Resource Center

PURPOSE: To secure data from residents regarding residency work hours and correlates.

METHOD: A national, random sample of postgraduate year 1 (PGY1) and year 2 (PGY2) residents in the 1998-1999 training year was identified using the American Medical Association's Graduate Medical Education database. Residents completed a five-page survey with 44 questions and 144 separate data elements relating to their residency experience.

BACKGROUND: Citizens have conveyed to professionals that care at the end of life is less than optimal. Efforts to improve matters have tended to work in piecemeal fashion, on tangible more than personal aspects of care, and without the benefit of documented perspectives of those who face dying. Policy initiatives and clinical interventions need guidance from a broad framework that is validated by patients' perspectives.

BACKGROUND: In addition to medical care, dying patients often need many types of assistance, including help with transportation, nursing care, homemaking services, and personal care. We interviewed terminally ill adults and their care givers in six randomly selected areas of the United States (five metropolitan areas and one rural county) to determine how their needs for assistance were met and the frequency with which they received such assistance from family members and paid and volunteer care givers.

One of the most remarkable developments in the field of health care during the past several decades has been the rapid proliferation and growth of new health professions and occupations. Where physicians once stood virtually alone, other health workers now greatly outnumber them.  There is a greater need for primary care and in many cases these services can be effectively delivered by health care professionals other than physicians, such as nurse practitioners (NP), physician's assistants (PA) and certified nurse midwives (CNM).  Still, territorial and power conflicts endure.

For the second year, the Department of Data Systems in the Medical Education Group of the American Medical Association gathered information on graduate medical education primarily by means of an electronic data collection system. Eighty-eight percent of 6622 programs surveyed responded, with 83% reporting detailed information on residents. Analysis of graduate medical education data shows that the number of residents increased by 34.9% from the academic years 1980-1981 to 1990-1991, while the number of graduate year 1 residents decreased by 2%.

The annual surveys of residency programs on which this report is based have had a higher than 90% response rate for the 5 years previous to 1989. Because of a change to the new electronic data collection system in 1989, the response rate decreased to 78.3%. To adjust for the lower response rate, a regression model computed from data from previous years was developed that permitted projected estimates for 1989 data. These numbers are included in several key tables. The number of GY-1 positions seems to have decreased for 1990, although this may be an artifact of the response rate.

This is a case study illustrating the wide variety of models for rural health care delivery found in a western "frontier" state. In response to a legislative mandate, the University of Nevada School of Medicine created the Office of Rural Health in 1977. Utilizing a cooperative, community development approach, this office served as a resource, as well as a catalyst, in the development and expansion of a variety of alternative practice models for health care delivery to small, underserved rural communities.

A number of activities that would eventually change the field of continuing medical education (CME) occurred between May 1, 1988, and May 1, 1989. This report summarizes many of these initiatives, as well as updates ongoing CME activities.

Please note: The full text of this article is only available to those with subscription access to the JAMA Network. Contact your institutional library or the publisher for details.

A relatively simple method for estimating the ability of rural communities to support health provider personnel services, the utilization of this tool is described and illustrated.

Healthcare professionals in the United States have been relatively unaware of the great interest in and experience with teamwork in health care going on in Great Britain and on the European continent. The author's reference to the famous call of Paul Revere, “the British are coming”, is not meant to imply that the British or their fellow Europeans are just arriving upon the scene, but, rather, that, in a more accurate historical sense, they have landed in force and are marching in well organized progression towards their objectives.