Two out of five medical students have an unconscious bias against obese people, according to a new study by researchers at Wake Forest Baptist Medical Center. The study is published online ahead of print in the Journal of Academic Medicine.

"Bias can affect clinical care and the doctor-patient relationship, and even a patient's willingness or desire to go see their physician, so it is crucial that we try to deal with any bias during medical school," said David Miller, M.D., associate professor of internal medicine at Wake Forest Baptist and lead author of the study.

"Previous research has shown that on average, physicians have a strong anti-fat bias similar to that of the general population. Doctors are more likely to assume that obese individuals won't follow treatment plans, and they are less likely to respect obese patients than average weight patients," Miller said.

Miller and colleagues conducted the study as part of their efforts to update the medical school's curriculum on obesity. The goal was to measure the prevalence of unconscious weight-related biases among medical students and to determine whether the students were aware of those biases.

The three-year study included more than 300 third-year medical students at a medical school in the southeastern United States from 2008 through 2011. The students were geographically diverse, representing at least 25 different states and 12 countries outside the United States.

The researchers used a computer program called the Weight Implicit Association Test (IAT) to measures students' unconscious preferences for "fat" or "thin" individuals. Students also answered a survey assessing their conscious weight-related preferences. The authors determined if the students were aware of their bias by seeing if their IAT results matched their stated preferences.

Overall, 39 percent of medical students had a moderate to strong unconscious anti-fat bias as compared to 17 percent who had a moderate to strong anti-thin bias. Less than 25 percent of students were aware of their biases.

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If it's a Monday, you can usually find Dr. David Brown parked next to a lake in Miami, spending the day inside a 36-foot-long RV. He's not on vacation. Brown is chief of family medicine at Florida International University's medical school. The RV is the school's mobile health clinic. Every Monday it's parked at the Royal Country Mobile Home Park in northwest Miami-Dade County. "It's a beautiful place right here," he says. "But this is not a wealthy community."

Brown helps direct FIU's Neighborhood HELP program. It's part of the school's curriculum that connects medical students with families in neighborhoods where medical care is scarce. Students visit families in their homes where they conduct examinations and provide basic care. But some things are better done in a clinic. So the medical school bought its own RV. "We're able to bring free basic primary care to our households relatively close to their community," Brown says.

In one of the RV's exam rooms, third-year medical student Veronica Alvarez met recently with patient Maritza Flores. Flores has diabetes and high blood pressure. With help from the school's faculty, Alvarez has been treating her since January.

Flores says with Alvarez's encouragement, she's begun exercising more and has improved her diet. And, thanks to FIU's doctors, she's begun taking medication for her diabetes and high blood pressure. In just a few months, Alvarez says, she's seen a big improvement. "The high blood pressure and the diabetes together is what you worry about," Alvarez says. "And now, her diabetes is well-controlled and her hypertension is well-controlled as well."

Over the last decade, a pressing need for new doctors has led many universities to open medical schools. Seventeen new schools have been accredited since 2005, and several are looking at new ways to train doctors. When it was founded just four years ago, Florida International University took on a mission — to improve the health of nearby communities. Another focus for the school is to train more doctors in primary care.

Nationally, there's a shortage of primary care doctors — one that's expected to worsen as millions more Americans get access to health care under the Affordable Care Act. But Dr. John Rock, the medical school's dean, says the two missions go together. Sending students out to treat patients in their communities teaches them the art of primary care.

FIU just graduated its first class from the medical school. Nearly half of the students, Rock says, are doing residencies in primary care. Several other new medical schools are also developing programs that allow students to develop ongoing relationships with patients. And there are others that, like FIU also have a social mission — to improve the quality of life in medically-underserved communities.

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Training healthcare providers to be able to respond to any situation they might find themselves in is crucial to their development as healthcare professionals. With recent advancement in the use of technology, simulation training provides an excellent (and safe) learning environment in the curriculum of students as well as for ongoing training for current healthcare professionals.

While hands-on learning with real patients cannot be completely replaced, simulation training provides a safe environment for learning. Making mistakes can be a valuable part of the learning process. In the simulation environment, patients at not put at risk.

