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Wednesday, September 18, 2013

For Residents

Explore medical ethics via online journal competition

Applications are due Oct. 15 for residents and medical students who are interested in exploring medical ethics in-depth by getting involved in Virtual Mentor, the AMA's online ethics journal.

The journal is seeking applications for theme issue editors for 2014. Open-access and advertisement-free, Virtual Mentor explores the ethical issues and challenges that students, residents and other physicians are likely to confront in their training and daily practice.

Each issue of Virtual Mentor has a theme, such as a medical specialty field or a topic of concern or debate in medical ethics. Medical students and residents are encouraged to apply to serve as theme issue editors. With help from Virtual Mentor staff editors, each theme issue editor undertakes the following tasks, to be accomplished at each editor's "home" location:

  • Selecting a theme for the issue and defining the ethical and professionalism concerns inherent in that theme.
  • Generating case narratives that provide opportunities for examining those concerns in clinical and educational contexts.
  • Identifying, securing and corresponding with 10–15 contributors to the issue.
  • Reviewing unsolicited manuscripts that are submitted.
  • Editing copy of solicited manuscripts and reviewing page proofs before the issue goes live on the first working day of the month.

Theme issue editors, selected in November, meet in Chicago with Virtual Mentor staff in January. Each theme issue editor receives a $1,500 stipend.

The abilities to critique an argument or article, work well with authors, and meet deadlines are essential. Experience in editing or journalism is desirable. Visit the Virtual Mentor website to learn more about applying.

Debate over duty hour restrictions continues

The debate over the efficacy of the Accreditation Council for Graduate Medical Education (ACGME) resident duty hour restrictions has again received national media attention, this time in a New Yorker article by cardiologist Lisa Rosenbaum, MD.

Dr. Rosenbaum laments the toll duty hour restrictions have taken on continuity of care and wonders whether the new system might actually yield more errors than in the pre-reform era of 30-hour shifts for resident physicians.

She also expresses concern over the lack of patient ownership some residents exhibit under the new system. "The stories of our patients, which we used to own, now come in fits and spurts, passed along via an unending game of telephone," she writes. "‘Anyone know why the heart failure patient's diuretic was held?' the team leader might ask. ‘Anyone?' With the resident who made the decision often gone, a mad shuffling of pages invariably ensues, as trainees flip through their lists until someone finds the patient and utters the six saddest words of the shift-limit era: ‘I don't know. I'm just covering.'"

In the end, Dr. Rosenbaum says that duty hours are easy to restrict because they're easy to measure. However, that may leave behind important things that are harder to quantify, like quality of care and resident education.

Meanwhile, Dr. Rosenbaum's fears don't appear to be borne out by a new study published in the Journal of General Internal Medicine. Researchers confirmed that there were no systematic effects on mortality in the first three years post-reform, but their data do suggest a relative improvement in mortality at high-teaching-intensity hospitals by the fifth year post-reform among both medical and surgical patients.

"Concerns about worsening outcomes seem unfounded," the researchers concluded.

At the 2013 Annual Meeting, AMA delegates voted to adopt policy recommending that the ACGME use evidence-based approaches to any future revision or introduction of resident duty hour rules. Learn more about the debate over resident duty hours on the AMA's Resident and Fellow Section Advocacy and Policy Web page.