Clinical Update Lifestyle Medicine

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Lifestyle Medicine

Author : Jeffrey I. Mechanick
Publisher : Springer
ISBN 13 : 3319246879
Total Pages : 363 pages
Book Rating : 4.3/5 (192 download)

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Book Synopsis Lifestyle Medicine by : Jeffrey I. Mechanick

Download or read book Lifestyle Medicine written by Jeffrey I. Mechanick and published by Springer. This book was released on 2016-03-18 with total page 363 pages. Available in PDF, EPUB and Kindle. Book excerpt: Lifestyle – the manner in which people live – is fundamental to health, wellness, and prevention of disease. It follows that attention to lifestyle is critically important to effective and successful health care. But here’s the challenge: health care professionals receive very little, if any, formal training about lifestyle counseling and therefore are ill equipped to incorporate lifestyle issues into clinical practice. In response, “Lifestyle Medicine” is evolving as a means to fill this knowledge gap. Lifestyle medicine approaches health and wellness by harnessing the power of lifestyle-related behaviors and influencing the environment we live in. It is a formal approach that promises to enhance and strengthen a re-invigorated health care system that is still outpaced by the epidemic proportions and complexity of chronic diseases like obesity, diabetes, depression, hypertension, and cancer, among others. Lifestyle Medicine: A Manual for Clinical Practice presents this formal approach in a pragmatic context. This unique and practical manual provides clear and succinct guidance on nearly all aspects of lifestyle medicine. The approach is both explanatory and pragmatic, providing case studies and bulleted translation of academic information into clinical practice recommendations. There is an emphasis on scientific evidence wherever possible as well as opinions by the expert chapter authors who practice lifestyle medicine. There is a “how-to” rationality to the book, consistent with a premise that any and all health care professionals should, and perhaps must, incorporate lifestyle medicine. A valuable checklist is included at the close of the book that summarizes key points and provides a practical tool for routine patient encounters.

Clinical Update: Lifestyle Medicine

Author : S Arulrhaj
Publisher : Jaypee Brothers Medical Publishers
ISBN 13 : 935465973X
Total Pages : 89 pages
Book Rating : 4.3/5 (546 download)

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Book Synopsis Clinical Update: Lifestyle Medicine by : S Arulrhaj

Download or read book Clinical Update: Lifestyle Medicine written by S Arulrhaj and published by Jaypee Brothers Medical Publishers. This book was released on 2022-12-20 with total page 89 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Manual of Lifestyle Medicine

Author : James M. Rippe
Publisher : CRC Press
ISBN 13 : 1000381404
Total Pages : 223 pages
Book Rating : 4.0/5 (3 download)

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Book Synopsis Manual of Lifestyle Medicine by : James M. Rippe

Download or read book Manual of Lifestyle Medicine written by James M. Rippe and published by CRC Press. This book was released on 2021-05-06 with total page 223 pages. Available in PDF, EPUB and Kindle. Book excerpt: The fundamental premise of lifestyle medicine is that daily habits profoundly impact health and quality of life both in the short-term and long-term. Written by lifestyle medicine pioneer and cardiologist , Dr. James Rippe, this book provides a clinically oriented, evidence-based look into key lifestyle factors and how to prescribe them to individuals of all ages. Written for professionals working at all levels of medical and healthcare practice, this manual summarizes the major components of lifestyle medicine, from physical activity and nutrition to weight management and the avoidance of tobacco products. It includes clinical guidelines and practices for using lifestyle medicine principles to lower the risk of numerous chronic conditions. The manual also provides information on behavior change, approaches to lowering the risk of dementia, treatment of addictions and injury prevention. Features: Explains how lifestyle medicine can reduce the risk of heart disease, diabetes, cancer, osteoarthritis, dementia and many other chronic conditions. Chapters begin with bulleted key points and conclude with a list of clinical applications. Provides strategies for prescribing physical activity and helping patients improve their nutrition, lose weight if necessary and reduce stress. Includes clinically relevant sections on “Treating Addiction, Preventing Injury and Improving Brain Health”. This book provides updated and clinically targeted summaries used in conjunction with Dr. Rippe's major academic textbook Lifestyle Medicine, now in its third edition, published by CRC Press/Taylor & Francis Group, LLC.

