another of medicine (Ludmerer, 1999; Starr, 1992). Graduate medical education—internships, residencies, and fellowships—now supplement medical school education, providing practical training in clinical practice in medical specialties and subspecialties. Specialty boards were created to oversee this training, and eventually the control and regulation of training was transferred from academic medical centers to these specialty boards (Ludmerer, 1999).

Subsequently, new methods of disease prevention, diagnosis, and treatment were developed and tested through clinical research, thus bringing laboratory results to the bedside. Clinical epidemiology provided a scientifically rigorous evidentiary foundation for clinical practice, which has been widely adopted by medical specialties and has led to the notion of “evidence-based medicine.” Changes in medical education reflected and reinforced the specialization in fields of medical research and practice, and graduate education of health professionals is now characterized by deep knowledge in narrow fields; a focus on individual patient care, with the primary emphasis on diagnosis and treatment and a lesser emphasis on disease prevention; little appreciation for populations/or public health; and almost no emphasis on the structure and processes of health care delivery. No substantive perspective on the entire system of health care or training in the uses and implications of systems tools and information/ communications technologies for managing and improving the system is included in medical education.

Students of engineering and management are much more likely than their counterparts in health fields to be trained in systems thinking and the uses and implications of systems-engineering tools and information/communications systems for the management and optimization of production and delivery systems. Nevertheless, students at most U.S. engineering and business schools are not likely to find courses that address the operational challenges to the quality and productivity of health care delivery.

One major contributing factor to the absence of health care delivery challenges in engineering curricula has been the long-standing lack of demand for engineers in the health care delivery sector. In contrast to engineering careers in device and pharmaceutical companies and other for-profit industries, engineering careers in medical care institutions are nearly nonexistent. In addition, there is a pervasive under-appreciation by engineering faculty, researchers, and practitioners of the magnitude, complexity, and importance of the operational challenges and opportunities facing the nation’s health care system combined with a reluctance to meddle in the “art” of highly respected health care professionals.

A PLATFORM FOR INTERDISCIPLINARY RESEARCH, EDUCATION, AND OUTREACH

In the preceding chapters, the committee has recommended a number of actions by industry, government, academia, and the health and engineering professions to begin to break down barriers to the use of systems-engineering tools, information/communications technologies, and business and managerial knowledge. Recommendations have included calls for public- and private-sector investments in research and development, demonstration projects, new approaches to reimbursement, expanded outreach and dissemination efforts by public- and private-sector health care quality improvement organizations, actions to advance the development of health care data, software, and network standards and other components of a National Health Information Infrastructure, and steps to harness the power of wireless integrated microsystems. The committee believes that action on these recommendations will accelerate the development, adaptation, implementation, and diffusion of systems-engineering tools and information/communications technologies in health care delivery. However, breaking down barriers and improving the overall health care system will also require bold, intentional, far-reaching changes in the education of researchers, educators, and practitioners in health care, engineering, and management through interdisciplinary research.

First, the academic research and educational engineering enterprise must be more closely linked to “real-world” needs in the public and private sectors to help bridge disciplinary research-to-application gaps in health care delivery. Some steps have already been taken in this direction. The NSF-sponsored Engineering Research Centers (ERCs) Program—which started in the 1980s and currently supports 22 centers—brings together industrial and academic researchers and graduate students on university campuses to conduct cross-disciplinary research focused on a single topical area and, in the process, encourages multidisciplinary interactions among faculty and students (NAE, 1983) (see Box 5-1).1 In addition, guidelines for the ERCs explicitly call for strengthening connections between research and the creation of new curricular material (NAE, 1983). ERCs have had a significant impact on both research and academic programs in the institutions where they are located.

NSF and other agencies have also established other university-based interdisciplinary research centers involving engineering (e.g., NSF science and technology centers and materials research science and engineering centers; U.S.

1  

These include the Center for the Engineering of Living Tissues at Georgia Institute of Technology and the Emory School of Medicine; the Engineering Research Center for Computer-Integrated Surgical Systems and Technology at Johns Hopkins University; the Engineering Biomaterials Engineering Research Center at the University of Washington; the ERC in Bioengineering Educational Technologies at Vanderbilt University; the Biotechnology Process Engineering Center at Massachusetts Institute of Technology; the Engineering Research Center for Wireless Integrated Microsystems at the University of Michigan; and the Engineering Research Center for Biomimetic Microelectronic Systems at the University of Southern California (NSF, 2004a).



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