Academic Health Centers Leading Change in the 21st Century (2004) / Chapter Skim
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3 The Academic Health Center as a Reformer: The Education Role
3 The Academic Health Center as a Reformer: The Education Role
Pages 45-64
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From page 45... ...
Doing so will require much more than curricular reform, requiring consideration of how the clinical settings in which students are trained reinforces the attributes desired of health professionals in the 21st century. · All teaching environments will need to provide a sound base of knowledge that includes not only the emerging sciences, such as genomics, but also the social, behavioral, and other sciences that are important to 45
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From page 46... ...
· As part of their education role, AHCs need to work with educators and other resources within their parent universities to develop the evidence base for clinical education so that the approaches used will be based on sound educational principles that improve understanding of the quality of clinical education. As university-affiliated, academic organizations, AHCs need to take a leadership role in meeting these challenges.
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From page 47... ...
. The clinical learning environment, sometimes referred to as the informal curriculum, communicates values, culture, personal development, priorities, and the language of the field to students (Accreditation Council for Graduate Medical Education, 2002)
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From page 48... ...
Yet team interactions in practice often fall short of expectations, in part as a result of current approaches in clinical education that emphasize hierarchy, individual decision making, and the organization of work around professional roles rather than patient needs (Institute of Medicine, 2001b)
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From page 49... ...
and the identification of risk factors and how to mitigate them. The focus on the biomedical basis of disease that characterizes the current model for clinical education assumes that ill health is fully explained by disease, so that the core of medical science is the diagnosis and treatment of disease (Cassell, 1999)
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From page 50... ...
For example, there may be opportunities to foster interdisciplinary training between doctors and nurses in a hospital, but it is less clear how to bring public health into the training model. Some have recommended that public health training be incorporated into medical and nursing schools and that schools of medicine and nursing partner with schools of public health to develop interdisciplinary and joint programs (Institute of Medicine, 2003c)
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From page 51... ...
Clinical education programs that fail to incorporate state-of-the-art information systems into their training will be unable to prepare students for practice today, let alone tomorrow.
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From page 52... ...
The inpatient model for clinical education will be increasingly ineffective in the coming decades, however. The rate of hospital admissions has been declining; lengths of stay are becoming shorter; many diagnostic problems are being handled outside the hospital; patients in hospitals have the most complex conditions and therefore present a relatively narrow spectrum of diseases; and the sicker patients admitted require increasingly technical care (Kassirer, 1996; Goroll et al., 2001)
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From page 53... ...
. On the other hand, between 1984 and 1994, the percentage of all medical students who participated in one or more clerkships increased from just under half to almost three-quarters, and the average number of weeks in ambulatory settings increased as well (The Commonwealth Fund Task Force on Academic Health Centers, 2002)
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From page 54... ...
. The Association of Academic Medical Centers recently launched the Institute for Improvement in Medical Education to examine ways to improve medical education curricula, reform the clinical education of medical students and residents, enhance public health education in medical schools, promote professionalism during medical education, engage in international medical education activities, and better meet the need for continued professional development of physicians once they enter practice (Association of American Medical Colleges, 2003a)
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From page 55... ...
. Eighteen schools were funded to initiate curricular innovations in undergraduate medical education aimed at supporting graduates in practicing high-quality, population-based, cost-effective medicine while maintaining a commitment to care of the individual.2 The areas addressed in the reforms included health systems finance and organization; the practice of evidenced based medicine, with emphasis on population health; health care ethics; patientprovider relationships and communication skills; leadership and interdisciplinary teamwork; quality measurement and improvement; systems-based care; medical informatics; and wellness and disease prevention.
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From page 56... ...
The third factor relates to the weak evidence base for clinical education, which makes it difficult to know which changes will have a positive effect on student preparation for practice. The fourth factor relates to financing.
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Accreditation of continuing medical education programs is offered by the Accreditation Council for Continuing Medical Education. The American Osteopathic Association has a separate council for continuing education.
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From page 58... ...
. Graduate allopathic medical education: Accreditation of graduate medical educa tion is overseen by the Accreditation Council for Graduate Medical Education (ACGME)
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From page 59... ...
The Council on International Osteopathic Medical Education and Affairs address international training concerns. Osteopathic graduate training is organized around community based training consortia, known as Osteopathic Postdoctoral Training Institutions.
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From page 60... ...
As noted earlier, teaching faculty are under pressure to see patients and conduct research, leaving little time for teaching (The Commonwealth Fund Task Force on Academic Health Centers, 2002; Ludmerer, 1999)
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From page 61... ...
Better information is needed on the effectiveness of various teaching approaches for clinicians, on how principles of adult education can be applied appropriately to clinical education, on what types of teaching technologies are most effective and under what circumstances, on the characteristics associated with high-quality clinical education, and on the cost of training various health professionals. Good quality measures in clinical education do not currently exist (Blumenthal and Bass, 2001)
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From page 62... ...
. Many schools have not budgeted systematically for clinical education (The Commonwealth Fund Task Force on Academic Health Centers, 2002)
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From page 63... ...
IMPLICATIONS FOR THE FUTURE There have been many calls for reform of clinical education, especially medical education. A recent Institute of Medicine report (2003a)
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From page 64... ...
Policy makers need to consider how financing methods can support both short- and long-term changes in clinical education. Innovative approaches are especially needed in implementing methods to support interdisciplinary education, and to provide training in information management, as well as in developing nonhospital training sites.
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