How can engaged patients improve health care? BUSM's Suzanne Mitchell, MD, and other...
Intimate partner violence (IPV) is a significant health issue faced by women veterans, but little has been known up until now about their preferences for IPV-related care. A new study has found that most of these women support routine screening for IPV and want options, follow-up support, transparent documentation and Veterans Health Administration (VHA) and community resources. These findings appear in the journal Research in Nursing and Health.
Although women of all socio-demographic groups are at risk for IPV, population-based research suggests that women veterans are at higher risk for IPV than non-veteran women. In order to better understand their attitudes and preferences regarding IPV screening and response issues, five focus groups were conducted with 24 female patients of the Veterans Health Administration (VHA) with and without a lifetime history of IPV.
“In general, we found that women veterans support routine IPV screening and comprehensive IPV-related care within the VHA,” explained corresponding author Katherine Iverson, PhD, assistant professor of psychiatry at Boston University School of Medicine (BUSM) and a clinical research psychologist at the VA Boston Healthcare System and the VA’s National Center for PTSD. “As we move forward with routine IPV screening, it is important that these women are offered options in terms of what, how, when, and to whom to disclose and follow-up support. In addition, these women must be approached with sensitivity and connectedness with the understanding that different patients are in different stages of recovery.”
Overall, women indicated that the HITS screening tool [the four-item screening tool (Hurt/Insult/Threaten/Scream) tested by Iverson and her colleagues that can be used in under four minutes] could be useful in helping VHA providers identify women who have experienced IPV. Using the existing clinical reminder dialogue system a notification could be imbedded into a patients’ electronic medical records (EMR’s) to use HITS to assess IPV, ensuring that screening is occurring. This would be similar to clinical EMRs for mammograms and pap smears.
The researchers point out that use of EMRs may be a potential barrier to disclose for some women because of privacy and confidentiality concerns. Study participants suggested that this barrier can be overcome by providers’ use of transparency with respect to documentation. For example, providers can talk with their patients about what they would like to document in the EMR and problem-solve any concerns the patients may raise. In addition, providers can discuss privacy protections in place at VHA and engage patients in conversations about the advantages and disadvantages of documentation. EMRs can also prompt providers to engage in other procedures that were recommended by participants in this study, such as offering information about VHA and community resources.
The researchers believe the VHA has a timely opportunity and is well-positioned to serve as a national model for the implementation of best practices for IPV screening and response. “By incorporating the recommendations expressed by women in this study, VHA and other health care providers may increase the likelihood of identifying IPV, improve patient satisfaction with care, connect veterans with the services they need, reduce healthcare costs to the patient and system at large, and ultimately improve the health and well-being of female veteran patients,” added Iverson.
This research was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development (HSR&D) as part of Iverson’s HSR&D Career Development Award (CDA-2; 10-029) and the BUSM Lynne Stevens Award, which Iverson received in 2011.
Robert Stern, PhD, professor of neurology, neurosurgery, and anatomy & neurobiology at BU School of Medicine as well as co-founder of BU’s Center for the Study of Traumatic Encephalopathy, testified before the U.S. Senate’s Special Committee on Aging at the June 25 hearing, “State of Play: Brain Injuries and Diseases of Aging.”
Stern, who is also Director of the Clinical Core of the BU Alzheimer’s Disease Center, gave an overview of the long-term consequences of repetitive brain trauma in athletes, in particular, chronic traumatic encephalopathy or CTE. CTE has been found in individuals, including youth, college, and professional contact sport athletes (including football, hockey, soccer, and rugby players), military service members exposed to blast trauma and other brain injuries, and others with a history of repetitive brain trauma.
He explained that although little is known about CTE what studies have shown thus far is that, in some individuals, early repetitive brain trauma triggers events in the brain leading to progressive destruction of the brain tissue including the build-up of an abnormal protein called tau, one of the abnormal proteins also seen in Alzheimer’s disease.
According to Stern, the ability to diagnose CTE during life is the next critical step in the study of CTE. He believes it will lead to the ability to answer important questions about this disease, such as: How common is CTE? What are the risk factors for CTE? Can it be prevented? How can we treat it? “At this point, we actually know very little about this disease, however one thing we do know about CTE is that every case of post-mortem diagnosed CTE has had one thing in common: a history of repetitive brain trauma,” Stern testified.
