In Reply to Longmaid et al: We greatly appreciate the letter from Longmaid, Branch, and Rider, which highlights multiple crucial components of medical education that ultimately aim to support the practitioner–patient relationships. We agree that, ideally, medical education should incorporate all human values, but we argue that further research is required for effecting widespread and lasting reform in a complex and changing system of health care education and delivery.
We are inspired by the International Charter for Human Values in Healthcare, which provides an important framework of five core human values for curriculum development and health care delivery.1 Focusing on these could begin to address the many gaps and opportunities for improvement in medical training and health care delivery cited by the American Medical Association’s Initiative to Transform Medical Education (ITME): “treating” the health care system, serving as patient advocates, dealing with uncertainty, and communication skills.2 In addition, we face a technological boom of education modalities. Interestingly, however, we are learning that bridging gaps in information and health care access (e.g., distance education, telemedicine) can simultaneously threaten other components of care delivery (e.g., depersonalization, commercialization, isolation).
Hence, our task to improve medical education is made even more difficult in a complex and dynamic context with limited resources, raising the question of priority. In the absence of scientific evidence showing the efficacy of one human value over another, priority becomes a matter of opinion and plausibility. We must decide how to approach reforming medical education. Do we focus on one or two elements at a time, or employ a “holistic method,” as some medical schools have already begun to do?3 Regardless of what set of values is imparted, experimentation and iterative learning and sharing of different approaches are crucial.
We must continue to assess and learn which human values, technology, and ITME objectives are most synergistic and effective at different levels of medical training. The lens of a third-year medical student and that of a senior resident vary tremendously. The former may benefit from honing communication skills and focusing on other aspects of the patient–provider relationship, while the latter may seek tools to enable effective teaching and team management. Through further research and experience, we can begin to identify best practices for incorporating all human values into the curriculum in the most opportune ways.
Victoria Y. Fan, ScD, SM
Research fellow, Center for Global Development, Washington, DC; firstname.lastname@example.org.
Steven C. Lin, MD, MPH
Resident physician, Department of Internal Medicine,University of California San Diego Medical Center, San Diego, California.
3. Witzburg RA, Sondheimer HM. Holistic review—Shaping the medical profession one applicant at a time. N Engl J Med. 2013;368:1565–1567