Recently, I learned from several Orthopedic colleagues active in residency training in a well-established and well-respected English-speaking country that upwards of 50% of graduating Orthopedic trainees failed their certification examinations—a remarkable change from expected outcomes. Although to my knowledge this may not reflect similar observations throughout the developed world, it does bring to focus as to whether or not our traditional educational methods are no longer effective.
The United States spends $15 billion/yr on physician training, with teaching hospitals substantially supplementing this investment, yet we are beginning to realize that today’s physicians may lack essential skills for 21st century practice. This should not really be surprising as health care delivery has changed dramatically in the recent years, whereas medical education remains tethered to a model from another era, designed without attention to its effectiveness.
Today’s medical education has failed to incorporate expanding knowledge about how adults learn, and fails to effectively develop or use technology for improving education. In addition, medical education exists within a regulatory environment that stifles innovation. There is little funding available for research to help optimize physicians’ training and thereby enhance the quality of their practice.
Increasingly, concerns are being raised about the range of skills and level of competence (both cognitive and technical) of residency graduates, as well as the learning environments in which they are educated and work. The current model of medical education continues to produce a physician workforce and health care system with widespread quality and safety gaps across specialty areas related to diagnostic error, therapeutic decision making, and technical expertise. Recognizing all of this, a 2011 Macy Foundation report recommended creation of a “National Institute of Medical Education Research” to lead improvement in medical education; however, there is no realistic prospect that such an entity will be created.
Transformation of the current medical education model is unlikely to occur without a bold vision, significant resources, and the leadership to drive change.