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AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES _A-08_ by keara

VIEWS: 8 PAGES: 32

									                                         DISCLAIMER

     The following is a preliminary report of actions taken by the House of Delegates at
     its 2008 Annual Meeting and should not be considered final. Only the Official
     Proceedings of the House of Delegates reflect official policy of the Association.


            AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES (A-08)


                               Report of Reference Committee C

                                 David M. Lichtman, MD, Chair


 1   In keeping with Resolution 601 (A-96), the Reference Committee recommends the
 2   following consent calendar for acceptance:
 3
 4   RECOMMENDED FOR ADOPTION
 5
 6   1.    Council on Medical Education Report 2 – Sunset Review of 1998 House of
 7         Delegates Policies and Directives
 8
 9   2.    Council on Medical Education Report 3 – Physician Lifelong Learning
10
11   3.    Council on Medical Education Report 7 – Diversity in the Physician Workforce
12         and Access to Care
13
14   4.    Council on Medical Education Report 10 – Independent Regulation of Physician
15         Licensing Exams
16
17   5.    Council on Medical Education Report 12 – Observerships for International
18         Medical Graduates
19
20   6.    Council on Medical Education Report 14 – Employment Benefits for Residents
21         and Fellows
22
23   7.    Resolution 301 - Support for the Epidemic Intelligence Service (EIS) Program
24         and Preventive Medicine Residency Expansion
25
26   8.    Resolution 309 – Increasing Medical School Class Sizes
27
28   9.    Resolution 311 - Credentialing Materials: Timely Submission by Residency and
29         Fellowship Programs
30
31   10.   Resolution 324 – Competition for Clinical Training Sites
32
33   RECOMMENDED FOR ADOPTION AS AMENDED OR SUBSTITUTED
                                                             Reference Committee C (A-08)
                                                                                  Page 2


 1   11.   Board of Trustees Report 19 – Gender Disparities in Physician Income and
 2         Advancement
 3
 4   12.   Council on Medical Education Report 4 – Educational Implications of the Medical
 5         Home Model
 6
 7   13.   Council on Medical Education Report 5 – Enforcement of Duty Hours Standards
 8         and Improving Resident, Fellow And Patient Safety
 9         Resolution 318 - Protecting Patients and Residents by Reducing Extended Work
10         Shifts
11
12   14.   Council on Medical Education Report 6 – Physician Reentry
13
14   15.   Council on Medical Education Report 8 – One-Year Public Health Training
15         Options for All Specialties
16
17   16.   Council on Medical Education Report 11 – Improving Parental Leave Policies for
18         Residents and Fellows
19         Resolution 316 – Loss of Status Following Family Medical Leave Act Qualified
20         Leave During Residency Training
21
22   17.   Council on Medical Education Report 13 – Financial Conflicts in CME
23
24   18.   Resolution 305 – Oppose Discrimination in Residency Selection Based on
25         Location of Medical School
26
27   19.   Resolution 307 – Student Loan Empowerment
28
29   20.   Resolution 308 – Encouragement of Interprofessional Education Among Health
30         Care Professions Students
31
32   21.   Resolution 310 – Solutions to Tackling the Increasing Cost of Medical Education
33
34   22.   Resolution 315 – Evaluation of Increasing Resident Review Committee
35         Requirements
36
37   23.   Resolution 317 – Telemedicine and Medical Licensure
38
39   24.   Resolution 319 - Medical Education in Disaster Response
40
41   25.   Resolution 321 – Promotion of Better Pain Care
42
43   26.   Resolution 323 – Improvements to the Maintenance of Certification Process
44
45   27.   Resolution 327 – Eliminating Disparities in Licensure for IMG Physician
46
                                                             Reference Committee C (A-08)
                                                                                  Page 3


 1   RECOMMENDED FOR REFERRAL
 2
 3   28.   Resolution 302 – Recognition of Osteopathic Education and Training
 4
 5   29.   Resolution 304 – Medical Student Debt Crisis
 6         Resolution 313 – Alternative Approaches to Dealing with Medical School Tuition
 7         Costs and Student Indebtedness
 8         Resolution 320 – Tax Deductibility of Medical Education
 9
10   30.   Resolution 314 – Physician Scientist Benefit Equity
11
12   RECOMMENDED FOR NOT ADOPTION
13
14   31.   Resolution 306 – Waiver of US Medical Licensing Examination Step 2-CS
15         Requirements
16
17   32.   Resolution 312 – Study of the Impact of Medical Education on Patient Safety
18
19   33.   Resolution 326 – IMGs on State Medical Licensing Boards
20
21   RECOMMENDED FOR REAFFIRMATION IN LIEU OF
22
23   34.   Resolution 325 – Licensing for Qualified Physicians on Case by Case Basis
24
                                                                Reference Committee C (A-08)
                                                                                     Page 4


 1   (1)    COUNCIL ON MEDICAL EDUCATION REPORT 2 –
 2          COUNCIL ON MEDICAL EDUCATION SUNSET REVIEW
 3          OF 1998 HOUSE OF DELEGATES POLICIES AND
 4          DIRECTIVES
 5
 6          RECOMMENDATION:
 7
 8          Mr. Speaker, your Reference Committee recommends that
 9          the recommendations in Council on Medical Education
10          Report 2 be adopted and the remainder of the report be
11          filed.
12
13             HOD ACTION: Council on Medical Education Report 2
14             adopted and the remainder of the report filed.
15
16   Council on Medical Education Report 2, Sunset Review of 1998 House of Delegates
17   Policies and Directives, recommends actions on 1998 policies and directives of the
18   House of Delegates relating to medical education.
19
20   Your Reference Committee heard limited but supportive testimony for adoption of the
21   report.
22
23   (2)    CME REPORT 3 - PHYSICIAN LIFELONG LEARNING
24
25          RECOMMENDATION:
26
27          Mr. Speaker, your Reference Committee recommends that
28          the recommendations contained in the Council on Medical
29          Education Report 3 be adopted and the remainder of the
30          report be filed.
31
32             HOD ACTION: Council on Medical Education Report 3
33             adopted as amended and the remainder of the report filed.
34
35   Council on Medical Education Report 3, Physician Lifelong Learning, summarizes the
36   requirements for lifelong learning across the medical education continuum; discusses
37   the possible barriers to physicians acquiring the skills and engaging in the activities that
38   characterize lifelong learning; and identifies a general approach to addressing the
39   barriers. The report proposes solutions to better prepare physicians for ongoing self-
40   assessment and lifelong learning.
41
42   Your Reference Committee heard testimony all in support of this report.
                                                               Reference Committee C (A-08)
                                                                                    Page 5


 1   (3)    COUNCIL ON MEDICAL EDUCATION REPORT 7 -
 2          DIVERSITY IN THE PHYSICIAN WORKFORCE AND
 3          ACCESS TO CARE
 4
 5          RECOMMENDATION:
 6
 7          Mr. Speaker, your Reference Committee recommends that
 8          the recommendations in Report 7 of the Council on
 9          Medical Education be adopted and the remainder of the
10          report be filed.
11
12             HOD ACTION: Council on Medical Education adopted and
13             the remainder of the report filed.
14
15   Council on Medical Education Report 7, Diversity in the Physician Workforce and Access
16   to Care, summarizes current data about diversity and distribution in the physician
17   workforce, as well as the status and impact of initiatives to enhance physician workforce
18   diversity and access to care in underserved areas. The report recommends continued
19   advocacy efforts for programs, adequate funding, and a centralized database of
20   scholarship and loan repayment programs. Lastly, the report recommends that our AMA
21   continue to study factors related to choice of practice in underserved areas with a report
22   back to the House of Delegates.
23
24   Your Reference Committee heard strong support for adoption. Testimony noted that
25   diversity has many facets, including economic, cultural, racial, ethnic, and sexual
26   orientation, as well as others. While your Reference Committee is sensitive to this
27   perspective, the Committee did not believe it was necessary to elaborate on the word
28   “diversity.”
29
30   (4)    COUNCIL ON MEDICAL EDUCATION REPORT 10 -
31          INDEPENDENT REGULATION OF PHYSICIAN
32          LICENSING EXAMS
33
34          RECOMMENDATION:
35
36          Mr. Speaker, your Reference Committee recommends that
37          the recommendations in Council on Medical Education
38          Report 10 be adopted and that the remainder of the report
39          be filed.
40
41             HOD ACTION: Council on Medical Education Report 10
42             adopted as amended with the addition of a sixth
43             recommendation and the remainder of the report filed.
44
45             6. That our AMA work with American Osteopathic
46                Association and National Board of Osteopathic Medical
47                Examiners to stay apprised of any major potential
48                changes in the Comprehensive Osteopathic Medical
49                Licensing Examination (COMLEX).
                                                               Reference Committee C (A-08)
                                                                                    Page 6