BU School of Medicine is participating in the American Association of Medical Colleges (AAMC) Faculty Forward Engagement Survey to benchmark our faculty members’ engagement levels with peer institutions, and to provide data for us to enhance our efforts to attract, retain, support and advance our faculty.
Who is eligible: All full time and part time faculty members at BUSM
When: June 24 launch
How: You will receive an email from the AAMC with a personalized link to the Survey
Confidentiality assured: The AAMC’s staff administers all aspects of the Survey
Please share your views candidly to help us understand how you view specific BUSM institutional policies and practices and prioritize key workplace issues that are important to our faculty.
For questions or concerns, contact Robina Bhasin.
Please participate in this important initiative!
Richard Babayan, MD, professor and chair of Urology at Boston University School of Medicine (BUSM) and chief of the department of urology at Boston Medical Center (BMC), has been elected president of the American Urological Association (AUA). He is the first Boston urologist to be elected national AUA president since 1988.
This three-part role begins May 2015 when Babayan will be named president elect of the association. From May 2016-17, he will assume the presidency and preside over the AUA Annual Meeting that will be held in Boston. Finally, he will serve as past president from May 2017-18.
Babayan has previously served in both local and national urological associations. He was the president of the Massachusetts Association of Practicing Urologists from 2012-14 and the New England Section representative to the AUA Board of Directors from 2005-09. In 2011, the AUA Leadership Program and Board of Directors honored him with a Distinguished Service Award.
Babayan has been actively involved in minimally invasive therapies within the field of urology. His clinical interests include benign prostatic hyperplasia, prostate cancer, urologic oncology and endourology. He performed the first robot assisted radical prostatectomy in Boston and is currently one of three urologic surgeons at BMC using the daVinci Robot for minimally invasive procedures.
After earning his medical degree from Indiana University School of Medicine, Babayan completed his surgical training at Yale-New Haven Hospital and a urology residency at the former University Hospital, now BMC. Babayan also served as an AUA Research Scholar working in the field of hyperthermia at both the Massachusetts Institute of Technology and BUSM. He joined the BUSM faculty in 1980 and has been chairman of Urology since 2000.
Donald Hess, MD, FACS, was appointed the Program Director of the Boston University School of Medicine (BUSM) Surgery Residency Program. Hess is currently an assistant professor of surgery at BUSM and the chief of the Section of Minimally Invasive and Weight Loss Surgery at Boston Medical Center (BMC).
His clinical practice is devoted to minimally invasive and bariatric surgery. He has tremendous surgical expertise in laparoscopic bariatric surgery (sleeve gastrectomy, gastric banding and gastric bypass) and revisional bariatric surgery. He also has an interest in minimally invasive surgery, robotic surgery, surgery for disease of the stomach and esophagus, intestinal surgery, single-site surgery, complex hernia surgery and general surgery.
He is a member of the Association of Metabolic and Bariatric Surgeons, the Society of American Gastrointestinal and Endoscopic Surgeons and a fellow of the American College of Surgeons (ACS). He has been recognized by Boston Magazine’s “Top Docs” issue for being “top” in his respective field four years in a row and was a 2013 recipient of the BUSM Evans Center Collaborator of the Year Award.
Hess is a graduate of Williams College in Williamstown, Mass. and received his medical degree from the University of Rochester School of Medicine and Dentistry in Rochester, N.Y. He completed a residency in general surgery at Beth Israel Deaconess Medical Center and a fellowship in Surgical Oncology at New England Deaconess Hospital, both in Boston. He joined BUSM after working for the U.S. Air Force as an assistant professor of surgery stationed at Wright-Patterson Air Force Base in Ohio.
A better understanding of how the transcription factor Peroxisome Proliferator-Activated Receptor Gamma (PPARgamma) works is critical to find new ways to improve medications to treat type 2 diabetes. Drugs that activate PPARgamma, called thiazolidinediones (TZDs), have long been regarded as a treatment for type 2 diabetes based on their anti-inflammatory and potent insulin-sensitizing activity. When taken orally, TZDs help decrease insulin resistance. However, most medications in that class have now been withdrawn from the market, or severely limited in their usage, given their dangerous side effects, which include weight gain, water retention and heart failure.