Encyclopedia of Lifestyle Medicine and Health

Author : James M. Rippe
Publisher : SAGE
ISBN 13 : 1412950236
Total Pages : 1297 pages
Book Rating : 4.4/5 (129 download)

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Book Synopsis Encyclopedia of Lifestyle Medicine and Health by : James M. Rippe

Download or read book Encyclopedia of Lifestyle Medicine and Health written by James M. Rippe and published by SAGE. This book was released on 2012-02-14 with total page 1297 pages. Available in PDF, EPUB and Kindle. Book excerpt: These three volumes sort out the science behind nightly news reports and magazine cover stories, and help define the interdisciplinary field of lifestyle medicine and health.

Lifestyle Medicine

Author : Garry Egger
Publisher : Academic Press
ISBN 13 : 0128104260
Total Pages : 484 pages
Book Rating : 4.1/5 (281 download)

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Book Synopsis Lifestyle Medicine by : Garry Egger

Download or read book Lifestyle Medicine written by Garry Egger and published by Academic Press. This book was released on 2017-03-18 with total page 484 pages. Available in PDF, EPUB and Kindle. Book excerpt: Lifestyle Medicine: Lifestyle, the Environment and Preventive Medicine in Health and Disease, Third Edition, is an adjunct approach to health practice that seeks to deal with the more complex modern determinants of chronic diseases—primarily lifestyle and the environments driving such lifestyles—in contrast to the microbial ‘causes’ of infectious disease. Our lifestyle choices have a profound effect on our health. As we live longer, one thing is clear: many of us will spend time living with injury and chronic illness due to our own choices. Changes in health patterns typically follow shifts in living conditions. Disease patterns have changed worldwide, from infectious to chronic diseases such as obesity, diabetes, and heart disease. This change has been so emphatic—nearly 70% of all presentations to a doctor in modern western societies are now chronic disease related—that medical services are being forced to change to accommodate this. New chapters in this third edition explain the link between energy intake and expenditure; consider how modern technology are determinants of chronic disease; show how environmental influences, such as endocrine disruptors, influence our health; and summarize recent research on early childhood experiences and chronic disease. Explores the relationship between lifestyle and environmental drivers and the major modern chronic diseases Outlines the knowledge and skills bases required by health professionals to deal with lifestyle and environmental determinants of chronic disease, as well as the tools and procedures available for doing this Develops pedagogy for Lifestyle Medicine that will enable it to become a practical adjunct to conventional health and medical practice Features new chapters explaining the link between energy intake and expenditure, and more

Lifestyle Medicine, Third Edition

Author : James M. Rippe
Publisher : CRC Press
ISBN 13 : 1351780999
Total Pages : 2152 pages
Book Rating : 4.3/5 (517 download)

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Book Synopsis Lifestyle Medicine, Third Edition by : James M. Rippe

Download or read book Lifestyle Medicine, Third Edition written by James M. Rippe and published by CRC Press. This book was released on 2019-04-17 with total page 2152 pages. Available in PDF, EPUB and Kindle. Book excerpt: The field of lifestyle medicine, which is the study of how daily habits and actions impact on both short- and long-term health and quality of life, continues to expand globally. The scientific and medical literature that supports the success of these lifestyle habits and actions is now overwhelming. Thousands of studies provide evidence that regular physical activity, maintenance of a health body weight, following sound nutritional practices, stress reduction, and other good practices all profoundly impact both health and quality of life. Following its predecessors, Lifestyle Medicine, Third Edition, is edited by lifestyle medicine pioneer, cardiologist Dr. James Rippe. This edition has been thoroughly updated and represents the expert opinions of 20 section editors as well as more than 150 expert chapter authors whose knowledge span all aspects of this emerging discipline. Topics cover lifestyle medicine practices including regular physical activity, proper nutrition, and weight management. These principles are applied to the prevention and or treatment of a wide variety of chronic conditions ranging from heart disease and diabetes to cancer, mental health, addiction, and injury prevention. This book serves as evidence base for individuals who wish to practice lifestyle medicine or incorporate some of its principles into either general medicine or subspecialty practice. It provides valuable information to healthcare workers in the fields of nutrition, exercise physiology, psychology, behavioral medicine, health promotion, and public policy where lifestyle medicine principles play an ever-increasing role.

