 2005 and 2006.  During the initial phase, non-web-based educational materials and those that are available on external websites will be peer-reviewed, referenced, and linked on the MedEdPORTAL site.  Faculty may submit their web sites or educational materials at anytime for peer review and if accepted, the resources will be referenced in the Med! EdPORTAL system as a peer reviewed resource.
 
The MedEdPORTAL web address is http://www.aamc.org/mededportal
 
Individuals interested in submitting educational materials for peer review can review the peer review guidelines and download the submission form from the following MedEdPORTAL web page: www.aamc.org/meded/mededportal/publish.htm

A detailed implementation timeline is available on the following MedEdPORTAL web page: http://www.aamc.org/meded/mededportal/timeline.htm
 
Please send questions to Robby Reynolds or Dr. Chris Candler at mededportal@aamc.org

An article in the April 27 issue of JAMA raises an interesting point:

Researchers funded by the National Institute of Mental Health (NIMH), part of the National Institutes of Health, have found that requests from patients for medications have a "profound effect" on physicians prescribing for major depression and adjustment disorder. These findings indicate that direct-to-consumer (DTC) marketing of prescription medications for depression may exert significant influence on treatment decisions.

If I read it right, though, while the first conclusion makes sense, I don’t see how they got to the second conclusion that it’s DTC marketing that’s influencing treatment decisions. Seems to me it instead points to a need for more CME that teaches doctors to not cave in to patient requests and give them whatever they ask for, but instead prescribe whatever will best treat that particular patient.

According to a different study conducted by the FDA a couple of years ago, 53 percent of docs said they didn’t feel pressure to prescribe when a patient asked about an advertised drug during the office visit. But when the patient asked about a specific brand-named drug, the number of physicians reporting they still felt no pressure dropped to 39 percent.

This is your brain. And, according to a study done by the Institute of Psychiatry on behalf of Hewlett-Packard, this is your brain on tech overload:

That’s right, our Blackberry addictions and compulsive e-mail checking is lowering our IQs. From the press release:

Far from making workers more productive, the findings of a new scientific experiment reveal that those who  over juggle and who constantly disrupt meetings and important tasks to read and respond to messages, significantly reduce their IQ. In a series of tests carried out by Dr Glenn Wilson, Reader in Personality at the Institute of Psychiatry, University of London, an average worker s functioning IQ falls ten points when distracted by ringing telephones and incoming emails. This drop in IQ is more than double the four point drop seen following studies on the impact of smoking marijuana. Similarly, research on sleep deprivation suggests that an IQ drop of ten points is equal to missing an entire night of sleep. This IQ drop was even more significant in men who took part in the tests.

And just earlier today, when someone asked me how I do all this blogging and my day job, I thought I was kidding when I said, “Might as well face it, I’m addicted to blog” (apologies to Robert Palmer). But seriously, now that docs theoretically are getting techier, and the trend toward point-of-care learning continues, is it possible that the quality of patient care actually could decrease as IQs plummet as the doc uses technology in the office? That just hurts my brain. Better go check my e-mail…what was I talking about again?

According to this article in The Standard, docs in Hong Kong are joining U.S. physicians, among others, in having to participate in CME to maintain licensure:

The government is pushing ahead with a controversial plan to amend legislation relating to doctors despite strong opposition.



Under the amendment, doctors will be barred from practising if they do not complete a number of courses in a specified time.




The government plans to table an amendment to the Medical Registration Ordinance during the next legislative year, which starts in September, forcing doctors to obtain a Continuing Medical Education certificate, and obtain a license valid for only three years.




The Medical Council, which licenses all 10,100 practising doctors in Hong Kong, decided three years ago to extend the mandatory continuing medical education (CME) program from covering only specialists to all doctors.