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H S Jonas

Publications and source records attributed to H S Jonas.

At least 19 recordsLinked to original sources
PubMed2000

Educational programs in US medical schools, 1999-2000.

We used data from the 1999-2000 Liaison Committee on Medical Education Annual Medical School Questionnaire, which had a 100% response rate, and other sources to describe the status of medical education programs in the United States. In 1999-2000, the number of full-time faculty members was 102,446, a 4.3% increase from 1998-1999. The number of basic science faculty increased by less than 0.5%, while the number of clinical faculty increased by about 5%. There were 38,529 medical school applicants in 1999, a 6% decrease from 1998. Women constituted 45.8% and underrepresented minorities made up 12.1% of the 1999-2000 first-year class. New content, such as alternative medicine and cultural competence, and new methods of instruction, such as computer-based learning, are being incorporated by many schools. Seventy schools (56% of the total) require students to pass both Step 1 and Step 2 of the US Medical Licensing Examination for advancement or graduation, an increase from 62 schools (50%) in 1998-1999. The use of standardized methods of assessment, such as objective structured clinical examinations, to evaluate students' clinical performance was highly variable among schools. JAMA. 2000;284:1114-1120

Curriculum↗
PubMed1999

Educational programs in US medical schools, 1998-1999.

To describe the current status of medical education programs in the United States and to trace trends in medical education over this century, we used data from the 1998-1999 Liaison Committee on Medical Education Annual Medical School Questionnaire, which had a 100% response rate, and data from other sources. In 1998-1999, total full-time faculty members numbered 98202, a 1.5% increase from 1997-1998. The number of applicants to medical school declined for the second consecutive year, from 43020 in 1997 to 41004 in 1998, but the academic qualifications of entering students remained steady. The number of applicants from underrepresented minority groups decreased 1.3% from 1997 to 1998, compared with an 11.1% decrease between 1996 and 1997. Women constituted 43.4% of applicants in 1998, slightly more than the 42.5% in 1997. The total number of required hours in the first and second years of the curriculum and the number of scheduled hours per week have declined over the past 15 years, while the average lengths of clinical clerkships remained about the same. The number of schools requiring students to pass Steps 1 and 2 of the United States Medical Licensing Examination continued to increase in 1998-1999, with 50% of schools requiring passing both examinations, compared with 46% in 1997-1998.

Clinical Clerkship↗
PubMed1998

Educational programs in US medical schools, 1997-1998.

To describe the current status of medical education programs in the United States, we used data from the 1997-1998 Liaison Committee on Medical Education Annual Medical School Questionnaire, which had a 100% response rate, and from other sources. There were 96733 full-time medical school faculty members, a 1.2% increase from 1996-1997. The 43020 applicants for the class entering in 1997 represents an 8.4% decrease from 1996. The number of 1997 applicants who were members of underrepresented minority groups decreased 11.1 % from 1996, and the number of entering underrepresented minority group students decreased 8.4%. More than half of medical schools reported that the number of inpatients available for medical student education had decreased in at least some of their clinical sites or in some disciplines during the past 2 years. Thirty-nine medical schools (31.2%) reported having more difficulty recruiting or retaining volunteer clinical faculty to participate in medical student teaching in 1997 than in 1995.

Curriculum↗
PubMed1998

Late-term abortion.

Recent proposed federal legislation banning certain abortion procedures, particularly intact dilatation and extraction, would modify the US Criminal Code such that physicians performing these procedures would be liable for monetary and statutory damages. Clarification of medical procedures is important because some of the procedures used to induce abortion prior to viability are identical or similar to postviability procedures. This article reviews the scientific and medical information on late-term abortion and late-term abortion techniques and includes data on the prevalence of late-term abortion, abortion-related mortality and morbidity rates, and legal issues regarding fetal viability and the balance of maternal and fetal interests. According to enacted American Medical Association (AMA) policy, the use of appropriate medical terminology is critical in defining late-term abortion procedures, particularly intact dilatation and extraction, which is a variant of but distinct from dilatation and evacuation. The AMA recommends that the intact dilatation and extraction procedure not be used unless alternative procedures pose materially greater risk to the woman and that abortions not be performed in the third trimester except in cases of serious fetal anomalies incompatible with life. Major medical societies are urged to collaborate on clinical guidelines on late-term abortion techniques and circumstances that conform to standards of good medical practice. More research on the advantages and disadvantages of specific abortion procedures would help physicians make informed choices about specific abortion procedures. Expanded ongoing data surveillance systems estimating the prevalence of abortion are also needed.