One promising approach to target PPARgamma to treat the issues related to type 2 diabetes is to dissect the regulatory strategies that control different subsets of PPARgamma target genes in cells. The ultimate goal would be to target the “negative” side of PPARgamma activity without impacting on the “good” ones.
A recent study led by BUSM researchers, published in Cell Reports, identifies one such strategy regulating fat tissue activity and PPARgamma in adipose cells. It is based on a group of cellular factors that bind to DNA and help PPARgamma in the regulation of a specific subset of target genes, including enzymes important for the mobilization of lipids.
“There is a great need to develop new treatments for people with type 2 diabetes,” said Valentina Perissi, PhD, assistant professor of biochemistry at BUSM and the study’s corresponding author. “Targeting PPARgamma still represents a powerful approach, however we need to further improve our understanding of PPARgamma function and how its activity is regulated in normal cells in order develop more effective treatments.”
To view the full study, visit http://www.cell.com/cell-reports/abstract/S2211-1247(14)00435-5
Throughout the 2013-14 academic year, Boston University School of Medicine (BUSM) faculty were honored for their research, clinical expertise, contributions to their profession and community service. Scientific scholarship conducted by BUSM researchers was cited around the world and garnered national and international media attention. More than 100 faculty members as well as the Department of Pediatrics received local, regional and national honors this year.
In addition, 68 BUSM faculty members from 32 different disciplines were included in Boston Magazine’s annual list of Top Docs 2013. To read the full listing of BMC Top Docs, click here.
The Department of Pediatrics received the annual Academic Pediatric Association Health Care Delivery Award, which recognizes an innovative and effective program that provides health care in the context of a teaching setting. Pediatrics is being recognized for its outstanding leadership in the area of child health, for its years of program development for underserved populations and for the department’s commitment to education both locally and nationally.
Edward Alexander, MD, a professor of medicine and physiology and a nephrologist at BMC, was the 2013 recipient of the Jerome Klein Award for Physician Excellence, selected by a senior committee of BMC and BUSM physicians.
Gary Balady, MD, professor of medicine and assistant dean of admissions, and director of Preventive Cardiology and the Non-Invasive Cardiovascular Laboratories at BMC, received the American Heart Association’s (AHA) prestigious Paul Dudley White Award. Dr. Balady was honored for his outstanding work in the field of preventive cardiology. The award is bestowed annually to a Massachusetts medical professional physician.
Stephen Brooks, MD, clinical assistant professor of surgery and a general and vascular surgeon at Cape Cod Hospital, received the 2014 Volunteer Clinical Faculty Award for BUSM. He was selected by the members of the BUSM Class of 2014 who are members of Alpha Omega Alpha, the honor medical society.
David Center, MD, and William W. Cruikshank, PhD, have been named Fellows of the National Academy of Inventors (NAI). Election to NAI Fellow status is a high professional distinction accorded to academic inventors who have demonstrated a prolific spirit of innovation in creating or facilitating outstanding inventions that have made a tangible impact on quality of life, economic development and the welfare of society.
David Coleman, MD, Wade Professor and chair of the Department of Medicine and Physician-in-Chief at BMC, was elected to an at-large member of the Association of Professors in Medicine (APM) Council. He will serve a three-year term. APM is the organization of departments of internal medicine represented by chairs and appointed leaders at medical schools and affiliated teaching hospitals in the United States and Canada. It is one of five academically focused specialty organizations, which comprise the Alliance for Academic Internal Medicine (AAIM). The APM Council is the organization’s governing body.
Gerard Doherty, MD, James Utley Professor and chairman of the Department of Surgery at Boston University School of Medicine and Surgeon-in-Chief at BMC, has been elected as President of the American Association of Endocrine Surgeon (AAES). He will serve as President through 2015.
Melody J. Eckardt, MD, MPH, instructor in obstetrics and gynecology, has been honored by her peers of the Norfolk South District Medical Society as the 2014 Community Clinician of the Year. The Community Clinician of the Year Award was established by the Massachusetts Medical Society (MMS) to recognize a physician from each of the Society’s 20 district medical societies who has made significant contributions to his or her patients and the community and who stands out as a leading advocate and caregiver.
Jerrold Ellner, MD, professor of medicine and chief of the Section of Infectious Diseases at BMC, has been elected as to the U.S. chair for the executive committee of RePORT India Consortium Secretariat.
