Medical Education and Societal Needs A Planning Report for Health Professions (1983) / Chapter Skim
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3. Issues for Targeted Study
3. Issues for Targeted Study
Pages 29-69
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From page 29... ...
3) What are the implications from question 2 for medical education and education of other health professions?
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From page 30... ...
In addition, research funding resulted in the development of institutional research capability and research faculty. Now the institutions of medical education, especially the medical schools and the teaching hospitals, must adjust to changing policy and funding environments.
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The worry about teaching hospitals is that they may collapse because of fiscal pressures -- competition from community hospitals, changes in reimbursement schedules, increasing costs of technology and health personnel, and a larger than proportionate share of pat tents who are unable to pay their hospitalization costs (Chapter 10, Appendix B)
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From page 32... ...
Relevant to the impact on students are analyses of factors af fecting: o the cos t of medical education o the availability and types of f inancial assistance. The impact of the changing financial support structure for teaching hospitals and medical schools would consider such topics as: o educational impact of cost containment measures O availability of residency slots 0 medical practice plans o states' roles in financing.
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From page 33... ...
It is difficult to devise the research needed to develop guidelines for such decisions. Some obvious difficulties arise from the mix of activities of each faculty member -- differences between basic sciences and clinical teaching, overlap or involvement of medical schools with their universities, the similar involvement with patient care institutions, and the problem of developing outcome measures against which to judge differences.
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From page 34... ...
The pool of applicants to medical schools may continue the decline that has already begun, with a possible reduction of quality of student. There may be an especially severe impact on medical schools that educate a great proportion of black or other minority students, such as Meharry and Howard Universities, whose graduates are more likely to practice in underserved areas than graduates of other schools.7 (See Appendixes C and D.)
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From page 35... ...
It is unknown whether there is a correlation between debt and default, between default and institutional policy, between student income level * At Howard University, for example, a relatively large number of students -- 35 percent -- participated in the Health Professions Student Loan (HPSL)
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From page 36... ...
If decision-making is to rest increasingly at the state level, the impact of state policies on the local physician supply should be investigated. Changes that are taking place (such as the proposed reduction in the Health Science program of the University of California, tuition increases in public schools, changes in state medical service payback scholarships, and changes in state contract seat arrangements)
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From page 37... ...
There may be reductions in the size of residency programs. Medical schools and teaching hospitals may start to rethink and restructure their relationships with each other.
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Additional costs include supervision, extra tests and procedures, and space for teaching. It is unclear whether it is these costs or the severity of patients' illnesses or a combination of these and other factors that result in higher patient care costs in teaching hospitals than in others.
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Educators should then be able to select measures with the most desired, or least undesired, impact. This approach is exemplified by Lewin, who suggests that, since faculty represent the largest single medical school expenditure, studies of faculty costs, through an examination of how faculty spend their time and the revenues they generate, would provide useful information for management, budgeting, and planning.17 A logical approach to performing research useful to decision-makers could use as a base the work begun by the Institute of Medicine in the 1974 report on the Cost of Education in the Health Professions.3 This study examined the cost components of 14 medical schools and noted variations among schools in many of the variables investigated.
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* Some members of the committee suggest that it might be productive to look at foreign medical schools that, at a lower cost than domestic schools, graduate high-quality physicians.
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From page 41... ...
These studies emerged from committee discussions and background materials, and are presented in order of priority set by the committee: 0 identifying, selecting for, and nurturing desired qualities in physicians 0 health manpower policy 0 potential new roles for and changing demands on the physicians (e.g.,.as health educators, as care providers for the elderly or chronically ill) and division of labor among health professionals o educating physicians to be researchers.
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From page 42... ...
Desired Qualities in Physicians Are there qualities, such as honesty, curiosity, and skepticism, that are required in all those seeking a career in medicine, regardless of whether patient care, research, administration, or some other activity is their major responsibility? The AAMC study on the "General Professional Education of the Physician and College Preparation for Medicine" has a working group on Personal Qualities, Values and Attitudes that is charged to describe desirable traits that students should develop during college preparation for medicine and during medical school, to assess how faculties might best select students who possess the capability to develop these traits, and to consider how faculties can foster the development of these traits in college and medical school.l9 The findings of this working group should be available in approximately one year and should be a helpful for further work in this field.
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How can appropriate role models be selected for faculty within the cultures of the medical school and clinical teaching settings ? A number of innovative medical educational programs have attempted to nurture particular qualities in future physicians.
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An international forum for discussion would be invaluable in this regard as well. Health Manpower Policy The increasing supply of physicians in respect to other health professionals, modifications in roles of non-physician health care personnel, scientific advances, and changing demographic patterns and burdens of illness, may well lead physicians into new roles.
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From page 45... ...
A health manpower policy is critically important for long-range funding of medical and other health profession schools and teaching hospitals, to provide reliable information to high school and college students concerning opportunities in the health professions, and to provide useful information for long-range planning of the health services industry. Our supply of health researchers also is a crucial component of manpower policy.
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From page 46... ...
