Ensuring the Availability of Clinical Clerkships at U.S. Hospitals: A Tale of 2 States.

U.S. medical schools are facing growing competition for limited clinical training resources, notably slots for the core clerkships that students most often complete in the third year of their undergraduate medical education. In particular, medical schools in the Caribbean (often referred to as offshore medical schools) are buying clerkship slots at U.S. hospitals for their students, most of whom will be U.S. citizen international medical graduates. For hospitals, especially those that are financially stressed, these payments are an attractive source of revenue. Yet, this practice has put pressure on U.S. medical schools to provide similar remuneration for clerkship slots for their students or to find new clinical training sites.In this Perspective, the authors outline the scope of the challenge facing U.S. medical schools and the U.S. medical education system. They outline legislative strategies implemented in 2 states (New York and Texas) to address this issue and propose the passage of similar legislation in other states to ensure that students at U.S. medical schools can access the clerkships they need to obtain the requisite clinical experience before entering residency. Such legislation would preserve the availability of clerkships for U.S. medical students and the educational quality of these clinical training experiences and, therefore, preserve the quantity and quality of the future physician workforce in the United States.

How the Social Contract Can Frame International Electives.

Short-term experiences in global health (STEGHs) are common ways trainees engage in global health activities, which can be viewed by students as either altruistic or opportunistic. This article explores how STEGHs express the social contract medicine has with society, emphasizes areas of breakdown in this social contract, and calls for medical schools, licensure boards, STEGH-sponsoring organizations, and professional societies to take active roles in addressing these ethical challenges.

Racial-ethnic diversity in allied health: the continuing challenge.

Despite gains over the last few decades, the racial-ethnic diversity of health professionals has not kept pace with demographic changes in the general population of the United States, with significant consequences for the health of minority populations and access to health care services. We analyzed data for allied health educational programs accredited in 1989-90 and 2006-07, with particular attention to the race/ethnicity of enrollments, attrition, and graduates and the types of institutions that were more or less likely to have increased diversity over the time period. Our data show that blacks and Hispanics have higher attrition rates than whites and Asian or Pacific Islanders. In addition, federal institutions and for-profit institutions have higher rates of student racial/ethnic diversity, and both have become more diverse over time, although for-profit institutions have higher attrition rates than other types of institutions. Because minority students are more likely to attend for-profit institutions, the higher attrition rate at these institutions versus other types of institutions merits continued attention and additional study. At the same time, all institutions must direct resources toward increasing diversity and ensuring higher graduation rates among racial/ethnic minority students.

Emergency preparedness for residency/fellowship programs: lessons learned during Hurricane Katrina and applied during Hurricane Ike.

When it struck the US Gulf Coast in 2005, Hurricane Katrina severely disrupted many graduate medical education residency/fellowship programs in the region and the training of hundreds of residents/fellows. Despite the work of the Accreditation Council for Graduate Medical Education in responding to this natural disaster and facilitating communication and transfer of residents/fellows to other unaffected training programs, the storm exposed the gaps in the existing system. Subsequently, the Accreditation Council for Graduate Medical Education, with the aid of its member organizations, including the American Medical Association, developed a new disaster recovery plan to allow for a more rapid, effective response to future catastrophic events. These policies were instrumental in the rapid relocation of 597 residents/fellows from the University of Texas Medical Branch at Galveston after the landfall of Hurricane Ike in September 2008. As a further accommodation to affected trainees, medical certification boards should be as flexible as possible in waiving continuity requirements in the event of a disaster that affects residency/fellowship programs.

Coming together, moving apart: a history of the term allied health in education, accreditation, and practice.

In recent years, several groups, including the physician assistant, health information management, ophthalmic medical technician/technologist, and athletic training review committees, have left the Commission on Accreditation of Allied Health Education Programs (CAAHEP) system to form their own, profession-specific accrediting bodies. Their motivation was typically a desire for greater professional visibility and autonomy. Combined, these professions represented one third of the CAAHEP's programs. This article reviews the history of allied health and examines current attempts to bring cohesion and identity to this increasingly fractured segment of the U.S. health care system.