We are in the midst of a golden age of medical education, with schools expanding at an unprecedented level.
MedPage Today reports from a recent summit of medical educators, where they concluded that, with nine medical schools set to open and the majority of the remaining 126 schools planning to expand class size, this is an “unparalleled opportunity” to reform physician training.
That time can’t come soon enough.
The disconnect between academics and real world practice has never been greater. An emphasis on improving patient communication, as well as more training to deal with the business aspects of medicine, will better prepare our future doctors for the health care environment that awaits them.
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“Golden Age” usually refers to quality, not quantity. No, I think the golden age of medical education is past. The essential qualities required for another have all but been eradicated from our culture.
The report states “conspicuous gap that exists between the rhetorical commitment to high professional standards and the actual behavior on display in many present-day learning environments,” and recommends several things, like putting more emphasis on quality improvement, patient safety, and patient-centered care; teamwork, and putting students in community-based settings with less hospital-based training. I agree with all these suggestions, but are they the answers to the proposed problems. It is interesting to me to note that this report was also posted the same day that Pauline Chen wrote on the teaching of bedside manner (also posted on KevinMD). She talks about the hidden curriculum, which is what studies have shown most shape today’s physicians. Does the commitee’s solutions solve the problem of the hidden curriculum?
I would argue that it will not.
As director of our school’s ambulatory medicine clerkship, I am a big fan of more outpatient medicine. However, many docs in the outpatient world are not that happy either.
Though there is much that ought to be changed about medical education, the gap between the professional standards that schools attempt to teach and what is actually practiced is much less about what is formally taught in medical school, but what is actually seen in clinical practice. In other words, the root of the problem of our institutions not producing ideal physicians is likely mostly due to the ills of the health care system that they train in. Until our health care systems rewards (pays for) things like quality improvement, safety, and patient-centered care and teamwork; these will rarely be practiced and thus never learned by trainnees.
What I would love to see is this expansion in medical training really focus on growing the primary care workforce for the US. Medical schools mainly just pay lip service to the value of primary care and then turn around and promote sub-specialty care. It starts with the admissions committees and goes from there. Public medical schools in particular ought to work harder to provide the medical workforce their states actually need.
I agree that doctors should have a modicum of business training, say in marketing, accounting/finance, and perhaps entrepreneurship. But I doubt there will be significant training reform without significant payment reform WRT hospital-based specialist procedures vs “cognitive services” (e.g. improved patient communication).
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