Archive for June, 2010

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Foreign Medical Schools

Wednesday, June 30th, 2010

The Government Accountability Office released a report this week on the role of federal student loans in supporting foreign medical schools. Like the recent Congressional hearings on for-profit undergraduate education, foreign medical schools claim billions of dollars in federal aid from students with little evidence about return on the investment.

One of the GAO’s findings, as reported in Inside Higher Ed is that 97% of U.S. medical school graduates pass the Step 1 licensure exam on the first try, but only 64% of foreign medical school graduates do. If foreign medical schools, some of the largest of which are for-profit, receive taxpayer money, then they should produce competent doctors.

At the same time, foreign medical schools help meet the need for physicians in this country. And no doubt many of their graduates are outstanding doctors. The larger issue may be the high cost of medical education at home and abroad, which requires students to go deeply in debt to pursue their dreams.

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Residents’ Hours

Tuesday, June 29th, 2010

My doctor friends always joke not to get sick around the first of July. That's when the new class of interns, those recent medical school graduates, arrive at the hospital. They're not only less experienced, but they're also subject to harsh work routines. As fatigue increases, so does the likelihood of medical error.

Under proposed new guidelines, interns would be limited to 16-hour shifts (down from 30 hours at a stretch) and receive more supervision. The accreditation agency would also increase monitoring and penalties for programs that fail to adhere to the new rules.

Seems sensible enough, but there are arguments on both sides. Some say 16-hour stretches are still to long to ensure sound judgment. Others fear that shortening work shifts will lead to more disruptions in patient care.

My sense is that one goal of residency is to initiate M.D.s into being a doctor, so to make the rite of passage more effective, there must be a period of disorientation and suspension of normal rules. To prove themselves ready, many residents will want to work longer hours. The key change seems to be not in the number of hours worked, but in the amount of supervision offered. That will help guarantee satisfactory patient outcomes.

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Zotero

Monday, June 28th, 2010

Since grad school, I've been a fan of the bibliographic software EndNote. In the late 1990s, I had pretty much abandoned the card catalog for finding references, but I had yet to discover the rich, full-text databases that would later emerge. So I didn't mind cutting and pasting authors' names and other publication information into the EndNote fields.

Nowadays, most researchers conduct literature reviews exclusively on-line. If an article's full-text does not appear on the web, I find myself questioning whether I really need that citation. Over the years, EndNote has added more web functionality with the ability to import fields and link to PDFs and URLs. Still, it remains a separate, proprietary system that sits on my hard drive.

I'm trying a new program called Zotero. It is a way of organizing citations directly within your browser. Because it's integrated into the very frame in which you search for sources, it captures text easily and seamlessly. Citations can be tagged like blog posts and organized into collections. With some more setting up, you can access the bibliographies from a remote computer. And it's free! I know there are a lot of competing software out there, but Zotero seems to have been designed by researchers for other researchers.

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Dr. Diversity

Friday, June 25th, 2010

The security slogan for the post-9/11 age has been, "See something, say something." When it comes to insensitive remarks in the workplace, the motto could be, "Hear something, say something."

Karen Hoelscher, an education researcher who studies student identities, remembers being labeled "Dr. Diversity" by her older, male colleagues at the start of her career. Then, she was too bashful and too concerned about tenure to speak up when they made insensitive comments.

Even if a racial joke or discriminatory remark is humorous, it should not go unchallenged. The daily interactions are what make a workplace tolerant and supportive of everyone.

Too often, we laugh at the joke and then later wish we had said something. To avoid that regret, it helps to have a few stock replies at the ready. Hoelscher suggests:

  • “I’ve always thought of you as a fair-minded person, so I’m surprised to hear you say that.”
  • “Please don’t use that language when I’m around.”
  • “I’m sorry – what’s so funny?”

Even if the remark does not offend you, others will be glad that you had the courage to undermine the insensitive comment.

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The Searchers

Thursday, June 24th, 2010

When I chaired my first faculty search committee, many of the university policies seemed cumbersome to me. The language of the job ad had to be approved, the composition of the applicant pool screened, and each decision accounted for.

In retrospect, I see that the scrutiny served a useful purpose. As psychologists have shown unconscious biases can cloud our judgment of candidates. Also, it's easy to advertise a job among friends and then shrug when few minorities apply. It requires networking beyond your usual circle and publicizing beyond the usual places to reach a more diverse audience.

