health care will put pressures on clinical education programs, particularly given the outlay of public dollars for clinical education.

The types of new or enhanced skills required by health professionals might include, for example, the ability to:

  • Use a variety of approaches to deliver care, including the provision of care without face-to-face visits (e.g., using electronic communications to provide follow-up care and routine monitoring) (see Chapter 3).

  • Synthesize the evidence base and communicate it to patients (see Chapter 6).

  • Combine the evidence base, knowledge about population outcomes, and patient preferences to tailor care for an individual patient (Weed and Weed, 1999a) (see Chapter 6).

  • Communicate with patients in a shared and fully open manner to support their decision making and self-management (to the extent they so desire), including the potential for unfettered access to the information contained in their medical records (see Chapter 3).

  • Use decision support systems and other tools to aid clinical decision making in order to minimize problems of overuse and underuse and reduce waste (Weed and Weed, 1999a) (see Chapter 6).

  • Identify errors and hazards in care; understand and implement basic safety design principles, such as standardization and simplification (Institute of Medicine, 2000) (see Chapter 5).

  • Understand the course of illness and a patient’s experience outside of the hospital (where most training is conducted).

  • Continually measure quality of care in terms of both process and outcomes; develop and implement best practices (Berwick et al., 1992) (see Chapter 5).

  • Work collaboratively in teams with shared responsibility (Chassin, 1998) (see Chapter 5).

  • Design processes of care and measure their effectiveness, even when the members of the team that cares for a patient are not in the same physical locale (Berwick et al., 1992).

  • Understand how to find new knowledge as it continually expands, evaluate its significance and claims of effectiveness, and decide how to incorporate it into practice (Chassin, 1998) (see Chapter 6).

  • Understand determinants of health, the link between medical care and healthy populations, and professional responsibilities.

Teaching these skills will likely require changes in curriculum. Although some schools have added courses that are consistent with the desired skills, the needed content is likely to evolve over time. For example, many schools now have courses in patient communications, information systems, and biostatistics.

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