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with shift work in medicine, he says, pointing to emergency medicine as one of the earliest examples. “It’s the profes- sionalism and the process that has to be managed,” and the rules and programs alike need to adapt to changes in health care. For example, handoffs, in one form


or another, are a regular part of today’s team-based care model.


“The question is: What do handoffs look like, and should they be based on duty hour requirements per se, or is there some other appropriate way to sig- nal that transition needs to occur? But most importantly, it has to be a good handoff process,” Dr. Weiss said. Researchers at Johns Hopkins agreed


that “increased supervision and training in handoffs may mitigate” related risks for medical errors, suggesting “an urgent need to study, standardize, teach, and improve this critical component of care.” One study conducted at Vanderbilt University Medical Center and published in the April issue of Academic Medicine showed that interns in internal medicine did not experience decreased clinical ex- posure to common medical problems and procedures with the new shift lim- its. But researchers noted that was likely due in large part to the fact the program prepared three months in advance of the new rules to change schedules and troubleshoot.


Meanwhile, authors of one of the


NEJM surveys proposed that rather than a one-size-fits-all approach, individual residency review committees should be able to develop specialty-specific work- hour rules that balance education and patient safety.


Whatever the path forward, resident


buy-in is another important element, says Dr. Mirkes, who agrees that more evidence-based study of the issue is needed. He brought together a task force of first- and second-year residents; gave them a piece of paper and copies of the program curriculum, duty hours, and rotations requirements; and let them set a schedule they could stick to without violating the ACGME regulations. “It took a lot of time and effort, but we really got them on board,” he said.


Resident “Match Day” sets record; more choose primary care


Annual “Match Day” set a record this year with an all-time high of 40,000 medical school graduates participating to match to residency training positions across the country, with more students choosing primary care. This year also saw a record 29,171 slots offered, about 2,400 more than in 2012. The National Resident Matching Pro- gram (NRMP) attributed the rise to a growing number of new medical schools graduating their first classes, as well as enrollment expansions in existing medi- cal schools.


Still, the Association of American Medical Colleges (AAMC) expressed con-


cern about what it says is a high number of qualified U.S. medical school gradu- ates who did not match to a residency training position. NRMP figures showed that roughly 1,100 graduates went un- matched this year, up from 850 in 2012. About half of those, 528 seniors, did not find a position following a second infor- mal match selection process — double the number of unmatched graduates in 2012.


AAMC President and Chief Executive Officer Darrell G. Kirch, MD, said the results “demonstrate the urgent need to increase federal support for graduate medical education” to increase the num- ber of residency training slots. Among those graduates who did match, 79 percent found one of their top three preferred programs, and more than half of U.S. seniors and almost half of independent applicants matched to their first choice, according to NRMP. Primary care saw gains over last year,


Texas Medical Board appearance?


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