We threw out the baby with the bath water when we discarded carbohydrate counting’, said Pat Clarke, Diabetes Specialist Nurse in Nottingham.

Pat described the case of a 21-year-old builder diagnosed with type 1 diabetes in 2000. He was put straight on to insulin but experienced consistently high glucose levels, particularly in the afternoons. A major problem identified was that he never changed his insulin doses to match the number of carbohydrate portions consumed. Being educated on how to do this has since helped him control his diabetes.

Local school districts nationwide are experiencing increases in special education costs. In states that are placing a high priority on education reform, the special education cost increases are rapidly compromising the ability of districts to effectively fund the implementation of these reforms. However, in searching for a way to address rising costs, policymakers often err in their diagnosis of the problem.

Policymakers point to two major causes of the increase in costs. First, they claim schools are funneling too many children into special education to ease the burden on the classroom teacher of addressing behavioral and learning problems. Second, they point to the increased advocacy on the part of parents and physicians.

Based on these assumptions, policymakers tend to recommend that states impose financial disincentives for increases in special education populations. They believe these disincentives will force school districts to apply more rigorously the eligibility requirements, leading to smaller special education enrollment and less special education spending.

Primary Factors

Although these two factors may play a minor role in the increase in special education enrollments, far more significant causes generally have been ignored. In a case study of cost increases in Massachusetts, we determined that the increases were not caused by school district policy and practice. In fact, just the opposite was the case.

School district policy and practice was effective in containing and even reducing the percentage of children who required special education services. We found that cost increases were primarily due to the increased number of children with more significant special needs who require more costly services.

The root causes of these increases were factors beyond the control of schools, such as advances in medical technology, the deinstitutionalization of children with special needs and privatization of services. Also contributing were economic and social factors, such as the rising number of children in poverty and the number of families experiencing social and economic stress.

Because the increase in special education enrollments reflects real increases in the needs of children in the overall population, the solutions recommended by policymakers only exascerbate the problem by making funding to serve these children more difficult to access. This produces a no-win situation for both regular education children and special education children whose interests too often are pitted against each other in funding debates.

These findings emerged from a study of special education cost increases in Massachusetts completed by a task force of the Massachusetts Association of School Superintendents. Although the results of the study draw from data in one state, the national data on special education suggest these factors may be influencing the increased number of special education children nationally.

The Cost Reality

The special education components of the school funding formula for education reform in Massachusetts were built on the assumption that school districts did not effectively contain costs and identified more children than necessary as having special needs. Specific elements of the formula were designed as disincentives to these practices. For example, in all areas other than special education, actual enrollment within a district is used to calculate state aid. Additional allocations are provided for the actual number of students who are from low-income families or who are in bilingual or vocational programs.

In contrast, allocations for special education are based on a preset percentage of children in special education, set at a rate lower than the state average. In addition, the cost allocations for providing services are set at levels well below the actual costs. These disincentives were designed to cause districts to be more rigorous in their use of the eligibility standards and to encourage more cost-effective placement of students.

Our analysis of the data for Massachusetts school districts, not including regional vocational schools, shows that these assumptions are not accurate. In fact, schools have done a good job containing costs. They rigorously have applied eligibility standards and provided regular education and inclusive programming for children as an alternative to special education services. The percentage of children enrolled in special education in Massachusetts reached a high in 1991-92 of 17.4 percent but declined to 16.3 percent in 2000-2001.

In spite of the districts’ best efforts, costs have continued to increase as districts have enrolled a greater number of children with more serious needs. We found that between 1989-90 and 2000-01 per-pupil expenditures in special education escalated from $6,675 to $12,416, while they increased by only one-third as much in regular education from $4,103 to $6,177. This represents an increase of 86 percent in per-pupil special education expenditures in contrast to a 50.5 percent increase in per-pupil regular education expenditures.

In their statement of principles, the Council of Heads of Medical Schools indicate that the purpose of a medical education is to graduate individuals well fitted to meet the present and future needs of society for medical care.[1] They go on to state that this can be achieved, at least in part, if the social, cultural, and ethnic backgrounds of graduates reflect broadly the diversity of the patient population. It seems that this principle is not currently met by medical schools in the United Kingdom. In a study commissioned by the Council of Heads of Medical Schools in 1998, McManus found that certain groups (students from ethnic minorities, sixth form colleges or further education institutions, and lower socioeconomic groups) were disadvantaged when seeking admission to medical school.[2] As a result, the council devised an action plan in which medical schools were required to draw up policies relating to equal opportunities as a matter of urgency.