The AAMC leadership blog offers some advice for search committee composition. I would add a rule that applies in arts and sciences departments: shy away from hiring your own trainees. Such insular practices denies the department the infusion of new ideas. At the same time, it makes it harder for junior colleagues to feel truly independent as scholars.

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Are Women Better PIs?

Wednesday, June 23rd, 2010

Riffing on a New York Times article about women in business, The Scientist.com asks if female PIs run better labs. They marshal some evidence that women are more attuned to emotions and more prone to work collaboratively, but the verdict is mixed.

Talking about all women or all men is not particularly useful since lab workers usually have just one supervisor, and there's no guarantee that person behaves like the majority of her or his gender.

There's also the danger of positive stereotyping. Even if women get tagged with a complimentary reputation as good leaders, it is still condescending to treat female supervisors as predictably sensitive team players. The real victory for gender equality will be when a female researcher is treated as simply a PI, not a woman PI.

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Helping Hospitals

Tuesday, June 22nd, 2010

Harvard Medical School will receive $36 million in support from its partner hospitals. According to a Boston Globe article, the medical school relies primarily on research and endowment funds to support its operations. With a decline in investments and increased debt obligation, it is facing a shortfall.

In the scope of the school's $580 million budget, the contributions will not drastically change the financial situation, but it does represent a shift in the historically loose relationship between the medical school and its teaching hospitals.

It's also significant that one of the concessions the hospitals asked from the medical school was a quicker appointments and promotion process for the physician faculty. Again, faculty development plays a crucial role in the health of an academic medical center.

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Beating Burnout

Monday, June 21st, 2010

You've heard of absenteeism as a problem in the workforce, but what about "presenteeism?" For her dissertation in health management, Janie Crosmer surveyed faculty in universities across the country about their job performance. She found that many show up for work, but do not really feel engaged. They are present, but they are burned out.

This is more serious than playing Solitaire on the office computer. These faculty teach classes, advise students, and participate in governance without much thought. Research and education require constant self-evaluation and improvement, so these faculty members are not maximizing their potential.

Dr. Crosmer's study suggests making university work more collaborative with professors filling in for each other when one is feeling swamped. The incentives for academic achievement do no seem to favor this arrangement. One cheap way to combat burnout is to make the workplace more enjoyable. Leadership can make humor and camaraderie more acceptable in a department without sacrificing intellectual quality.

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Mentoring Millennials

Friday, June 18th, 2010

I'm a member of Gen X. There are some 50 million members of my age cohort, born between 1965 and 1976. If the demographers are correct, I distrust institutions, strive for work-life balance, and expect to change jobs frequently. Millennials, the generation born after me, work well in groups, embrace technology, and thrive on structure.

In the mentoring literature, several authors recommend tailoring mentorship to different generational styles. For Gen X, that means a more casual, hands-off approach. Millennials, on the other hand, thrive on structured meetings.

I endorse flexibility in mentoring programs, but I can't help but liken these recommendations to astrology. Does everyone born in the same twenty-year span share similar characteristics? What was the dramatic shift that happened on January 1, 1977? Or was it 1980? Just the fact that experts can't agree on the boundaries of each generation attests to how squishy a theory this is.

The best mentoring programs are based on research into learning styles. They should be interactive and relevant. That way participants of all ages can benefit.

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Ethics and the NIH

Thursday, June 17th, 2010

In 2008, Emory University ruled that Charles Nemeroff, a professor of psychiatry, was ineligible to apply for NIH grants for two years. Dr. Nemeroff had failed to disclose over $1 million in payments from pharmaceutical companies whose products he promoted in academic journals.

Now, a Chronicle of Higher Education investigation has revealed that Dr. Nemeroff ducked punishment by applying for a jot at the University of Miami Medical Center. One of his recommenders was none other than the National Institute of Mental Health director who wrote the ethics rule that Nemeroff violated. While Nemeroff was accepting drug company donations, he was also cultivating friends at the NIH, who returned his favors.

Revealing conflicts of interest is not just some nicety that applies to researchers with little clout. It is integral to the research process itself. Unsurprisingly, Nemeroff promoted drugs in which he had a financial stake, consistently downplaying their serious side effects. Penalties should follow a researcher from institution to institution, pointing to the need for better oversight at the NIH.

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