 1   Council on Medical Education Report 10, Independent Regulation of Physician Licensing
 2   Exams, describes the membership of the organizations that sponsor and govern the
 3   United States Medical Licensing Examination (USMLE). In addition, information about
 4   the structure and composition of the organizations and their committees which provide
 5   oversight for the licensure exams administered to nurses, pharmacists, dentists, and
 6   clinical social workers is presented.
 7
 8   Your Reference Committee heard strong support for the report from both the Council on
 9   Medical Education and the Federation of State Medical Boards. Both stressed that the
10   governance of the USMLE is diverse and that there are multiple opportunities to provide
11   feedback to the USMLE test development process. Collegiality and collaboration
12   between the two organizations was also emphasized. Both the Resident and Fellow
13   Section (RFS) and the Medical Student Section (MSS) supported the report but had
14   reservations that the document did not provide adequate discussion of possible external
15   oversight mechanisms. Your Reference Committee also had a lengthy and spirited
16   discussion and came to the conclusion that, based on the independent nature of the
17   USMLE, no additional oversight is possible. Therefore, your Reference Committee
18   recommends adoption of the report as written.
19
20   (5)    COUNCIL ON MEDICAL EDUCATION REPORT 12 -
21          OBSERVERSHIPS FOR INTERNATIONAL MEDICAL
22          GRADUATES (RESOLUTION 308, A-07)
23
24          RECOMMENDATION:
25
26          Mr. Speaker, your Reference Committee recommends that
27          the recommendation in Council on Medical Education
28          Report 12 be adopted and the remainder of the report be
29          filed.
30
31             HOD ACTION: Council on Medical Education Report 12
32             adopted and the remainder of the report filed.
33
34   Council on Medical Education Report 12, Observerships for International Medical
35   Graduates describes the need for educational programs to assist IMGs in preparing to
36   enter residency training in the US health care system and the role the AMA is well-
37   positioned to play with external groups. The report recommends the development of
38   guidelines for observership programs including educational objectives and a model
39   curriculum; identification of informational materials to address the objectives; and
40   creation of materials related to legal, organizational, and operational issues for program
41   implementation.
42
43   Your Reference Committee heard testimony in support of the need for defined and
44   carefully structured observership programs to be created for international medical
45   graduates. Concern was expressed that the report did not explicitly define the
46   guidelines for such programs. However, the Council on Medical Education and the
47   International Medical Graduates Section stated that the report is meant to be a first step
48   that would allow the collaborative development of such desired guidelines.
                                                              Reference Committee C (A-08)
                                                                                   Page 7



 1   (6)    COUNCIL ON MEDICAL EDUCATION REPORT 14 -
 2          EMPLOYMENT BENEFITS FOR RESIDENTS AND
 3          FELLOWS (RESOLUTION 309, A-07)
 4
 5          RECOMMENDATION:
 6
 7          Mr. Speaker, your Reference Committee recommends that
 8          the recommendations in Council on Medical Education
 9          Report 14 be adopted in lieu of Resolution 309, A-07, and
10          that the remainder of the report be filed.
11
12             HOD ACTION: Council on Medical Education Report 14
13             adopted in lieu of Resolution 309, A-07, and the remainder
14             of the report filed.
15
16   Council on Medical Education Report 14, Employment Benefits for Residents and
17   Fellows, was prompted by Resolution 309, A-07, that asked our AMA to encourage
18   equal and same benefit options for resident and fellow physician employees as
19   compared to other hospital employees with regard to health care, insurance and
20   retirement benefits. However, residents and fellows, as both learners and service
21   providers, are likely not to be in the same employee classification as other hospital
22   employees, and may be in a unique classification and it may not be feasible to determine
23   equality in benefit options. More importantly, it may not be in the best interests and
24   could be detrimental for resident to advocate such equality, as it could result in a
25   reduction to current benefits that resident and fellows receive. Therefore, CME Report
26   14 recommends that our AMA, through its appropriate sections, study the status of
27   employment benefits offered to residents and fellows and report back to the 2010 Annual
28   meeting.
29
30   Your Reference Committee heard testimony in strong support of this resolution from the
31   Resident and Fellow Section that had sponsored Resolution 309, A-07, and other groups
32   who testified.
33
34   (7)    RESOLUTION 301 - SUPPORT FOR THE EPIDEMIC
35          INTELLIGENCE SERVICE (EIS) PROGRAM AND
36          PREVENTIVE MEDICINE RESIDENCY EXPANSION
37
38          RECOMMENDATION:
39
40          Mr. Speaker, your Reference Committee recommends that
41          Resolution 301 be adopted.
42
43             HOD ACTION: Resolution 301 adopted.
44
45   Resolution 301, Support for the Epidemic Intelligence Service (EIS) Program and
46   Preventive Medicine Residency Expansion, introduced by the American College of
47   Preventive Medicine, asks our AMA work to support increased federal funding for
48   training of public health physicians through the Epidemic Intelligence Service Program
                                                               Reference Committee C (A-08)
                                                                                    Page 8


 1   and work to support increased federal funding for preventive medicine residency training
 2   programs.
 3
 4   Your Reference Committee heard unanimous and eloquent testimony describing the
 5   importance and the contribution that the nearly 3,000 EIS Officers have made since
 6   1951 to the advancement of medical and public health science, of the need of increased
 7   funding for this critical program, and in support of this resolution.
 8
 9   (8)    RESOLUTION 309 - INCREASING MEDICAL SCHOOL
10          CLASS SIZES
11
12          RECOMMENDATION:
13
14          Mr. Speaker, your Reference Committee recommends that
15          Resolution 309 be adopted.
16
17             HOD ACTION: Resolution 309 adopted.
18
19   Resolution 309, Increasing Medical School Class Sizes, introduced by the Medical
20   Student Section, asks our AMA to support increasing the number of medical students,
21   provided that such expansion would not jeopardize the quality of medical education.
22
23   Your Reference Committee heard general testimony in support of the intent of the
24   resolution. However, a number of individuals noted that an increase in medical school
25   class size alone will not necessarily result in an overall increase in the number of
26   practicing physicians. An increase in the number of residency training positions will also
27   be needed. Our AMA already is involved in advocacy to support increasing funding for
28   residency positions. At the 2007 Interim Meeting, the AMA House of Delegates
29   reaffirmed D-310.971 which supported the passage of pending and future legislation that
30   will increase residency positions throughout many states while not undermining funding
31   for existing residency positions in any of the states.
32
33   (9)    RESOLUTION 311 - CREDENTIALING MATERIALS:
34          TIMELY SUBMISSION BY RESIDENCY AND
35          FELLOWSHIP PROGRAMS
36
37          RECOMMENDATION:
38
39          Mr. Speaker, your Reference Committee recommends that
40          Resolution 311 be adopted.
41
42             HOD ACTION: Resolution 311 adopted.
43
44   Resolution 311, Credentialing Materials: Timely Submission by Residency and
45   Fellowship Programs, introduced by the New York Delegation, asks our AMA to
46   encourage residency programs and fellowship programs to properly complete and
47   promptly submit verification of resident education/training on credentialing and re-
48   credentialing forms to the requesting agency within thirty days of the request. The
49   resolution also asks our AMA to encourage the Accreditation Council for Graduate
50   Medical Education to add to the accreditation standards for residency and fellowship
                                                                Reference Committee C (A-08)
                                                                                     Page 9