In general, the groups of people that are underrepresented in the medical profession tend to be overrepresented in the patient population as a result of many factors, including poverty, poor diet and housing, poor educational standards, and occupational factors. Pupils from lower socioeconomic groups are disadvantaged in many ways when applying for entry to medical education. Their secondary schools are not usually those with a record of high academic achievement, and progression to further or higher education is not a tradition. Similarly, the pupils come from backgrounds where participation in higher education is rare. They often do not have the opportunity to undertake suitable work experience and thus have difficulty demonstrating through their application that they are suitable for a career in a caring profession. As a result, their application forms do not often contain the type of features usually looked for by admissions tutors and may therefore not be considered further.

Schemes aimed at widening access Should be designed to attract this previously untapped pool of potential doctors into medicine, thus providing the NHS with a clinical workforce which more accurately reflects the socioeconomic base of society. Such schemes need to raise awareness of higher education in general and to show pupils that a career in medicine, which might at first seem outside their wildest aspirations, is in fact possible. The schemes should attempt to provide some sort of compensation for pupils’ relatively poor academic base and in particular should provide the type of generic, transferable skills to which such pupils may have had limited exposure. Communication skills are particularly important in this regard. Finally, the schemes should make appropriate work experience and exposure to the profession in general available to the pupils.

A new recruitment programme

The University of Sheffield as a whole has shown a longstanding commitment to widening access to higher education, particularly in the local area, and already attracts high numbers of students from lower socioeconomic groups, as evidenced by the substantial Widening Participation premium additional funding allocated by the Higher Education Funding Council for England to the University for 1999-2000. The medical school already participates in some of these activities and will shortly begin a new recruitment programme aimed specifically at students from non-traditional and underrepresented backgrounds. This early outreach programme is described in detail below, but the medical school has already shown its commitment to widening access by welcoming applications from applicants with nontraditional backgrounds. We already have a relatively high proportion of mature students (25% of entrants to the six year foundation course and 14% of entrants to the five year course). Students with a background in nursing are particularly welcome, and we have a relatively high proportion of students with nontraditional educational backgrounds, including BTEC and GNVQ courses.

The Compact Scheme

The Compact Scheme began in medicine in 1994. It provides individual support by trained admissions staff, and the formal academic entry requirements are relaxed where appropriate. Year 12 pupils whose personal, domestic, or financial circumstances may prevent them from displaying their full academic potential are helped in the application and admission process. Pupils are first identified in their schools and, if thought to be suitable, are referred by the school to the university and then to the scheme’s liaison officer for the school of medicine. In an informal interview, students are assessed in general terms and are given advice and support about their application. The majority then proceed to the formal interview stage, along with the standard applicants.

We feel it is important that such students should not be made to feel “different” from their fellow applicants and thus, although the interviewers are made aware of the pupil’s special circumstances, the other applicants being interviewed at the same time are not. Similarly, once admitted, these students are not identifiable in any way to their fellow students or to teaching staff, unless the students themselves decide to inform them. They receive no special treatment and in particular are not identifiable during assessment episodes. They are, however, followed closely during their studies and are made aware that they may seek advice and guidance from the liaison officer at any time.

Feb. 2-4: Certificate in business administration physicians program. Auburn University, Auburn. (15 hrs: P) Sponsor: Southern Medical Association. Contact Joyce Lane: 800-423-4992.

Alaska

Dec. 1-2: Child and adolescent psychiatry. Providence Alaska Medical Center, Anchorage. (7 1/2 hrs: E) Sponsor: Providence Health System Alaska. Contact Mark Agnew, M.D.: 907-261-3011.

Arizona

Dec. 6-7: Dermatologic procedures. Holiday Inn Sunspree Resort, Scottsdale. (16 hrs: P) Sponsor: National Procedures Institute. Contact Chantee DuFort: 517-631-4664.

Dec. 6-7: Sclerotherapy. Holiday Inn Sunspree Resort, Scottsdale. (11 1/4 hrs: P) Sponsor: National Procedures Institute. Contact Chantee DuFort: 517-631-4664.

