Training Tomorrow's Physicians: Science Alone Is Not Enough
November 16, 2012
Anchored in projections of population growth, illness burden, and the "right" ratio of clinicians to consumers, the numbers and skills of physicians and other health care professionals necessary to care for a growing and aging population remain a matter of debate. Some analysts suggest that other variables also come into play, such as the mix of health professionals, their ability to function as teams, and whether they are taught the skills that will allow them to deliver high-quality care cost-effectively.
But defining and inculcating the skills of 21st century physicians is a challenge in this time of change in medical practice. The explosion of biomedical knowledge, the rise of increasingly sophisticated technology, new frameworks such as patient-centered medical homes and accountable care organizations, and new professional requirements such as maintenance of certification have all played a role in accelerating change. Physicians are less likely to anticipate hanging up the traditional shingle as employment by a hospital, health system, or medical group becomes more common.
In response to changing times, medical education has made some curriculum adjustments, for example adding course material related to leadership, patient safety, population health, and information technology. New teaching methods, notably the use of simulation, have appeared. Some institutions have made strides toward interprofessional education.
For the most part, however, it is safe to say that practice has evolved at a more rapid clip than education. Most health professionals are taught in separate schools of medicine, nursing, pharmacy, etc. Medical education continues to rely on an apprenticeship model, giving students more responsibility for patient care over time but maintaining a hierarchy not particularly geared to innovation. Experience with chronic disease that has to be managed rather than cured is not necessarily mirrored in the day-to-day of an acute hospital environment where most medical education continues to take place.
Some leaders in medical education call for a revamping of the education process beginning in medical school and continuing through residency programs, incorporating a mix of experiences (for example, hospital and community care, didactic learning, and team exercises), and building rapid-learning mechanisms and expectations at all levels. These leaders also endorse a change in basic orientation, suggesting that health professions training programs should understand the needs of their communities and aim to produce a workforce that can meet them. Some further suggest that academic health centers should be held accountable for training students to deliver care that is both high in quality and cost-effective.
This Forum session considered ways in which medical education can and should evolve to meet the requirements of 21st century practice. Speakers offered examples of changes under way and their thoughts on further strategies for aligning education and community needs.
"Team-Based Care Takes Training: The Push for Interprofessional Education" (Forum Session, June 17, 2011).
See also The Macy Foundation's Ensuring an Effective Workforce for the United States (May 2011).