Creating a Lifestyle Medicine Center

Author : Jeffrey I. Mechanick
Publisher : Springer Nature
ISBN 13 : 3030480887
Total Pages : 374 pages
Book Rating : 4.0/5 (34 download)

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Book Synopsis Creating a Lifestyle Medicine Center by : Jeffrey I. Mechanick

Download or read book Creating a Lifestyle Medicine Center written by Jeffrey I. Mechanick and published by Springer Nature. This book was released on 2020-09-04 with total page 374 pages. Available in PDF, EPUB and Kindle. Book excerpt: Building on the groundbreaking work Lifestyle Medicine (2016), this unique new book bridges the gap between theory and practice by providing detailed information on the real-world development and creation of a Lifestyle Medicine Center, whether independently or as part of an established medical program or department. Part one sets the stage by establishing the rationale for creating a Lifestyle Medicine Center as well as the medical and economic burden it seeks to alleviate. The construction of the physical facility and all of the myriad details of the program and its key players are covered in part two, from the structural to the aesthetic, including informatics, developing patient resources and education tools, current technologies and applications, the role of the dietitian and exercise physiologist, inpatient consultation, the importance of community engagement, and more. Part three is comprised of case studies of existing, successful Lifestyle Medicine Centers across the country, with detailed descriptions of their history, development, programs and challenges. Chapters are supported with plentiful figures, tables and useful links. The burden of chronic disease in the U.S. and globally is growing, with pervasive direct and indirect multi-scale adverse effects on health and well-being, economics, and quality of life. Notwithstanding the remarkable progress in biomedical technology, the role of lifestyle medicine in managing chronic disease in a preventive care model is paramount; however, the relevant and effective education in lifestyle medicine is lacking. Translating the theory into action steps, instantiated by case studies with critical interpretations and problem-solving tools, Creating a Lifestyle Medicine Center is the go-to resource for family and primary care physicians, internal medicine physicians, and all clinical specialties interested in planning and developing a lifestyle medicine program.

Textbook of Lifestyle Medicine

Author : Labros S. Sidossis
Publisher : John Wiley & Sons
ISBN 13 : 1119704375
Total Pages : 291 pages
Book Rating : 4.1/5 (197 download)

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Book Synopsis Textbook of Lifestyle Medicine by : Labros S. Sidossis

Download or read book Textbook of Lifestyle Medicine written by Labros S. Sidossis and published by John Wiley & Sons. This book was released on 2022-01-19 with total page 291 pages. Available in PDF, EPUB and Kindle. Book excerpt: Textbook of Lifestyle Medicine The Textbook of Lifestyle Medicine provides foundational knowledge essential to students and scientists across various disciplines to better understand this new area of research and practice. Incorporating the latest evidence-based research on the relationships between lifestyle factors and disease, this unique book discusses the practical tools necessary to address growing public health crises such as obesity, cancer, diabetes, and cardiovascular disease using a holistic approach to physical, mental, and spiritual wellness. The book offers comprehensive and up-to-date coverage of how lifestyle medicine professionals can prevent and mitigate ‘Lifestyle Diseases’. Clear and accessible chapters explore modifiable lifestyle factors that positively affect health, nutrition, exercise, sleep, stress control, and social support, and highlight the negative impact of smoking, alcohol abuse, and other unhealthy lifestyles. Topics include sleep physiology, the genetic background and development of noncommunicable diseases (NCDs), the characteristics and principles of healthy lifestyle, the clinical significance of physical activity, and the mechanisms connecting social interaction and health implications. This important resource: Discusses the global burden and risk factors of the modern disease epidemic Covers a variety of nutritional approaches including the Mediterranean Diet and the Dietary Approaches to Stop Hypertension (DASH) diet Features in-depth coverage of the Mediterranean Lifestyle, a holistic approach to health and wellness Includes a clinical practice section and appendices on preventive medicine and public health tools and recommendations Contains key points, take-home messages, self-assessment questions, color artwork and numerous references, citations, internet links, and further reading suggestions Written by two world experts in this growing field, the Textbook of Lifestyle Medicine is a must-have volume for students and practitioners in nutrition, exercise physiology, psychology, addiction therapy, sleep therapy, as well as physicians, nurses, and other health professionals wanting to expand their knowledge and practice.

