Whitcomb, Michael E. MD
Several years ago, the Institute of Medicine (IOM) issued a seminal report on the need to markedly improve the quality of U.S. medical care.1 While the report has stimulated much attention on the specific problem of medical errors, it addresses a much broader set of issues. Of particular note, it is quite critical of the ways doctors and other health professionals are being educated and argues that major reforms are needed in health professions education if the quality of medical care is to improve.
The IOM followed up on that observation by convening a summit of health professions educators to consider ways to reform the education of health professionals. The report that summarized their deliberations is also quite critical of the state of health professions education:
Education for health professions is in need of major overhaul. Clinical education simply has not kept pace with or been responsive enough to shifting patient demographics and desires, changing health system expectations, evolving practice requirements and staffing arrangements, new information, a focus on improving quality, or new technologies.2
The same year that the summit report was issued, another IOM Committee—the Committee on the Roles of Academic Health Centers in the 21st Century—issued its final report.3 That committee, which had been at work for two years, also concluded that reforms of the clinical education of health professionals are badly needed and, in essence, it charged academic health centers (AHCs) to bring about those reforms. The committee acknowledged how challenging this would be, but also how crucial, since basic changes in health professions education are needed to initiate a cultural shift in the ways health care is delivered. Such a shift would emphasize the needs of patients and populations, and focus on improving health, using the best science and approaches to care.
The IOM committee was not the first to recognize the importance of the challenge AHCs face in attempting to reform health professions education. In 2002, the Commonwealth Fund Task Force on Academic Health Centers issued a report in which it expressed concerns about the ways AHCs were meeting their responsibilities for ensuring the quality of the educational programs they sponsor and noted the importance of AHCs’ education mission to the future of our health care system.4
Taken as a whole, the reports present an extraordinary challenge to the leadership of academic medicine's institutions—medical schools and teaching hospitals—and to the medical educators at those institutions. The challenge can be simply stated: improvement in the quality of the medical care provided in this country will require meaningful reforms in the ways doctors (and other health professionals) are being educated, and AHCs are responsible for seeing that those reforms occur. To meet this challenge, AHCs’ leaders will have to focus more of their attention on the quality of their institutions’ educational programs, and those responsible for the design and conduct of those programs must strive harder to better prepare new doctors for the challenges of medical practice.
The reports’ challenge has real meaning for Academic Medicine, since the journal's two target audiences share responsibility for meeting the reform goals set forth in the reports. As I pointed out in a previous editorial, the journal is unique because it provides an opportunity for medical educators and institutional leaders not only to communicate with those in their own communities (educator to educator, and leader to leader), but also to communicate across communities (educator to leader, and leader to educator). In other words, the journal helps individuals in each community to share ideas and experiences that relate to the core medical education mission of AHCs. This exchange is key to any serious efforts to improve the quality of medical education.
At the March meeting of the journal's editorial board, the board members discussed the journal's unique role in some detail. They reinforced for the editorial staff the importance of making sure that the journal continues to serve both of its target audiences. They also suggested a number of ways to accomplish this more effectively. One excellent idea was for the journal to solicit papers that will help readers from each community understand better what certain journal pieces may mean for them as they go about meeting their responsibilities on a daily basis. There was also a sense that since the constraints that must be overcome to improve the quality of medical education are often found at the institutional level, the journal should publish more pieces dealing with institutional issues. To do this, we will have to be more aggressive in soliciting certain kinds of papers, since we receive far fewer manuscripts addressing institutional issues than we do manuscripts addressing medical education issues.
The members of the board and of the editorial staff also recognize that for the journal to be most effective, it must become more visible to individuals holding important clinical leadership positions in academic medicine—department chairs, residency program directors, and clinical clerkship directors. During the next few months we will be developing a comprehensive plan for how we might accomplish this goal—and accomplish it we must if the journal is to realize its full potential as a resource for AHCs as they improve health professions education. I welcome ideas from readers on how the journal might better connect to clinical leaders.
Given that both the Commonwealth Fund Task Force and the IOM Committee concluded that improving medical education is the greatest challenge facing AHCs, it is important that everyone involved with the journal understand the unique role Academic Medicine can play in supporting this effort, and contribute in whatever way possible to making the journal as effective as it can be. In accepting this challenge, all involved must understand what is ultimately at stake: not just to improve medical education for the sake of improving medical education, but rather to do this to raise the quality of this country's medical care.
MICHAEL E. WHITCOMB, MDMichael E. Whitcomb, MD
1. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st century. Washington, DC: National Academy Press, 2001.
2. Institute of Medicine. Health Professions Education: A Bridge to Quality. Washington, DC: National Academy Press, 2003.
3. Institute of Medicine. Academic Health Centers: Leading Change in the 21st Century. Washington, DC: National Academy Press, 2003.
4. The Commonwealth Fund Task Force on Academic Health Centers. Training Tomorrow's Doctors: The Medical Education Mission of Academic Health Centers. New York: The Commonwealth Fund, 2002.