Kanter, Steven L. MD
In this issue of the journal, you will find 15 essays responding to my 2011 Question of the Year, What improvements in medical education will lead to better health for individuals and populations? In addition, 15 more essays appear online at http://journals.lww.com/academicmedicine/pages/collectiondetails.aspx?TopicalCollectionId=27.
These essays, selected from over 120 submissions, represent a set of important ideas, programs, and plans aimed at understanding and strengthening the link between medical education and the health of individuals and populations. As I mentioned in my January 2011 editorial,1 this is a goal that is shared by all who work in academic medicine around the world. It is a universal goal that transcends national boundaries, is relevant in any type of health system, and applies to the entire continuum of medical education.
As you read the responses to the 2011 Question of the Year, you will find that several of them wrestle with a fundamental tension: a physician's obligation to provide the best care for an individual patient versus that physician's obligation to be a good steward of society's finite resources. This tension goes right to the heart of medicine. It challenges us to reconcile a foundational focus on the patient–doctor relationship with what one author calls a “population consciousness.”
The authors of several essays argue, explicitly or implicitly, that we must reconcile these two notions in an effective way if we are to improve the health of both individuals and populations. These authors contend that incorporating key principles of public health and global health into curricula for medical students and residents provides fertile ground for examining this tension. One author adds that a deeper exploration of patient autonomy, physician authority, and trust in the patient-doctor relationship are key to navigating this tension in a way that will lead to better health outcomes.
Another cross-cutting theme that weaves its way through a number of responses to the 2011 Question of the Year is that educating physicians to be more effective members of teams will lead to better patient and population health. Authors' recommendations include improvements in interprofessional education, the development of outpatient teams, and the inclusion of librarians as contributing members of health care teams.
Some authors highlight the importance of diversity and its role in achieving better health outcomes, the need to prioritize a focus on health disparities, and the need for better political organization and more effective advocacy. Other authors propose to achieve better health through improved integration in medical student and resident curricula of selected topics that have could leverage important health gains—for example, nutrition, chronic disease, and patient safety. In a similar vein, two essays suggest educating students and residents to diagnose and treat common problems in areas that can have a dramatic impact on health in the primary care setting, such as dermatology and mental health. The author of another essay identifies improved education about the appropriate utilization of imaging studies as a way to quickly realize improvements in both health outcomes and cost.
A few additional authors also focus on cost. They suggest that the meaningful use of financial incentives for residents, teaching and practicing cost-conscious diagnostic testing, and teaching the economics of health care could improve physician education in a way that would lead to better health outcomes.
Additional suggestions to align medical education with health care needs include cultivating a more effective educational research workforce and developing better approaches to understanding and maintaining the well-being of students, residents, and faculty. And, finally, some authors call for better approaches to learning and continuing professional development, including workplace learning, mastery learning, and life-long learning.
I am delighted that the 2011 Question of the Year resonated with the academic medicine community. We received many excellent submissions. I thank the members of the journal's editorial board and professional editorial staff for their efforts to help me judge the submitted responses and for their dedication and expertise. Taken together, this collection of essays provides a valuable set of recommendations to improve physician education in ways that can lead to better health for individuals and populations.
Steven L. Kanter, MD