| Departments — President’s Report | Spring 2009 |
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Course Adjustments Given my local and national perspectives on medical education—gathered during more than twenty-five years as a clinician–teacher and medical educator at HMS, and, more recently, five years directing medical education at the American College of Physicians—I decided to use this column to discuss four major environmental changes affecting health care and medical education. Emphasis on quality of care. Catalyzed by the Institute of Medicine’s Crossing the Quality Chasm report, physicians are now judged not only by what they know, but more importantly by what they do when caring for patients—that is, the quality of care they provide. Students and trainees must be educated in an environment in which quality of care is a core value, and they must also understand the importance of assessing and continually improving the quality of care they provide. Faculty who supervise these students must embrace a culture of quality, commit to teaching the principles of quality improvement and the delivery of high-quality care, and serve as role models for the implementation of such improvement and care. Change in the nature of inpatient care. For several years now, the inpatient setting is no longer an ideal place for trainees to learn how to diagnose acute illness, follow the course of acute disease, and take primary responsibility for patient care. Instead, preadmission diagnoses, shortened inpatient stays that focus on throughput, and the delegation of decisions to attending physicians and consultants all detract from the student’s experience and professional development. As a consequence, the outpatient setting must play a greater role in training future physicians and must assume a focus on prevention and on better management of chronic illness to avoid hospitalization. Limitations on duty hours. In recent years, regulatory bodies have imposed restrictions on resident work hours, with the intent of reducing resident fatigue and improving patient safety. The subsequent increase in physician-to-physician handoffs has led, however, to concerns about diminished continuity and the potential for decreased quality of care. Reconciling these concerns necessitates creative approaches to scheduling and patient coverage that balance and best meet the needs of both trainees and patients. Pressures on teaching faculty. Faculty members need time and support for the responsibilities that are critical to the professional development of students and trainees: evaluation through direct observation, frequent and high-quality feedback, mentorship, and role modeling. Yet faculty members are under increasing pressure to generate more revenue through either clinical productivity or grant funding. As teaching activities do not generate revenue, clinical institutions require clinician–teachers to see a greater number of patients, a move that lowers the priority placed on their teaching responsibilities. Fortunately, many institutions have acknowledged the need to support teaching faculty by remunerating their educational duties and emphasizing quality and quantity of teaching in criteria for promotion. These four areas do not capture all the changes affecting medical Steven E. Weinberger ’73 is senior vice president for medical education at the American College of Physicians in Philadelphia. Photo: ©iStockphoto.com |
education; notably absent are the pressures accompanying the current economic downturn. They do, however, represent areas over which medical schools, teaching hospitals, and educational leaders have some control. How well institutions address these challenges will determine how well they can meet the educational needs of students and trainees and the clinical needs of patients.
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