During the MOC debate that JAMA sponsored, I was asked what I would do if “I were king” of MOC. As an internist, I believe in first making a diagnosis, then prescribing a treatment. So I have spent time diagnosing my needs as an internist. When I passed my boards I showed knowledge competency. But medicine changes over time. We have major advances and changes since I took my boards. Some examples follow:

shutterstock_215289142 When my husband started medical school, we immediately got hooked on getting student loans. After spending years of being broke all through undergrad, we felt like we were getting “magic” checks in the mail. Life was good. We could go out to dinner, buy our son the toys we wanted him to have, go shopping. We were enjoying all the luxuries ...

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acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com. How many of you have heard a flight attendant or pilot announce, “We know you have a choice of airlines when you fly, and we want to thank you for flying with us”? Over the years, many other industries have adopted similar statements.  Continuing medical education (CME) ...

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Do physicians in training take better care of patients or perform better on their exams when their work hours are restricted?  Two recent studies in the Journal of the American Medical Association suggest that the answer is no.  In one, patients of surgery residents showed no difference in morality or postoperative outcomes after duty hour restrictions were implemented.  Their test scores did not improve either.  In the other, hospitalized Medicare ...

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A while ago, I wrote about a medical student whose school tried to dismiss him just prior to graduation for unprofessional behavior. A judge ruled that the school could not do so because it had tolerated some similar behavior earlier in his medical school career and had not considered it important enough to mention in his letters of recommendation. In that post, I said, "'Professionalism' is difficult to define, especially when trying to ...

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You’ve made it. Four years of college, four years of medical school, and three years (sometimes four or five) of residency, depending on the specialty you chose. You’ve earned a prestigious title. You are a doctor. But wait, you are not done yet. Want to be a cardiologist, oncologist or gastroenterologist? Add another three years to the eleven spent to become an independent practitioner. Another three years of interest rate on that six ...

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He was known to the hospital as someone who would try to manipulate his caregivers. And I fell for it anyway. Frequently admitted for pain crises associated with a chronic illness, he spent most of his hospital course avoiding eye contact with the team. So, too, were avoided answers that involved more than a few words. Providing care for him was business-like; we knew better than to expect pleasantries. The day of ...

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shutterstock_242182051 In our transition to medical school as first-year medical students, one significant part of our learning has been adopting the dress of the medical profession. Twice a week, in our first-year practice of medicine course, we wear professional attire and don our white coats, the famous symbol of the medical profession. As we learn how to interview and interact with patients, ...

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Despite the changes around us, the training of physicians has stayed much the same. Sure, there are new work hour limitations and a push to move towards competency-based assessments, but the overall structure of our training remains largely untouched. We spend the vast majority of our time training in hospitals, with the remaining time spent practicing in traditional outpatient clinics. However, health care is being increasingly delivered outside these two arenas. ...

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The issues around race and how it plays out in modern day American society are numerous, deeply personal to many and utterly complex to most. The incidents in Ferguson, Mo., which began in August and erupted late November in nationwide protests, are an example of the many problems with race relations that persist in our country. While I believe we have made significant progress since the civil rights movement began, ...

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