According to the report "Revisiting the Medical School Educational Mission at a Time of Great Expansion," medical schools are experiencing an historic growth spurt. By 2020, allopathic medical schools are expected to graduate an additional 5,000 doctors each year. There are nine new allopathic medical schools underway or in the planning stages, and 108 of the nation's 126 medical schools are increasing class size, some by adding new branches. The number of osteopathic schools is growing as well. Today, there are 28 such schools in the United States, nine more than in 2000, with more planned.
"If we are going to open new schools and expand existing schools, we want to be sure we're doing it in the most socially responsible way," says George Thibault, MD, president of the New York-based Josiah Macy, Jr. Foundation. Thibault says this is even more important given the renewed prospects of health reform under the new Obama Administration. If more people have health insurance, there will be a much greater demand for physicians to deliver care. "What we're saying to medical educators is let's seize this opportunity to address the mismatch between the kinds of physicians we're producing and what people want and need," he says.
The 36-member panel is chaired by Jordan Cohen, MD, the former president of the Association of American Medical Colleges, and composed of medical and institutional leaders from around the country. The group was convened by the Macy Foundation in 2008 to assess ways in which expansion of enrollment could be harnessed to advance the effectiveness of medical education.
"What medical education needs to recognize is that it has a fundamental social mission to train future physicians for a rapidly changing health care system that seeks different competencies than in the past," says Cohen. "The leaders of medical education institutions need to seize the opportunity that expansion affords to ensure that their institutions are responsive to their public purpose."
Highlights of what areas schools should focus on:
- Giving student more opportunities to learn the principles of quality improvement, patient safety and patient-centered care;
- Preparing students to work effectively and collaborative as members of health care teams and as part of a system of care;
- Using community-based settings more as classrooms, and hospital settings less, to expose students to a more realistic practice environment;
- Ensuring that physicians have more background in public health education and the role that social factors play in affecting patient health; and
- Emphasizing the importance of problem solving and self-directed learning as a way to keep up with the fast-paced health care environment.
Expanding Diversity and Instilling Professionalism
Increasing the diversity of the applicant pool should be a top priority, the group says. One way to do this would be to relieve the burden of medical student debt. More than 80 percent of medical students today graduate with educational debt that averages $160,000.
The group suggests several ways schools can ease that burden including making additional funds available from endowments or other sources; organizing the curriculum to allow students the option of meeting graduation requirements in three rather than four years; capping tuition at current or reduced levels; and advocating the creation or support of more government programs that provide debt forgiveness in return for limited public service such as the National Health Service Corps.
The high price tag of medical schools discourages too many college students of high potential but modest means from even considering medical careers, the panel adds. The high debt also affects the kinds of physician's medical students choose to become, which is helping to fuel a shortage of lower paid primary care doctors, such as family physicians and geriatricians.
There also is strong support for re-examining the medical school admissions process to make it more flexible, which would be an important step to attract and produce a more diverse workforce that is more culturally competent and reflective of society. The panel says schools should reduce their reliance on standardized tests, college grade point averages, and traditional undergraduate course requirements as part of the admissions process, and instead employ a more balanced, comprehensive set of admissions criteria to attract, matriculate and support students.
When it comes to professionalism, the group says there is a "conspicuous gap" between what educators say about their commitment to high professional standards and the actual behavior on display in many student learning environments. The panel says schools need to more aggressively commit to professionalism during training and expose students to positive role models that espouse the ethic of putting patients first.
What Barriers Stand in the Way?
Despite the possibility of reform, the panel admits there are substantive barriers to overcome, including:
- The need to capture the attention and active participation of institutional leaders, without which meaningful change won't happen.
- The perception that current accreditation standards for both undergraduate and graduate medical education are overly rigid. The panel acknowledges that this perceived rigidity may keep educators from considering changes that would shift away from traditional training experiences they have grown comfortable with.
Barriers aside, the panel says schools should not let this opportunity pass them by - especially those medical schools that are just opening their doors or still in the planning stages. "They are in an optimal position to think freshly about how they are constructing their programs so they can be better aligned with societal needs," says Cohen.
Copies of the report "Revisiting the Medical School Educational Mission at a Time of Expansion" can be obtained by visiting http://www.macyfoundation.org
The Josiah Macy, Jr. Foundation is a privately endowed philanthropy located in the borough of Manhattan, New York City. The Foundation supports programs designed to improve the education of health professionals in the interest of the health of the public.