Lifestyle Medicine, Second Edition

Author : James M. Rippe
Publisher : CRC Press
ISBN 13 : 1439845425
Total Pages : 1633 pages
Book Rating : 4.4/5 (398 download)

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Book Synopsis Lifestyle Medicine, Second Edition by : James M. Rippe

Download or read book Lifestyle Medicine, Second Edition written by James M. Rippe and published by CRC Press. This book was released on 2013-03-15 with total page 1633 pages. Available in PDF, EPUB and Kindle. Book excerpt: There is no doubt that daily habits and actions exert a profound health impact. The fact that nutritional practices, level of physical activity, weight management, and other behaviors play key roles both in the prevention and treatment of most metabolic diseases has been recognized by their incorporation into virtually every evidence-based medical guideline. Despite this widespread recognition, physicians and other healthcare workers often cannot find a definitive and comprehensive source of information on all of these areas. Designed for physicians and other health care workers, Lifestyle Medicine, Second Edition brings together evidence-based research in multiple health-related fields to assist practitioners both in treating disease and promoting good health. Sections cover nutrition and exercise, behavioral psychology, public policy, and management of a range of disorders, including cardiovascular disease, endocrine and metabolic dysfunction, obesity, cancer, immunology and infectious diseases, pulmonary disorders, and many more.

Nutrition in Lifestyle Medicine

Author : James M. Rippe
Publisher : Humana Press
ISBN 13 : 3319430270
Total Pages : 433 pages
Book Rating : 4.3/5 (194 download)

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Book Synopsis Nutrition in Lifestyle Medicine by : James M. Rippe

Download or read book Nutrition in Lifestyle Medicine written by James M. Rippe and published by Humana Press. This book was released on 2016-12-29 with total page 433 pages. Available in PDF, EPUB and Kindle. Book excerpt: This newest addition to the Nutrition and Health series focuses on nutrition’s key role in lifestyle interventions to prevent and manage diseases. The book pays particular attention to nutritional considerations related to obesity, diabetes, and cardiovascular disease. Edited by cardiologist, Dr. James Rippe, a well-known expert in the nascent specialty of Lifestyle Medicine, Nutrition in Lifestyle Medicine will also focus on a variety of specialized areas such as nutrition for athletes and physically active individuals, hydration, and nutrition throughout the life cycle (spanning from children to individuals over the age of 60). In addition, chapters will be included on controversies in nutrition, such as health effects of added sugars and saturated fatty acids in the diet. Finally, specialized chapters will be included in such areas as nutrition for women, nutrition for men, nutrition for latinos, the use of supplements, communication about nutrition, public policy issues, and the interface between nutrition and physical activity. Lifestyle Medicine, supported by the American Journal of Lifestyle Medicine, Dr. Rippe’s textbook Lifestyle Medicine (CRC Press, 2013) and American College of Lifestyle Medicine (ACLM), is a new national medicine specialty that stresses the use of lifestyle interventions in the treatment and management of disease. Its practitioners effectively manage medical treatments alongside the lifestyle interventions, for example lowering insulin treatment for patients with diabetes, reducing the dose of anti-hypertension medications for people with hypertension, and prescribing certain medical interventions that aid in smoking cessation.

Social Media in Clinical Practice

Author : Bertalan Meskó
Publisher : Springer Science & Business Media
ISBN 13 : 144714306X
Total Pages : 159 pages
Book Rating : 4.4/5 (471 download)

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Book Synopsis Social Media in Clinical Practice by : Bertalan Meskó

Download or read book Social Media in Clinical Practice written by Bertalan Meskó and published by Springer Science & Business Media. This book was released on 2013-07-22 with total page 159 pages. Available in PDF, EPUB and Kindle. Book excerpt: The number of patients using social media and the number of applications and solutions used by medical professionals online have been sky-rocketing in the past few years, therefore the rational behind creating a well-designed, clear and tight handbook of practical examples and case studies with simple pieces of suggestions about different social media platforms is evident. While the number of e-patients is rising, the number of web-savvy doctors who can meet the expectations of these new generations of patients is not, this huge gap can only be closed by providing medical professionals with easily implementable, useful and primarily practical pieces of advice and suggestions about how they should use these tools or at least what they should know about these, so then when an e-patient has an internet-related question, they will know how to respond properly. As all medical professionals regardless of their medical specialties will meet e-patients, this issue with growing importance will affect every medical professionals which means there is a huge need for such a easily understandable handbook.

