Combined internships between community hospitals.
For the past seven years the physicians of Pittsfield, Mass, have been engaged in an experiment in graduate medical education. This report states the purpose of the project, describes the initial phases, preliminary results, and discusses the interrelationships between a community hospital and a university medical center. Medical educators agree that the highest quality of education, with few exceptions, is found in the university environment. In 1966, university hospitals accommodated only one half the total number of house officers; the other half were located in nonuniversity hospitals. Since university hospitals cannot soon cope with this problem, an urgent challenge emerges: Community hospital programs, of comparable caliber to the university medical center, must be developed. 1 The Pittsfield Affiliated Hospitals Education Program was devised to produce an educational environment by simulating the university medical center. The Council on Medical Education has been continuously consulted about the objectives and the progress of
How a Teaching Hospital Implemented Its Termination Policies for Disruptive Residents
The development of Policy Standards for Termination that both protect and support residents while safeguarding sponsoring institutions has become increasingly necessary. To date, however, there has been little in the literature that discusses policies that have undergone thorough testing to the highest levels of the U.S. judicial system. Berkshire Medical Center (BMC), an acute-care community teaching hospital affiliated with the University of Massachusetts Medical School, developed a set of specific policies to cope fairly with the resident dismissal process. The authors describe a nine-year legal test of these policies in the case of a resident whose disruptive behavior required their implementation. Also presented is a summary of due process as it applies in such cases. The dismissed resident tested the policies through the Courts of the Commonwealth of Massachusetts all the way to the United States Supreme Court, the Equal Employment Opportunity Commission, and the Massachusetts Department of Industrial Accidents. At every level the termination action was upheld. The resident had previously been in two graduate medical education programs at other institutions, and neither of them had communicated issues of concern that would have forewarned BMC's program about potential problems. A plea for honest and open communication between programs is made. This may help to avoid the lengthy, expensive, and potentially serious consequences of such situations. However, the authors emphasize that when such situations arise, strong policies serve as an ultimate legal protection.
Aristocratic Century: The sinews of power: political
In his excellent book on the Secretaries of State, Mark Thomson offered ‘the paradox of continuing domination of the aristocracy and the simultaneous insignificance of the House of Lords, per se ’. It is true that, by the beginning of the eighteenth century, the supremacy of the House of Commons in financial matters was a wellestablished convention. The claims of the Commons to an undisputed control over money matters, which had been urged before the Civil War, were resumed immediately after the Restoration and a protracted dispute with the House of Lords began. In 1661 the Lords resolved that there were no precedents in history for this new claim by the House of Commons. In 1671, the Commons retorted that taxation ought not to be questioned by the Lords and in 1678 they reiterated that supply was ‘the undoubted and sole right of the Commons’ and ‘ought not to be changed or altered by the House of Lords’. The Lords' attempt in 1692 to assess their own taxes was also abandoned, though they retired under cover of a rather insubstantial smoke-screen that they maintained their power of amendment to be a ‘fundamental, inherent and undoubted right from which their lordships can never depart’. That established, they departed. Geoffrey Holmes quotes a nice example from 1702 when the bishop of Carlisle found himself the only peer answering to a money bill, ‘no other lord in the House regarded what was doing, this being only (pro forma) to preserve a seeming right to dissent from, or amend, any part of a money bill’.