Issue link: https://beckershealthcare.uberflip.com/i/759111
48 CMO / CARE DELIVERY 27. Valproate should not be prescribed for mental disorders to preg- nant women or those planning a pregnancy. e drug should only be used in these cases if other treatments have been resisted or in high risk clinical situations. 28. CT or MRI scans are not necessary when psychosis is diagnosed unless specific indications of signs or symptoms suggest neurologi- cal problems. 29. Chemotherapy should be minimized in advanced cancer treat- ment if it is unlikely to be beneficial and may cause harm. 30. Imaging is not necessary for minor head injuries. 31. Uncomplicated back pain does not require imaging, unless asso- ciated with "red flags" or radicolupathy. 32. Routine scanning aer cancer treatment is only necessary when beneficial to the patient. 33. Patients at high risk of death or severely impaired functional re- covery should not go on life support. Comfort should be prioritized. 34. Routine tests and investigations are unnecessary and should only be used to answer specific questions. 35. Blood transfusions are not necessary when hemoglobin is above 70 g/L, unless the patient is unstable or actively bleeding. 36. Deep sedation is unnecessary for patients who are mechanically ventilated. 37. Abnormal vaginal discharge caused by thrush or bacterial vagi- nosis, when occuring in a woman at low risk for a sexually transmit- ted infection, does not require a vaginal swab. 38. A woman with recurrent thrush should not be given additional courses of treatment. Instead, a skin examination should be con- ducted to determine if she has allergies, lack of estrogen or another condition. 39. Women over the age of 45 with typical symptoms of menopause do not require bloods tests to check hormone levels. 40. Women who have a copper intrauterine device or hormonal in- trauterine system do not need professional advice unless they cannot feel the threads hanging from the device. n AMA Reveals Latest in Medical Education Reform: New Pillar of Study, New Textbook By Emily Rappleye T he American Medical Association unveiled a formal- ized strategy on Nov. 1 to revamp medical education, complete with a textbook to support the emerging curriculum. The new strategy adds a third area of study to medical ed- ucation: health systems science. This third pillar, which will be added to basic and clinical science, covers value-based care, patient safety, quality improvement, teamwork, lead- ership, clinical informatics, population health, socioecolog- ical determinants of health, healthcare policy and health- care economics. "We know that the way healthcare is being delivered is changing, but until now those changes have not been widely incorporated into the way we teach our physicians. Our medical schools are very good at preparing students for the basic and clinical sciences that are paramount to providing care to patients, but what is largely missing is how to deliver that care in a complex health system," AMA CEO James Madara, MD, said in a statement. The curriculum is the result of the work of 32 medical schools around the country that received grants to push the bound- aries of medical education under the AMA's Accelerating Change in Medical Education program. The impetus behind the program was "to have these schools innovate, collabo- rate and rethink medical education from the ground up," Dr. Madara said during a media conference. The textbook for health systems science was written by the consortium's 11 founding schools. The book will be available to all medical schools mid-December, but many consortium schools have already begun teaching with it, including Penn State College of Medicine in Hershey, Pa., and Brown University's Warren Alpert Medical School in Providence, R.I. Penn State began its systems navigation curriculum in fall 2014 with the help of $1 million in funding from the AMA, according to Jed Gonzalo, MD, associate dean for health systems education. This longitudinal curriculum focused on population health, social determinants of health and the leadership processes of healthcare delivery — topics which were not taught in depth at Penn State before, Dr. Gonzalo said. Penn State also developed a year-long opportunity to embed students as patient navigators. The school is now working to extend these curricular components to third and fourth year medical students and into its other grad- uate programs. Brown University's Warren Alpert Medical School used its $1 million grant to develop a primary care/population medicine program, which allows students to earn a dual medical degree and master's degree in four years. The school ultimately plans to roll out similar programs for spe- cialties beyond primary care, according to Jeff Borkan, MD, PhD, assistant dean for primary care-population medicine program planning at Brown. The idea is to prepare future physicians to better under- stand how patients receive and access care. It aims to help students "hit the ground running to handle the business side of healthcare, in addition to knowing how to diagnose and treat patients," said AMA Vice President for Medical Ed- ucation Outcomes Susan Skochelak, MD. n