medical education

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Even At Mass. General, Medical Training On Addiction Deemed Lousy

Massachusetts General Hospital is one of the highest paid in the state. (Steven Senne/AP)

Massachusetts General Hospital. (Steven Senne/AP)

Even at the lofty institution that bears the nickname Man’s Greatest Hospital, most medical residents think they’re not taught well enough about addiction and substance abuse, a 2012 survey found.

The hospital itself, Massachusetts General Hospital, sent over word of the study today, and says it has since increased addiction training for medical residents, who estimate that one-quarter of the inpatients they see have a substance abuse problem. From its press release:

BOSTON – A 2012 survey of internal medicine residents at Massachusetts General Hospital (MGH) – one of the nation’s leading teaching hospitals – found that more than half rated the training they had received in addiction and other substance use disorders as fair or poor.

Significant numbers felt unprepared to diagnose or treat such disorders, results similar to surveys of practicing physicians. In response to the findings, published online in the journal Substance Abuse, the MGH has increased residents’ training in addiction medicine.

“Our residents estimated that one in four hospital inpatients has a substance use disorder, which matches what other studies have found and represents a disease prevalence similar to that of diabetes,” says Sarah Wakeman, MD, chief medical resident at MGH and lead author of the report. “Finding that the majority of residents feel unprepared to treat addiction and rate the quality of their education so low represents a tremendous disparity between the burden of disease and the success of our current model of training.”

The study’s authors note that residents provide most direct medical care in teaching hospitals and often find caring for patients with addictions to be troublesome – possibly due to a lack of training and faculty role models – which can lead to a lack of trust between patients and physicians. Continue reading

Latest Data: Average Med School Grad Owes Over $166K


Know a virtuous young person who wants to become a doctor for all the right reasons? Think their soaring idealism might need a bit of ballast from financial reality? Here it is: The latest figures on medical school debt, just out today from the Association of American Medical Colleges.

The mean debt load for students from all medical schools is $166,750, up 3 percent from last year, and the median is $170,000, up 5 percent from last year. And it doesn’t much help if you go to a public medical school — the mean debt is about $156,000, compared to nearly $184,000 for a private school.

Depending on your repayment schedule, the new AAMC data show, your total repayment after graduating could total as much as $476,000. And we wonder why health care is so expensive in this country? Doctors’ salaries are of course only one element of our high price tags, but it’s an element that sets us apart from Europe, where medical education tends to be lower-cost or free.

Amednews.com reported recently here:

Meanwhile, tuition rates continue to increase dramatically. The median cost of attending a private allopathic medical school has grown at 1.8 times the rate of inflation during the last 13 years. At public schools, it has grown more than twice the rate of inflation, the AAMC said.

Public medical schools have been particularly hard hit, as states have reduced funding in a poor economy.

Readers, what is to be done? See the full AAMC data below. One interesting note: 30% of graduates plan to enter loan forgiveness or repayment programs: Continue reading

What Med Students Learn From Sticking With Their Patients

Altaf Saadi, a Harvard Medical School student doing an "integrated clerkship" at Cambridge Health Alliance

Medical school is an infamous time of maximal stress, as a student bounces quickly from specialty to specialty and patient to patient, building emotional calluses. In a fascinating interview just out in The Boston Globe about medicine’s tendency to “dehumanize” doctors, Dr. Omar Sultan Haque says, “Empathy decreases as you get more experience with patients. The nicest people you’ll ever find who are doctors are in the first two years of medical school.”

But what if it doesn’t have to be that way? At least, not all of it? A study just out in the journal Academic Medicine reports positive findings on a different model for the third year of medical school: Students follow their patients “longitudinally,” through all their treatments, even from hospital to home.

The study of third-year students in Harvard Medical School’s “integrated clerkship” at Cambridge Health Alliance found that they scored just as well as their peers on standardized tests, but they felt differently about their experience. They saw it “as more humanizing (even transformational) and less marginalizing than do their peers in more traditional clerkships. Strikingly, these strongly positive perceptions exist in the face of an experience that is described as both more hectic and more stressful than the traditional clerkship.”

Here, Altaf Saadi, a third-year Harvard medical student currently participating in the Cambridge Integrated Clerkship, describes what it’s like to have real time to spend with a patient who is going through cancer treatment and navigating the medical system.

By Altaf Saadi
Guest Contributor

This Monday, my internal medicine supervising physician and I saw Helen’s bald head for the first time. “Do you want to see it?” she asked. And, with our encouragement, she slowly removed her caramel-colored wig.

“You two are the first people to see my head like this.”

She was in her third cycle of Cytoxan and Taxol — two chemotherapy medications for treatment of her breast cancer — and she had lost her hair, among a dizzying number of other side effects she has experienced. So we sat there in the primary care clinic, weathering the initial influx of pain, bearing witness to her experience of cancer.

These are real fears patients have, fears that often do not get communicated when relationships are not established with patients.

Helen (not her real name) is one of nearly 500 patients I have seen as part of my third year at the Cambridge Health Alliance. I am one of ten students in this year’s Harvard Medical School-Cambridge Integrated Clerkship, an innovative model for third year medical education that centers learning on the experience of the patient. Traditionally, third year medical students complete discrete “block” rotations in core disciplines such as Internal Medicine, Pediatrics, Obstetrics, and Surgery. They rarely see patients more than once. As part of the Cambridge Integrated Clerkship, we instead spend time in all of the disciplines throughout the year by following “our” patients through those disciplines. Continue reading