 1   programs and to the Institutional Program Requirements the requirement of the proper
 2   completion and prompt submission of verification of resident education/training on
 3   credentialing and re-credentialing forms to the requesting agency within thirty days of the
 4   request.
 5
 6   Your Reference Committee heard testimony in support of the resolution from its author
 7   and others. It was pointed out that the two resolves of Resolution 311 were an
 8   improvement to those of Resolution 312, A-07 (with the same title) that had been
 9   adopted by the House of Delegates in June 2007 because it applies to all residents
10   regardless of year of graduation (not simply “graduating residents and fellows”).
11
12   (10)   RESOLUTION 324 - COMPETITION FOR CLINICAL
13          TRAINING SITES
14
15          RECOMMENDATION:
16
17          Mr. Speaker, your Reference Committee recommends that
18          Resolution 324 be adopted.
19
20             HOD ACTION: Resolution 324 adopted.
21
22   Resolution 324, Competition for Clinical Training Sites, introduced by the Section on
23   Medical Schools, asks our AMA, through the Council on Medical Education, to conduct
24   an analysis of the adequacy of clinical training sites and to study the impact of the
25   growing pressure, including political and financial, to accommodate clinical training in
26   U.S. hospitals for U.S. citizen international medical students.
27
28   Your Reference Committee heard testimony that medical school expansion inside and
29   outside of the United States has put increasing pressure on the availability of sites for
30   medical student clinical training. The Council on Medical Education will be presenting a
31   report on this topic at the 2008 Interim Meeting. The report will summarize current and
32   projected data on availability of training positions for US medical students in the context
33   of both offshore medical school expansion and expansion in the training programs for
34   other health professionals.
35
36   (11)   BOARD OF TRUSTEES REPORT 19 - GENDER
37          DISPARITIES IN PHYSICIAN INCOME AND
38          ADVANCEMENT
39
40          RECOMMENDATION A:
41
42          Mr. Speaker, your Reference Committee recommends that
43          Report 19 of the Board of Trustees be amended by
44          insertion of a new Recommendation 5 to read as follows:
45
46          5. That our AMA provide training on leadership
47             development, contract and salary negotiations and
48             career advancement strategies, to combat gender
49             disparities as a member benefit.
                                                               Reference Committee C (A-08)
                                                                                   Page 10


 1          RECOMMENDATION B:
 2
 3          Mr. Speaker, your Reference Committee recommends that
 4          the recommendations in Board of Trustees Report 19 be
 5          adopted as amended and the remainder of the report be
 6          filed.
 7
 8               HOD ACTION: Board of Trustees Report 19 adopted as
 9               amended and the remainder of the report filed.
10
11   Board of Trustees Report 19, Gender Disparities in Physician Income and Advancement,
12   reviews the literature on gender-based practice/professional differences. The report
13   discusses the underlying causes and contributing factors to gender disparities and
14   recommends that the AMA and the profession continue to study these issues and
15   provide information and physician support for achieving equity in the profession.
16
17   Your Reference Committee heard enthusiastic support for this report. The Board of
18   Trustees and the Women Physician Congress were highly commended for their
19   collaborative effort. Testimony indicated that the additional recommendation regarding
20   leadership development would strengthen this excellent report even more.
21
22   (12)   COUNCIL ON MEDICAL EDUCATION REPORT 4 -
23          EDUCATIONAL IMPLICATIONS OF THE MEDICAL
24          HOME MODEL
25
26          RECOMMENDATION A:
27
28          Mr. Speaker, your Reference Committee recommends that
29          recommendation 2 of Council on Medical Education Report
30          4 be amended by insertion and deletion on page 6, lines
31          44-45 to read as follows:
32
33          2.    That our AMA ask the Liaison Committee on Medical
34                Education and the Accreditation Council for Graduate
35                Medical Education to review their accreditation
36                standards to assure that the accreditation process
37                facilitates so as not to impede education in and about
38                the PC-MH model.
39
40          RECOMMENDATION B:
41
42          Mr. Speaker, your Reference Committee recommends that
43          the Recommendation 3 of Council on Medical Education
44          Report 4 be amended by deletion on page 7, lines 1-2:
45
46          3.    That our AMA advocate for public (federal and state)
47                and private payers to develop reimbursement
48                systems to fit practice in the PC-MH model.
49                (Directive to Take Action)
                                                              Reference Committee C (A-08)
                                                                                  Page 11


 1          RECOMMENDATION C:
 2
 3          Mr. Speaker, your Reference Committee recommends that
 4          the recommendations in Council on Medical Education
 5          Report 4 be adopted as amended and the remainder of the
 6          report be filed.
 7
 8             HOD ACTION: Council on Medical Education Report 4
 9             adopted as amended and the remainder of the report filed.
10
11   Council on Medical Education Report 4, Educational Implications of the Medical Home
12   Model, describes the educational implications of the “medical home” concept and the
13   chronic care model, as well as AMA efforts to work collaboratively with other
14   organizations to bring substantive improvements to medical education across the
15   continuum aimed at enhancing physician and health system performance. A number of
16   curricula and initiatives that have been developed to assist in the implementation of the
17   PC-MH and chronic care models are also identified.
18
19   Your Reference Committee heard testimony from several sections and caucuses in
20   broad general support of the concepts identified in Council on Medical Education Report
21   4. However, since there are multiple demonstration projects underway to assess the
22   financial requirements and efficiencies of the PC-MH, several groups recommended
23   deleting the language calling for “public and private payers to develop reimbursement
24   systems”.        In addition, much testimony supported the substitute wording in
25   recommendation 2 to provide the medical education community with the time and
26   flexibility to develop educational standards for such settings.
27
28   (13)   COUNCIL ON MEDICAL EDUCATION REPORT 5 -
29          ENFORCEMENT OF DUTY HOURS STANDARDS AND
30          IMPROVING RESIDENT, FELLOW AND PATIENT
31          SAFETY (RESOLUTION 305, A-07)
32          RESOLUTION 318 - PROTECTING PATIENTS AND
33          RESIDENTS BY REDUCING EXTENDED WORK SHIFTS
34
35          RECOMMENDATION A:
36
37          Mr. Speaker, your Reference Committee recommends that
38          Recommendation 1 of Council on Medical Education
39          Report 5 be amended by insertion on page 6, line 35 to
40          read as follows:
41
42          1. That our American Medical Association reaffirm
43             support of the current Accreditation Council for
44             Graduate Medical Education duty hour standards.
45             while opposing any new ACGME mandates at this
46             time. (Directive to Take Action)
                                                        Reference Committee C (A-08)
                                                                            Page 12


 1   RECOMMENDATION B:
 2
 3   Mr. Speaker, your Reference Committee recommends that
 4   Recommendation 4 of Council on Medical Education
 5   Report 5 be amended by deletion on page 7, lines 3-4 to
 6   read as follows:
 7
 8   4.   That our AMA review, evaluate, and publicize the
 9        work of the ACGME Committee on Innovation, in
10        particular its pilot projects related to duty hours, and
11        encourage participation by ACGME Residency
12        Review Committees and residency programs in these
13        and other efforts towards innovation and improvement
14        in graduate medical education and patient safety, to
15        include the voluntary reduction or elimination of
16        extended work shifts (>16 hours). (Directive to Take
17        Action)
18
19   RECOMMENDATION C:
20
21   Mr. Speaker, your Reference Committee recommends that
22   Recommendation 6 of Council on Medical Education
23   Report 5 be amended by insertion on page 7, line 12 to
24   read as follows:
25
26   6. That our AMA encourage publication of studies about
27      the effects of duty hour standards, extended work
28      shifts, hand offs and continuity of care procedures, and
29      sleep deprivation and fatigue on patient safety, medical
30      error, resident well-being, and resident learning
31      outcomes, and disseminate study results to GME
32      designated institutional officials (DIOs), program
33      directors, resident/fellow physicians, attending faculty,
34      and others. (Directive to Take Action)
35
36   RECOMMENDATION D:
37
38   Mr. Speaker, your Reference Committee recommends that
39   the recommendations in Council on Medical Education
40   Report 5 be amended by insertion of a tenth
41   recommendation to read as follows:
42
43   10. That our AMA urges the ACGME and AOA to
44       decrease the barriers to reporting duty hour violations
45       and resident intimidation. (Directive to Take Action)
                                                                 Reference Committee C (A-08)
                                                                                     Page 13


