Demonopolizing Medical Knowledge

Arora, Sanjeev MD; Thornton, Karla MD, MPH; Komaromy, Miriam MD; Kalishman, Summers PhD; Katzman, Joanna MD; Duhigg, Daniel DO

Academic Medicine:
doi: 10.1097/ACM.0000000000000051
Commentaries
Abstract

In the past 100 years, there has been an explosion of medical knowledge—and in the next 50 years, more medical knowledge will be available than ever before. Regrettably, current medical practice has been unable to keep pace with this explosion of medical knowledge. Specialized medical knowledge has been confined largely to academic medical centers (i.e., teaching hospitals) and to specialists in major cities; it has been disconnected from primary care clinicians on the front lines of patient care. To bridge this disconnect, medical knowledge must be demonopolized, and a platform for collaborative practice amongst all clinicians needs to be created. A new model of health care and education delivery called Project ECHO (Extension for Community Healthcare Outcomes), developed by the first author, does just this. Using videoconferencing technology and case-based learning, ECHO’s medical specialists provide training and mentoring to primary care clinicians working in rural and urban underserved areas so that the latter can deliver the best evidence-based care to patients with complex health conditions in their own communities. The ECHO model increases access to care in rural and underserved areas, and it demonopolizes specialized medical knowledge and expertise.

Author Information

Dr. Arora is professor of medicine and director, Project ECHO (Extension for Community Healthcare Outcomes), University of New Mexico Health Sciences Center, Albuquerque, New Mexico.

Dr. Thornton is professor of medicine and associate director, Project ECHO (Extension for Community Healthcare Outcomes), University of New Mexico Health Sciences Center, Albuquerque, New Mexico.

Dr. Komaromy is associate professor of medicine and associate director, Project ECHO (Extension for Community Healthcare Outcomes), University of New Mexico Health Sciences Center, Albuquerque, New Mexico.

Dr. Kalishman is associate professor and clinician evaluation director, Project ECHO (Extension for Community Healthcare Outcomes), University of New Mexico Health Sciences Center, Albuquerque, New Mexico.

Dr. Katzman is associate professor and medical director, Project ECHO (Extension for Community Healthcare Outcomes), University of New Mexico Health Sciences Center, Albuquerque, New Mexico.

Dr. Duhigg is assistant professor and psychiatry faculty, Project ECHO (Extension for Community Healthcare Outcomes), University of New Mexico Health Sciences Center, Albuquerque, New Mexico.

Funding/Support: The Robert Wood Johnson Foundation (HSC-12074), the Agency for Healthcare Research and Quality (5 UCI HS015135, 1R24 HS016510, 1 R18 HS018171), the GE (General Electric) Foundation, and Centers for Medicare and Medicaid Services have supported this project.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Dr. Arora, Project ECHO, 1 University of New Mexico MSC07-4245, Albuquerque, NM 87131; telephone: (505) 272-2808; e-mail: SArora@salud.unm.edu.

© 2014 by the Association of American Medical Colleges