According to the Society for Simulation in Healthcare, simulation training is “the imitation or representation of one act or system by another” and serves as “a bridge between classroom learning and real-life clinical experience.” No longer must students practice giving injections by using an orange or budding surgeons practice suturing by using a piece of felt.

Healthcare is catching up to other industries in using scenario based training. For instance, aviation has been a long-time user of simulation training for pilots. In fact, the first known flight ‘simulator’ was the Antoinette Trainer developed in 1909. Rudimentary by today’s standard, the simulator consisted of a “half-barrel mounted on a universal joint, with flight controls, pulleys, and stub-wings.” Over time, the setup became more advanced. Beginning in the 1950’s, technology was introduced to aviation simulation. By the 1980‘s, it was much more integrated. Today, many aviation simulators are so advanced, it would be tough to tell them apart from the real thing.

Aviation knew the importance of training pilots in situations where they could “achieve, test, and maintain proficiency in the operation of an airplane without risk to person or property and at a lower cost to training in the air” (Aviation WikiJournal).

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New Whitepaper: "Innovative Technology Allows Regional Medical Campus to Educate Tomorrow's Top Physicians"

[Excerpted from the whitepaper]

A regional medical campus can be an effective method for medical schools to grow in size while successfully addressing such challenges as meeting accreditation standards, upholding local and state laws, lowering financial costs, and providing high-quality clinical practice opportunities for students. One example and success story of these principles is St. Luke's University Health Network, which acted in conjunction with Temple University School of Medicine to meet and satisfy the need for more undergraduate medical students.

"As a medical school, we needed to have an AV system to record our simulation sessions," says Joshua Onia, Simulation/Standardized Patient Director. "We also needed a solution to keep track of how we are meeting our accreditation standards and manage the operations of our sim center..."

Click here to request the whitepaper.

Over the past decade, in response to public concerns about medical errors arising from fatigue, the Accreditation Council for Graduate Medical Education, the organization responsible for accrediting American medical residency programs, has been progressively limiting the number of hours that trainees can work. The latest mandate, which took effect in 2011, is the most stringent and deals most specifically with interns. These youngest doctors are allowed to work no longer than 16 hours in a day; and residency programs that violate the restriction risk losing their accreditation.

In response to the 16-hour mandate and faced with a Rubik’s-cube conundrum of covering all the work with the same number of interns working fewer hours, training programs across the country came up with several innovative scheduling configurations. Some created complicated and overlapping shifts where outgoing doctors “signed out” their patients, passing off their responsibilities to the incoming shift. Others adopted a “night float” system that meant a resident just a year out of internship had to carry the work of as many as 12 interns at night, looking after more than 100 patients and fielding questions about those patients at best every 20 minutes and at worst every 11 minutes throughout the night.

Now, two years after the 16-hour mandate was established, studies on the outcomes are being published, and the results reveal one thing.

Maybe we should have thought a little harder about the arithmetic.

Contrary to expectations, these studies have shown that interns have not been getting significantly more sleep. Moreover, they are not happier, nor are they studying more. In one national survey, nearly half of all doctors in training disapproved of the regulations altogether. Another study revealed that interns were spending less time in educational activities because the additional time required for such conferences and lectures would push them over the 16-hour limit.

In addition, there has been no significant improvement in the quality of care since the work limits took effect. In one case, doctors had to scrap the night float system because the nurses thought the care offered by trainees on that schedule was so poor. Another study revealed that interns confessed to having more concerns about making serious medical errors after the mandate than before.

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Medical interns spend just 12 percent of their time examining and talking with patients, and more than 40 percent of their time behind a computer, according to a new Johns Hopkins study that closely followed first-year residents at Baltimore's two large academic medical centers. Indeed, the study found, interns spent nearly as much time walking (7 percent) as they did caring for patients at the bedside.

Compared with similar time-tracking studies done before 2003, when hospitals were first required to limit the number of consecutive working hours for trainees, the researchers found that interns since then spend significantly less time in direct contact with patients. Changes to the 2003 rules limited interns to no more than 30 consecutive hours on duty, and further restrictions in 2011 allow them to work only 16 hours in a row.

"One of the most important learning opportunities in residency is direct interaction with patients," says Lauren Block, M.D., M.P.H., a clinical fellow in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine and leader of the study published online in the Journal of General Internal Medicine. "Spending an average of eight minutes a day with each patient just doesn't seem like enough time to me."