 1          RECOMMENDATION E:
 2
 3          Mr. Speaker, your Reference Committee recommends that
 4          the recommendations in Council on Medical Education
 5          Report 5 be adopted as amended in lieu of Resolution 318
 6          and that the remainder of the report be filed.
 7
 8             HOD ACTION: Council on Medical Education Report 5
 9             adopted as amended in lieu of Resolution 318 and the
10             remainder of the report filed.
11
12   Council on Medical Education Report 5, Enforcement of Duty Hours Standards and
13   Improving Resident, Fellow and Patient Safety (Resolution 305, A-07), describes the
14   enforcement and impact of the Accreditation Council for Graduate Medical Education
15   duty hour standards as they relate to the larger issue of the optimal learning environment
16   for residents. The report also discusses the creation of an anonymous system for
17   reporting duty hour violations and resident intimidation, a system to protect
18   whistleblowers from retaliation; the development of a pamphlet on such violations; and a
19   proposal for the ACGME and AOA to create a system of incentives and disincentives for
20   programs to comply with the requirements. The report concludes with a series of
21   recommendations designed to provide a balance between resident education, patient
22   care, quality and safety to create the most effective learning environment possible.
23
24   Resolution 318, Protecting Patients and Residents by Reducing Extended Work Shifts,
25   introduced by the Resident and Fellow Section, asks our AMA to: 1) reaffirm support of
26   the current Accreditation Council for Graduate Medical Education (ACGME) duty hour
27   restrictions (Reaffirm HOD Policy); 2) encourage the voluntary reduction or elimination of
28   extended work shifts (greater than 16 hours) for residents and fellows by academic
29   medical centers and teaching hospitals while opposing a new ACGME mandate at this
30   time; 3) continue to evaluate outcomes-based research on the impact of reductions in
31   extended work shifts on patient safety, resident education, resident safety, resident
32   quality of life, and professionalism in transfer of care; and 4) develop specific prioritized
33   research questions/objectives to further evaluate issues related to resident duty-hour
34   reforms, such as best practices for signing out patients and organizing patient care
35   teams.
36
37   Your Reference Committee heard general support for this Council report. Amendments
38   were offered in the spirit of improving the report. The Resident and Fellow Section
39   offered amendments that led to Recommendations A and D and spoke in support of
40   adopting this report in lieu of their Resolution 318.
41
42   Several surgical groups spoke in opposition to the elimination of extended (>16 hour)
43   work shifts, noting that several surgical specialties have very long procedures and
44   continuity of care requirements. Furthermore several speakers pointed out that the duty
45   hour limits have been in place for less time than the length of their surgical residency
46   training programs and the data have not demonstrated that there have been
47   improvements in either surgical training or patient safety. This led your Reference
48   Committee to offer Recommendations B and C.
                                                                Reference Committee C (A-08)
                                                                                    Page 14



 1   (14)   COUNCIL ON MEDICAL EDUCATION REPORT 6 -
 2          PHYSICIAN REENTRY
 3
 4          RECOMMENDATION A:
 5
 6          Mr. Speaker, your Reference Committee recommends that
 7          Recommendation 3 in Council on Medical Education
 8          Report 6 be amended by insertion and deletion on page 8,
 9          line 32 to read as follows:
10
11          3. That our AMA support efforts work with interested
12             parties to establish a physician reentry program
13             (PREP) information data base that is publicly
14             accessible to physician applicants and which includes
15             information pertaining to program characteristics.
16             (Directive to Take Action)
17
18          RECOMMENDATION B:
19
20          Mr. Speaker, your Reference Committee recommends that
21          the recommendations contained in Council on Medical
22          Education Report 6 be adopted as amended and the
23          remainder of the report be filed.
24
25             HOD ACTION: Council on Medical Education Report 6
26             adopted as amended and the remainder of the report filed.
27
28   Council on Medical Education Report 6, Physician Reentry, discusses the need for and
29   barriers to physician reentry programs; defines reentry and related terms; provides
30   information on existing physician reentry programs in the United States; discusses state
31   reentry guidelines; presents alternatives to reentry; provides information on the work by
32   key organizations on the issue of reentry; and presents guiding principles, priorities, next
33   steps and offers recommendations.
34
35   Your Reference Committee heard considerable testimony, all unanimously supportive of
36   this report. The Council on Medical Education stressed that this was the first of several
37   reports as part of the Initiative to Transform Medical Education, and that future reports
38   would deal with the issues of physician remediation and physician retraining. The
39   Federation of State Medical Boards also offered support for the report and its
40   recommendations.       A suggestion was made that the database referred to in
41   recommendation 3 needs to have an organizational sponsor, and because of the
42   collaborative nature of this initiative, the words, “work with interested parties,” were
43   added to the third recommendation.
                                                                Reference Committee C (A-08)
                                                                                    Page 15


 1   (15)   COUNCIL ON MEDICAL EDUCATION REPORT 8 - ONE-
 2          YEAR PUBLIC HEALTH TRAINING OPTIONS FOR ALL
 3          SPECIALTIES
 4
 5          RECOMMENDATION A:
 6
 7          Mr. Speaker, your Reference Committee recommends that
 8          the recommendations in Council on Medical Education
 9          Report 8 be amended by insertion of a third
10          recommendation to read as follows:
11
12          3.       That AMA Policy D-305.974, Funding for
13                   Preventive Medicine Residencies be reaffirmed.
14
15          RECOMMENDATION B:
16
17          Mr. Speaker, your Reference Committee recommends that
18          the recommendations in Council on Medical Education
19          Report 8 be adopted as amended and the remainder of the
20          report to be filed.
21
22               HOD ACTION: Council on Medical Education Report 8
23               adopted as amended and the remainder of the report filed.
24
25   Council on Medical Education Report 8, One-Year Public Health Training Options for All
26   Specialties, responds to a request made by the House of Delegates at the 2007 Annual
27   Meeting, asking the AMA, through its Council on Medical Education, to monitor the
28   progress of the Institute of Medicine (IOM) study, Training Physicians for Public Health
29   Careers, and provide an updated report based on the IOM study recommendations.
30
31   Your Reference Committee heard eloquent and compelling testimony unanimously in
32   support of this report and on the importance of producing well-trained public health
33   physicians that will be able to address the public health needs of our society. In addition,
34   your Reference Committee heard testimony on the desirability of reaffirming current
35   AMA policy in support of funding for Preventive Medicine Residencies which reads “Our
36   AMA will work with the American College of Preventive Medicine, other preventive
37   medicine specialty societies, and other allied partners, to formally support legislative
38   efforts to fund preventive medicine training programs. (Resolution 324, A-05.”)
                                                                Reference Committee C (A-08)
                                                                                    Page 16



 1   (16)   COUNCIL ON MEDICAL EDUCATION REPORT 11 -
 2          IMPROVING PARENTAL LEAVE POLICIES FOR
 3          RESIDENTS AND FELLOWS (RESOLUTION 303, A-07)
 4          RESOLUTION 316 - LOSS OF STATUS FOLLOWING
 5          FAMILY MEDICAL LEAVE ACT QUALIFIED LEAVE
 6          DURING RESIDENCY TRAINING
 7
 8          RECOMMENDATION A:
 9
10          Mr. Speaker, your Reference Committee recommends that
11          recommendation 1 in Council on Medical Education Report
12          11 be amended by insertion and deletion on line 18 of
13          page 6 to read as follows:
14
15          1. That our American Medical Association encourage the
16             Accreditation Council of Graduate Medical Education
17             to study the feasibility of requiring training institutions
18             to offer paid maternity FMLA-qualified leave for
19             residents of no less than six weeks duration, and to
20             permit unpaid maternity FMLA-qualified leave of an
21             additional six weeks.
22
23          RECOMMENDATION B:
24
25          Mr. Speaker, your Reference Committee recommends that
26          recommendation 2 in Council on Medical Education Report
27          11 be amended by deletion and insertion on page 6 line 24
28          to read as follows:
29
30          2. That our AMA propose to the American Board of
31             Medical Specialties member boards that they
32             standardize their policies regarding parental leave,
33             absence from training, and the timing of entrance into
34             the board certification examination process, so that at
35             a minimum, all residents are allowed six weeks
36             absence of training for parental FMLA-qualified leave
37             per academic year without disproportionately
38             increasing the length of training, or postponing
39             certification.
                                                                Reference Committee C (A-08)
                                                                                    Page 17