A Prescription for Healthy Living

Author : Emma Short
Publisher : Academic Press
ISBN 13 : 0128215747
Total Pages : 338 pages
Book Rating : 4.1/5 (282 download)

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Book Synopsis A Prescription for Healthy Living by : Emma Short

Download or read book A Prescription for Healthy Living written by Emma Short and published by Academic Press. This book was released on 2021-01-05 with total page 338 pages. Available in PDF, EPUB and Kindle. Book excerpt: A Prescription for Healthy Living: A Guide to Lifestyle Medicine takes an evidence-based approach to health promotion and disease prevention. Medical doctors, healthcare professionals and research scientists from a variety of backgrounds provide informed advice on how to encourage patients to take charge of their health and future. This book addresses the impact that socioeconomic and environmental factors have on the health of a population and explores the psychology of health-related behavioral change, as well as considering a variety of subject areas as diverse as nutrition, physical activity, the practice of gratitude, the adverse health impacts of loneliness and the importance of achieving a satisfactory work-life balance. A Prescription for Healthy Living aims to encourage and inspire healthcare practitioners and public health officials to empower patients to make simple behavioral changes that will have a large and positive effect on their physical and mental wellbeing. Written by qualified medical professionals and research scientists from a variety of specialties Addresses a variety of health promotion, disease prevention and wellbeing topics Provides evidence-based information in a digestible and actionable way

Improving Women’s Health Across the Lifespan

Author : Michelle Tollefson
Publisher : CRC Press
ISBN 13 : 1000472493
Total Pages : 460 pages
Book Rating : 4.0/5 (4 download)

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Book Synopsis Improving Women’s Health Across the Lifespan by : Michelle Tollefson

Download or read book Improving Women’s Health Across the Lifespan written by Michelle Tollefson and published by CRC Press. This book was released on 2021-10-24 with total page 460 pages. Available in PDF, EPUB and Kindle. Book excerpt: The book is an evidence-based source of information on women’s health issues for health professionals already practicing lifestyle medicine, as well as an entry level textbook for those new to the field of lifestyle medicine. The collective expertise of each of the editors along with content provided by leaders within the American College of Lifestyle Medicine fills a much-needed void within the specialty of Lifestyle Medicine and is for providers of women’s health globally.

Integrative Preventive Medicine

Author : Richard H. Carmona
Publisher : Oxford University Press
ISBN 13 : 019024125X
Total Pages : 585 pages
Book Rating : 4.1/5 (92 download)

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Book Synopsis Integrative Preventive Medicine by : Richard H. Carmona

Download or read book Integrative Preventive Medicine written by Richard H. Carmona and published by Oxford University Press. This book was released on 2017-12-12 with total page 585 pages. Available in PDF, EPUB and Kindle. Book excerpt: For most clinicians, the science and evidence for many integrative therapies is largely unknown or considered suspect. Most physicians don't have time to learn integrative approaches and aren't sure what to recommend or which approaches have merit or improved outcomes. Here, clinicians have easy access to the best practices in integrative medicine and expectations for outcomes

Lifestyle Medicine

Author : Garry Egger
Publisher : McGraw-Hill Book Company Australia
ISBN 13 : 9780070138179
Total Pages : 320 pages
Book Rating : 4.1/5 (381 download)

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Book Synopsis Lifestyle Medicine by : Garry Egger

