Academic medicine : journal of the Association of American Medical Colleges
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To evaluate the frequency and nature of ethical disagreements over patient care between housestaff and attending physicians. ⋯ The residents' disagreements with attending physicians over ethical aspects of patient care were common and usually concerned issues of overtreatment. Since most of the housestaff did not express their concerns, the attending physicians were largely unaware of them. The findings suggest that residency directors need to encourage housestaff to discuss their ethical conflicts with attending physicians.
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Historical Article
Reengineering academic medical centers: reengineering academic values?
Academic medicine is entering an era of profound, unsettling change resulting not simply from the drastic transformation of the health care marketplace but more fundamentally from the chronic, growing gap between academic medicine's seemingly insatiable demand for total resources and the supply of resources that society is willing to provide. To examine this problem, the author reviews the major factors that have shaped the development of academic medical centers (AMCs) since World War II and are now the roots of their vulnerability. The first was the major federal investment in university-based programs of science research and education that began in the 1940s; the second was the enactment in the 1960s of the Medicare/Medicaid legislation that established federal responsibility for the support of graduate medical education. ⋯ Of particular concern are the fate of the clinical investigator and the future of clinical research. The author concludes with a list of four feasible strategic options for AMCs (e.g., "build one's own system") and an extensive list of what he believes AMCs will do to respond to the stresses now upon them (e.g., capitalize on unique strengths rather than trying to compete in all areas). He concludes that it will take courage for AMCs to preserve their core values in the new era, but that this can be done if AMCs craft new adaptive structures that are better attuned to the new environment and not wedded to one that is vanishing.
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The United States is the world leader in biomedical science (BMS) education and research. This preeminence is reflected in superior medical education, the attraction of U. S. educational institutions to foreign visitors seeking advanced training, and a high rate of transfer of knowledge between basic biomedical research and the delivery of health care at the bedside. ⋯ Full examination of the issues involved, including a case study of doctoral graduates and postdoctoral fellows at Tulane Medical Center, leads the authors to conclude that a biomedical PhD "glut" does not exist at the present time, that downsizing training programs would have a serious, long-term negative impact on biomedical research, and that medical school administrators and faculty should resist attempts to reduce biomedical research and training at the local and national level. However, times have changed and training programs must evolve to adapt to the technologic changes occurring in the workplace. Alternatives, such as new alliances with industry, must be sought to compensate for decreased resources at federal and institutional levels; new and innovative curricula must be developed to prepare biomedical scientists for nonacademic, as well as academic, job opportunities in the twenty-first century; and medical center administrators and faculties must work together to increase the visibility of BMS and stress its critical relationship to the research base of the nation.