In the centennial year of the Carnegie Foundation's ground-breaking Flexner Report that radically changed medical education, Carnegie is releasing another call for reform. Educating Physicians: A Call for Reform of Medical School and Residency, by Molly Cooke, David M. Irby and Bridget C. O'Brien, was published by Jossey-Bass and was funded by The Carnegie Foundation for the Advancement of Teaching and The Atlantic Philanthropies.
"The huge increases in medical knowledge, technology and specialization in recent decades have interacted with a now near-chaotic system of health care delivery, magnifying the challenges facing medical education," the authors write. "There is a need to motivate continuous learning and improvement across the whole arc of medical training. Those who teach medical students and residents must choose whether to continue in the direction established over a hundred years ago or take a fundamentally different course, guided by contemporary innovation and new understanding about how people learn."
They write that a new vision is needed to drive medical education to the next level of excellence. "The future demands new approaches to shaping the minds, hands and hearts of physicians." And they call for a much-needed dialogue to strengthen medical education and ultimately, provide better patient care.
Fundamental change in medical education will require new curricula, new pedagogies and new forms of assessment. Among the authors' recommendations are:
- To standardize learning outcomes and assess competencies over time. A focus on learning outcomes and milestones could end the time-based structure of medical school and residency.
- To strengthen connections between formal and experiential knowledge across the continuum of medical education, specifically by incorporating more clinical experiences earlier in medical school and providing more opportunities for knowledge-building later in medical school and throughout residency.
- To promote learners' ability to work collaboratively with other health professionals, such as medical assistants, nurses, pharmacists, physical therapists and social workers.
- To support learners' responsibility for quality of care, team performance and their own learning while providing skilled supervision.
- To make professional formation an explicit area of focus in medical education through strategies such as formal instruction in ethics and reflective practice, exploration of the role of the physician-citizen and establishment of more supportive learning environments.
- To cultivate a spirit of inquiry and improvement in learners and in health care teams; this spirit supports both innovations in daily practice that translate into better service to patients, system improvements and improved patient outcomes as well as the development of larger research agendas, new discoveries, and knowledge building.
- To be more intentional about our selection, development and support of teachers and medical educators.
The authors note that in order for medical schools to innovate, the funders, regulators and professional organizations that control and influence medical education must be actively engaged. New policies will be required.
The study's seven policy recommendations are that:
- 1. The Association of American Medical Colleges (AAMC) and medical schools work together to revise pre-medical course requirements and admission processes, ensuring the diversity of those in medical schools.
- 2. Accrediting, certifying, and licensing bodies together develop a coherent framework for the continuum of medical education and establish effective mechanisms to coordinate standards and resolve jurisdictional conflicts.
- 3. CEOs of teaching hospitals and directors of residency programs align patient care and clinical education to improve both and develop educational programs that are consistent with practice requirements.
- 4. Deans of medical schools and CEOs of teaching hospitals support the teaching mission of the faculty by providing financial support, mentoring, faculty development, recognition and academic advancement.
- 5. Deans of medical schools and CEOs of teaching hospitals collaboratively make funding for medical education transparent, fair and aligned with the missions of both medical schools and teaching hospitals.
- 6. AAMC, American Medical Association (AMA), Accreditation Council for Graduate Medical Education (ACGME), medical specialty societies, and medical schools advocate for sustained private, federal and state funding commitments to support infrastructure, innovation and research in medical education. Medical education is a public good that should be supported by society.
- 7. AAMC, AMA, ACGME, medical specialty societies, and medical schools collaborate on the development of a medical workforce policy for the United States. A variety of interventions addressing the cost of medical education, length of training, and practice viability ensure that the country has the mix of specialty and subspecialty physicians to meet the needs of the population.
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Molly Cooke is a professor of clinical medicine and holds the William G. Irwin Endowed Chair at the University of California, San Francisco School of Medicine. Dr. Cooke is a 2006 recipient of the Robert J. Glaser/AOA Distinguished Teacher Award, a national award bestowed by the American Association of Medical Colleges. She is a board member for the National Board of Medical Examiners which oversees the licensing of American physicians. She is also the director of the Haile T. Debas Academy of Medical Educators, which serves as a community for medical school faculty with a significant commitment to medical education, and advocates for both teachers in the promotion process and for enhanced funding in support of teaching. She holds an M.D. from Stanford University.
David M. Irby is vice dean for education and a professor of medicine at the University of California, San Francisco School of Medicine. He directs the undergraduate, graduate and continuing medical education programs of the School of Medicine and heads the Office of Medical Education. He earned a doctorate in education from the University of Washington, a master's of divinity from Union Theological Seminary, and completed a postdoctoral fellowship in academic administration at Harvard Medical School.
Bridget C. O'Brien is assistant professor in the Office of Medical Education at the University of California, San Francisco School of Medicine. She is involved in several research projects related to workplace learning and clinical education and teaches in the Health Professions Education Pathway and the Teaching Scholars Program at UCSF. She has a B.S. from Cornell University, a master's from the Haas School of Business at the University of California at Berkeley and a doctorate from the Graduate School of Education at UC Berkeley.