GRADUATE MEDICAL EDUCATION ISSUES -- GRADUATE MEDICAL EDUCATION ISSUES -- CONTENTS -- PREFACE -- Chapter 1 HOW ARE RESIDENCY PROGRAMS PREPARING OUR 21ST CENTURY INTERNISTS? -- SUMMARY -- Key Findings -- 1. INTRODUCTION -- 2. METHODS -- 3. SAMPLE AND INTERVIEW CHARACTERISTICS -- 4. FINDINGS -- Practice-based Learning and Improvement -- Evidence-based Medicine -- Quality Improvement Methods -- Using Decision Aids -- Systems-Based Practice -- Patient Care Coordination -- Working in Multidisciplinary Teams -- Awareness of Absolute and Relative Costs -- Patient Safety and Patient Safety Methods -- Interpersonal and Communication Skills -- Communicating with other Health Care Providers -- Communicating with Patients -- Communicating with Special Populations -- Communicating about end-of-Life Issues and Advanced Directives -- Care Settings and Information Technology Infrastructure -- Care Settings -- Electronic Medical Record (EMR) & Computer Order Entry (COE) -- Reported Facilitators and Barriers -- Information Technology -- Faculty Expertise and Time -- Setting -- Institutional Support -- Resident Time, Baseline Knowledge, and Interest -- Research in Educational and Evaluation Strategies -- 5. SUMMARY AND DISCUSSION -- Graduate Medical Education (GME) Financing -- Accreditation Standards -- Specialty Certification Exam -- Undergraduate Medical Education -- Research -- Limitations -- Conclusions -- APPENDIX A: MEDICAL SCHOOL TRAINING IN SELECTED TOPICS: A REVIEW OF WRITTEN CURRRICULA -- Introduction -- Methods -- Sample -- Findings -- Overall Structure of Curricula -- Practice Based Learning and Improvement -- Systems-Based Practice -- Interpersonal and Communication Skills -- Communicating about End-of-Life Issues and Advanced Directives -- Care Settings and Information Technology (IT) Infrastructure -- Discussion -- Limitations -- Next Steps.

APPENDIX B: INTERVIEW PROTOCOL -- Introduction -- Practice-Based Learning and Improvement -- Systems-Based Practice -- Section 4 - Interpersonal and Communication Skills -- Section 5- Conclusion -- REFERENCES -- End Notes -- Chapter 2 MEDICAL EDUCATION IN THE UNITED STATES: SUPPORTING LONG-TERM DELIVERY SYSTEM REFORMS -- SUMMARY -- PROCESS OF BECOMING A PHYSICIAN AND CONTINUING PRACTICE -- Undergraduate Preparation -- Medical School -- Diversity in Medical Education -- Student Debt -- Graduate Medical Education -- Physician Licensure -- Specialty Certification -- ACCREDITATION AND CERTIFICATION ORGANIZATIONS -- MEDICARE'S SUBSIDIES FOR GRADUATE MEDICAL EDUCATION -- Payments toward Direct and Indirect Costs -- Number of Residents that Medicare Supports -- Non-Medicare Funding Sources for Graduate Medical Education -- Medicare Payments to Teaching Physicians for Services when Supervising Residents -- Economic Costs and Benefits of Participating in Teaching Activities -- MEDICAL EDUCATION SHOULD SUPPORT NEEDED DELIVERY SYSTEM REFORM -- Study Suggests that Curricula in Many Internal Medicine Residency Programs Fall Short in Topics Associated with Delivery System Reform -- Practice-Based Learning: Measuring Care Quality and Improving Medical Practice -- System-Based Practice: Care Coordination, Cost Awareness, and Patient Safety -- Interpersonal Communication -- Use of Health Information Technology -- Residency experience in nonhospital settings -- Factors Affecting Programs' Instruction in Selected Topics -- Study Limitations -- FINANCIAL INCENTIVES AND REGULATORY BARRIERS DISCOURAGE NONHOSPITAL RESIDENCY ROTATIONS -- Residents Provide Clinical Labor in Hospitals -- Medicare Supports Didactic (Nonpatient Care) Instruction in the Hospital Setting Only -- Medicare Regulates Specific Provisions of Hospital-Nonhospital Residency Arrangements.

Impacts of Hospital Focus on Residency Experience -- WORK FOR FUTURE EXPLORATION -- Linking Medical Education Incentives with Delivery System Reforms -- Structuring Medical Education Subsidies to Produce the Professionals We Need -- Enlisting Other Payers to Contribute Explicitly to Medical Education -- REFERENCES -- End Notes -- Chapter 3 GRADUATE MEDICAL EDUCATION FINANCING: FOCUSING ON EDUCATIONAL PRIORITIES -- RECOMMENDATIONS -- SUMMARY -- Commission's Summary Assessment of the GME System -- Commission Recommendations to Address Gaps in the GME System -- COMMISSION'S SUMMARY ASSESSMENT OF THE GME SYSTEM -- Gaps in the Current GME System -- Physician mix -- Content and outcomes of physician training -- Payers' role in fostering gaps in GME system -- Medicare's Role in GME Reform -- Physician Mix -- Content and outcomes of physician training -- Role of other Federal Programs -- COMMISSION RECOMMENDATIONS TO ADDRESS GAPS IN THE GME SYSTEM -- Link Payments to Performance to Meet Education and Training Goals for Delivery System Reform -- Accelerate the Progress of Improving GME Outcomes -- Other educational efforts are beginning to address deficits -- Particular focus needed to increase experience in nonhospital settings -- Increase accountability through performance- based payments -- RECOMMENDATION 4-1 -- Rationale 4-1 -- Implications 4-1 -- Spending -- Beneficiary and Provider -- Improve collaboration between educators and teaching hospitals by increasing the transparency of medicare payments -- Payment data -- Resident count data -- Cost data -- Other issues -- RECOMMENDATION 4-2 -- Rationale 4-2 -- Implications 4-2 -- Spending -- Beneficiary and Provider -- Determine health workforce needs for a reformed delivery system -- RECOMMENDATION 4-3 -- Rationale 4-3 -- Implications 4-3 -- Spending -- Beneficiary and Provider.

Examine the net impact of residency program costs and benefits on hospitals' financial performance -- Costs of supporting residency programs -- Benefits of supporting residency programs -- RECOMMENDATION 4-4 -- Rationale 4-4 -- Implications 4-4 -- Spending -- Beneficiary and Provider -- Increase diversity among future physicians -- RECOMMENDATION 4-5 -- Rationale 4-5 -- Implications 4-5 -- Spending -- Beneficiary and Provider -- REFERENCES -- End Notes -- CHAPTER SOURCES -- INDEX.