An overview of reform initiatives in medical education: 1906 through 1992
Article Abstract:
Fifteen major studies conducted between 1906 and 1992 have recommended changes designed to improve undergraduate medical education. These studies have addressed curriculum content, instructional methods, medical school structure and the relationship between medical schools and external organizations such as accrediting and licensing agencies. Many changes have not been implemented because organizations with conflicting objectives are responsible for different aspects of medical education and accreditation. Medical schools themselves have become complex organizations, emphasizing research and the needs of their associated medical centers rather than education. Basic sciences have not been integrated into clinical medicine. Additional reforms will not occur until all groups involved in medical education cooperate. These groups should develop a national database to permit analysis of the educational process including, education, evaluation, accreditation, certification and licensure.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1992
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Economics
Article Abstract:
Savings associated with managed care may be linked to a healthier group of patients enrolled in these plans. Managed care uses health maintenance organizations (HMO), preferred provider organizations (PPO) independent practice association (IPA), and managed indemnity plans. Between 54% and 63% of Medicare HMOs had a preferable pool of enrollees, which yielded 6% to 28% savings. The Medicare HMO had less disability and hospital use before enrollment. Medical treatment under managed care differs little from care under fee-for-service arrangements. The Medicaid Demonstration Project in Minnesota recorded no differences in mortality, health functioning, diabetes or hypertension, even though the enrollees used fewer HMO services. Managed care may affect the development of relationships between physician and patient, and between primary care doctors and specialists.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1995
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