7 Changes for Medical Schools to Train Doctors for Reform Era Care

Cheryl Clark, for HealthLeaders Media , June 10, 2010

Cooke and her UCSF co-authors, David Irby, vice dean for education and Bridget O'Brien, assistant professor in UCSF's Office of Medical Education, recommend seven radical policy changes. They include:

1. Revising pre-medical course requirements and readmission processes to ensure socio-economic and racial-ethnic diversity of medical training.

2. Accrediting, certifying and licensing agencies work together to coordinate standards and resolve jurisdictional conflicts.

3. CEOs of teaching hospitals and directors of residency programs align patient care and clinical education to improve educational programs.

4. Medical school deans and teaching hospital CEOS should provide financial support, mentoring, faculty development, and recognition of academic advancement.

5. Medical school deans and teaching hospital CEOs should make funding for medical education transparent and fair.

6. The AAMC, AMA, Accreditation Council for Graduate Medical Education (ACGME), medical specialty societies, and medical schools advocate for sustained private, federal and state funding commitments to support innovation, infrastructure and research in medical education.

7. The above organizations should collaborate on developing a medical workforce policy to create interventions that address the cost of medical education, length of training and practice viability to ensure the nation has enough of and the right specialties of physicians.

The report also sums up four goals for medical education.

1. In the model of what medical education should be, a blueprint designed by Abraham Flexner 100 years ago, two years of basic science instruction is followed by two years of clinical experience. Today, medical education should instead standardize learning outcomes and general competencies, but provide options for individualizing the learning process for students and residents, such as offering the possibility of fast tracking within and across research, policymaking, education, to reflect "the broad role" played by today's doctors.

2. Students and residents need to understand and prepare to integrate the diverse roles they are expected to play to "educate, advocate, innovate, investigate and manage teams" while they "constantly integrate all aspects of their knowledge, skills and values." To do this, students should be provided with earlier clinical immersion, and residents should be more intensely exposed to the sciences underlying their practices.

3. Medical schools should engage physicians-in-training to be inquisitive, interested in discovery, and systems innovation.

4. More attention should be focused on developing physicians' professional values, communication, and interpersonal skills as well as ethical and legal understanding, aspirational goals, accountability, humanism, and altruism.

The report seems to push for training that empowers physicians to be more advocacy-oriented, "to change the policies that affect the design and delivery of U.S. medical education."

And, the report goes in to some detail about preparing doctors to avoid burnout and depression.

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