To the Editor: In their recent Perspective, Cook and West1 argue that clinical outcomes should not be the sole focus of medical education research, and they offer excellent advice for designing research and selecting outcomes that will best inform medical education. Although we agree it is challenging to extend the end point of medical education research to the clinical environment, we believe such work is critical to improvements not only in education but also in patient safety and health care quality.
Our country stands at a critical juncture. As we struggle to manage unsustainable health care costs and implement the Affordable Care Act, physicians and other providers are being asked to improve value by providing higher-quality care at lower cost.2 Yet, critical questions remain unanswered. How will we form teams to deliver effective multidisciplinary care for complex patients across ambulatory and inpatient settings? How will we respond to penalties for readmissions and hospital-acquired conditions that are often a result of poor communication? How will we reduce use of expensive imaging and other tests when patients expect them?
Medical educators have a critical role to play in these discussions. Education had a major role in the study that reduced catheter-related bloodstream infections throughout Michigan.3 Improved communication between providers reduces medical errors,4 and team training dramatically reduced mortality rates in a large VA study.5 Research in areas such as patient counseling, communication skills, and medical decision making has the potential to improve health care delivery in innovative ways. Through research, medical educators can contribute important insights about the education, preparation, and assessment of a well-trained workforce. This is a time for bold action, not caution. We urge the medical education community to continue to study clinical outcomes. Our community’s perspective is sorely needed as part of the national discourse on health care reform.
Diane B. Wayne, MD
Dr. John Sherman Appleman Professor of Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; [email protected]
Jeffrey H. Barsuk, MD
Associate professor of medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
William C. McGaghie, PhD
Professor of medicine and director, Ralph P. Leischner, Jr., MD Institute for Medical Education, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois.
1. Cook DA, West CP. Perspective: Reconsidering the focus on “outcomes research” in medical education: A cautionary note. Acad Med. 2013;88:162–167
2. Porter ME. What is value in health care? N Engl J Med. 2010;363:2477–2481
3. Dixon-Woods M, Bosk CL, Aveling EL, Goeschel CA, Pronovost PJ. Explaining Michigan: Developing an ex post theory of a quality improvement program. Milbank Q. 2011;89:167–205
4. O’Leary KJ, Buck R, Fligiel HM, et al. Structured interdisciplinary rounds in a medical teaching unit: Improving patient safety. Arch Intern Med. 2011;171:678–684
5. Neily J, Mills PD, Young-Xu Y, et al. Association between implementation of a medical team training program and surgical mortality. JAMA. 2010;304:1693–1700