The following is part of a series of original guest columns by the American College of Physicians.
by Steven Weinberger, MD, FACP
At times of calendar transitions, e.g., at the onset of a new year or a new decade, the popular press often takes a broad view in looking retrospectively at the outstanding or defining events and people of the past year or decade. Since we are now at a transition to both a new year and a new decade, I would like to take this opportunity as a medical educator to look forward rather than backward, summarizing what I think are 10 major challenges (in no special order) that confront the continuum of medical education over the next decade.
1. Educating students, residents, and practicing physicians about cost-conscious care. Given the unsustainably high costs of health care, it is critical to educate both current and future physicians about the appropriate and rational use of diagnostic and therapeutic modalities in order to minimize their overuse and misuse.
2. Establishing a culture in medical school and residency programs that fosters trainees to enter fields and practice medicine in areas of greatest societal need, e.g., primary care and care in underserved areas. Besides the need for financial remuneration to attract students and residents, appropriate recognition and prestige must be provided during training to these specialties and areas of practice need.
3. Focusing medical education on wellness and disease prevention. Whereas medical education has traditionally focused on diagnosis and treatment of disease, a high priority must simultaneously be placed upon education relating to maintenance of health and prevention of disease.
4. Establishing the proper balances among experience and education of trainees, number of hours and intensity of resident workload (duty hours), and patient safety. While the public is concerned about safety when being cared for by sleep-deprived residents, this must be balanced against concerns about discontinuity of care associated with patient handoffs, as well as the impact of duty hour restrictions on resident education and clinical experience.
5. Educating medical students and residents in a way that appropriately balances a scientific/pathophysiologic and an evidence-based approach to patient care. The current emphasis on evidence-based care must be integrated with, rather than replace, a firm grounding in the scientific and pathophysiologic principles underlying clinical medicine.
6. Preparing medical students and residents for a team-based, patient-centered approach to patient care. Medicine is increasingly becoming a “team sport,” and physicians must be well-trained to work as both a member and a leader of health care teams designed to provide high quality, patient-centered care.
7. Establishing an educational culture in which trainees and physicians examine their performance and measure patient outcomes, with the ultimate aim of continually improving the quality of care they provide. Measuring and improving quality of care needs to be embedded into the cultures of medical education and patient care; an important step has been the designation of practice-based learning and improvement as one of the required six general competencies for residents.
8. Establishing and developing “core” educational faculty who have the competencies necessary to train and promote the professional development of medical students and residents. Given the pressures on academic faculty for both clinical and research productivity, we must identify, support, and train a cadre of faculty for whom educating, assessing, and guiding the next generation of physicians represent the central component of their academic contributions.
9. Developing a system to support continuing medical education that avoids either the reality or the perception of bias by commercial interests. Given the increasing public concern about bias and conflict of interest resulting from commercial support of continuing medical education, a mechanism must be developed to support the high costs of continuing education that is sustainable and avoids even the perception of bias or conflict of interest.
10. Expansion of financial models to support medical student education with appropriate service paybacks to meet societal health care needs. Expanding opportunities to link tuition support for medical students with an obligation to provide needed health care services simultaneously serves the needs of students and patients, and potentially allows students to choose careers without the worry of oppressive educational debt.
These 10 challenges are daunting in their scope, but they are laudable goals for the medical profession and its educational arm over the next decade.
Steven Weinberger is Deputy Executive Vice President and Senior Vice President, Medical Education and Publishing, of the American College of Physicians. His statements do not necessarily reflect official policies of ACP.