James A. Feldman, MD, professor of emergency medicine, has been honored by the Massachusetts Medical Society (MMS) as the 2014 recipient of the Grant V. Rodkey Award, an honor recognizing a Massachusetts physician for outstanding contributions to medical education and medical students.
Eva Greenwood, MBA, vice chair of Finance and Administration for the Department of Medicine, has been elected as institutional member-at-large to the Administrators of Internal Medicine. She will serve a three-year term starting July 1, 2014.
Ali Guermazi, MD, PhD, professor of radiology, director of the Quantitative Imaging Center at BUSM and section chief of musculoskeletal Imaging at BMC, was appointed a deputy editor of the journal Radiology editorial board by the Radiological Society of North America (RSNA). Guermazi is the first faculty member from either institution to take on this role. With this appointment, he will also serve as a member of the Margulis Award for Scientific Excellence Nominating Committee. .
Tsuneya Ikezu, MD, professor of pharmacology and neurology, was honored by the Alzheimer’s Art Quilt Initiative (AAQI) for his continued efforts in Alzheimer’s disease (AD) research. AAQI is a national grassroots charity that raises awareness and funds research through the donation and sale of small art quilts.
Robin R. Ingalls, MD, associate professor of medicine and microbiology, was selected as a member of the Immunity and Host Defense Study Section of the NIH Center for Scientific Review beginning July 1, 2014, until June 30, 2020.
Katherine Iverson, PhD, assistant professor of psychiatry, has been named a recipient of the Presidential Early Career Award for Scientists and Engineers. The highest honor bestowed by the U.S. Government on science and engineering professionals in the early stages of their independent research careers, Dr. Iverson also is a clinical research psychologist at the VA Boston Healthcare System.
Brian Jack, MD, professor and chair of family medicine and chief of Family Medicine at BMC, has been elected to the Institute of Medicine (IOM). Election to the IOM is considered one of the highest honors in the fields of health and medicine and recognizes individuals who have demonstrated outstanding professional achievement and commitment to service. Jack also earned the Peter F. Drucker Award for Nonprofit Innovation for redesigning hospital discharge procedures.
Lisa A. Kachnic, MD, professor of radiology and chief and chair of the Department of Radiation Oncology, has been elected president-elect of the Board of Trustees of the American Board of Radiology (ABR). The ABR certifies physicians as qualified in the practices of diagnostic radiology, interventional radiology, radiation oncology and medical physics. Dr. Kachnic will serve a two-year term starting July 1, 2014.
Terence M. Keane, PhD, professor of psychiatry and assistant dean for research, received the Distinguished Scientific Contributions to Clinical Psychology Award from the American Psychological Association (APA) at the annual conference of the Society for Clinical Psychology.
Ducksoo Kim, MD, professor of radiology and director of the vascular and interventional radiology fellowship at BMC and Karen Buch, MD, a third year radiology resident at BMC have been selected as Grand Challenges Explorations (GCE) winners, an initiative funded by the Bill & Melinda Gates Foundation. They will use nanotechnology to develop a next- generation condom to prevent breakage and improve efficiency in order broaden its appeal and increase usage.
Thomas Kilgore, DMD, and William Lehman, PhD, were the recipients of the 2014 Spencer N. Frankl Award for Excellence in Teaching from BU Goldman School of Dental Medicine (GSDM). Dr. Kilgore, former GSDM associate dean for academic affairs and for advanced education and international programs, is a professor of oral and maxillofacial surgery at GSDM. Dr. Lehman is a professor of physiology and biophysics at BUSM and a faculty member in the Cellular Biophysics Program at Boston University.
Judith A. Linden, MD, associate professor of emergency medicine, was honored by her physician peers as the 2014 Community Clinician of the Year of the Suffolk District Medical Society, one of the district societies of the Massachusetts Medical Society, the statewide professional association of physicians.
Devin Mann, MD, MS, assistant professor of medicine and attending physician at BMC, has been appointed to the Health Information Technology (HIT) Policy Committee by the U.S. Government Accountability Office (GAO).
Rafael Ortega, MD, professor of anesthesiology and vice chair for academic affairs for the Department of Anesthesiology, and Alcy Torres, MD, assistant professor of pediatric neurology, have been listed among the 100 most influential Latinos in Massachusetts by El Planeta, Boston’s Latino daily newspaper.
