Despite intense publicity about avoidable adverse drug events, only 16% of internal medicine clerkship programs in U.S. medical schools included formal lectures last year on adverse reactions and interactions, according to a government-funded study published last week.
What's more, 35% of clerkship directors surveyed had little or no familiarity with the 1999 Institute of Medicine report that sparked the publicity.
The study's authors, reporting in the Sept. 5 Journal of the American Medical Association, said they surveyed internal medicine clerkships because the average 12-week rotation is the longest of any required clinical experience in medical training and because the discipline involves caring for patients with complex problems frequently requiring multiple medications.
After reading a brief summary of the IOM report, To Err is Human, 83% of the clerkship directors agreed that heightened surveillance and training were needed to decrease adverse drug events. Some 61% said education on error prevention would be of value and they would incorporate it into their internal medicine program.
The study was financed by the National Institutes of Health and the Agency for Healthcare Research and Quality.
Overall, medical students completing their training in internal medicine, family practice and six specialties rated themselves as prepared to tackle most of the common conditions they would expect to encounter, according to another study in JAMA.
But more than 10% in each discipline said they felt unprepared to undertake one or more tasks relevant to their discipline.
For example, more than 15% of residents in internal medicine, family practice and obstetrics/gynecology felt unprepared to care for patients with HIV, AIDS or substance abuse problems. Nearly 40% of orthopedic surgery residents considered themselves unprepared to perform spinal surgery. And more than 30% of anesthesiology residents felt unprepared to manage chronic pain.
Meanwhile, although middle-aged men may disagree, Viagra was rated as one of America's least-important medical innovations in a survey of 225 leading internists. The survey, meant to highlight a national debate about the costs and benefits of expensive medical technology and drugs, ranks Sildenafil, the generic version of the impotence drug Viagra, as the 28th least-important of 30 medical innovations in recent years. Only nonsedating antihistamines and bone-marrow transplants were rated lower.
"The need to compare the value to patients of new technologies with their effect on spending is a major source of tension among physicians, hospitals, patients, insurance companies and government policymakers," according to a report on the survey in the September/October issue of Health Affairs.
The authors, Victor Fuchs, professor emeritus at Stanford University, and Harold Sox Jr., editor of the Annals of Internal Medicine, said theirs was the first study that asks active internists "to look at the relative value to patients of different innovations."
MRIs and CT scanners were ranked as the most important medical innovations, followed by ACE inhibitors, balloon angioplasty, cholesterol-reducing statins and mammography. Generally, diagnostic and surgical procedures ranked higher than medications. In a one-page survey, internists were asked to select five to seven innovations from a list of 30 to determine which innovations, if lost, would probably have the most adverse effect on patients, as well as five to seven whose loss would have the least adverse effect.
-With Michael Romano