It's not unusual for July's return to refocus attention on medical education issues. As a new class of interns and residents begin their rotation, familiar themes draw new attention.


There is the perennial issue of the "July Effect," which postulates increased medical errors in teaching hospitals in this period. A 2007 study found a 41-percent increased risk for mortality early in the academic year versus the final months in academic medical centers, though the etiologies were undefined.1 Last year, another group's review of 300,000-plus Medicare surgery cases found July to be as safe as any other month in teaching hospitals.2 This month comes another study that documents a 10-percent spike in fatal medication errors in teaching hospitals in July and in no other month.3


Clearly, a period of changeover in any institution is fraught with potential dangers and opportunities. Our health-care system is poised to undergo as significant a changeover as anyone can remember, though it will take years, not months to play out. That's why another take on medical education that appeared this month deserves attention.


Researchers at George Washington University looked at the performance of U.S. medical schools, not by the usual metrics such as research dollars, reputation and student selectivity, but by what they term "the social mission of medical education."4


This ranking consists largely of the percentage of graduates an institution produces who practice in three areas that have been defined as concerns as early the 1950s: those in primary care; those in geographic areas with shortages of health professionals; and members of underserved minorities.


The findings suggest that the schools that historically rank highest in the more commonly measured aspects tend to cluster at the bottom of the social mission ranking. Not surprising. To some degree, it's a matter of what society wants its medical schools to do.


What's interesting is that there are notable exceptions at either end of the spectrum. There are major institutions in terms of NIH funding and the like that also are fulfilling their social mission. Similarly, there are community based public medical schools that would seem well-situated to fulfill the social mission but do not. As the authors suggest, the opportunity is to identify the schools that defy the trends and determine whether their success can be transferred to other schools. As we transition into a new health-care system, the need to address these critical social issues will only increase.


1. Ann Surg 2007 Sep;246(3):456-62

2. Ann Surg 2009 June;249(6):871-876

3. J Gen Intern Med 2010 May 29. [epub ahead of print].

4. Ann Intern Med 2010;152:804-811.