MSS Chair's Column

Rana Yehia
MSS Chair

December 2007

It was great seeing everyone at the Interim Meeting in Honolulu, Hawaii. Over the past several months, your Governing Council has been hard at work at reaching out to our chapters and advocating for you on a national level. Below is an update on the direction of our section and major goals we are accomplishing this year. In addition, we want to ensure that every MSS member’s voice is heard. To voice your ideas or concerns, you can complete a GC Action Item Form. Through acting together and soliciting the input of the entire national MSS membership, we can ensure that the AMA-MSS truly represents the voice of all medical students.

Access to Care – Voice for the Uninsured Campaign

On Aug. 23, 2007, in Washington, D.C., the AMA launched a three-year, multi-million dollar campaign called "Voice For The Uninsured" to spur action to cover the uninsured. The national launch began with a press conference at the National Press Club and full-page ads in the New York Times and USA Today.

This year, the AMA is reaching out to voters and candidates to talk about the problem of the uninsured and the AMA's solution. The second year of the campaign will focus on influencing Americans to vote with the issue of the uninsured in mind. The third year, post-election, the AMA will urge members of Congress to pass legislation to cover all Americans.

From Labor Day through the end of this year, AMA ads will appear in various television, print, radio, and online outlets in Washington, D.C., and the early primary states of Iowa, New Hampshire, and South Carolina. Additional outreach in these markets includes ads on pharmacy bags, billboards, and in transit stations. During September and December, the Metro Center station in Washington, D.C., will be blanketed with 100 ads.

In addition, the AMA sponsored a day at the Iowa State Fair (Aug. 16) and had a presence at the Iowa Straw Poll (Aug. 11). Other sponsored events include the New Hampshire Hopkinton State Fair (Aug. 30) and Rochester Fair (Sept. 14). The AMA Voice for the Uninsured campaign will also be at home football games at the University of South Carolina, Clemson University, the University of Iowa, and Iowa State University. AMA leaders will continue to share the AMA proposal through speaking engagements with various community, civic, and patient groups.

The MSS has had a strong presence in the Voice for the Uninsured Campaign. Through our Committee on Legislation and Advocacy (COLA), we have reached out to chapters in the key early primary states, and students in those states have been attending home football games to spread the message about the uninsured. COLA has generated an Access to Care module, consisting of a presentation of the AMA proposal for reform with a script, to enable chapter leaders to host an educational event for their members. In addition, COLA has generated an Issue Brief on Access to Care to highlight the key facts about the issue and how students can get more involved. COLA is working on formulating a “Town Hall Meeting Guide” to encourage leaders to host local events at their chapters. We are also in the process of approving a “Media Press Release Guide” to help chapters increase public attention about the uninsured, the AMA proposal for reform, and how to get involved with the Campaign. Our National Service Project (NSP) at the Interim Meeting specifically focused on the Voice for the Uninsured Campaign. Medical students from all across the country visited the Aloha Stadium for the Hawaii High School State Championship Football Tournament to spread the word about the issue of the uninsured and the AMA proposal for reform. Over the course of the next several months, we are looking at using the MSS Regional Meetings as a springboard to host rallies with the Voice for the Uninsured Campaign.

Economic Hardship Loan Deferment – The 20/220 Rule

On Sept. 27, 2007, Congress passed, and President Bush signed into law, the College Cost Reduction and Access Act of 2007 (H.R. 2669), which new could adversely affect loan repayments for up to 67 percent of entering resident physicians. This bill eliminated the 20/220 rule as of Oct. 1, 2007. The 20/220 rule was a regulation that enabled many resident physicians to qualify for economic hardship deferment, and defer payment for three years without accruing interest on subsidized loans. Residents qualified for 20/220 rule if their debt burden was greater than 20 percent of their income, and if their income minus their debt burden was not greater than 220 percent of the federal poverty level (FPL, the poverty line is $10,210 single/$13,690 couple). Now that the 20/220 rule has been eliminated, few residents will qualify for hardship deferment based in the income threshold set at 150% of the FPL, leaving forbearance as the only remaining option for residents needing to avoid payments for there first three years in training. H.R. 2669 created an Income-Based Repayment program in which loan repayments will be capped at 15 percent of the borrower’s income that is above 150 percent of the federal poverty level. However, this new program does not even begin until July 1, 2009.

