Tuesday, February 22, 2011

Time To Reform Medical Education (and include instruction on population health management)

The Disease Management Care Blog hasn't had much patience for our nation's medical schools. While there are exceptions, too many of them have imperial Deans, all-powerful Chairs, bloated bureaucracies, huge palatial edifices, and a pernicious skill in overproducing specialist physicians. These medical-industrial blobs continue to be unaccountable and tax-sheltered money machines and their leadership just doesn't get it.

Of course, that isn't going to stop reasonable suggestions on medical education reform from appearing in print from time to time. Case in point is a Perspective article by Mitesh Patel, Matthew Davis and Monica Lypson appearing in the New England Journal titled "Advancing Medical Education by Teaching Health Policy." It's just appeared on line, but that's OK because you read the DMCB.

The authors are proposing that the nation's medical schools adopt a "standardized health policy curriculum." They suggest that it focus on four domains: 1) health care systems (insurance, the safety net, workforce health information technology), 2) health care quality (outcomes measurement, quality improvement, patient safety), 3) safety, value and equity (economics, decision making, comparative effectiveness, disparities) and 4) health politics and law (legislation, adverse events and medical errors).

The authors also point out there are three barriers getting in the way: 1) the canard that there is simply no more room in undergraduate education (there is research that says otherwise), 2) the faculty don't exist (er, the truth is that they haven't been hired) and 3) the best way to teach this hasn't been developed (pending research on the topic, that doesn't mean that excellence should be the enemy of the good).

The DMCB wholeheartedly agrees, but being published in the Journal doesn't mean its going to happen. Perhaps what's called for is a top-to-bottom reform of medical education akin to what happened after the publication of Carnegie Foundation's The Flexner Report in 1910 (that's a pic of Abraham Flexner, circa 1895). The Foundation is still at it and many of its current proposals dovetail nicely with Patel et al. Perhaps it's time to link funding or tax policy to "performance," not the least of which should be an increase in the number of docs pursuing primary care careers.

The DMCB will close with an interesting recommendation from the Carnegie Foundation's list of reform proposals. The parts bolded by the DMCB speak to the importance of including team and outcomes-based principles of population health improvement in the curriculum. As a result, it deserves support by the care management community.

As we move forward with health reform, hopefully medical school reform will move to the top of the list:

To cultivate a spirit of inquiry and improvement in learners and in health care teams; this spirit supports both innovations in daily practice that translate into better service to patients, system improvements and improved patient outcomes as well as the development of larger research agendas, new discoveries, and knowledge building.

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