Abortion, Legal↗
PubMed1998

Obstetrics and gynecology residencies: education in preventive and primary health care for women.

OBJECTIVE: To test the hypothesis that the Residency Review Committee program requirements for obstetrics and gynecology residencies, when properly followed, will result in residents being educated in preventive and primary ambulatory health care for women during their residency training program as specialists in obstetrics and gynecology. METHODS: The 60 requisite residency training competencies identified as essential to educate generalist physicians, and viewed by some educators as a benchmarking standard, each were evaluated to determine whether residents in obstetrics and gynecology are now being educated in each of these areas. The answer was considered affirmative if any of the following pertained: 1) the Residency Review Committee program requirements indicate that the competency "must" or "should" be taught, 2) the Residency Review Committee requests numerical verification related to the competency on the accreditation review application, or 3) by virtue of a specific rotation required by the Residency Review Committee it can be assumed that the resident will be educated in the competency. To make our assessment, we identified and listed the section of the Residency Review Committee for Obstetrics-Gynecology program requirements, which, when properly followed, would result in education in the particular competency. RESULTS: Fifty-seven of the 60 competencies were considered applicable to obstetrician-gynecologists (care of infants, care of children, and infant/child preventive care were not), and residents in obstetrics and gynecology were found to be educated in 54 (95%). CONCLUSION: During their residency training programs as specialists in obstetrics and gynecology, residents are being educated to be able to be providers of preventive and ambulatory primary health care for women.

Female↗
PubMed1997

Educational programs in US medical schools, 1996-1997.

We use data from the 1996-1997 Liaison Committee on Medical Education Annual Medical School Questionnaire, which had a 100% response rate, to describe medical education programs in the United States. In the 1996-1997 academic year, there were 95 568 full-time medical school faculty members, a 4.5% increase from 1995-1996. In clinical departments, the largest increases were in emergency medicine (a 29% increase from 1995-1996) and family medicine (a 13% increase). Of all full-time faculty members in clinical departments, 76.9% have an MD or DO as the highest degree, 4.5% have both an MD and PhD, 13.9% have a PhD, and 4.7% have an academic or professional bachelor's or master's degree as their final degree. The total number of applicants for the class entering in 1996 was 46968 (0.8% increase from 1995), while the number of first-time applicants decreased 1% from 1995. First-year medical students who were members of underrepresented minority groups numbered 2236, a 4% decrease from 1995. In 1996-1997, the total number of medical students was 66712 (0.3% less than in 1995-1996). For students graduating during the 1995-1996 academic year, 13% took longer than 4 years to complete the program. There were 47 medical schools that reported that 1 or more hospitals used for required clinical clerkships had changed ownership, merged, or closed during 1996. Medical schools used an average of 6 (range, 1-36) hospitals for core clinical clerkship. Ninety-five schools required a passing grade on Step 1 of the US Medical Licensing Examination (USMLE) for promotion or graduation; 54 schools required a passing grade on Step 2 of the USMLE.

Accreditation↗
PubMed1996

Education programs in US medical schools, 1995-1996.

We present herein data on US medical education programs and describe how medical schools are adapting to a changing health care environment. The data mainly derive from the 1995-1996 Liaison Committee on Medical Education Medical School Questionnaire, which had a 100% response rate. The data indicate that in the 1995-1996 academic year there were 91 451 full-time faculty members in basic science and clinical departments, a 1.6% increase from 1994-1995. In clinical departments, major increases occurred in emergency medicine (a 10.6% increase in full-time faculty) and family medicine (a 13.5% increase). Applicants for the class entering in 1995 numbered 46 591, an increase of 2.7% from 1994; however, the number of first-time applicants decreased slightly (0.6%). Of the 17 357 applicants accepted, 2179 (12.6%) were members of underrepresented minority groups. Health system changes are affecting medical school clinical affiliations. During the past 2 years, 42 schools saw a merger, acquisition, or closure involving medical school-owned or medical school-affiliated hospitals used for core clinical clerkships. At 15 sites, this change affected the distribution of students across clinical sites. In 1995-1996, 40 medical schools or their universities owned a health maintenance organization or other managed care organization, 93 schools contracted with a managed care organization to provide primary care services, and 96 schools contracted with managed care to provide specialty services. During the past year, 57 schools acquired primary care physician practices, and 70 started primary care clinics in the community.

