7 Changes for Medical Schools to Train Doctors for Reform Era Care

Cheryl Clark, June 10, 2010

The U.S. must aggressively reform the way it trains its physicians if they are to competently provide care to meet the mandates, hopes, and expectations of health reform, according to a report from The Carnegie Foundation for the Advancement of Teaching.

"It's generally recognized that our healthcare system is not functioning well," explains one of the report's three authors, Molly Cooke, MD, an HIV specialist at the University of California San Francisco and a member of the National Board of Medical Examiners, which oversees the licensing of American physicians.

One reason, she says, is that this country's new doctors don't get the training they should that teaches them to work with an integrated team.

"If you talk to any of the integrated health systems, you will hear that it takes them a year or two to take a very bright graduate from a very good residency program and convert that person into somebody who is functional in and engaged with the system. Right now, they can't function effectively as a member of a team," Cooke says.

What that means is summed up in the 320 pages of the report, "Educating Physicians: A Call for Reform of Medical School and Residency." The document was compiled on the basis of interviews with 10 faculty members, the dean, the education-related associate deans and the CEO, at each of 14 community, academic, and non-university teaching hospitals in 11 urban and rural states. They included Cambridge Hospital in MA, University of North Dakota, the Mayo Medical School in Rochester MN.

For example, in the report's summary, Cooke and colleagues wrote "clinical education is overly focused on inpatient clinical experience, supervised by clinical faculty who have less and less time to teach and who have ceded much of their teaching responsibilities to residents, and (who are) situated in hospitals with marginal capacity to support their teaching mission."

Also, the authors found "poor connections between formal knowledge and experiential learning and inadequate attention to patient populations, systems of healthcare delivery, and effectiveness."

Students don't have enough opportunity to work with patients over time and "observe the course of illness and recovery," and medical training is "inflexible, excessively long and not learner centered," the report said.

The Association of American Medical Colleges (AAMC) and the American Medical Association (AMA) did not respond immediately yesterday to requests for comment about the report.

The report calls for indirect and direct medical education funding from the Centers for Medicare and Medicaid Services to be realigned to support "infrastructure, innovation, and research in medical education."

"Everyone is doing what they believe to be good and useful, and so people don't appreciate it when it's suggested that perhaps the activity of a particular organization isn't as good and useful as it might be," Cooke says.

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