Dec. 8: Flexible sigmoidoscopy. Holiday Inn Sunspree Resort, Scottsdale. (6 3/4 hrs: P) Sponsor: National Procedures Institute. Contact Chantee DuFort: 517-631-4664.

Dec. 8-9: Orthopedics for the office practice. Holiday Inn Sunspree Resort, Scottsdale. (12 hrs: P) Sponsor: National Procedures Institute. Contact Chantee DuFort: 517-631-4664.

Dec. 14-17: Intensive conversational medical Spanish/culture workshop. Manicopa Medical Center, Phoenix. (36 3/4 hrs: P) Sponsor: Rios Associates. Contact Joanna Rios: 520-907-3318;

Reduced funding, rising student numbers, geographical dispersal, and increased competition in a complex global market have put medical schools under pressure to embrace computer assisted learning

New technologies may have important educational advantages, but without support and training for staff and students they could prove an expensive disaster

Expansion of computer assisted learning requires cultural change as well as careful strategic planning, resource sharing, staff incentives, active promotion of multidisciplinary working, and effective quality control

It is becoming “a truth universally acknowledged” that the education of undergraduate medical students will be enhanced through the use of computer assisted learning. Access to the wide range of online options illustrated in the figure must surely make learning more exciting, effective, and likely to be retained. This assumption is potentially but by no means inevitably correct.

Deans of medical faculties often receive requests for development funding for computer assisted learning projects. Decisions to introduce these projects into the undergraduate curriculum are generally justified by one or more of the arguments listed in box 1.

Box 1: Why fund computer assisted learning?

Computer assisted learning is inevitable–Individual lecturers and departments are already beginning to introduce a wide range of computer based applications, sometimes in a haphazard way. Planned and coordinated development is better than indiscriminate expansion

It is convenient and flexible–Courses supported by computer assisted learning applications may require fewer face to face lectures and seminars and place fewer geographical and temporal constraints on staff and students. Students at peripheral hospitals or primary care centres may benefit in particular

Unique presentational benefits–Computer presentation is particularly suited to subjects that are visually intensive, detail oriented, and difficult to conceptualise, such as complex biochemical processes or microscopic images.[1] Furthermore, “virtual” cases may reduce the need to use animal or human tissue in learning

Personalised learning–Each learner can progress at his or her preferred pace. They can repeat, interrupt, and resume at will, which may have particular advantages for weaker students

Economies of scale–Once an application has been set up, the incremental cost of offering it to additional students is relatively small

Competitive advantage–Potential applicants may use the quality of information technology to discriminate between medical schools. A “leading edge” virtual campus is likely to attract good students

Achieves the ultimate goal of higher education–The goal is to link people into learning communities. Computer applications, especially the internet and world wide web, are an extremely efficient way of doing this[2]

Expands pedagogical horizons–The most controversial argument for using computer assisted learning in higher education is the alleged ability of the virtual campus to alter fundamentally the relation between people and knowledge[3]

Developing applications

Computer assisted learning applications generally require the student to follow the content without immediate or direct supervision from the tutor. But the computer can be a temperamental and unforgiving beast, and computer assisted learning applications must therefore embody the quality features described in box 2. For all these reasons, computer assisted learning materials are initially much more labour intensive and time consuming to prepare than most face to face courses, and they often require input from fairly senior members of staff. Once the basic format is agreed and the initial materials have been written, however, materials can be maintained and updated relatively easily and by more junior members. Off the shelf templates that allow someone with no specific training to produce materials of professional quality are increasingly available. Introducing computer assisted learning technologies into a traditional course will generally occur in stages, as described in box 3. Adapting pre-existing materials designed as handouts or revision notes can sometimes save considerable time.

Box 2: Quality features of applications

Open learning (self study) materials–Applications must be prepared in advance, cover explicit course aims and learning objectives, and include a high degree of “signposting,” explanatory text, and trouble shooting information

Website design–Websites should have a logical structure and sequence, utilise features such as hypertext and graphics, and include links to public access, web based materials such as electronic journals where appropriate

Technical design–Applications must be user friendly and operate effectively within the hardware and software constraints of the end user

University culture–Applications must present an academic ethos in the untidy, commercial, and laissez-faire culture of web based publishing and protect the student from the distractions of the internet

“I was extremely pleased with the quality of the material, lectures and
discussions. The format made me feel like I had a personal relationship
with the instructors, even though this is distance learning.”
–William Biermann, MD Vice President, Blue Bell, PA

[ILLUSTRATION OMITTED]

InterAct courses come in many shapes and sizes.

