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AMA Meeting Reignites Excitement

Passion of interim meeting reaffirms commitment to organized medicine By Katy March

The 2013 Interim Meeting of the American Medical Association (AMA) recently convened in National Harbor, Maryland. Medical students, residents, fellows, and physicians assembled to discuss proposed policy changes and learn about the current state of health care. The opening House of Delegates session is personally one of my favorite parts. It brings me back to my very first House meeting where I stood in awe while 1,000 physicians surrounded me and sang our National Anthem, their voices combined and filling the room.

That moment sets the tone for a meeting in which we will share our concerns, discuss our differences of opinion, but in the end reach an agreement on how to proceed for the good of our patients and for the good of our chosen profession. The opening session also re-ignites excitement over what the AMA is really doing. Hearing updates on the strategic plan, on discussions with legislators, and the work of the AMA Foundation and Alliance reaffirms my commitment to staying involved with organized medicine. Our strength in numbers  certainly allows us to achieve all of these great things.

The House heard several key updates. The Council on Ethical and Judicial Affairs held a special session to discuss the modernization of the AMA’s Code of Medical Ethics. Currently entering the final stage of the project, the newly updated Code will be available for review and comment by AMA members beginning this December. Next, the delegates received a much-anticipated update on the repeal of the Sustainable Growth Rate (SGR) formula for Medicare reimbursement. With strong bipartisan, bicameral support for repeal of the SGR, along with the lowest cost projections for repeal in years, the AMA leadership emphasized the importance of SGR repeal now. The House also reaffirmed its strong support for SGR repeal and its goals of aligning proposed legislation with current AMA policy.

The AMA created numerous policies on topics ranging from residency training to drug abuse. Several policies were adopted regarding the use and availability of medications and directed the Council on Science and Public Health to report at each meeting the state of drug shortages. They also ask the Joint Commission to evaluate its accreditation standard for pain management, and for policy to address opioid-associated overdoses and death. In response to reports of patients who have received termination notices for existing insurance policies, the AMA voted to support timely efforts to maintain coverage and facilitate a smooth transition to alternative insurance options.

From the medical student perspective, we had numerous successes ranging from firearm safety in undergraduate education to evidence-based guidelines for athletic organizations on the management of concussions, to privacy issues on explanation of benefits for minors. An issue of particular interest brought forth by the Medical Student Section was the U.S. Medical Licensure Exam Step 2 Clinical Skills. The Step 2 CS exam is currently a requirement for medical school graduation, residency selection, and medical licensure.

Originally proposed to evaluate the competency of international medical graduates for their ability to practice in the United States, the test evolved into a requirement for U.S. medical graduates starting in 2004. The test is currently administered to fourth-year medical students and international medical graduates at only five testing centers in the U.S., at a cost of $1,200. With a pass/fail grading system and a 98% passage rate by first-time test takers from Liaison Committee on Medical Education (LCME) accredited U.S. and Canadian medical schools, many students questioned whether or not the benefit of this exam justified the cost.

Not only do medical students pay the high cost of the exam, but they also have the travel expense associated with testing because of the limited number of testing sites. As a result, many students use student loans to cover the financial burden, which ends up increasing the cost of the exam in the long run secondary to interest accrued. Additionally, the exam is graded on a pass/fail system without feedback to students, leading to questions about the exam’s value.

Currently, both the LCME and the Commission on Osteopathic College Accreditation require medical schools to evaluate student clinical skills as part of their curriculum. I would argue that these skills ideally should be fostered, evaluated, and remediated in the medical school setting. As such, the Step 2 CS exam should be thoroughly evaluated. The AMA House agreed and voted to direct the AMA to study the cost/value equation, benefits, and consequences of the implementation for licensure, as well as the barriers to more meaningful feedback.

I look forward to reading the report on the Step 2 CS exam and following up on other policies we passed. Maybe we will even be celebrating an SGR repeal at the next AMA meeting. Either way, if you haven’t participated in an AMA meeting, please consider joining us.

Katy March is a fourth-year medical student at Rush Medical College.

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