"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).