Medical Schools Need to Change Approach in Training Primary Care Physicians, Says Panel

Most medical school faculties are not well versed in the fundamental changes taking place in the nation's health care system, which makes it difficult for them to adequately prepare medical school students and residents for practicing in the changing health care environment. That was a central theme that emerged from a primary care policy forum held here recently by the American Board of Family Medicine.

"If we are going to talk about innovation and change, we often have to change the faculty, because their national inclination is to teach what they have been doing their whole careers and what they were taught," said George Thibault, M.D., president of the Josiah Macy Jr. Foundation, who spoke as part of a three-member panel. "That is different from what we want to transform the health care system into," he added.

Thibault said transformation of the health care system requires transformation of the educational process, a goal that can only be attained by having teachers in place to train students and residents about new and emerging health care payment and delivery models. "If we are going to have a reformed health care system, we need to pay attention to the workforce -- not just the numbers of the workforce, but the composition of the workforce," said Thibault.

What medical school professors teach is an accumulation of their work and educational experiences, he noted. "They can't teach what they don't know. We talk about new models of clinical education (moving) out of the academic center and into the community. It is integrated rather than fragmented. Those experiences were not the experiences faculty had when they were working."

Thibault also addressed interprofessional education, saying that most faculty members did not receive their training in an interprofessional setting. "They didn't learn from other faculty and leaders in other professions."

Moreover, most medical school faculties are unfamiliar with online learning and other technologies. "We want to and need to develop future leaders and innovators in education," said Thibault. But, he added, changes in medical school education will succeed only if entire faculties buy into the process. "The redesign of the education system and the redesign of the delivery system are only sustainable if they become the standard way we do business," Thibault noted.

Thibault and the two other speakers on the panel, Barbara Brandt, Ph.D., director of the National Center for Interprofessional Practice and Education, and Larry Green, M.D., professor and Epperson Zorn Chair for Innovation in Family Medicine and Primary Care at the University of Colorado, Denver, pointed out that medical education is undergoing fundamental changes in some parts of the country to better align with changes taking place in the health care system as a whole.

"There are physicians all across this country who are doing their (best) to change the training programs," said Green, who was the founding director of the AAFP's Robert Graham Center for Policy Studies in Family Medicine and Primary Care. In fact, he added, the three main primary care residencies -- family medicine, internal medicine and pediatrics -- are all engaged in efforts to redesign their residency training programs to achieve better health care.

As an example of the changes occurring within medical education, Thibault described a primary care faculty development initiative spearheaded by the American Board of Family Medicine, the American Board of Internal Medicine and the American Board of Pediatrics to develop some common goals and competencies around curriculum development.

The initiative, funded by the Josiah Macy Jr. Foundation, the Health Resources and Services Administration (HRSA) and private foundations, has identified particular skills or competencies needed for the primary care workforce of the future. These include

Brandt, meanwhile, said the push to develop competencies for interprofessional education is exemplified by the National Center for Interprofessional Practice and Education. The center is funded by HRSA and private foundations, making it a true public and private partnership. One of the main goals of the center is to transform the siloed U.S. health care system into one that engages patients, families and communities in collaborative, team-based care, said Brandt.

To achieve this goal, the center will create and test new health care organizations and structures while training a workforce that operates in team-based delivery systems to improve health care quality, safety and access.

"We really do not have a lot of evidence as far as what works in training and education for this type of practice," said Brandt. "That is going to be one of the marks of distinction of this particular national center."

The ultimate goal, Brandt said, "is better alignment of the health care system and higher education."