"Most of us went into medicine because we love spending time with the patients. Our systems have squeezed this out of medical training," says Leonard Feldman, M.D., the study's senior author and a hospitalist at The Johns Hopkins Hospital (JHH).

For the study, trained observers followed 29 internal medicine interns—doctors in their first year out of medical school—at JHH and the University of Maryland Medical Center for three weeks during January 2012, for a total of 873 hours. The observers used an iPod Touch app to mark down what the interns were doing at every minute of their shifts. If they were multi-tasking, the observers were told to count the activity most closely related to direct patient care.

The researchers found that interns spent 12 percent of their time talking with and examining patients; 64 percent on indirect patient care, such as placing orders, researching patient history and filling out electronic paperwork; 15 percent on educational activities, such as medical rounds; and 9 percent on miscellaneous activities. The researchers acknowledge that it's unclear what proportion of time spent at the bedside is ideal, or whether the interns they studied in the first year of a three-year internal medicine training program make up the time lost with patients later in residency. But 12 percent, Feldman says, "seems shockingly low at face value. Interns spend almost four more times as long reviewing charts than directly engaging patients."

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For decades, simulation has been a training mainstay in the aeronautical and military fields for its ability to prepare learners for real-life situations. Pilots-in-training clock flight time, heighten alertness, and learn how to react in emergencies. Seeing this success, many academic and medical institutions have also turned to simulation to develop advanced skills in their healthcare learners. Surgical learners in particular must enhance their hand range and dexterity, as well as the ability to anticipate how a patient's physiology will react to certain procedures. To specifically cultivate a surgeon's minimally invasive -- or laparoscopic -- techniques, a hospital or medical school can establish an in-house laparoscopic surgery training program.

First and foremost, an institution must determine the scope of its training requirements: what skills can be targeted to positively effect surgical skill deployment, and what simulation technology will be best suited for the environment? A robust laparoscopic surgery training program should include several tiers of educational equipment. Beginning surgical residents who wish to develop their laparoscopic skills must first master suturing and knot-tying. More advanced laparoscopic learners may next use tools to manipulate objects within a homemade, unplugged "box" trainer. Finally, a sophisticated virtual reality (VR) laparoscopic simulator allows surgeons-in-training to control virtual objects by handling wired, realistic laparoscopic instruments. Both box and VR laparoscopic simulators allow learners to improve muscle memory and refine their hand and arm range.

To encourage positive learning outcomes, a laparoscopic surgery training program must also make sure that simulation is fully integrated into the overall curriculum. Learners should be incentivized to work with the simulators: training outcomes show progress over time, can be tracked for mandatory skill mastery and course completion, and may even help establish an essential competitive spirit between users. Simulation sessions scheduled for every laparoscopic learner on a daily, weekly, or biweekly basis encourage skill retention and ensure regular assessment.

Simulation is also a key to skill standardization in a laparoscopic surgery training program. With both box and VR trainers, every learner completes the same simulation scenarios for diverse skill development. This allows instructors to make fair assessments of whether their laparoscopic learners have consistent reasoning ability, instrument positioning, posture, and spatial awareness.

As laparoscopic surgery training programs become more common worldwide, so too will there be more research and best practices available over time. Program administrators discuss what's worked, what hasn't, and go on to develop new practices for more advanced and efficient skill development. Ultimately, this is a boon for patients: better trained laparoscopic surgeons lead to better surgical outcomes and faster recovery times.

Sometimes earning an undergraduate degree is only the beginning of a student's educational goal. Thousands of new college students start school every year with the ultimate hope of an advanced degree—and few of those degrees have the mystique of an M.D.

Unfortunately, there are also few educational paths that have a price tag and time commitment quite as large as medical school. While new doctors will graduate into a profession with plenty of earning potential, they also tend to leave their seven to eight years of school with far higher debt than most graduates. Seventy-nine percent of med students graduated in 2012 with education debt of $100,000 or more, according to the Association of American Medical Colleges.