The AMA feels strongly that elimination of the 20/220 rule in the middle of the year is disruptive and unfairly hits resident physicians at a time when they will be least able to make monthly payments on their education loans. The average resident earns just over $43,000 a year and carries a debt burden of more than $130,000. In response to these measures, the AMA has already sent letters reflecting its position to Congress and the U.S. Department of Education. In addition, our AMA-MSS has responded by developing an action plan the focuses on galvanizing the entire AMA on this issue. The action plan contains short term and long term goals with a focus on national and grassroots efforts.

At the grassroots level, through regular communications with our chapter leaders, via phone, e-mail, and a telebriefing on new economic hardship deferment options, we have educated medical students on the issue and mobilized them into action. Our CapWiz Action Alert resulted in over 1000 communications sent to Congress. In addition, our COLA has generated Issue Briefs, presentation modules, call scripts, and template letters as part of an “Action Kit” for chapter leaders to utilize to mobilize action within their area. At the MSS Interim Meeting, we hosted a call-in encouraging members to contact their legislators and ask for the reinstatement of the 20/220 rule. At the national level, the MSS is synergizing with other sections of the AMA on these efforts, including working collaboratively with the Resident and Fellows Section (RFS). We have also been in contact with the AAMC, ACP, AMSA, and several other student groups to develop partnerships for our efforts across the country. 

Due to these tremendous efforts by our AMA, the Department of Education published a ruling to keep the 20/220 pathway intact, until a negotiated rule-making process can occur, which will not be completed until fall of 2008. In addition, Senator Richard Burr’s (R-NC) will be introducing a bill along with Senator Johnny Isakson (R-GA) which would reinstate the 20/220 rule.  Also, he does mention the AMA in the release, particularly because it was our office that provided his staff with all the necessary information. The bill would restore the 20/220 – but it would actually expand it slightly with regards to the income requirement.  The way it does that is by altering the number the residents who would qualify for the bill. Whereas previously the borrower had to have income minus debt of less than 220% of federal poverty, this bill calls for the borrower to have income minus debt of less than 220% of 150% of the federal poverty level, thus making more residents eligible to qualify for economic hardship deferment.

Medical Education

Over the past several months, the AMA-MSS GC has recommissioned the MedEd Brain Trust, which is formed from a group of leaders in the MSS that serve on specific committees, councils, and boards that regularly deal with issues around medical education. Our MedEd Brain Trust has been active with many issues this year.

Currently, through the efforts of Jason Etheredge, we are analyzing the results of the Clinical Skills Assessment Exam (CSAE) Survey. From May 2006 – May 2007, the AMA surveyed fourth year medical students, as well as first and second year residents about their experiences and opinions of the Step 2 Clinical Skills Assessment Exam. Over 4,000 total respondents participated in the survey, of which approximately 70% were fourth year medical students. The primary research goal was to generate insights regarding how medical students and residents perceive the exam as well as the exam’s overall effectiveness. Some of the preliminary results of the survey analysis indicate that most respondents averaged between $1000-$1500 on the exam. In addition, most of the respondents reported that they interviewed twelve “somewhat convincing” patients. They reported that they expressed little faith in the ability of the exam to evaluate their clinical skills and most respondents had similar testing at their own schools. We are still in the process of compiling the survey results and generating a report. However, we have initiated discussions with the NBME about the exam and ways to increase its value to students. These discussion include a focus on increased feedback on the exam, increased value added to the exam (through simulated clinical findings), increased effectiveness and efficiency of registering and taking the exam, and finally increased funding to help subsidize the cost of the exam for students. We are still maintaining our CSAE survey, in order, to track changes in sentiment and experiences with the exam since its implementation. The Committee on Medical Education has been effective in increasing publicity about the survey to students who have taken the exam.

 The AMA's Initiative to Transform Medical Education (ITME) is designed to reform the medical education and training system to ensure that physicians are prepared for practice in the evolving health care system. Spanning all levels of medical education, including pre-medical preparation and medical school admission, medical school education, and continuing physician professional development, the ITME consists of 3 phases. Phase 1 identified gaps in the current preparation of physicians. Stage 2 developed recommendations and strategies for changes in physician education and training. Finally, phase 3 hopes to implement changes and evaluate results (2007 – 2010). Currently, two additional medical student representatives, Peter Ragusa and Chris DeRienzo, have been added to serve as the medical student voice to the group.

