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Medical Education Beleaguered, Report Warns
In May the Commonwealth Fund Task Force on Academic Health Centers issued a report warning that medical education in the United States may not be keeping pace with new demands in the science and practice of medicine. Training Tomorrow’s Doctors: The Medical Education Mission of Academic Health Centers is the fifth report in a series that examines the effects of changes in the nation’s health care system on the social and academic missions of academic health centers (AHCs). The report, noting that the education of U.S. physicians occurs mainly in AHCs, argues that their familiarity with new medical discoveries and their ability to manage a system in turmoil “has never been more important.”
Yet unprecedented advances in medical knowledge and a transformation in the organization and financing of health care services over the past decade have stretched the ability of AHCs to educate new physicians. The challenges with which AHCs must grapple include a massive shift in care from inpatient to outpatient and ambulatory treatment, making it more difficult for doctors-in-training to track and learn from each case. Many of the deans interviewed reported that the move toward ambulatory care has also made it hard for them to recruit and retain high-quality clinician educators.
Other problems involve financial pressures on AHCs that have increased the clinical workloads of faculty, leaving them less time for teaching, and the primacy of research over instruction. “The ascendancy of research and the dependence on income from clinical activities have contributed to . . . the devaluation of teaching,” the task force found.
In addition to these obstacles, the report noted that many medical schools do not budget systematically for their education missions or create systematic learning objectives for their programs. “The fundamental rationale for the existence of academic health care centers is education of the nation’s health care workforce, yet we have no way of measuring how well they are performing this task,” commented David Blumenthal, the executive director of the task force and director of the Institute for Health Policy at Massachusetts General Hospital. “This is unacceptable, since the quality of care that the public receives is linked to the quality of medical education that students and residents are given.”
To improve medical education, the task force recommended, among other measures, that AHCs develop ways to evaluate the costs and quality of their educational missions; make it possible for faculty to spend more time teaching, especially in ambulatory care environments; and intensify their efforts to prepare physicians to care for an increasingly diverse population.
In a separate development in June, the Accreditation Council for Graduate Medical Education, which accredits all of the country’s medical residency programs, announced new standards limiting residents’ workweeks to eighty hours. The new standards also stipulate that residents should have at least one of every seven days free, should not be on call more than every third night, and should be assured of at least ten hours of rest between shifts. The accreditor issued the standards in response to ongoing criticism of the long hours required of many residents.
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