To help offset some of your potential debt, you can turn to scholarships every step of the way, from undergrad to resident. It will come as no surprise that since medical schools themselves are highly competitive, so are their scholarship competitions. Learn the criteria and start your applications early so that when you can finally call yourself "doc," you can enjoy the fruits of your labor instead of shelling out money to loan companies.

If you're heading into your junior or senior year of college next year and you're planning on a career in health or medicine, you can apply for the Gallagher Koster Health Careers Scholarship, which will award five $5,000 scholarships to students who apply by May 3. Students in a wide variety of healthcare-related majors—from biology to nursing to child development, and more—are invited to apply, as long as they anticipate graduating between spring of 2014 and spring of 2015.

The Palo Alto Foundation Medical Group is one of a number of more locally focused organizations that give out pre-med scholarships, and its awards are among the largest. The scholarship pays out $20,000 over five years to its recipients, who must be high school seniors from one of the four California counties served by the foundation. It's an amazing opportunity if you live in the area; if not, you should spend a day or two talking to your own local and regional clinics and health foundations to find out about similar programs.

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For years, medical students who chose a residency in radiology were said to be on the ROAD to happiness. The acronym highlighted the specialties — radiology, ophthalmology, anesthesiology and dermatology — said to promise the best lifestyle for doctors, including the most money for the least grueling work.

Not anymore. Radiologists still make twice as much as family doctors, but are high on the list of specialists whose incomes are in steepest decline. Recent radiology graduates with huge medical school debts are having trouble finding work, let alone the $400,000-and-up dream jobs that beckoned as they signed on for five to seven years of relatively low-paid labor as trainees. On Internet forums, younger radiology residents agonize about whether it is too late to switch tracks.

At St. Barnabas Hospital in the Bronx, a dozen radiologists in training, including Dr. Luke Gerges, 28, are suddenly stranded on an expensive road to nowhere. All received termination notices recently because their hospital is ending their residency program next year as part of a plan to replace its radiologists with a teleradiology company that reads diagnostic images remotely.

“Those days of raking in the dough with radiology are gone,” said Dr. Gerges, who is four years beyond medical school and $300,000 in debt. He said he chose a specialty he loves without caring that big salaries were waning, but never imagined it would be this hard to finish his postgraduate training and get a job.

“No one is going to hire me to be a radiologist without my training,” he said.

Few specialties have been immune to the same factors depressing radiology: deep Medicare cuts, cut-rate competition driven by technology, doubts about the health value of many tests and procedures and new measures to tilt public money to primary care.

The case of St. Barnabas may be extreme, said Dr. Paul H. Ellenbogen, chairman of the American College of Radiology, the principal organization of the nation’s 30,000 radiologists, who called the hospital’s treatment of the residents “unconscionable.” But it is part of a larger pattern that has made radiology the target of a dozen cuts in Medicare reimbursement since 2006, he said, totaling $6 billion.

“We were somewhat victims of our success,” said Dr. Ellenbogen, in Dallas, whose career spans what radiologists call the golden years, when the cost of diagnostic imaging grew faster than other items in health care.

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Giving residents less time on duty and more time to sleep was supposed to lead to fewer medical errors. But the latest research shows that’s not the case. What’s going on?

Since 2011, new regulations restricting the number of continuous hours first-year residents spend on-call cut the time that trainees spend at the hospital during a typical duty session from 24 hours to 16 hours. Excessively long shifts, studies showed, were leading to fatigue and stress that hampered not just the learning process, but the care these doctors provided to patients.

And there were tragic examples of the high cost of this exhausting schedule. In 1984, 18-year old Libby Zion, who was admitted to a New York City hospital with a fever and convulsions, was treated by residents who ordered opiates and restraints when she became agitated and uncooperative. Busy overseeing other patients, the residents didn’t evaluate Zion again until hours later, by which time her fever has soared to 107 degrees and she went into cardiac arrest, and died. The case highlighted the enormous pressures on doctors-in-training, and the need for reform in the way residents were taught. In 1987, a New York state commission limited the number of hours that doctors could train in the hospital to 80 each week, which was less than the 100 hour a week shifts with 36 hour “call” times that were the norm at the time. In 2003, the Accreditation Council for Graduate Medical Education followed suit with rules for all programs that mandated that trainees could work no more than 24 consecutive hours.

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