 1          RECOMMENDATION C:
 2
 3          Mr. Speaker, your Reference Committee recommends that
 4          recommendation 4 in Council on Medical Education Report
 5          be amended on line 32 of page 6 by deletion and insertion
 6          to read as follows:
 7
 8           4. That our AMA convene a group of appropriate
 9              interested parties, including the ACGME and the
10              ABMS, to discuss options for standardization of
11              parental FMLA-qualified leave policies that would not
12              disproportionately increase length of training or result
13              in postponement of certification.
14
15          RECOMMENDATION D:
16
17          Mr. Speaker, your Reference Committee recommends that
18          the recommendations in Council on Medical Education
19          Report 11 be adopted as amended in lieu of Resolution
20          316 and that the remainder of the report be filed.
21
22          RECOMMENDATION E:
23
24          Mr. Speaker, your Reference Committee recommends that
25          the title of Council on Medical Education Report 11 be
26          changed to read as follows:
27
28          FAMILY AND MEDICAL LEAVE ACT POLICIES FOR
29          RESIDENTS AND FELLOWS
30
31             HOD ACTION: Council on Medical Education Report 11
32             adopted as amended in lieu of Resolution 316 and the
33             remainder of the report filed.
34
35   Council on Medical Education Report 11, Improving Parental Leave Policies for
36   Residents and Fellows (Resolution 303, A-07), describes current federal law (specifically
37   the Family Medical Leave Act), institutional requirements of the ACGME, AMA policies,
38   prevailing trends in US employment, common medical leave configurations of health
39   care institutions, and training duration specifications as set forth by the member boards
40   of the American Board of Medical Specialties. The recommendations in the report asks
41   the AMA to study and encourage the participation of the Accreditation Council for
42   Graduate Medical Education’s (ACGME) the American Board of Medical Specialties
43   (ABMS) in such study of 1) the feasibility of considering guaranteed paid maternity leave
44   for residents of no less than six weeks duration, with the possibility of unpaid maternity
45   leave of an additional six weeks; 2) written leave policies for residents for paternity and
46   adoption; and 3) the effect of such maternity, paternity, and adoption leave policies on
47   residency programs.
                                                               Reference Committee C (A-08)
                                                                                   Page 18


 1   Resolution 316, Loss of Status Following Family Medical Leave Act Qualified Leave
 2   During Residency Training, introduced by the Resident and Fellow Section, asks our
 3   AMA to oppose requiring residents to repeat a year of training when returning to work
 4   following a leave that qualifies under the federal Family Medical Leave Act. The
 5   resolution also asks our AMA to urge the American Board of Medical Specialties and its
 6   member boards to be in compliance with the FMLA and to retract any policies that do not
 7   comply.
 8
 9   The Family and Medical Leave Act (FMLA) guarantees to eligible employees a total of
10   12 weeks of unpaid leave during a 12-month period for one or more of the following
11   reasons:
12
13         the birth of a child of the employee
14         the adoption of a child by the employee
15         to care for an immediate family member with a serious health condition or,
16         for the employee to take medical leave
17
18   Your Reference Committee heard consistent and enthusiastic support for this report.
19   The Resident and Fellow section supported this report in lieu of their Resolution 316.
20   The amendments are offered by the Reference Committee so that the recommendations
21   apply to all FMLA-qualified leave.
22
23   (17)   COUNCIL ON MEDICAL EDUCATION REPORT 13 -
24          FINANCIAL CONFLICTS IN CME
25          (RESOLUTION 310, A-07)
26
27          RECOMMENDATION A:
28
29          Mr. Speaker, your Reference Committee recommends that
30          the Recommendation in Council on Medical Education
31          Report 13 be amended by insertion on line 9 to read as
32          follows:
33
34          That our American Medical Association continue to monitor the implementation of
35          the Accreditation Council for Continuing Medical Education 2004 Standards for
36          Commercial Support and report to the House of Delegates any major evidence
37          that these requirements are or are not effective in ensuring the independence of
38          or adversely impact the availability of continuing medical education. (Directive to
39          Take Action)
40
41          RECOMMENDATION B:
42
43          Mister Speaker, your Reference Committee recommends
44          that the recommendation contained in Council on Medical
45          Education Report 13 be adopted as amended and the
46          reminder of the report be filed.
47
48             HOD ACTION: Council on Medical Education Report 13
49             adopted as amended and the reminder of the report filed.
                                                                  Reference Committee C (A-08)
                                                                                      Page 19


 1
 2   Council on Medical Education Report 13, Financial Conflicts in CME, responds to
 3   Resolution 310, A-07, which asked our AMA to work with the Accreditation Council for
 4   Continuing Medical Education (ACCME) to develop more specific disclosure criteria for
 5   financial conflicts that include a written statement, current at the time of publication of the
 6   program and included in the program, quantifying in broad categories the size of the
 7   conflict of interest in the last twelve calendar months. The Council on Medical Education
 8   did not find evidence in the literature to support the course of action suggested by the
 9   resolution. The Council recommends instead continued monitoring of the implementation
10   of the ACCME Standards for Commercial Support and a report to the House of
11   Delegates if any major evidence exists that these requirements are not effective in
12   ensuring the independence of or adversely impact the availability of continuing medical
13   education.
14
15   Your Reference Committee heard testimony in support of the Council on Medical
16   Education Report and of the current process in place to address conflicts of interest.
17   There was also testimony to more accurately reflect the intent of the recommendation by
18   amending the wording. Only one person testified in opposition to the recommendation.
19
20   (18)   RESOLUTION 305 - OPPOSE DISCRIMINATION IN
21          RESIDENCY SELECTION BASED ON LOCATION OF
22          MEDICAL SCHOOL
23
24          RECOMMENDATION A:
25
26          Mr. Speaker, your Reference Committee recommends that
27          the following Substitute Resolution 305 be adopted:
28
29          RESOLVED, That our American Medical Association
30          request that the Accreditation Council for Graduate
31          Medical Education include in the Institutional Requirements
32          a requirement that will prohibit a program or an institution
33          from having a blanket policy to not interview, rank
34          or accept international medical graduate applicants.
35          (Directive to Take Action); and be it further
36
37          RESOLVED, That our AMA recognize that the assessment
38          of the individual international medical graduate residency and
39          fellowship applicant should be based on his/her education
40          and experience. (New HOD Policy); and be it further
41
42          RESOLVED, That our AMA disseminate this new policy on
43          opposition to discrimination in residency selection based on
44          international medical graduate status to the graduate medical
45          education community through AMA mechanisms. (Directive to Take Action)
46
47          RECOMMENDATION B:
48
49          Mr. Speaker, your Reference Committee recommends that
50          Substitute Resolution 305 be titled:
                                                              Reference Committee C (A-08)
                                                                                  Page 20



 1          OPPOSE DISCRIMINATION IN RESIDENCY SELECTION
 2          BASED ON INTERNATIONAL MEDICAL GRADUATE
 3          STATUS
 4
 5             HOD ACTION: Substitute Resolution 305 adopted with a
 6             change in title.
 7
 8   Resolution 305, Oppose Discrimination in Residency Selection Based on Location of
 9   Medical School, introduced by the Michigan Delegation, asks our AMA to lobby the
10   Accreditation Council for Graduate Medical Education to include international medical
11   graduates in its list of prohibited discriminations.
12
13   Testimony pointed out that there are many different approaches to residency selection
14   based on the quality of the applicants education and experience. To address this
15   concern the Substitute Resolution was proposed. The sponsors of the resolution were
16   supportive of this change.
17
18   (19)   RESOLUTION 307 - STUDENT LOAN EMPOWERMENT
19
20          RECOMMENDATION A:
21
22          Mr. Speaker, your Reference Committee recommends that
23          Resolution 307 be amended by insertion and deletion on
24          lines 22 and 23 to read as follows:
25
26          RESOLVED, That our American Medical Association
27          support legislation that requires a requirement that medical
28          schools to inform students of all government loan
29          opportunities along with private loans, and requires
30          disclosure of reasons that preferred lenders were chosen.
31          (New HOD Policy)
32
33          RECOMMENDATION B:
34
35          Mr. Speaker, your Reference Committee recommends that
36          Resolution 307 be adopted as amended.
37
38             HOD ACTION: Resolution 307 adopted as amended.
39
40   Resolution 307, Student Loan Empowerment, introduced by the Medical Student
41   Section, asks our AMA to support legislation that requires medical schools to inform
42   students of all government loan opportunities along with private loans, and requires
43   disclosure of the reasons that preferred lenders were chosen.
44
45   Your Reference Committee heard testimony that was generally in support of the intent of
46   the resolution. Transparency is important. However, there was concern expressed that
47   legislation would not be the appropriate way to accomplish the desired objective.
48   Instead, medical schools should be responsible for providing the information to students.
                                                               Reference Committee C (A-08)
                                                                                   Page 21