Thomas Perls, MD, MPH, professor of medicine and a geriatrician at BMC was honored with the Ewald W. Busse Research Award. One of the most prestigious in the field of gerontological research, the award is given every four years in conjunction with the World Congress of Gerontology and Geriatrics and recognizes the achievements of late junior or mid-career scientists, encouraging their continued contributions to aging research.
Patricia Resick, PhD, ABPP, professor of psychiatry and psychology, received the American Psychological Association’s (APA) Division of Trauma Psychology Award for Lifetime Achievement in the field of Trauma Psychology.
Joshua D. Safer, MD, associate professor of medicine and director of the endocrinology fellowship program, has been elected president-elect of the Association of Specialty Professors (ASP) starting July 1, 2014, followed by a year as president and the following year as past president. ASP is the organization of specialty internal medicine divisions at medical schools and community teaching hospitals in the U.S. and Canada.
David J. Salant, MD, professor of pathology and laboratory medicine and chief, section of nephrology at BMC, has been awarded the 2013 John P. Peters Award from the American Society of Nephrology (ASN).
Jeffrey I. Schneider, MD, assistant professor of emergency medicine and residency program director for the BMC Department of Emergency Medicine, was named recipient of the 2014 Distinguished Educator Award by the Council of Emergency Medicine Residency Directors (CORD) Academy for Scholarship in Education in Emergency Medicine. This national award recognizes outstanding educators meeting standards of academic excellence.
Robert Sege, MD, PhD, professor of pediatrics and director of BMC Department of Pediatrics Division of Child and Family Advocacy was named a Senior Fellow at the Center for the Study of Social Policy (CSSP) in Washington D.C. The CSSP is a nonpartisan Washington D.C. nonprofit that works with policymakers and communities across the country to promote smart policies that improve the lives of children and their families.
Avrum Spira, MD, MSc, the Alexander Graham Bell Professor of Medicine and chief of the Division of Computational Biomedicine at BUSM and physician in the pulmonary, critical care and allergy department at BMC, received the Alton Ochsner Award Relating Smoking and Disease. This award recognizes Spira’s seminal research contributions that have enhanced the understanding of the biological response of lung tissue to tobacco smoke, which can cause lung cancer and chronic obstructive lung disease (COPD).
Richard Wainford, PhD, assistant professor of pharmacology and medicine and director of the Laboratory of Cardio-renal research, has received the American Physiological Association 2014 Arthur C. Guyton Award in Integrative Physiology.
Mary Warner, MMSc, PA-C, director of the Physician Assistant program, was honored by the American Academy of Physician Assistants (AAPA) with its PAragon Research Publishing Award, which recognizes a PA who published an exceptional research article within the past year. Lead author of “Career Patterns of Physician Assistants: A Retrospective Longitudinal Study,” the article received a Gold Medal for Best Original Research from the American Society of Healthcare Publication Editors and was published in the June 2014 edition of the Journal of the American Academy of Physician Assistants. It takes a closer look at the education, training and practice patterns of PAs post-graduation.
Robert Witzburg, MD, professor of medicine and associate dean and director for admissions, received the Association of American Medical College’s Northeast Group on Student Affairs (NEGSA) inaugural Outstanding Service award for his innovative admissions initiatives and national leadership on the transition of medical school admissions programs to focus on holistic review as a tool to enhance the diversity of the physician workforce.
Benjamin Wolozin, MD, PhD, associate professor of pharmacology and neurology has been awarded the Zenith Fellows Award from the Alzheimer’s Association. The award will support Wolozin’s research in the pathogenesis of Alzheimer’s disease. The goal of this work is to determine the molecular foundation of the proteins responsible for causing Alzheimer’s.
Gopal Yadavalli, MD, assistant professor of medicine and director of the internal medicine residency program, has been elected to the Council of the Association of Program Directors in Internal Medicine (APDIM). The APDIM is the international organization of accredited internal medicine residency programs. Dr. Yadavalli, a member of the infectious diseases faculty, will serve a three-year term beginning July 1, 2014.
Many patients require medication to thin blood, and some of these patients also have liver disease. Often warfarin is prescribed for this condition. This presents a challenge for physicians and patients, as the risk of bleeding in patients with liver disease taking warfarin is unknown and has not been studied.
