Limits of Medicine: The Doctor’s Job in the Coming Era
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Despite the fact that many physicians may be very good communicators, they do not necessarily have the time or encouragement to make communication with stakeholders a top priority. Accordingly, some schools, such as Hofstra Northwell, has incorporated patient-centered communication skills throughout its four-year curriculum. Educators across disciplines—nurses, social workers, and doctors—work with students on an ongoing basis.
Many other initiatives are accelerating the pace of change in medical education. These include initiatives to develop faculty and to provide funding for transformation. A key strategy for moving medical education forward is training faculty to teach new skills and capabilities. The AAMC has established a leadership development unit that trains executives, faculty, and administrators at AAMC medical schools in the skills needed to transform academic medical centers for the future.
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This program aims to help the 15—20 new medical school deans appointed each year learn communication, public policy, and other leadership skills. Acknowledging the up-front cost and difficulty associated with organizational change, the American Medical Association AMA has provided funding to jump-start transformation.
The goal is to stimulate innovation and transform how physicians are taught. Skochelak says that the AMA began its transformation initiative by looking for ways to improve health outcomes. Rather than operating the initiative like a grant program, the AMA has established a learning group consortium to share ideas in order to drive changes across the schools selected, as well as to conduct a national evaluation plan.
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Though 85 percent of US medical schools applied to be a part of the program, the AMA selected 11 schools to start with. Noting that roughly 40 percent of new medical students come to school from nontraditional pathways, the AMA wants to encourage an education system that is more competency-based. The four-year family medicine track emphasizes population health management education, interpersonal team-based care, and managing transitions of care, among other areas.
The question of what skills are imperative to deliver medicine in the 21st century—as well as what part of the curriculum should be dropped to make the time and space for new material—will continue to challenge academic medical institutions.
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It is difficult to make major changes to curricula even when medical school leaders know that reform is inevitable. Even though students stay in medical school for four years, they still undergo a very full and demanding medical curriculum. Change is hard. Grover notes that, in order to successfully educate new physicians about costs, public policy, public health, and leadership, medical schools need to have faculty with expertise in these areas.
Funding transformation is still a hurdle for many institutions. Skochelak emphasizes that medical education as an industry is motivated to change and meet the demands of 21st-century practice. However, the financial challenges of transformation are more difficult. System transformation requires an up-front investment, and not all schools have the resources to experiment with curriculum and system redesign without outside funding. That said, there are positive signs on the horizon: This past winter, the AMA announced that 20 more medical schools were joining the consortium in an effort to learn from broader experimentation and disseminate the results quicker and further.
Some areas where skills may be needed are still being defined. One of these is population health. Doctors receive minimal training in nutrition, for example. The varying roles of different caregivers for those with chronic disease, chronic care management systems that are outside the realm of the health care system, and upstream solutions to maintaining health make aligning incentives very challenging. Medical education has traditionally emphasized two goals: preparing physicians as researchers and training them to provide care. In general, physicians are overly trained and prepared to address patients in the hospital rather than in ambulatory or community care settings.
Moving forward, medical education could transition from acute care needs to outcomes-based care, focusing on the complex components of managing disease and relationships. Competency-based learning, or the idea that medical or residency training should be evaluated based on outcomes rather than time in training, is often mentioned as a way to transform medical education and reduce the time needed for some to become a new physician. When discussing the possibility of competency-based learning, Dr.
Grover of the AAMC noted that more schools are evaluating how residents communicate with other members of their teams and that, if doctors in training score poorly, there is remediation to educate them on needed communication skills. Competency-based learning might keep a student or resident from advancing if the attending physician thinks that he or she is not proficient. Additionally, Dr. Today, almost 20 years later, if the number of residents being trained at a teaching hospital exceeds the limit, that hospital receives no additional IME or DGME payments.
If teaching hospitals want more flexibility in the current residency training funding structure, then policy changes are needed. However, absent more federal funding, little change has occurred. Medical schools know that medicine is changing, and they are trying to adapt.