 1   (20)   RESOLUTION 308 - ENCOURAGEMENT OF
 2          INTERPROFESSIONAL EDUCATION AMONG HEALTH
 3          CARE PROFESSIONS STUDENTS
 4
 5          RECOMMENDATION A:
 6
 7          Mr. Speaker, your Reference Committee recommends that
 8          the first resolve in Resolution 308 be amended by deletion
 9          on line 26 to read as follows:
10
11          RESOLVED, That our American Medical Association recognize that
12          interprofessional education and partnerships are a top priority of the
13          American medical education system. (New HOD Policy)
14
15          RECOMMENDATION B:
16
17          Mr. Speaker, your Reference Committee recommends that
18          Resolution 308 be adopted as amended.
19
20             HOD ACTION: Resolution 308 adopted as amended.
21
22   Resolution 308, Encouragement of Interprofessional Education Among Health Care
23   Professions Students, introduced by the Medical Student Section, asks our AMA to: 1)
24   recognize that interprofessional education and partnerships are a top priority of the
25   American medical education system; and 2) explore the feasibility of the implementation
26   of the Liaison Committee on Medical Education and the American Osteopathic
27   Association accreditation standards requiring interprofessional training in medical
28   schools.
29
30   Your Reference Committee heard testimony that interprofessional education could
31   enhance the development of useful competencies, such as communication skills and
32   systems based practice. There are successful models of interprofessional education
33   that achieve these aims. While this is an important issue, it should not be considered a
34   “top” priority. There was some concern voiced that interprofessional education might
35   confuse the public about the appropriate roles for individuals from various health
36   professions. Your Reference Committee agrees that the intent of the resolution is
37   education and that it does not touch on issues related to scope of practice.
38
39   (21)   RESOLUTION 310 - SOLUTIONS TO TACKLING THE
40          INCREASING COST OF MEDICAL EDUCATION
41
42          RECOMMENDATION A:
43
44          Mr. Speaker, your Reference Committee recommends that
45          the following Substitute Resolution 310 be adopted.
                                                               Reference Committee C (A-08)
                                                                                   Page 22


 1          RESOLVED, That our American Medical Association
 2          encourage the development of policies by Liaison
 3          Committee on Medical Education- and American
 4          Osteopathic Association-accredited medical schools that
 5          ensure information on the use of funds from tuition and fee
 6          increases is disclosed in a standardized format and in a
 7          timely manner to prospective and current medical students.
 8          (Directive to Take Action)
 9
10          RECOMMENDATION B:
11
12          Mr. Speaker, your Reference Committee recommends that
13          Substitute Resolution 310 be titled:
14
15          TRANSPARENCY IN MEDICAL SCHOOLS’ UTILIZATION
16          OF FUNDS FROM TUITION AND FEE INCREASES
17
18             HOD ACTION: Substitute Resolution 310 adopted with a
19             change in title.
20
21   Resolution 310, Solutions to Tackling the Increasing Cost of Medical Education,
22   introduced by the Medical Student Section, asks our AMA to support policies that ensure
23   that funding gained by medical schools from all future increases to medical school tuition
24   and fees be allocated directly to improve the education of medical students. The
25   resolution also asks our AMA to support policies that ensure that all information related
26   to the allocation of funds from tuition and fee increases be disclosed to all prospective
27   and current medical students for each respective medical school campus.
28
29   Your Reference Committee heard testimony that it is critical to build transparency into
30   the process of allocating funds from tuition and fees. Medical school financing is
31   complex, but medical students should be informed of how tuition dollars are spent.
32   Testimony noted, however, that the cost of educating a medical student exceeds
33   revenue from tuition. Therefore, your Reference Committee did not want funding to
34   improve the educational program to be limited to increases in revenue from tuition, as
35   could be implied from the original first Resolved.
36
37   (22)   RESOLUTION 315 - EVALUATION OF INCREASING
38          RESIDENT REVIEW COMMITTEE REQUIREMENTS
39
40          RECOMMENDATION A:
41
42          Mr. Speaker, your Reference Committee recommends that
43          the resolve in Resolution 315 be amended by insertion on
44          lines 14-15 to read as follows:
45
46          That our American Medical Association work with and
47          monitor the Accreditation Council for Graduate Medical
48          Education and American Osteopathic Association in studying
49          residency/fellowship   documentation      requirements   for
50          program accreditation and the impact of these documentation
                                                              Reference Committee C (A-08)
                                                                                  Page 23


 1          requirements on program directors and residents with
 2          recommendation for improvement.
 3
 4          RECOMMENDATION B:
 5
 6          Mr. Speaker, your Reference Committee recommends that
 7          Resolution 315 be adopted as amended.
 8
 9             HOD ACTION: Resolution 315 adopted as amended.
10
11   Resolution 315, Evaluation of Increasing Resident Review Committee Requirements,
12   introduced by the Resident and Fellow Section, asks our AMA to study
13   residency/fellowship documentation requirements for program accreditation and the
14   impact of these documentation requirements on program directors and residents with
15   recommendations for improvement.
16
17   Your Reference Committee heard testimony that it would be more appropriate for the
18   ACGME to assess the impact of their documentation requirements for program
19   accreditation requirements on program directors and residents. In addition, adopting this
20   resolution as amended would reduce the fiscal impact of an independent AMA study
21   from $38,602 to under $500.
22
23   (23)   RESOLUTION 317 - TELEMEDICINE AND MEDICAL
24          LICENSURE
25
26          RECOMMENDATION A:
27
28          Mr. Speaker, your Reference Committee recommends that
29          Resolution 317 be amended by insertion on line 37 to read
30          as follows:
31
32          RESOLVED, That our American Medical Association work
33          with the Federation of State Medical Boards to study how
34          guidelines regulating medical licenses are affected by
35          telemedicine and medical technological innovations that
36          allow for physicians to practice outside their states of
37          licensure. (Directive to Take Action)
38
39          RECOMMENDATION B:
40
41          Mr. Speaker, your Reference Committee recommends that
42          Resolution 317 be adopted as amended.
43
44             HOD ACTION: Resolution 317 adopted as amended.
45
46   Resolution 317, Telemedicine and Medical Licensure, introduced by the Resident and
47   Fellow Section, asks our AMA to study how guidelines regulating medical licenses are
48   affected by telemedicine and medical technological innovations that allow for physicians
49   to practice outside their states of licensure.
                                                                Reference Committee C (A-08)
                                                                                    Page 24


 1   Your Reference Committee heard considerable testimony from the Federation of State
 2   Medical Boards (FSMB) which described two current initiatives that facilitate license
 3   portability. The FSMB is are committed to finding solutions that allow physicians to
 4   practice across state boundaries without compromising the level of public protection.
 5   They also expressed support for research and collaboration with the AMA in this area.
 6   Our Council on Medical Education also encouraged the AMA to work with the FSMB and
 7   the sponsors of the resolution, the Resident and Fellow Section, concurred with that
 8   recommendation. An update or report on this should be prepared by A-10.
 9
10   (24)   RESOLUTION 319 - MEDICAL EDUCATION IN
11          DISASTER RESPONSE
12
13          RECOMMENDATION A:
14
15          Mr. Speaker, your Reference Committee recommends that
16          Resolution 319 be amended by insertion and deletion on
17          lines 14-15, to read as follows:
18
19          RESOLVED, That our American Medical Association study
20          the current status of disaster preparedness education and
21          training in medical schools, with report back to the House of
22          Delegates at A-09, and in graduate medical education
23          programs, and continuing medical education, with a report
24          back to the House of Delegates at the 2009 2010 Annual
25          Meeting. (Directive to Take Action)
26
27          RECOMMENDATION B:
28
29          Mr. Speaker, your Reference Committee recommends that
30          Resolution 319 be adopted as amended.
31
32             HOD ACTION: Resolution 319 adopted as amended.
33
34   Resolution 319, Medical Education in Disaster Response, introduced by the South
35   Carolina Delegation and the American College of Surgeons, asks our AMA to study the
36   current status of disaster education and training in medical schools, with a report back at
37   the 2009 Annual Meeting.
38
39   Your Reference Committee heard testimony that all physicians need to be prepared to
40   respond in disaster situations. The current extent of education is unknown. Many
41   individuals testifying before the Reference Committee stated that the study of education
42   should not be limited only to what occurs during medical school. Because of expansion
43   of the scope of the study, and its increasing complexity, your Reference Committee
44   recommends changing the date for the report to the House of Delegates to 2010.
                                                                Reference Committee C (A-08)
                                                                                    Page 25