Download or read book Lifestyle Medicine written by Garry Egger and published by McGraw-Hill Book Company Australia. This book was released on 2007-12-04 with total page 320 pages. Available in PDF, EPUB and Kindle. Book excerpt: "Up to 70% of all visits to a doctor are now thought to have a predominantly lifestyle-based cause." 5 STAR DOODY'S REVIEW! ". It has a refreshingly broad scope, as it addresses many issues rather than the usual, single-issue book on lifestyles....This is an outstanding book, easy to read, with a very broad scope, and full of useful approaches to discuss lifestyle problems with patients. This is a tremendous addition to every clinician's armamentarium."--Doody's Review Service "This comprehensive yet highly readable text summarizes the theoretical framework behind lifestyle medicine and provides practical guidance for GPs and allied health professionals to implement preventative 'three A' (Assess, Advise, Arrange) interventions in brief clinical consultations....this excellent resource offers strategies that may provide health care teams with practical approaches that are, for the most part, realistic to implement in primary care settings."--American Journal of Lifestyle Medicine Lifestyle Medicine is the essential book for contemporary times. It concentrates largely on the contribution that can be made directly by the clinician at the personal level. But what is "lifestyle medicine?" Lifestyle medicine calls for a modified approach to health management to help clinicians effectively prevent, treat, and manage a range of modern health problems with predominantly lifestyle-based etiologies. The rise in obesity worldwide has focused attention on lifestyle as a prominent cause of disease. However, obesity is just one manifestation, albeit an obvious one, of lifestyle-related problems. A wide range of others have resulted from the environment and behaviors associated with our modern way of living. Inactivity, poor and over-nutrition, smoking, drug and alcohol abuse, inappropriate medication, stress, unsafe sexual behavior, inadequate sleep, risk-taking, and environmental exposure (i.e. sun, chemicals, the built environment) are significant modern causes of disease. New and adaptive approaches to health management are needed to deal with these complex problems. Lifestyle Medicine provides these tools to enable clinicians to successfully manage patients in our current environment. Key Features: Presents the latest research Written by a team of renowned experts Highly practical and accessible format Includes practice tips, key points, and professional resources

Increasing Physical Activity: A Practical Guide

Author : James M. Rippe
Publisher : CRC Press
ISBN 13 : 1000224473
Total Pages : 216 pages
Book Rating : 4.0/5 (2 download)

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Book Synopsis Increasing Physical Activity: A Practical Guide by : James M. Rippe

Download or read book Increasing Physical Activity: A Practical Guide written by James M. Rippe and published by CRC Press. This book was released on 2020-11-17 with total page 216 pages. Available in PDF, EPUB and Kindle. Book excerpt: Only a fifth of adults in the United States do enough physical activity to meet the guidelines set by Centers for Disease Control. The health benefits of regular physical activity are beyond dispute, yet less than 40% of physicians routinely counsel their patients on the importance of physical activity. Increasing Physical Activity: A Practical Guide equips healthcare practitioners to include physical activity counseling in the daily practice of medicine. Written by lifestyle medicine pioneer and cardiologist, Dr James Rippe, this book proves inactivity is a stronger risk factor than other lifestyle factors for cardiovascular disease, diabetes, and many other diseases. It provides evidence-based information on the role of physical activity in preventing and treating chronic conditions and includes practical strategies for healthcare practitioners to prescribe this powerful method to enhance both short and long-term health and quality of life. Features: Specific chapters explain the role of physical activity in reduction of risk of heart disease, diabetes, cancer, osteoarthritis, dementia and many other chronic conditions. Chapters begin with bulleted, key points and conclude with a list of clinical applications. Strategies are provided to encourage previously sedentary individuals to adopt regular physical activity. Physical activity is placed in the context of other lifestyle medicine concepts including maintenance of a healthy body weight, following sound nutritional practices, stress reduction and other practices which impact on health and quality of life. Written for healthcare practitioners at all levels, this is a user-friendly, evidence-based manual for healthcare practitioners looking to incorporate more physical activity counseling into either general medicine or subspecialty practices.

Nutrition Education in U.S. Medical Schools

Author : National Research Council
Publisher : National Academies Press
ISBN 13 : 0309035872
Total Pages : 152 pages
Book Rating : 4.3/5 (9 download)

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Book Synopsis Nutrition Education in U.S. Medical Schools by : National Research Council

Download or read book Nutrition Education in U.S. Medical Schools written by National Research Council and published by National Academies Press. This book was released on 1985-02-01 with total page 152 pages. Available in PDF, EPUB and Kindle. Book excerpt: As the general public has become more aware of advances in nutrition, consumer demands for advice on matters of diet and disease have grown. This book offers recommendations to upgrade what were found to be largely inadequate nutrition programs in U.S. medical schools in order that health professionals be better qualified to advise and treat their patients. A comprehensive study of one-third of American 4-year undergraduate medical schools provided information on the current status of nutrition programs at each school. Conclusions were drawn and recommendations made from analysis of this gathered information. Questions examined in this volume include: Has medical education kept pace with advances in nutrition science? Are medical students equipped to convey sound nutritional advice to their patients? What strategies are needed to initiate and sustain adequate teaching of nutrition in medical schools?