ACP: Primary care education and training: Time for change?

A guest column by the American College of Physicians, exclusive to

by John Tooker, MD, MBA, MACP

The Annals of Internal Medicine recently published an article by Mullan and colleagues on the social mission of medical schools. In the article, medical schools were ranked on their record of educating and training physicians to care for the “population as a whole”. Not surprisingly, medicals schools varied widely in graduating doctors who become primary care physicians, are underrepresented minorities in the physician work force, and who provide service to underserved populations.

The Josiah Macy Jr. Foundation, which provided the primary funding for the Mullan article, released a separate report separate report  in April of 2010 on the provision and training of primary care professionals, noting that medical schools and other health professions schools “hold the societal responsibility for the education of health professionals” and “have the opportunity and obligation to increase the size and strength of the primary care workforce”. The report contains many useful recommendations to improve the education and training of the professions who play a substantial role in team-based primary care.

As an internist familiar with medical practice in rural and urban settings, and with academic medical centers and community practice, I see the need, from multiple perspectives, for traditional medical schools in academic medical centers to increasingly value primary care as core to their mission, and to form partnerships with the states, regions and communities where practice is local and the need is greatest. The clinical teaching “partners” can and should include the leading physicians and other members of the primary care team who provide care for patients in these communities.

One such new innovative partnership is the Tufts University School of Medicine – Maine Medical Center Maine Track. In 2008, TUSM and MMC agreed to collaborate on a medical school initiative designed to address patient access needs in Maine, including access to primary care services.

Key Points of the Tufts-Maine Medical Center Track:

  • Well qualified students, most familiar with Maine
  • Appropriate class size (31 students in the Class of 2014)
  • Tuition assistance
  • Innovative and flexible curriculum
  • Experienced and committed clinical faculty
  • Early exposure and training access to a full range of clinical experience, including small town and rural practice and academic medical centers

These students were selected in a competitive process, most with a basic understanding of what living and practicing in Maine might be like. While this is an experiment yet to be validated, it is an important and innovative initiative that began as a “what if” idea, with the commitment and leadership to make it happen. This is the type of experiment being encouraged by other medical schools to meet the needs of the patients they serve.

So, in the spirit of innovation, best practices and shared learning, what ideas or models to improve primary care education and training would you like to share with the readers?

John Tooker is Associate Executive Vice President of the American College of Physicians. His statements do not necessarily reflect official policies of ACP.

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