Accreditation↗
PubMed1996

The initial employment status of physicians completing training in 1994.

OBJECTIVE: To gain information about the career status of residents who completed graduate medical education training programs in selected specialties and subspecialties during the 1993-1994 academic year. DESIGN: A descriptive one-page survey of residency program directors, including two mailed follow-up surveys, was conducted from January 1, 1995 to June 1, 1995. SETTING: Directors of residency programs in 26 specialties and subspecialties accredited by the Accreditation Council for Graduate Medical Education, totaling 4369 programs. MAIN OUTCOME MEASURES: Program directors identified the number of resident physicians who completed the program, the known career status of those physicians, the number of physicians who had experienced difficulty finding a practice position, the characteristics of the full-time clinical practice positions, and the number of physicians who could not find full-time employment. The perceptions about likely trends in the availability of practice opportunities for graduates in the future and the likely change in the number of resident positions were also assessed. RESULTS: A total of 3090 program directors (70.7%) completed the survey. Respondents reported that 15999 resident physicians completed training in one of the 26 specialties and subspecialties, and 63.2% of these graduates were potentially seeking a professional position. Most of those not seeking a position were pursuing additional training (92.9%). Of those seeking employment, the percentage who did not find a full-time position in their specialty or subspecialty ranged between none in urology to 10.8% in pathology. Across all specialties, about 70% of graduates looking for full-time positions entered clinical practice in their specialty of training. Physicians pursuing generalist careers had fewer problems finding preferred positions than those pursuing nongeneralist specialties. Finally, program directors in most nongeneralist specialties believed that the degree of difficulty their graduates will experience in finding a full-time practice position will increase during the next year. CONCLUSIONS: Physicians attempting to enter practice in some specialties and in some regions of the country are experiencing difficulty. In some cases up to 10% of the resident physicians did not find full-time positions in their specialty or subspecialty. The differences noted between the generalist and nongeneralist specialties are consistent with widespread perceptions about the current market. These data establish the baseline for analyzing trends.

Data Collection↗
PubMed1995

Educational programs in US medical schools, 1994-1995.

This is a time of considerable uncertainty about the future of medical education. There are threats to medical school finances from state and federal levels. While medical schools derive only an average of about 11% of total revenues from state and local sources, these funds potentially give states the basis for imposing specific mandates on medical schools, in areas such as enrollment levels, curriculum content, and a desired specialty mix of graduates. Medical schools appear to be changing at varying rates in response to the health care system, including the growth of managed care. While the total number of full-time faculty members continues to increase, there are regional differences. It is unclear how the faculty size and composition ultimately will be affected or what implications this will have for educational programs. A number of medical schools are expanding into the community to ensure a patient base, and educational opportunities for medical students appear to be increasing in the community, including some limited use of managed care organizations. as educational settings. Medical school practice sites in the community have the potential to exacerbate "town-gown" tensions in the increasingly competitive health care environment. This, in turn, could jeopardize community-based medical education by the large number of practicing physicians who serve as volunteer faculty members and who are a valuable resource. Care will need to be taken to minimize these tensions as much as possible. As the health care system becomes even more competitive, concerns are being raised about whether volunteer faculty will continue to serve without compensation. The ability to begin to compensate community physicians who serve as teachers could be affected by decreasing medical school revenues from patient care, which, in the past, have been used to support activities such as community-based education. This is a time for strong and visionary academic leadership: medical schools must not only adapt to a changing health care system, but also maintain excellence in education, research, and patient care. This annual article will continue to describe the efforts of educational programs to do so.

Accreditation↗
PubMed1994

Educational programs in US medical schools, 1993-1994.

