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Summary of Thirteenth Report

Physician Education for a Changing
Health Care Environment

March 1999

The full version of this report is available in PDF format (266 KB)

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Executive Summary

Purpose

This report is intended to clarify the need for, and to stimulate the further development of, fresh approaches to the professional education of physicians for contemporary and future medical practice. It presents an analysis of the issues influencing the preparation of physicians and recommends changes in teaching programs. Unlike previous COGME reports which have focused on primary care, the recommendations in this report apply to preparation for many medical specialties. In particular, the importance of clinical education in the community is no longer limited to the primary care specialties. In many specialties, the community offers unique educational opportunities that are complementary to those of the academic health center or teaching hospital. The comprehensive preparation of all modern physicians requires experience in both traditional and community settings.

This report advocates the development of high quality, community-based clinical teaching opportunities and a faculty incorporating community clinician teachers. It calls for expansion and enhancement of educational relationships with the community and a redefinition of the role of conventional medical school and residency program faculty. In addition, the report emphasizes the role of rigorous evaluation systems to assure consistent quality and guide the steady evolution of educational systems. Finally, the report addresses strategies to fund and sustain the recommended changes.

The findings and associated recommendations forming the core of the report are listed below:

I. UNDERSTANDING THE SYSTEM IN WHICH HEALTH CARE IS DELIVERED

FINDING 1: Physicians increasingly deliver health care to defined populations of patients in the context of integrated delivery systems or health plans. An improved understanding of the characteristics of the populations served and the attributes of the delivery systems is fundamental to effective medical practice.

Recommendations:

• Medical students and residents should learn the basic principles of health care financing, the benefits and limitations of typical health plans, and the characteristics of the systems in which health care may be delivered.

• The curricula of medical schools and residency training programs should include clinical learning experiences in the settings of each of the components of an integrated health care delivery system

• Medical schools and residency training programs should provide opportunities for medical students and residents to learn the contribution of other health professionals to the care of their patients and augment opportunities for learners to participate in a team approach to patient care.

• Educational programs for medical students and residents should address the care of the individual patient in the context of the population or community of which the patient is a member.