"If the Shoe Fits" – Editorial from the Association of American Medical Colleges

Jordan J. Cohen, MD, recently published his annual President's Address on the Association of American Medical Colleges' web site. I was struck by how closely the issues he cited paralleled contemporary P&O concerns, as well as how insightful many of his comments were.

Dr. Cohen highlighted five major present and future challenges facing US Medical Colleges:

• "Challenge number 1 is to increase the racial and ethnic diversity of the medical profession.
• Challenge number 2 is to lead the transformation of the health care system.
• Challenge number 3 is to strengthen the continuum of medical education.
• Challenge number 4 is to uphold the integrity of research and assure the safety of human research subjects.
• Challenge number 5 is to enlarge the capacity of LCME-accredited medical schools."

One of Dr. Cohen's more interesting suggestions was to stop considering the United States health care system as something "broken" that can be "fixed" and to, instead, view it as "an outmoded, archaic legacy system that must be replaced". He uses the analogy of a Model T automobile, arguing that although it could be made into a flying machine, it would be much more practical and economical to design an airplane for that purpose from the ground up. His thesis is that no one could have predicted the current constellation of problems in our health care system, which he characterizes as:

• "An overwhelming burden of chronic illness
• Unprecedented complexity and specialization
• Major system failures undermining patient safety
• Inexorable increases in health care costs, and
• Demands for greater accountability, reliability and quality."

In his view, our legacy system is too fragmented and too tolerant of wide practice disparities to effectively address such issues.

His editorial goes on to explain that, contrary to earlier predictions that the HMO model would eliminate the need for many physicians, there is now a growing shortage of MDs, and particularly those who are trained in accredited medical colleges. Dr. Cohen also discusses the importance of enhancing continuing education to make it more directly clinically relevant, and of measuring whether or not attendee's practices change as a result of further education.

He concludes with a passionate plea for a continued emphasis on ethics, both in medical education and in daily practice. In his words:

"Students emulate what we do, not what we say. And what we too often do is patently unprofessional. Every time we

• demean a nurse,
• disrespect a patient,
• harass a student,
• exploit a resident,
• overbill for services,
• fudge data to gain a favorable journal review,
• permit commercial interests to bias educational offerings,
• shill for a pharmaceutical company,

or do anything that would embarrass us if published on the front page of a newspaper, we chip away at the character we profess to cherish among the learners in our midst."

If you'd like to hear Dr. Cohen deliver an expanded version of his comments on the importance of ethics in clinical education, titled "What New Doctors Must Learn", it is webcast online at www.medscape.com (NOTE: you have to be a member of Medscape to view this - registration is free and this link will take you to the login screen).

Reader Comments: Read all user comments You have done very good job Hi all Brilliant site! Nice work... - Gaymen   6/6/2006 400Lb patient for a patient 36 years old who is in excess of 400 lbs and a community ambulator, with a knee disarticulation amputation, what if any knee is available? OWW no longer makes exo set ups and 350lbs is the highest weigth limit I can find. Any... read more - bill goldberg   5/12/2006 Re: 400Lb patient I can't think of any TF knees, whether KD style or not, rated higher than 350 pounds but perhaps a reader can. Otherwise, contact RehabTECH in Australia via email at rehab.tech@eng.monash.edu.au and request a copy of their report "Componen... read more - John Michael   5/12/2006 Roy Snelson, CPO (E). Ciudad de Mexico 27 de Abril, 2006. Estimado John Michael CPO, FAAOP. Enviamos nuestro mas sentido pesame por el fallecimiento del maestro Roy Snelson, CPO (E), el pasado 24 de Abril. Tuvimos la oportunidad de conocer personalmente al Sr.... read more - Alberto E. Castillo Moreno O. P.   4/27/2006 Re: Roy Snelson, CPO (E). Thank you, Sr. Castillo, for these words of remembrance about Roy Snelson. He was one of the giants in the field whose drive and wry humor helped the profession to evolve. --John Michael CPO - John Michael   4/29/2006 CAH information Hi I will pass on the fabrication part and go to the gait videos. After looking at the videos several times I am not sure the AFO’s really help. You could hear more noise at toe strike, with both AFO’s. One of the problems with the gai... read more - John Russell   4/3/2006 Re: CAH information To clarify, John, the video clips excerpted here are specifically intended to illusturate incorrect use of AFOs: too little and too much plantarflexion limitation respectively. The actual CD has a larger series of video vignettes so you ca... read more - John Michael   4/29/2006 informacion me pareceiomuy buena su pagina, yo soy ingeniero mecanico y vengo desarrollando una investigacion sobre protesis de tobillo articulado, mi interes es poder fabricar un tobillo adecuado para mejorar la marcha de las personas con discapacidad... read more - igor   3/20/2006 Re: informacion This is an important developemnt that is being pursued by a number of researchers around the world but has not yet been fully achieved. I am pleased if this Corner contributes to your work. --John Michael CPO - John Michael   3/30/2006 Re: informacion Edito en Buenos Aires una guia de proveedores para ortopedias (grafica y web) llamada NUCLEO ORTOPEDICO en la que tratamos de incluir notas interesantes a los ortesistas y protesistas. Lei su comentario en la pagina de oandp y deseo invitar... read more - norma maddalena   3/30/2006 Carta a mi Bisabuelo: Ciudad de Mexico 7 de Marzo, 2006. Estimado John Michael CPO, FAAOP: Para los practicantes en protesis de hoy en dia es mucho mas sencillo diseñar, elaborar y adaptar una protesis para una persona amputada de la extremidad inferior, si lo ... read more - Alberto E. Castillo Moreno O. P.   3/7/2006 Re: Carta a mi Bisabuelo: Thank you for this commentary, Sr. Castillo. I too was struck by how well the best of our predecessors did with only intuition and commitment to guide their efforts: on of the principle messages from Greg's epistle. Today's vastly more so... read more - John Michael   3/8/2006