From the data on faculty, students, and curriculum, is it possible to identify any responses to actual or anticipated health system changes? While one could foresee medical school downsizing in response to a potentially more competitive environment in which income from faculty practice would be reduced, what has occurred, on average, is steady growth in the number of faculty members across departments, with a large increase in the past year. However, expansion is not consistent across states. Between 1992-1993 and 1993-1994, the number of full-time faculty members decreased 1.5% in California medical schools, increased 3% in Minnesota medical schools, increased 6% in North Carolina medical schools, and increased 10% in New York and Pennsylvania medical schools. These differences may reflect the fiscal situation at the state level as well as differences in the practice environment in different areas. For example, managed care has not had a major effect in many markets. It will be important to monitor trends in faculty at both the national and regional levels to understand the full impact of health system changes. There is considerable diversity among US medical schools: in goals, in student profiles, and in curriculum structure. A number of schools have goals or objectives that contain a reference to the training of primary care physicians. The majority of these are public institutions, but a number of private schools have chosen to address the issue as well. Many schools, both public and private, are under external scrutiny related to the performance and specialty and practice location choices of their graduates.(ABSTRACT TRUNCATED AT 250 WORDS)

Accreditation↗
PubMed1993

Educational programs in US medical schools.

As described in the introduction, the data presented in this report can be viewed in both a historical and an environmental context. From a historical perspective, there has been change in many areas of medical education. The number of applicants to medical schools has risen sharply in the past few years, a result seemingly inconsistent with the dissatisfaction with medicine expressed by many physicians and with the uncertainties about the eventual outcomes of health system reform. The number of minority applicants and enrollees is slowly rising, but at rates below the goals identified by such initiatives as the Association of American Medical Colleges' "Project 3000 by 2000." Even with the expansion of the applicant pool, however, most medical schools do not anticipate enrollment increases. Medical school tuition also continues to increase significantly, in both public and private schools. The number of faculty members in the clinical disciplines also has continued to rise, although the rate of increase has become less marked. The decrease in the number of basic science faculty members that occurred this year will need to be monitored to ensure that appropriate faculty resources are available for teaching, especially with the initiatives to introduce more active learning formats during the basic science years. The medical curriculum continues to evolve at differing rates across schools. Many "innovations" have become part of the curricular repertoire; for example, medical schools have incorporated educational formats, such as problem-based learning or computer-assisted instruction, which emphasize active student learning, although in a number of cases they are limited to a small portion of the curriculum. In addition, the availability of clinical experiences during the first 2 years of the curriculum, especially those located in ambulatory settings, gives students an early glimpse of the world of actual medical practice. The use of standardized patients provides system and structure in the teaching and evaluation of clinical skills. Therefore, a look at medical education as a whole in the historical context reveals many positive changes (for example, an increase in student diversity over time, the introduction of alternative instructional formats, and attempts to evaluate student clinical competence more reliably). Within the context of environmental expectations, however, many challenges still remain. Medical schools are experiencing pressure to solve perceived problems with the specialty distribution of their graduates and with the specialty distribution of the general physician population, even though factors outside the control of the medical school, such as reimbursement and the practice environment, also influence specialty choice.(ABSTRACT TRUNCATED AT 400 WORDS)

Accreditation↗
PubMed1992

Educational programs in US medical schools.

Trends of the past few years indicate that the 1990s will be a time of intense activity in medical education reform. A number of areas described in this annual review of medical education are grounds for optimism, tempered, however, by caution. The applicant pool has been increasing rapidly over the past 2 years and has reached the levels of the early 1980s. The average proportion of women and some minorities also has been rising. While these are positive signs, efforts to ensure diversity in the student population should not be abandoned. The number of faculty members continues to rise, especially in the clinical disciplines. The increases, occurring in the context of stable medical student enrollments, raise questions about the various roles and responsibilities of medical school faculty. Many medical schools are in the process of curriculum review and revision; while these changes respond to identified problems, they may have implications for faculty and other resources. External financial support fueled previous waves of curriculum innovation, and some of these gains could not be maintained when that support was withdrawn. The revisions in the examinations of the NBME are being well received, and the single pathway to licensure through USMLE has been initiated. This system does, however, affect graduates' options for licensure. Finally, the increased interest in program evaluation, especially the definition of goals and the measurement of educational outcomes to assess their attainment, demonstrates that medical schools are serious about educational accountability. Some schools also are being asked to address externally imposed objectives, related specifically to specialty choice, creating a potential for conflict between the objectives that the medical school sets for itself and those mandated by its external constituencies. While this analysis may imply that medical education is now in a "good news/bad news" situation, the message is that planning and careful assessment of options are perhaps even more important today than they were in the past. Change has its costs and its implications, but it must nonetheless be undertaken.

