Academic health centers (AHCs) in the United States need to make the continuous improvement of medical education a top priority, according to this latest report from The Commonwealth Fund Task Force on Academic Health Centers. While AHCs—medical schools and their affiliated hospitals and physician groups—have been largely successful in training the nation's doctors, competing demands on these institutions pose a threat to the quality of physician education down the road.
Medical education in the United States faces a number of challenges, including the rapid increase in biomedical knowledge, constraints on cross-subsidies from clinical activities, and fundamental changes in how adults are educated in a medical setting, says David Blumenthal, M.D., the executive director of the Task Force and one of the authors of Training Tomorrow's Doctors: The Medical Education Mission of Academic Health Centers
In an effort to ensure that the most important mission of the nation's 125 AHCs is not overshadowed, the Task Force issued a series of recommendations in its report. One of these is for AHCs to school physicians in providing new types of care, in different locations and in new ways. Many young doctors, for example, do not feel confident counseling patients on such subjects as smoking, weight reduction, safe sex practices, domestic violence, and substance abuse. AHCs must do a better job of preparing physicians to deliver this important component of care, the report says. The report also urges medical schools to encourage faculty to expand and improve their teaching skills, step up recruitment of under-represented minorities, and prepare young physicians for an increasingly diverse patient population. Accrediting organizations and medical professional organizations can also take a leadership role by helping AHCs develop methods to train physicians to be lifelong learners.
Public policy has important responsibilities as well. One of these is support for research and development to produce reliable measures of the costs and quality of undergraduate and graduate medical education. As a primary funder of medical education, government stands to benefit from improved measures, which would allow the public to see what it is getting for its investment.
The Task Force also recommends the development of a comprehensive public strategy for covering the added costs of clinical care that accompany medical education activities. Such a strategy should identify a stable and explicit source of funding for medical education—and make sure these costs are distributed equitably among all who benefit. Until a national plan is developed, the federal government and the states should continue to pay their fair share of the incremental clinical costs associated with medical education, the Task Force contends.Facts and Figures
- The total number of medical residents in U.S. clinical facilities increased from 37,562 in 1960 to 97,989 in 1999.
- From 1982 to 1997, the average length of hospital stays for Medicare patients dropped 40 percent, from 10.2 to 6.3 days—providing less time for medical trainees to learn from each case.
- In 1995-96, there was a roughly twofold difference in the average cost per patient case between nonteaching hospitals ($5,034) and hospitals where teaching was most intense ($10,655).