In order to help facilitate the process by which ITME and CEUP will aid educators, the AMA-MSS will develop a comprehensive report describing innovations in medical education at each of the 151 allopathic and osteopathic medical schools in the United States. The MSS believes that this information goes a considerable distance in filling gaps in currently available information. At its core, this report will provide an element that has been missing from conversations surrounding the future direction of medical education and physician licensure. In doing so, it will enhance the ability of each to carry out its goal of developing patient-centered physicians who are competent and prepared to practice medicine in the 21st century.  This landmark report will serve as a resource for medical educators, licensing professionals and interested students as a sort of pulse on the future of medical education. In order to bring this report to fruition, the MSS has organized a core group of leaders, Peter Ragusa, Rana Yehia, Jamie Kearns, and Reid Orth, to spearhead the Innovations in Medical Education Task Force, which is composed of 15 MSS student leaders who will serve as the backbone of the project.

Membership

This year we have had a robust effort from our membership department to reach out to every chapter of the MSS. We have established recruiters at all by eight medical schools across the country. Through our Medical Student Section Outreach Program (MSSOP), we have reached out to chapter recruiters and supplied them with resources, including guides, “Booth-In-A-Box,” template letters and fliers, and other more. Through our “Succeeding in Medical School” (SIMS) events, we have targeted 92 schools, in which a leader from the AMA-MSS attends an event to educate students about the AMA and lead a third and fourth year panel discussion. The event is completely funded for the AMA, including lunch for the session. We have completed a total of 74 events with an average of 87 students per event. In addition, we have 576 students sign up on the spot, surpassing last year’s program total of 261. In addition, we are working with membership staff and the RFS to target third and fourth year students through specific resources and programs. We would also like to incorporate membership programming into the region meetings during the spring. Furthermore, our Membership Retention and Recruitment Committee (MRR) will be reexamining their role to better serve the MSS. The MRR will be looking into studying how chapters recruit, what makes them successful, and what struggles they may encounter, with the purpose of bettering this process for the future.
   
In addition, we have been working with the Section on Medical School (SMS) on piloting the Chapter Mentor Program (CMP) in the Chicago area. The program looks at linking every chapter within the AMA-MSS with an AMA faculty advisor from the local State Medical Society. The program is designed to link student up to key resources in the AMA and provide needed mentorship and guidance for chapter leaders and students. In addition, the program will help students value their future membership in the AMA and the role of a physician within organized medicine.

Communications

One of the GC goals for the year focused on improving communications across the continuum of the MSS. As a result of this goal, the MSS Communications Task Force (CTF) was established in August 2007 to disseminate information about the AMA-MSS to chapters, states and regions. The CTF is principally concerned with keeping individual chapters up-to-date with the latest information regarding national meetings, standing committees, grassroots efforts, regional updates, political advocacy and legislation and more. CTF strives to empower students with actionable information so they can serve as patient advocates and distinguished medical leader in the chosen specialty at the local, state, regional, national levels. The CTF has undertaken the grand responsibility of putting together monthly State of the MSS Presentations that can be given in a discussion/lecture format at each chapter on a monthly basis. In addition, the CTF along with the Governing Council, is currently working revamping and updating the current MSS website and developing a more user-friendly model. We are developing a mechanism to ensure efficient and effective communications via our listserv and the online weekly eVoice. We are also working to increase attention about the GC Action Item, which allows members to easily contribute to the AMA-MSS agenda, and our Chapter Involvement Grants. These grants will provide each chapter with $1000 to help coordinate an advocacy program, an educational session, or a community service event. We are working on compiling these projects into a database for members so that they can see what other unique projects are being developed across the country.

Lastly, we are working on streamlining communications across the continuum of our section and among our leaders. This effort includes the development of a GC Goals Grid, a Committee Goals Grid, and a GC Policy Grid which are regularly updated and available for members to track our progress and hold us accountable for our actions and promises to the MSS. In addition, we have developed a system to regularly communicate with region leadership, through regular conference calls and discussions, and councilors and liaisons within our section.