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How Do You Deliver a Good Obstetrician? Outcome-Based Evaluation of Medical Education

Asch, David A. MD; Nicholson, Sean PhD; Srinivas, Sindhu K. MD, MSCE; Herrin, Jeph PhD; Epstein, Andrew J. PhD, MPP

doi: 10.1097/ACM.0000000000000067

The goal of medical education is the production of a workforce capable of improving the health and health care of patients and populations, but it is hard to use a goal that lofty, that broad, and that distant as a standard against which to judge the success of schools or training programs or particular elements within them. For that reason, the evaluation of medical education often focuses on elements of its structure and process, or on the assessment of competencies that could be considered intermediate outcomes. These measures are more practical because they are easier to collect, and they are valuable when they reflect activities in important positions along the pathway to clinical outcomes. But they are all substitutes for measuring whether educational efforts produce doctors who take good care of patients.

The authors argue that the evaluation of medical education can become more closely tethered to the clinical outcomes medical education aims to achieve. They focus on a specific clinical outcome—maternal complications of obstetrical delivery—and show how examining various observable elements of physicians’ training and experience helps reveal which of those elements lead to better outcomes. Does it matter where obstetricians trained? Does it matter how much experience they have? Does it matter how good they were to start? Each of these questions reflects a component of the production of a good obstetrician and, most important, defines a good obstetrician as one whose patients in the end do well.

Dr. Asch is a physician, Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, professor, Perelman School of Medicine and Wharton School, University of Pennsylvania, and executive director, Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania.

Dr. Nicholson is professor, Department of Policy Analysis and Management, Cornell University, Ithaca, New York, and research associate, National Bureau of Economic Research, Cambridge, Massachusetts.

Dr. Srinivas is assistant professor of obstetrics and gynecology, Division of Maternal Fetal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Dr. Herrin is assistant professor of cardiology, Yale School of Medicine, Yale University, New Haven, Connecticut, and senior statistician, Health Research & Educational Trust, Chicago, Illinois.

Dr. Epstein is health science specialist, Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, and research associate professor, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Editor’s Note: A commentary on this article by T.J. Nasca, K.B. Weiss, J.P. Bagian, and T.P. Brigham appears on pages 27–29.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Previous presentations: This commentary is based on a presentation at the Research in Medical Education session at the 2012 Association of American Medical Colleges annual meeting in San Francisco.

Correspondence should be addressed to Dr. Asch, Penn Medicine Center for Innovation, 423 Guardian Dr.–Blockley Hall 1123, Philadelphia, PA 19104; telephone: (215) 746-2705; e-mail:

© 2014 by the Association of American Medical Colleges