Some InterAct courses include video on CD, some come with an audio track with PowerPoint presentations, and others are completely Web-based text courses. No matter what the format, InterAct courses can be taken on virtually any home or office computer.

Full InterAct courses include online sessions with faculty. These sessions are 3 to 6 weeks in length, but you don’t ever have to be online at a particular time of day. The discussions and case studies that take place during the scheduled online sessions are required for graduate degree or board certification credit.

InterAct Express courses do not include a scheduled online session. These are complete, self-study courses that you take at your own pace as your schedule permits.

Graduate degree and board certification credit

Most InterAct courses provide credit toward graduate management degrees with our university partners: Carnegie Mellon University, Tulane University, University of Massachusetts and University of Southern California. For more information about our graduate programs visit: www.acpe.org/degrees. The credit can also be used toward board certification with the certifying commission in medical management. For more information visit: www.ccmm.org

ACPE InterAct Courses

Here’s a catalog of our current InterAct courses and a brief course description.

For more detailed course descriptions, visit ACPE online at www.acpe.org/interact or call 800-562-8088.

Ethical Challenges of Physician Executives

* How much treatment is too much when a patient is terminally ill?

* When an HIV patient practices risky behavior, how do you balance the patient’s right to privacy against public welfare?

* Informed consent, confidentiality, ethics in managed care and the physician and organization’s roles are the focus of this course.

Faculty: Laurence McCullough, PhD

Full Interact     Express Version
Course            (self study)

CME               12                5
Graduate Credits  12 Core           –
Online Session    Yes (3 weeks)*    No
Technology        Video on CD       Video on CD
Price             $625 members      $325 members
$700 non-members  $400 non-members

Financial Decision Making

* The ability to apply financial principles and concepts to decision making is critical for the physician executive, but is often a mystifying blend of mechanical calculation and confusing theories.

* This course provides the knowledge and skills to turn the mysteries into tools you can use to shape your organization’s strategic future.

Faculty: Steven Finkler, PhD

All New for 2006

Full Interact      Express Version
Course             (self study)

CME               24                 12
Graduate Credits  24 Core            –
Online Session    Yes (6 weeks)*     No
Technology        Video on CD        Video on CD
Price             $1250 members      $650 members
$1400 non-members  $800 non-members

Essentials of health law

* This course will give you an understanding of laws pertaining to health care organizations.

* You’ll also focus on specific areas, including:

– HIPAA and patient rights

– Stark legislation, antitrust traps, employment contracts

– Peer review, disruptive practitioners, practitioner health

* Plus current legal trends and rulings and how they apply to your organization.

Faculty: Susan Lapenta, JD * Henry Casale, JD

Full Interact     Express Version
Course            (self study)

CME               14                8
Graduate Credits  14 Core           –
Online Session    Yes (3 weeks)*    No
Technology        Video on CD       Video on CD
Price             $625 members      $325 members
$700 non-members  $400 non-members

Managing Physician Performance

* This course will provoke your thinking about managing performance and vastly improve your practical knowledge through role-playing, case studies and exercises.

* You’ll learn about recruiting to hire the right candidate the first time, establishing performance expectations, giving informal and formal feedback, and handling the marginal performer.

Faculty: Howard Kirz, MD, MBA, FACPE * Susan Cejka * Timothy Keogh, PhD

Full Interact      Express Version
Course             (self study)

CME               24                 13
Graduate Credits  24 Core            –
Online Session    Yes (6 weeks)*     No
Technology        Video on CD        Video on CD
Price             $1250 members      $650 members
$1400 non-members  $800 non-members

A new proposed rule (Federal Register, Feb. 1, 2007) would change Medicare’s policies for graduate medical education payments to teaching hospitals when residents are being trained in non-hospital settings. Currently, hospitals must pay for almost all the costs for the training that residents receive in nonhospital settings in order to include these residents in their GME payment calculations.

Under the proposal, effective July 1, 2007, hospitals would be required to pay at least 90 percent of the total of the residents’ salaries and fringe benefits and the portion of the cost of teaching physicians’ salaries attributable to direct GME at the nonhospital site. To reduce the administrative burden of documenting these costs, CMS would allow hospitals to use proxies in place of actual cost data to help them determine whether they have met the 90 percent threshold. Comments on the proposed rule are due April 2, 2007.