 1   (25)   RESOLUTION 321 - PROMOTION OF BETTER PAIN
 2          CARE
 3
 4          RECOMMENDATION A:
 5
 6          Mr. Speaker, your Reference Committee recommends that
 7          the second resolve in Resolution 321 be amended by
 8          insertion and deletion on lines 20-26 to read as follows:
 9
10          RESOLVED, That our AMA encourage relevant specialties
11          to collaborate in studying Board of Trustees undertake a
12          study and report back by the 2009 Annual Meeting about
13          the following: (1) the scope of practice and body of
14          knowledge encompassed by the specialty field of pain
15          medicine; (2) the adequacy of undergraduate, graduate
16          and post graduate education in the principles and practice
17          of the specialty field of pain medicine, considering the
18          current and anticipated medical need for the delivery of
19          quality pain care; and (3) appropriate training and
20          credentialing criteria for this multidisciplinary subspecialty
21          field of medical practice; and 4) convening a meeting of
22          interested parties to review all pertinent matters scientific
23          and socioeconomic. (Directive to Take Action)
24
25          RECOMMENDATION B:
26
27          Mr. Speaker, your Reference Committee recommends that
28          Resolution 321 be adopted as amended.
29
30             HOD ACTION: Resolution 321 adopted as amended.
31
32   Resolution 321, Promotion of Better Pain Care, introduced by the California Delegation,
33   asks our AMA to undertake a study and report back at the 2009 Annual Meeting on: 1)
34   the scope of practice and body of knowledge encompassed by the specialty of pain
35   medicine; 2) the adequacy of education in the principles of practice of the specialty of
36   pain medicine; and 3) the advisability of pursuing primary board certification in pain
37   medicine available to physicians qualified by training and examination.
38
39   Your Reference Committee heard testimony supportive of the first resolve. Testimony
40   indicated that the AMA does not define fields of medical practice, which is in the purview
41   of the respective medical specialty societies and medical specialty boards. It was also
42   stated that this could set a precedent for other fields of practice to request a similar
43   study. In addition, testimony was heard that a multi-specialty group is already in place to
44   study this issue. Therefore, your Reference Committee amended the second Resolved
45   to reflect that ongoing work.
                                                              Reference Committee C (A-08)
                                                                                  Page 26


 1   (26)   RESOLUTION 323 - IMPROVEMENTS TO THE
 2          MAINTENANCE OF CERTIFICATION PROCESS
 3
 4          RECOMMENDATION A;
 5
 6          Mr. Speaker, your Reference Committee recommends that
 7          Resolution 323 be amended by deletion of item G on lines
 8          34-36 as follows:
 9
10          Coordinate with the Accreditation Council for Continuing
11          Medical Education (ACCME) to develop continuing medical
12          education (CME) credits for MOC preparation activities.
13          (Directive to Take Action)
14
15          RECOMMENDATION B:
16
17          Mr. Speaker, your Reference Committee recommends that
18          Resolution 323 be adopted as amended.
19
20             HOD ACTION: Resolution 323 adopted as amended.
21
22   Resolution 323, Improvements to the Maintenance of Certification Process, introduced
23   by the Young Physicians Section, asks our AMA Board of Trustees to write a letter, by
24   September 15, 2008, to the American Board of Medical Specialties (ABMS) asking the
25   ABMS to work with its 24 member boards to: A) to coordinate with specialty societies
26   and the AMA to ensure that demands of MOC are reasonable; B) increase physicians
27   understanding of the MOC process; C) solicit physician input and feedback on MOC
28   implementation; D) make recertification-related costs transparent; E) minimize disruption
29   of practice due to MOC requirements; F) ensure that the number of MOC-related testing
30   dates and locations are adequate; and G) work with the Accreditation Council for
31   Continuing Medical Education (ACCME) to develop CME credits for MOC preparation.
32
33   Your Reference Committee heard testimony consistently supportive of the entire
34   resolution except for item G. The Accreditation Council for Continuing Medical
35   Education (ACCME) accredits the providers of continuing medical education but does
36   not develop criteria or provide credit for continuing medical education activities.
37   Therefore, Item G is recommended for deletion.
38
39   (27)   RESOLUTION 327 - ELIMINATING DISPARITIES IN
40          LICENSURE FOR IMG PHYSICIANS
41
42          RECOMMENDATION A:
43
44          Mr. Speaker, your Reference Committee recommends that
45          the second resolve in Resolution 327 be amended by
46          deletion on lines 17-19 to read as follows:
47
48          RESOLVED, That our AMA give a status report on existing
49          licensure disparities to the House of Delegates every three
50          years until this disparity is eliminated by all states.
                                                                Reference Committee C (A-08)
                                                                                    Page 27


 1          (Directive to Take Action)
 2
 3          RECOMMENDATION B:
 4
 5          Mr. Speaker, your Reference Committee recommends that
 6          Resolution 327 be adopted as amended.
 7
 8             HOD ACTION: Resolution 327 adopted as amended.
 9
10   Resolution 327, Eliminating Disparities in Licensure for IMG Physicians, introduced by
11   the International Medical Graduates Section, asks our AMA to advocate and assist the
12   state medical societies to seek legislative action eliminating any disparity in the years of
13   graduate medical education required for full and unrestricted licensure between IMG and
14   LCME graduates and to give a status report on existing licensure disparities to the
15   House of Delegates every three years until this disparity is eliminated by all states.
16
17   Limited testimony reflected that the first resolve is a reaffirmation of existing AMA policy
18   but a definitive solution has not yet occurred. Additional attention needs to be drawn to
19   the issue. Deletion of the second resolve is recommended because a status report was
20   deemed not to be of significant benefit.
21
22   (28)   RESOLUTION 302 - RECOGNITION OF OSTEOPATHIC
23          EDUCATION AND TRAINING
24
25          RECOMMENDATION:
26
27          Mr. Speaker, your Reference Committee recommends that
28          Resolution 302 be referred.
29
30             HOD ACTION: Resolution 302 referred.
31
32   Resolution 302, Recognition of Osteopathic Education and Training, introduced by the
33   American Orthopaedic Foot and Ankle Society, asks our AMA to recognize the current
34   similarities in the accreditation and certification systems for allopathic and osteopathic
35   physicians and encourage greater collaboration between and mutual recognition of
36   education, training, and board certification systems.
37   Your Reference Committee heard testimony that expressed a wide range of opinions on
38   this resolution and described some of the complexities associated with it. The testimony
39   also included information on the work done by other organizations, such as the
40   Association of American Medical Colleges (AAMC) and the Liaison Committee on
41   Medical Education, regarding the similarities, but also differences, between allopathic
42   and osteopathic education. There was also a call for dialogue among organizations such
43   as our AMA, the AAMC, the American Osteopathic Association and the American
44   Association of Colleges of Osteopathic Medicine. Therefore, your Reference Committee
45   recommends that this resolution be referred.
                                                              Reference Committee C (A-08)
                                                                                  Page 28


 1   (29)   RESOLUTION 304 - MEDICAL STUDENT DEBT CRISIS
 2          RESOLUTION 313 - ALTERNATIVE APPROACHES TO
 3          DEALING WITH MEDICAL SCHOOL TUITION COSTS
 4          AND STUDENT INDEBTEDNESS
 5          RESOLUTION 320 – TAX DEDUCTIBILITY OF MEDICAL
 6          EDUCATION
 7
 8          RECOMMENDATION:
 9
10          Mr. Speaker, your Reference Committee recommends that
11          Resolutions 304, 313 and 320 be referred.
12
13             HOD ACTION: Resolutions 304, 313 and 320 referred.
14
15   Resolution 304, Medical Student Debt Crisis, introduced by the Michigan Delegation,
16   asks our AMA to pursue long-term debt solutions to the student debt crisis by hiring an
17   economic consulting firm to analyze the feasibility of novel solutions described in the
18   resolution.
19
20   Resolution 313, Alternative Approaches to Dealing with Medical School Tuition Costs
21   and Student Indebtedness, introduced by the Pennsylvania Delegation, asks our AMA,
22   through the Council on Medical Education and the Initiative to Transform Medical
23   Education, to study the applicability of novel models such as using endowment funds to
24   lessen the impact of educational costs on medical students, develop policy
25   recommendations, and suggest a work plan for how these models can be implemented
26   by medical schools, with a report back at 2009 Annual Meeting. The resolution further
27   asks our AMA to work with stakeholders such as the Liaison Committee on Medical
28   Education, the Association of American Medical Colleges, and all US medical schools, to
29   implement solutions based on novel models such as using endowment funds to
30   minimize student indebtedness, and provide an update on the status of these efforts at
31   the 2010 Annual Meeting and periodically thereafter.
32
33   Resolution 320, Tax Deductibility of Medical Education, introduced by the South Carolina
34   Delegation, asks our AMA to advocate that payments for medical education tuition or
35   medical education loans be deductible for US federal income tax purposes. The
36   resolution further asks our AMA to continue to work to make medical education
37   affordable for and accessible to all qualified and interested individuals.
38
39   Your Reference Committee heard considerable testimony about the seriousness of the
40   debt crisis facing medical students and young physicians. The mechanisms listed in
41   these resolutions are multi-faceted and complex, and would benefit from in-depth study.
42   Therefore, your Reference Committee recommends that Resolutions 304, 313 and 320
43   be referred together as the basis for a study that will result in a comprehensive set of
44   innovative and broad-based strategies to address the issue of medical student debt.
                                                               Reference Committee C (A-08)
                                                                                   Page 29


