Academic medicine's latest imperative: achieving better health care through global medical education standards.
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Biomedical subjects
Publications and source records attributed to Jordan J Cohen.
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The most important predictor of quality of health care across all racial and ethnic groups is access, especially insurance status and the ability to pay for health care. If we consider populations with equal access to health care, two groups emerge with differing qualities of health care: non-minority and minority populations. When studies control for the stage of disease at presentation, comorbidities, severity of illness, and other variables, substantial differences in health care based on race and ethnicity can still be found. Raising the consciousness of this issue is an important step toward recognizing and eliminating health care disparities.
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Upholding public trust in clinical research necessitates that human subjects be protected from avoidable harm and that the design, interpretation and reporting of research results be shielded from avoidable bias. On both counts, managing financial conflicts of interest is critically important, especially in the modern era when the opportunities for investigators to benefit personally from the commercialization of their intellectual property are overtly encouraged and rapidly expanding. Efforts are underway in the United States to provide more useful guidance to universities and medical schools for purposes of strengthening the oversight and management of financial conflicts of interest in clinical research.
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In recent years, the image of medicine as a caring profession has been badly tarnished by a rash of critical reports in the media. In the face of this negative publicity, do young people still want to be doctors? The author reviews conventional reasons given for the declining applicant pool (e.g., issues of declining income, loss of autonomy, etc.) and posits that an additional reason may be perceptions that doctors no longer command respect and that they are being oppressed by, rather than being guardians of, the health care system. Such views challenge academic medicine to broadcast to the world a realistic picture of the fabulous opportunities and gratifications that lie ahead for the next generation of physicians. However, academic medicine must also address some current realities within medical education, such as the admission process (where at present there is a tendency to overemphasize indices of academic achievement and underemphasize the personal characteristics sought in applicants) and the acculturation process in medical school (which can often dehumanize students and convert idealistic ones into cynics). The author acknowledges that these are tough challenges. He suggests as a first step that leaders of academic medicine prepare and disseminate an explicit statement of their commitments, a kind of compact between teachers and learners of medicine. He outlines these commitments, and states his hope that by fulfilling them, the academic medicine community can make clear that medicine-which at its core is still about the doctor-patient relationship-is a true calling, not just beleaguered occupation.
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Increasing the racial and ethnic diversity of the health care workforce is essential for the adequate provision of culturally competent care to our nation's burgeoning minority communities. A diverse health care workforce will help to expand health care access for the underserved, foster research in neglected areas of societal need, and enrich the pool of managers and policymakers to meet the needs of a diverse populace. The long-term solution to achieving adequate diversity in the health professions depends upon fundamental reforms of our country's precollege education system. Until these reforms occur, affirmative action tools in health professions schools are critical to achieving a diverse health care workforce.