Research and Markets (http://www.researchandmarkets.com/reports/c28996 ) has announced the addition of The Guide To Distributors of Medical Equipment & Supplies Worldwide 2006: Europe to their offering.** Please note this report is a subset of The Guide to Distributors of Medical Equipment & Supplies Worldwide 2006. For more information please search our site.

The Guide to Distributors of Medical Equipment & Supplies Worldwide 2006 contains 1,450 detailed and fully verified profiles of specialist distributors in more than 115 countries around the globe.

Whatever your sales representation needs this essential guide will help. Unlike simple address listings, each profile has been researched and verified directly with the company by our researchers, and details provided include, where available:

Sales success in export markets requires local business and cultural knowledge - knowledge that can effectively be found via sales agents and distributors.

Full contact details
Years established
Number of employees, including sales/servicing split
Turnover
Product areas represented
Potential new product areas
Companies represented

Summary

Volume I: Europe

Over 525 specialist medical sales companies in 41 countries

Armenia - Austria - Azerbaijan - Belarus - Belgium - Bosnia and Herzegovina - Bulgaria - Croatia - Cyprus - Czech Republic - Denmark - Estonia - Finland - France Germany - Greece - Hungary - Iceland - Ireland - Italy - Latvia - Lithuania - Macedonia - Malta - Moldova - Netherlands - Norway - Poland - Portugal - Romania - Russia - Serbia - Slovakia - Slovenia - Spain - Sweden - Switzerland - Turkey - Ukraine - United Kingdom

Local school districts nationwide are experiencing increases in special education costs. In states that are placing a high priority on education reform, the special education cost increases are rapidly compromising the ability of districts to effectively fund the implementation of these reforms. However, in searching for a way to address rising costs, policymakers often err in their diagnosis of the problem.

Policymakers point to two major causes of the increase in costs. First, they claim schools are funneling too many children into special education to ease the burden on the classroom teacher of addressing behavioral and learning problems. Second, they point to the increased advocacy on the part of parents and physicians.

Based on these assumptions, policymakers tend to recommend that states impose financial disincentives for increases in special education populations. They believe these disincentives will force school districts to apply more rigorously the eligibility requirements, leading to smaller special education enrollment and less special education spending.

Although these two factors may play a minor role in the increase in special education enrollments, far more significant causes generally have been ignored. In a case study of cost increases in Massachusetts, we determined that the increases were not caused by school district policy and practice. In fact, just the opposite was the case.

School district policy and practice was effective in containing and even reducing the percentage of children who required special education services. We found that cost increases were primarily due to the increased number of children with more significant special needs who require more costly services.

The root causes of these increases were factors beyond the control of schools, such as advances in medical technology, the deinstitutionalization of children with special needs and privatization of services. Also contributing were economic and social factors, such as the rising number of children in poverty and the number of families experiencing social and economic stress.

In their statement of principles, the Council of Heads of Medical Schools indicate that the purpose of a medical education is to graduate individuals well fitted to meet the present and future needs of society for medical care.[1] They go on to state that this can be achieved, at least in part, if the social, cultural, and ethnic backgrounds of graduates reflect broadly the diversity of the patient population. It seems that this principle is not currently met by medical schools in the United Kingdom. In a study commissioned by the Council of Heads of Medical Schools in 1998, McManus found that certain groups (students from ethnic minorities, sixth form colleges or further education institutions, and lower socioeconomic groups) were disadvantaged when seeking admission to medical school.[2] As a result, the council devised an action plan in which medical schools were required to draw up policies relating to equal opportunities as a matter of urgency.

In general, the groups of people that are underrepresented in the medical profession tend to be overrepresented in the patient population as a result of many factors, including poverty, poor diet and housing, poor educational standards, and occupational factors. Pupils from lower socioeconomic groups are disadvantaged in many ways when applying for entry to medical education. Their secondary schools are not usually those with a record of high academic achievement, and progression to further or higher education is not a tradition. Similarly, the pupils come from backgrounds where participation in higher education is rare. They often do not have the opportunity to undertake suitable work experience and thus have difficulty demonstrating through their application that they are suitable for a career in a caring profession. As a result, their application forms do not often contain the type of features usually looked for by admissions tutors and may therefore not be considered further.