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Crossing the Quality Chasm: A New Health System for the 21st Century
fundamental change in medical education was needed. This was true for their own institutions as well as medical education overall. Petersdorf and Turner (1995) report that the education given to students is “dated and arcane” and not in tune with societal needs. In interpreting their survey of young physicians, Cantor et al. (1993) found that “while medical training has remained largely unchanged, the demands placed on practicing physicians have changed dramatically.”
Some believe that the premises of the current apprenticeship model of medical education are so faulty in today’s complex health care environment that they need drastic overhaul (Chassin, 1998). Others have suggested that “research’s stranglehold on medical education reform needs to be broken by separating researchers from medical student teaching and from curriculum decision making” (Regan-Smith, 1998). Teaching should be an explicit and compensated part of one’s job. Still others have called for new relationships between medical schools and academic health centers that would permit the latter to focus on making the best decisions for patient care and allow medical schools to control education and its location (Thier, 1994). In such a circumstance, academic health centers might be affiliated with several medical schools and medical schools might be affiliated with multiple health centers to allow for greater flexibility by the partners.
Medical curriculum has not been static over the years, but has undergone extensive changes (Anderson, 2000; Milbank Memorial Fund and Association of American Medical Colleges, 2000). However, many believe that in general, the current curriculum is overcrowded and relies too much on memorizing facts, and that the changes implemented have not altered the underlying experience of educators and student (Ludmerer, 1999; Regan-Smith, 1998). Despite the changes that have been made, the fundamental approach to clinical education has not changed since 1910. A number of reasons have been cited for so little response to so many calls for reform:
Lack of funding to review curriculum and teaching methods and of resources to make changes in them (Griner and Danoff, 2000; Meyer et al., 1997)
Emphasis on research and patient care, with little reward for teaching (Cantor et al., 1991; Griner and Danoff, 2000; Ludmerer, 1999; Petersdorf and Turner, 1995; Regan-Smith, 1998)
Need for faculty development to ensure that faculty are available at training sites and able to teach students effectively (Griner and Danoff, 2000; Weed, 1981)
Decentralized structure in medical schools, with powerful department chairs (Cantor et al., 1991; Marston, 1992; Petersdorf and Turner, 1995; Regan-Smith, 1998)
No coordinated oversight across the continuum of education, and fragmented responsibilities for undergraduate and graduate education, licensing, certification, etc. (Enarson and Burg, 1992; Ludmerer, 1999)