BUSM Associate Professor of Medicine Adam Rose, MD, who is also affiliated with the VA of Bedford, Mass., Lydia Efird, MD, a former BMC resident (2013) in internal medicine and first author, and others have found that patients with liver disease taking warfarin have more bleeding events, and that certain lab values are most predictive of bleeds. Using these findings, they created a simple predictive scoring tool to assist clinicians. In a retrospective cohort study of more than 100,000 VA patients taking warfarin the researchers identified outcomes in more than 1700 patients with liver disease. Findings include:
- Patients with liver disease taking warfarin have poorer anticoagulation control and more major bleeds.
- Low albumin levels and poor renal function, as measured by creatinine, are most predictive of these poor outcomes.
The researchers created a 4-point clinical predictive tool to help identify and individualize the risks of treatment and direct future interventions. The system uses albumin and creatinine which help predict patients that are at risk of a major bleed while taking warfarin. “Prescribing blood thinners to patients with liver disease is challenging. This simple tool allows a quick calculation, in the office or bedside, to help clinicians predict which patients may safely receive warfarin and in which patients it is best avoided,” said Efird.
This article was published in Circulation Cardiovascular Quality Outcomes, May 20 2014. Epub May 13, 2014, 4 p.m. (Circ Cardiovasc Qual Outcomes. 2014;7:461-467) http://circoutcomes.ahajournals.org/
Lauren Sweetser, a first year student at the BU School of Medicine, was named an Albert Schweitzer Fellow for the 2014-15 class. She will join approximately 220 other 2014-15 Schweitzer Fellows spending the next year learning to effectively address the social factors that impact health, and developing lifelong leadership skills. In doing so, they will follow the example set by famed physician-humanitarian Albert Schweitzer, for whom their Fellowship is named.
Sweetser’s focus is addressing issues of pediatric homelessness in Roxbury, Mass. with a service-learning project “Resources and Education for Adolescents and their CHildren” (REACH). The mission of REACH is for medical students to work with and learn from homeless teenaged mothers and their young children by actively supporting them through educational workshops, constructive childcare and longitudinal multifaceted mentorship.Ultimately, the goal is for medical students to serve as healthcare liaisons for this often-neglected population while encouraging positive consistent relationships for both mother and infant.
Upon completion of the Fellowship year, the 2014-15 Boston Schweitzer Fellows will become Schweitzer Fellows for Life and join a vibrant network of nearly 3,000 Schweitzer alumni who are skilled in, and committed to, addressing the health needs of underserved people throughout their careers.
Since it started more than 30 years ago, funding the graduate medical education (GME) system has not evolved even as there has been a revolution in GME. The United States contributes almost $10 billion a year from Medicare into funding the GME system. However this system fails to provide the workforce needed for the 21st century and lacks the necessary transparency and accountability.
With an aging population and millions of people newly registered for health insurance because of the Affordable Care Act, there is a pressing need to increase the number of primary care physicians. In the United States, it is estimated that only 20.9 percent of residents graduating from GME programs will practice primary care.
Recommendations recently published in the Journal of General Internal Medicine prepared by the Health Policy Education Subcommittee of the Society of General Internal Medicine (SGIM) outline how to reform the GME system to support the development of a physician workforce that can provide high quality, high value, population-based, and patient-centered health care, aligned with the dynamic needs of America’s healthcare delivery system.
Angela Jackson, MD, associate dean for student affairs at Boston University School of Medicine and a physician in general internal medicine at Boston Medical Center, is the article’s first author and is Co-Chair of the SGIM’s Health Policy Committee.
“SGIM hopes its policy and paper will invigorate the debate on GME funding, moving beyond discussions limited to funding levels to discussions on GME program accountability for public fund use and how to shape a GME system that will provide the nation with the physician workforce that we need,” said the authors.
The recommendations address workforce analysis, funding mechanisms, transparency, competency-based curriculum accountability, distributions of physician specialties and educational innovation, and call for:
1. Fully funding the National Health Care Workforce Commission
2. Having all payers for care contribute toward GME
3. Rebasing direct and indirect medical education payments to reflect 21st century costs
4. Requiring transparency in spending GME funds
5. Using GME funding exclusively for trainee education and related costs
6. Requiring training programs demonstrate their graduates are competent to practice 21st century medicine
7. Developing incentives for training programs to align the practice patterns of their graduates with regional and national workforce needs
8. Funding to develop GME innovations designed to impact the physician workforce positively.