Resetting our sails to educate tomorrow's physicians

A message to all physicians from AMA President Cecil B. Wilson, MD.

By Cecil B. Wilson, MDis an internist in private practice in Winter Park, Fla. He served as chair of the AMA Board of Trustees during 2006-07 and was AMA president during 2010-11. Posted Sept. 6, 2010.

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Anyone who sails knows that even the sleekest boat and years of experience cannot make sailing a sure thing. What happens when you leave port is different every time.

Sometimes the original set of sails is good for a long distance. Eventually, though, an experienced sailor will make modifications to take advantage of a change in the wind to keep the craft going in the right direction. Any trip requires constant adjustment. That's probably one reason I love to sail so much.

To me, sailing is a good metaphor for much in life -- and certainly for the practice of medicine today. I doubt there is a physician anywhere who hasn't felt as though he or she was beating against the wind just to stay on course.

If we, who are in the forefront of patient care, feel as though we are in the midst of a perfect storm of new technology, new laws, new societal expectations and new patients, what of those who come after? How can we be sure that tomorrow's physicians are being trained to practice medicine in tomorrow's world?

In fact, the process has already begun to reset those particular sails -- and change the direction of medical education to reflect the real world of medical practice. And as has been the case since American physicians first came together at the behest of Nathan Davis, the AMA has taken a leading role in this process.

Charting a new course

When the AMA was founded in 1847, we charted a course by establishing a code of medical ethics and developing nationwide standards for medical education. Those two things provided a tremendous boost to medical competence and professionalism.

Just after the turn of the last century, the AMA conducted studies on education quality at American medical schools and identified wide variations in standards and among the physician graduates of the 160 medical schools operating at that time.

In 1908, the Carnegie Foundation for the Advancement of Teaching decided to conduct its own evaluation of U.S. medical education, and consulted the AMA Council on Medical Education. Leaders in these two organizations worked closely together on the ensuing study.

The Carnegie Foundation then hired a passionate educator -- whose brother, incidentally, was a medical researcher -- to do his own study and make recommendations. Abraham Flexner visited all of the country's medical schools. In 1910 he issued a report that catalyzed significant reform in medical education and set the course for the next 100 years.

The work of Flexner and the AMA had a huge and lasting impact on American medical education. Between 1905 and 1915, 65 underperforming medical schools closed, decreasing the number to 95. By 1925, only 80 medical schools remained in the U.S., and this number remained constant into the 1960s.

However, since the Flexner report was issued, the changes that we have seen in science, technology and society have been vast, and the field of medicine has become increasingly complex. Developments in medical practice, such as using electronic medical records, creating patient-centered medical homes and working in health care teams, need to be part of every medical student's education today. Even more changes are on the horizon.

The AMA recognizes the need to re-evaluate the set of our sails around promoting quality and standards in medical education.

So, in light of both the Flexner report's 100-year anniversary and our changed world, the AMA and the American Assn. of Medical Colleges -- the parent organization of the Liaison Committee on Medical Education responsible for accrediting all U.S. and Canadian medical schools -- are taking another look at medical education.

Taking the next step

Three hundred medical educators, physicians and other health care professionals and medical students will gather in Washington, D.C., Sept. 20-22 at an invitational conference sponsored by the AMA and AAMC. Titled "New Horizons in Medical Education: A Second Century of Achievement," the conference will be a major step toward ensuring the best possible educations for future physicians.

However, the process to transform the way new physicians are educated already has begun on the Internet.

Because the AMA wants to make the opportunity to define new directions in medical education available to all physicians, students and interested members of the health care community, the AMA and AAMC are jointly sponsoring a New Horizons discussion forum. The goal is to gather comments and suggestions before it begins and bring that data to the meeting.

Discussion topics include:

  • Technology infrastructure.
  • Financing of medical education.
  • Work force development.
  • Research/assessment of the outcomes of the meeting and what follows.
  • Regulatory barriers in the educational continuum.
  • Social accountability of medical schools, faculty and trainees.
  • Leadership.
  • Assessing key trends in health care delivery.

I encourage you to find the forum and submit an opinion on one or more topics or, at least, to look over some of the very thoughtful -- and thought-provoking -- comments that have been posted.

To add your comments, go to the AMA's online New Horizons discussion forum (link).

Comments posted on the forum will be incorporated into the conference discussions and what comes afterward.

Once the conference has ended, the recommendations from the conference and website will be synthesized into a set of new directions for medical education.

Representatives from U.S. and Canadian medical schools will take those ideas back home for discussion, fine-tuning them for potential implementation. These representatives will gather again to continue the process at the national meeting of the AAMC in November.

Support for this whole effort will come from the AMA Center for Transforming Medical Education.

Established in January, the center is headed by Susan Skochelak, MD, MPH, vice president of medical education and a former professor and senior associate dean at the University of Wisconsin School of Medicine and Public Health.

The Web forum, the New Horizons Conference and the follow-up gatherings are an audacious step toward transforming medical education. But we need no less.

President Franklin Roosevelt once said, "To reach a port, we must sail -- sail, not tie at anchor -- sail, not drift."

The AMA has set sail, and I urge you to sail with us. Go to the New Horizons Web page on the AMA website. Look at the discussion topics and add your expertise to what has been written.

Few times in our history has the medical community had such an opportunity to affect the future.

Cecil B. Wilson, MD is an internist in private practice in Winter Park, Fla. He served as chair of the AMA Board of Trustees during 2006-07 and was AMA president during 2010-11.

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