 1   (30)   RESOLUTION 314 - PHYSICIAN SCIENTIST BENEFIT
 2          EQUITY
 3
 4          RECOMMENDATION:
 5
 6          Mr. Speaker, your Reference Committee recommends that
 7          Resolution 314 be referred.
 8
 9             HOD ACTION: Resolution 314 referred.
10
11   Resolution 314, Physician Scientist Benefit Equity, introduced by the Resident and
12   Fellow Section, asks our AMA to support the concept that all resident and fellow
13   physicians who function in a role as physician scientists are provided with benefits
14   packages comparable to those provided to their peers in clinical residencies or
15   fellowships, to include disability insurance, life insurance, HIV indemnity, malpractice
16   insurance including tail coverage, retirement benefits, health, sick leave and wages
17   commensurate with their education and experience, and if a given benefit or salary is
18   provided to some residents within a given program at the same postgraduate level, then
19   that benefit must be provided to all residents.
20
21   Your Reference Committee heard extensive testimony regarding the complexity of the
22   issues that are referenced in this resolution. They include, but are not limited to, the
23   sources of funding, which can be different for physician scientists than for residents and
24   fellows, payroll issues that may be different depending on the employer, and the benefit
25   packages available. While supportive of the ideals behind the resolution, the
26   recommendation by the speakers was that the resolution be referred, a recommendation
27   that was agreeable to the sponsors of the resolution. Therefore, your Reference
28   Committee recommends that this resolution be referred.
29
30   (31)   RESOLUTION 306 - WAIVER OF US MEDICAL
31          LICENSING EXAMINATION STEP 2-CS
32          REQUIREMENTS
33
34          RECOMMENDATION:
35
36          Mr. Speaker, your Reference Committee recommends that
37          Resolution 306 not be adopted.
38
39             HOD ACTION: Resolution 306 not adopted.
40
41   Resolution 306, Waiver of US Medical Licensing Examination Step 2-CS Requirements,
42   introduced by the Michigan Delegation, asks our AMA to lobby the United States Medical
43   Licensing Examination to allow the Educational Commission for Foreign Medical
44   Graduates (ECFMG) certificate holders who started their residency training before
45   January 1, 2005, to be eligible to sit for Step 3 without having to take Step 2-CS.
46
47   Your Reference Committee heard testimony that this resolution applies to a very small
48   fraction of individuals who started residency programs before July 1, 1998. At that time,
49   there was a 7 year window of opportunity to complete the examination and that window
50   closed in 2005. Since that date was 1998, the information had been widely
                                                                Reference Committee C (A-08)
                                                                                    Page 30


 1   disseminated, and this would involve creating a special exception to the ECFMG rules,
 2   your Reference Committee recommends non-adoption.
 3
 4   (32)   RESOLUTION 312 - STUDY OF THE IMPACT OF
 5          MEDICAL EDUCATION ON PATIENT SAFETY
 6
 7          RECOMMENDATION:
 8
 9          Mr. Speaker, your Reference Committee recommends that
10          Resolution 312 not be adopted.
11
12             HOD ACTION: Resolution 312 not adopted.
13
14   Resolution 312, Study of the Impact of Medical Education on Patient Safety, introduced
15   by the Pennsylvania Delegation, asks our AMA work with the federal government to
16   update the 1986 study by the US Congressional Office of Technology Assessment on
17   the impact of physician education versus nurse practitioner or physician assistant
18   education on patient welfare and safety.
19
20   Your Reference Committee heard limited testimony in support of the resolution and one
21   suggestion that it be referred. However, further testimony pointed out that the federal
22   office that originally wrote the study in 1986 has been out of existence since 1995 and it
23   is unclear whether there are any federal agencies that have assumed that responsibility.
24   Therefore, your Reference Committee recommends that the Resolution not be adopted.
25
26   (33)   RESOLUTION 326 - IMGS ON STATE MEDICAL
27          LICENSING BOARDS
28
29          RECOMMENDATION:
30
31          Mr. Speaker, your Reference Committee recommends that
32          Resolution 326 not be adopted.
33
34             HOD ACTION: Resolution 326 not adopted.
35
36   Resolution 326, IMGs on State Medical Licensing Boards, introduced by the
37   International Medical Graduates Section, asks our AMA and the IMG Section to draft a
38   letter to all state medical licensing boards and Governors recommending proportional
39   representation of IMGs and other minorities on their state medical licensing boards.
40
41   Your Reference Committee heard strong opposition to this resolution. Since most state
42   medical licensing boards are appointed by their respective governors, implementation of
43   the resolution was believed to be unworkable. In addition, the mission of the state
44   medical licensing boards is to protect the health and welfare of the patients in that state,
45   not to proportionally represent physicians.
                                                               Reference Committee C (A-08)
                                                                                   Page 31


 1   (34)   RESOLUTION 325 - LICENSING FOR QUALIFIED
 2          PHYSICIANS ON CASE BY CASE BASIS
 3
 4          RECOMMENDATION:
 5
 6          Mr. Speaker, your Reference Committee recommends that
 7          HOD policy H-255.982, Equality in Licensure and
 8          Reciprocity be reaffirmed in lieu of Resolution 325.
 9
10             HOD ACTION: HOD Policy H-255.982, Equality in Licensure
11             and Reciprocity reaffirmed in lieu of Resolution 325.
12
13   Resolution 325, Licensing for Qualified Physicians on Case by Case Basis, introduced
14   by the International Medical Graduates Section, asks our AMA to lobby all state medical
15   boards to assure that licensing decisions on applications of physicians already licensed
16   in another state are based on the physician’s medical qualifications and not on the
17   location of the physician’s medical school.
18
19   Your Reference Committee heard testimony regarding the development of licensing
20   legislation and rules among the different licensing jurisdictions and common threats such
21   as educational and ethical standards. The testimony, while generally supportive of some
22   of the sentiments expressed in the resolution, pointed out that the issues raised were
23   already addressed by existing AMA policy H-255.982 that states as follows:
24
25   Our AMA (1) reaffirms its policy that it is inappropriate to discriminate against any
26   physician because of national origin or geographical location of medical education; (2)
27   continues to recognize the right and responsibility of states and territories to determine
28   the qualifications of individuals applying for licensure to practice medicine within their
29   respective jurisdictions; and (3) supports the development and distribution of model
30   legislation to encourage states to amend their Medical Practice Acts to provide that
31   graduates of foreign medical schools shall meet the same requirements for licensure by
32   endorsement as graduates of accredited US and Canadian schools.
33
34   Therefore, your Reference Committee recommends that current policy be reaffirmed in
35   lieu of the original resolve.
36
                                                           Reference Committee C (A-08)
                                                                               Page 32


1   Mr. Speaker, this concludes the report of Reference Committee C. I would like to thank
2   Melissa B. Behringer, MD, Joshua M. Cohen, MD, Harry S. Jonas, MD, Jerry
3   McLaughlin, MD, Alik S. Widge, PhD, Baligh R. Yehia, MD, and all those who testified
4   before the Committee.




    Melissa B. Behringer, MD (Alternate)          Jerry McLaughlin, MD
    Alabama                                       New Mexico




    Joshua M. Cohen, MD                           Alik S. Widge, PhD (Alternate)
    New York                                      Pennsylvania




    Harry S. Jonas, MD                            Baligh R. Yehia, MD
    American College of Obstetricians and         Maryland
    Gynecologists



                                                  David M. Lichtman, MD
                                                  American Society for Surgery of the
                                                  Hand
                                                  Chair

								
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