Accreditation↗
PubMed1991

Educational programs in US medical schools.

One noteworthy finding for the 1990-1991 academic year is the increasing number of applicants to medical school, coupled with stabilization in the credentials of accepted applicants. This increase appears to be reversing the downward trend of the 1980s. The percentages of women and total minority students in the entering class increased from the previous year. The prevalence of instructional formats such as problem-based learning and computer-assisted instruction illustrates that medical schools are willing to experiment with educational innovation. A number of schools are in the process of curriculum review, which may lead to important changes. The financial support offered by private foundations interested in curriculum innovation, for some, will be an added stimulus for change. While the majority of medical schools continue to require that students take the examinations and the subject tests of the NBME, evaluation formats that test clinical skills are receiving increased attention. The number of schools using multiple station examinations (often with standardized patients) is rising. The impact of the new US Medical Licensing Examination on medical school curricula should be analyzed in the future. Although steady increases have been reported in the number of medical school faculty members, especially clinical faculty, there is little information about how these faculty members apportion their time between teaching, research, and patient care. The assumption is that the increases are primarily driven by medical schools' need to provide clinical services, which are a source of income. Another explanation for faculty increases could relate to the need for more faculty involvement in educational innovations such as problem-based learning and new methods of clinical skills evaluation, which are relatively more faculty-intensive. Continued monitoring of the growth in clinical faculty will be necessary, as will more careful analysis of how medical school faculty spend their time. Since medical school faculty who have heavy involvements in teaching frequently do not receive appropriate recognition or reward, it will also be interesting to examine the effectiveness of diverse incentives used by the schools to reward teaching faculty. An appropriate reward system for teaching is important if undergraduate medical education is to command a high priority in institutions awarding the doctor of medicine degree.

Accreditation↗
PubMed1990

Undergraduate medical education.

The number of applicants to US medical schools, which declined steadily between 1985 and 1988, increased slightly for the class entering in 1989. The profile of entering students showed a small decline from last year in the percentage of students with grade point averages categorized as "A" (3.5 or above on a 4-point scale) and slight declines in four of the six MCAT subtest scores. The percentage of both women and minority students in the entering class increased from the previous year. An interesting observation is the large percentage increase this year in students transferring to LCME medical schools from graduate and professional degree programs and from osteopathic medical schools. While the number of full-time faculty members in medical schools continues to increase, significant vacancy rates exist in some departments. More than 5% of full-time faculty positions are vacant in genetics, pathology, dermatology, family medicine, neurology, obstetrics-gynecology, orthopedics, otolaryngology, pediatrics, and surgery departments. Along with faculty vacancies, there has been a considerable turnover of medical school deans. The curriculum in most medical schools includes some innovative instructional formats, such as problem-based learning and computer-assisted instruction. However, current data do not allow a generalization about the extent to which these are being utilized. It seems that, at least in some institutions, multiple methods are being used to assess the clinical competence of medical students (observation by faculty members and residents, written and oral examinations, and multiple station examinations), including the use of standardized patients. About half of the medical schools require students to pass the NBME Part I examination and about one third require passage of Part II. The subject examinations provided by the NBME seem to be used widely, at least in the clinical disciplines. Within the past year, about 14% of medical schools have reported the presence of students or residents who have been diagnosed with human immunodeficiency virus infection, and 12% have had students or residents diagnosed with hepatitis B virus infection. It is critical that medical schools teach students how to prevent occupational exposure to these infections, as well as ensuring that adequate health insurance coverage be provided for these conditions.

Accreditation↗