The vision of an M.D. school in Fort Worth took another big step Thursday when the University of North Texas regents voted unanimously to proceed with plans to establish a program at the UNT Health Science Center. Already, $25 million has been raised for start-up costs, said Dr. Scott Ransom, president of the health science center. "This is a win, win, win," he said, adding that about 90 donors have contributed to the program and many more commitments have been made. "This is a huge deal for Fort Worth, Texas." At the meeting, two osteopathic physicians expressed concern that an M.D. school would detract from the highly regarded Texas College of Osteopathic Medicine and asked the regents to reject the plan. The plan calls for students to begin classes in 2013. But the Legislature must first approve the program during the 2011 session.
Beginning in 2014, Medicaid greatly expands under the new healthcare law to include adults without children, who generally have been excluded. The Medicaid expansion also will enable agencies that serve the homeless to divert resources now spent on medical care to other services such as finding housing and jobs. The new law provides another boost through a five-year, $11 billion expansion of the community health center system that treats many in this population. These benefits and President Obama's recently announced plan to prevent and end homelessness mark a watershed moment in federal efforts on this issue, advocates say. Among its goals, the plan calls for greater coordination among housing, medical care and behavioral health programs to help end chronic homelessness in five years and homelessness for families and children over the next decade.
The incoming CEO of the Bay State's largest health insurer acknowledged yesterday that he is staring down the barrel of another year in the red, declaring "we will lose money" this year.
"We've had a challenging last few years," said Blue Cross Blue Shield of Masssachusetts Executive Vice President Andrew Dreyfus, slated to become the insurer's head honcho Sept. 7.
City commissioners voted unanimously to allow hiring decisions to be based on religious beliefs at Helen Ellis Hospital to clear the way for a merger that could save the financially strapped facility. Commissioners voted 5-0 on a request by Adventist Health System Sunbelt, which is associated with the Seventh-day Adventist Church, to waive a clause in their lease agreement with the hospital that prohibited discrimination based on religion. "I'm looking at this as an opportunity, a great opportunity for our hospital to survive," Commissioner Susan Slattery said. The vote will enable Adventist Health System to finalize its merger with University Community Hospital Inc., which operates the hospital.
Nurses in Duluth voted overwhelmingly to reject a new labor contract, setting the stage for a 24-hour strike. More than 90 percent of nurses who voted from St. Mary's Medical Center and SMDC Medical Center, and more than 86 percent of those from St. Luke's Hospital voted to reject the contract offer primarily because it did not include language that would allow them to close a unit to new admissions if they felt overwhelmed. "The hospitals left us with no choice," said Steve Strand, a registered nurse at SMDC Medical Center. "We can't handle another three years of one nurse taking care of eight, nine or even 12 patients at once. Neither can our patients. How many more patients have to sit in their own stool because nobody can answer their call light?" The Minnesota Nurses Association had recommended that the 1,320 nurses who work for the three hospitals in Duluth reject the contract.
Between the Accreditation Council for Graduate Medical Education's (ACGME) call for more stringent supervision standards and charges of improper amounts of resident supervision, Texas's Parkland Hospital's—resident supervision is a hot button issue for hospitals.
Supervision is a fundamental principle of medical education, but it hasn't been a focus of accreditation, educational, professional, or governmental organizations' standards until recently. The lack of attention means that residents may not be receiving appropriate supervision during training.
“Supervision really requires attending physicians to be proactive in providing supervision, and residents understanding and appreciating that role and seeking supervision,” Jeanne M. Farnan, MD, MHPE, assistant professor of medicine at the University of Chicago explains.
Faculty usually are not trained on how to provide proper supervision, making it even more important to encourage residents to actively seek help when they need it, says Vineet M. Arora, MD, MA, assistant professor of medicine, internal medicine associate program director, and assistant dean for curricular innovation at the Pritzker School of Medicine and the University of Chicago.
The following are reasons why residents feel uncomfortable contacting their attending physicians:
Concern over revealing a knowledge gap. Residents fail to call because they're afraid the attending physician will think that they're not as smart as their peers, and they are hesitant to admit that they do not know something. Both attending physicians and residents must view uncertainty as an impetus for the resident to reach out to the supervisor, Farnan says.
A desire to make decisions on their own. “Often, calling an attending and asking a question will interfere with the resident's own decision-making style and their own processing of the case,” Farnan explains. Residents want to talk to the attending physician about the case without having their clinical decision-making influenced by the attending physician.
Perception that the attending physician does not want to be called. Attending physicians often communicate a call-me-but-don't-call-me message to residents, which prevents residents from reaching out. “An attending will say, 'Here's my pager and my cell phone. Call me anytime, but I'm going to be at a dinner,' ” Farnan says. “Clearly that sends a message of 'Don't call me.'" Not answering calls or pages or chastising residents for calling also lessens the likelihood residents will reach out when they need help.
Attending physicians must take steps to facilitate supervision, but they need training and support from program leadership.
“People assume that you graduate from residency and you know how to be a good supervisor. Sometimes that's the case, and sometimes it's not,” Arora says.
The following tips will help faculty members become better at providing supervision and also eliminate many of the barriers residents face when asking for help:
Set clear expectations up front. Specifically outline in what circumstances you want the resident to notify you about a patient's condition. For example, Farnan tells residents that she wants them to call her anytime an end-of-life decision arises, or when a patient suffers an adverse event, dies, or goes to the ICU. Residents write these instructions on the sign-out sheets, and Farnan receives calls from the cross-cover residents caring for her patients, too.
Also, establish a time every night at which the resident will call you, such as 10 p.m. Recognize that residents get busy and may forget to call. If that is the case, attending physicians should take responsibility and page the residents, Arora says.
Be available. Attending physicians should answer all calls while on service. Some attending physicians may think that not responding or not providing residents guidance when asked promotes trainees' autonomy, but that's not the case. Instead, absentee attendings often cause residents to feel abandoned, Arora says.
Address uncertainty. Faculty members should assure residents, especially junior trainees, that uncertainty is part of education and they should not feel bad about asking for help.
Faculty members should also be aware of when residents feel the most uncertain, such as during rapidly escalating situations when many decisions must be made in a compressed time frame, and let residents know that it's okay to call during those high-stress encounters, says Farnan.
Tailor supervision. A one-size-fits-all approach does not apply to supervision, Arora says. Faculty members need to do some reconnaissance work up front and tailor their approach in order to provide appropriate supervision. Attending physicians should consider the learner's background and determine what his or her needs are.
Make discussions worthwhile. Conversations should be a back-and-forth dialogue between the resident and attending physician. Because few attending physicians have formal training in being a supervisor, they may tend to overmanage and not cultivate the resident's clinical decision-making skills.
Focus on patient safety. Because residents can sometimes resent supervision, program leaders and attending physicians should focus on patient safety when supervising trainees. “We tell residents that part of learning about patient safety is working on a team, and part of working on a team is communicating with your attending and others on team,” Arora says.
Julie McCoy is associate editor for the residency market. For more residency-related news, click here.