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As our elected officials craft legislation that could transform US health care into a more equitable system that rewards high-value and coordinated care, academic leaders must embrace the challenge of training medical and health care professionals to serve successfully in this new environment.
During the past few decades, professional associations and organizations have called for health profession education reform, asserting that current programs inappropriately emphasize memorization of scientific knowledge over teamwork, clinical judgment, practical skills, and character/values development.1,2 Indeed, students in health professions currently are educated in a highly competitive environment that fosters individual knowledge, responsibility, and autonomy. After completing training, most of today's physicians enter private practice, where the world is often centered around them.
However, in a high-quality, integrated health care system, the world must be centered on the patient. In the essay “American Medical Education 100 Years After the Flexner Report,” Cooke et al3 said that “the moral dimension of medical education requires that students and residents acquire a crucial set of professional values and qualities, at the heart of which is the willingness to put the needs of the patient first.”
In April 2009, more than 150 national leaders gathered at Mayo Clinic's site in Rochester, MN, for the National Symposium on Health Care and Medical Education Reform to build consensus on how to realign US education programs to create a workforce capable of realizing this patient-centered vision. Participants acknowledged the mismatch between how professionals are currently being educated and the needs of society. Through discussion and submission and ranking of reform principles, participants identified 3 priorities for education reform: culture, curriculum, and financing.
During Michael Jordan's freshman year at the University of North Carolina, coach Dean Smith remarked, “Michael, if you can't pass, you can't play.”4 Jordan, the future 5-time National Basketball Association Most Valuable Player, at 19 years of age, had yet to master the fundamentals of teamwork.
Health care professionals face the same challenge. Educated on separate tracks, physicians, nurses, and other health care professionals ultimately work together with the common goal of serving an individual patient. Yet few have developed the essential team skills to help them work productively with their colleagues, analyzing outcomes and processes of care to improve continuously, by using each person's skills to the fullest. To realize these benefits, we need to infuse the value of teamwork into the medical education culture through specific curriculum changes.
In addition, we must shift our focus away from requiring students to accumulate large quantities of information. “It is possible to store the mind with a million facts and still be entirely uneducated,” wrote Aleck Bourne, MD, in A Doctor's Creed.5 Memorization is not education. With discoveries in genomics and proteomics, new information and knowledge will develop at an increasing speed during the next decade. In the information age, no one can know it all. Instead, health care professionals must be able to use information technology to find and interpret scientific information to provide evidence-based care. This quest to provide the most up-to-date, relevant medical advice to patients must continue throughout the professional's career.
Finally, we must renew our commitment to nurture the tenets of professionalism in our students. Professionalism does not just happen—it must be taught and it has not been a priority. Professionalism is the behavior required of all medical professionals to fulfill our compact with society, which at its core is to work in the patient's best interest.6 Cooke et al3 wrote:
Professional values are continuously exemplified and enacted in the course of medical education through role modeling, setting expectations, telling stories….However, the values of the profession are becoming increasingly difficult for learners to discern; the conclusions they draw, as they witness the struggle of underinsured working people to obtain health care, marked differences in the use of expensive technologies in different health care environments, and their physician-teachers in complicated relationships with companies that make health care products, should concern us.
We need to tear down classroom walls, both literally and figuratively. Students from diverse disciplines, such as physician assistant, nursing, and medical students, could take some classes together. Eventually, this type of broad restructuring would be cost-effective. As a purposefully designed additional benefit, students would learn to know and respect those in other disciplines, fostering teamwork. As students advance, they need to be offered more opportunities to learn and work side-by-side in realistic, interdisciplinary settings.
It is time to rethink the academic calendar, in which students mark time with 2 semesters a year, 4 years to a Bachelor's degree, and 4 years to a medical degree. Why not 3 semesters, instead of 2, to condense learning time? Why not a more flexible approach to better accommodate work, family, and learning?
Here is a recommendation that will resonate with students: Measure what matters and it is not grade point average. Today's evaluations do not reflect much of what is important in practicing medicine—coordinating care, working in teams, and finding answers that will help patients. We need to move away from standard examinations as primary assessment tools. A better approach would be to benchmark student performance against outcomes, cost, and value.
After graduation, real-time learning opportunities must be more accessible. Our current attend-a-lecture approach to continuing education does not improve care. Self-directed learning does improve patient care.7 Self-directed learning might be a virtual lounge, where professionals learn from each other and can access the latest research. Or it could be a desktop performance dashboard that logs completion of and performance on topic updates relevant to a professional's practice. This type of learning is possible when we think outside the current classroom structure.
Knowing where the money comes from, where it goes, and how much education costs are important steps in health care education reform. In fact, participants at the symposium indicated that transparency in education costs is a top priority.
For many programs, the fixed, variable, and marginal costs of education are difficult to determine. Cost transparency will make it easier to determine efficiencies and help ensure responsible stewardship, so that financial resources in health profession education are aligned with the needs of patients, the overall health care system, and society.
One of those societal needs is more primary care physicians. At the symposium, Mark Kelly, MD, CEO of the Henry Ford Medical Group in Detroit, identified impediments that discourage students from pursuing primary care: “The workload is too much, and the pay scale is too little. So why would any smart medical student who's looking out in that horizon want to go into primary care?”
Educators can make this important role more appealing through debt forgiveness and loan deferments. This is an example of how medical education can, in the big picture, better meet patient needs and support broader health care reform.
Can education reform advance without overall health care reform? We think that education reform must move for ward in conjunction with national health care reform. Within the next year, the Mayo Clinic Health Policy Center (http://www.mayoclinic.org/healthpolicycenter) and partner organizations will host a series of forums on medical-education culture, curriculum, and financing. The goal is to gather input and build consensus around a vision for education and the steps that must be taken to accomplish that vision.
While this work in under way, academic centers can begin making changes with an eye to the future—teaching students how to provide care in a more coordinated, patient-focused system. We need to teach our students how to deliver great outcomes, safety, and service while being mindful of costs (ie, create value), not just perform procedures.
Creating value and reforming the payment system are cornerstones of the Mayo Clinic Health Policy Center's recommendations for improving American health care. These principles have been developed during the past 3 years with input from thousands of people, including insurers, health care professionals, academics, employers, and patients.
We will continue to work toward overall health care reform so that our future health care professionals will be rewarded for providing value. Waiting to advance health care education reform is not an option. There is no rationale to keep future professionals boxed into today's culture and classrooms. Symposium attendee Jack Stobo, MD, from the University of California, summarized it best: “We are in control of health professional education. It's ours to win or lose.”
We thank Shelly W. Plutowski, BA, and Ronda Willsher, MBA, for their editorial contributions to the submitted manuscript.