States will have to determine their health manpower needs, the dis tribution of existing providers by location and specialty, the inflow and outflow of health professionals, and the return rates on funds for health professions training. State legislatures, facing increased budgetary pressures, will want guidance on future levels of medical and other health professional school enrollments.
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From page 47... ...
A health manpower policy can only be implemented successfully through broad consensus, developed by all sectors that have a role to play. Po tential New Roles for Physicians Wi th changing patterns of health and disease and an increasing supply of physicians to interact with a variety of health care providers, the division of labor among health professionals may undergo major shifts.
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From page 48... ...
or eliminating those that have outlived their usefulness, would benefit from an appreciation of the social organization and functioning of the medical education system. As social organizations, medical schools and teaching hospitals have distinctive characteristics, patterns of authority and power, and expectations of behavior.
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From page 49... ...
There are major differences in the cultures of medical schools and schools for educating health professionals that physicians must interact with. An example is the difference between schools of medicine and of public health in reference to income, way of life, and political view.
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One format would employ a social scientist and a health profession&l, working as a team, to conduct site visits and interviews with key people in medical schools and hospitals selected to be representative of a genre (e.g., private, research oriented or community, primary care oriented)
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From page 51... ...
Faculty Roles : Fostering Teaching, Research, and Service The role of research in medical schools and academic health centers has grown strong since World War II. Only more recently have practice plans grown in importance.
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The environment for the education of both clinicians and researchers will otherwise not be conducive to building the integrity both require. Li ttle research has been done since the 1950s and early 1960s on how medical schools work as social organizations or on student or faculty attitudes to the educational experience.~8~29 Studies of schools selected for their different cultures or different career preferences of students would illuminate the informal processes of medical education, and help to identify levers for change.
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From page 53... ...
Most of the observations of role models for physicians occur in clinical settings, and the significance of those settings in the professional development of the physician should be explored. Clinical training, for the most part, has been centered in tertiary care university teaching hospitals.
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Medical education is poised for drastic re-examination; either the teaching hospitals must change their essential character, or the mix of hospitals classified as teaching hospitals, expecially for the purposes of training residents, must change. The former alternative appears less likely than the latter.
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The teaching hospital has concentrated on "doing things right," and now the question is whether we are "doing the right things." A very different series of debates, frustrations and challenges are upon our institutions. Recent studies and writings have reviewed the problems of academic health centers, the financial dilemmas of the teaching hospitals, and some of the attempts at coping with the fiscal problems The focus has been on those issues that loom largest -- the economic pressures and pressures for relevance to community needs.
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From page 56... ...
What messages are perceived and passed on as senior students in college and in medical school report back on their medical school and residency interviews? What communications occur amongst faculties and administrators at the several institutions, including teaching hospitals?
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From page 57... ...
Three major questions will provide a focus for analysis. These questions emerged from committee discussions, the background papers, and some relevant independent activities such as the Macy Foundation sponsored conference "Teaching the New Biology:"32 o what is the current and projected science base for the practice of medicine?
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From page 58... ...
How then to adequately educate students to the full science base of medicine? First, there must be agreement on what that science base is.
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From page 59... ...
They too must forge a new place in the training of physicians . We must fully understand the confounding variables in discussions of what constitutes the science base in medicine.
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A diverse background of the student body seems desirable botch for the medical schools and for the profession as a whole. What constitutes a reasonable minimum background for entrance to medical school and what level of intellectual diversity should be encouraged f or premedical students in college ?
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From page 61... ...
This tool could simplif y teaching and learning, but there is the danger that instead the computer technology will be Created as yet another package of inf ormat ion to be learned -- adding to the students ' burden rather than easing it. In this age of computers in the home, grade school, and summer camp, incoming medical students will bring computer facility to their medical education.
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From page 62... ...
Better integration of science training programs within and among institutions (colleges, medical schools, ant teaching hospitals) might conserve time, one of the scarcest resources in medical education.
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Does the existence of research activities in medical schools increase the cost of medical education? Some of the questions have been answered, or partially answered, by existing research.
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From page 64... ...
Because there are fears that the quality of medical education will suffer if there is a diminution of research activity, and apparently no consensus on the level of research involvement necessary to instill the necessary qualities (ability to absorb the results of research, understanding of deductive processes, scientific curiosity) in students intending to practice clinical medicine, at this time monitoring actions are required to determine how medical schools are reacting to diminishing funds.
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From page 65... ...
Conclusion Most of the issues outlined here pertain not only to physicians but to a wide range of health professions. For example, in such areas as financing of education, qualities sought by a~mi ssions comb ttees, developing curricula, and acquisition of new knowledge through research.
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From page 66... ...
Impact of Changes in Federal Policy on Academic Health Centers. Washington, D.C.: AAl1C, 1982.
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From page 67... ...
G "The Future Role of Non-Physician Health Professionals, " 8th Private Sector Conference, Duke University Medical Center, March 13-1S, 1983.
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From page 68... ...
34. National Research Council, Assembly of Life Sciences, Committee on Maternal and Child Health Research.
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From page 69... ...
The Ef fects of Federal Biomedical Research Programs on Academic Health Centers. Biomedical Research Panel.
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