Some changes may happen naturally and without system-wide reform. For example, as Millennials comfortable with apps, digital platforms, and online communication graduate and begin to practice medicine, they could be more prepared to integrate digital tools into their day-to-day work than older generations. Other changes, such as team-based care, moving away from memorization, and embracing a cultural shift toward continuous learning likely will come from more deliberate curriculum redesign.
Hofstra Northwell School of Medicine dean Dr. Lawrence Smith, along with Dr. Judith Brenner, associate dean for curricular integration and assessment at Hofstra Northwell School of Medicine, have noted that, when developing a new way to train physicians, continual quality improvement and a commitment to ongoing curriculum evolution are key.
Some strategies will work and others will not—and schools and health systems need the flexibility to learn from success and failure. As medical school administrators look to accelerate change in the way future physicians practice medicine, they might consider:. Even if medical school curricula changed overnight, it would only be one step toward addressing the skills needed by all the practicing doctors.
Continuing medical education—the ongoing medical education requirements that help physicians maintain their skills and learn about developing areas of their field—could be integral to transforming how existing physicians practice medicine. Health systems and group practices, and their own physician leaders, also will likely need to work to provide ongoing education for practicing physicians. Tight margins.
Heightened regulation and reform. The shift to value over volume. Rapid consolidation. New technology and infrastructure considerations. These are just a few of the challenges facing health care providers today. Deloitte offers a range of services that help organizations address these pressing needs:. Visit the Health Care Providers area of www.
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Welcome back. Still not a member? Join My Deloitte. Article 05 April Ken Abrams, MD. Arielle Kane. Executive summary As the health care market changes, so are the capabilities physicians need to best practice medicine and serve their patients.
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Increasingly, consumers expect to partner with doctors instead of relying passively on them to make treatment decisions. Physicians report anticipating that approximately 50 percent of their total compensation will be paid through value-based payment models in the next 10 years and that they expect to need new business, health information technology HIT , and communication skills to practice effective value-based care VBC.
A century of medicine Around , it became possible to say in the United States that a patient with any disease consulting a doctor chosen at random stood better than a chance of benefiting from the encounter. These programs come in a variety of forms: Participation in accountable care organizations ACOs or bundling pilots Development of a provider-sponsored health plan Pay-for-performance contracting that include financial penalties and bonuses Hospitals will likely shift their focus to ambulatory care, as inpatient services are no longer the economic engine they have been in the past.
Consumerism is changing doctor-patient relationships Interviewed health system CEOs expressed that they also expect an increase in consumerism in health care.
What skills will physicians need? A successful physician will need an understanding of the health care business, as well as business acumen to assess growth opportunities. Stakeholder groups are working to accelerate change Many other initiatives are accelerating the pace of change in medical education.
A slow evolution toward change Medical schools know that medicine is changing, and they are trying to adapt. As medical school administrators look to accelerate change in the way future physicians practice medicine, they might consider: Looking for funding in unconventional places : This could include partnering with hospital systems, different schools within a university system that is, business schools, engineering schools, or hospitality schools , or other outside private entities seeking to add value to the health care system.
Additionally, the philanthropic sector, while their contributions are typically significantly smaller than those available from public or for-profit funders, has moved to invest in medical research and medical education. Integrating technology into medical education : Acknowledging that technology is changing how care is delivered, medical schools and residency programs could consider incorporating new tools into the curriculum. This could be as simple as allowing the use of tablet technology in the classroom setting or using advanced imaging tools during anatomy courses.
Providing experiences beyond hospital or clinic walls : Challenging students or residents to work with stakeholders outside of hospital or clinic-based health services could enhance understanding of the patient and consumer experience. This could include, for instance, helping low-income patients apply for Medicaid or hosting integrated educational experiences with the justice system.
Medical schools and residency programs could consider investing in leadership forums, policy seminars, and technology training for their faculty and administrators. View in article Janet M.