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9 Preparing the Workforce
Pages 207-224

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From page 207...
... In general, health professionals are also conservative, stressing the application of precedent and risk avoidance in clinical practice, particularly relative to changes that may affect the quality of care for patients. As a result, any change can be exceedingly slow and difficult to accomplish, especially if there is not a clear understanding of why the change may be needed or of its impact on current practices.
From page 208...
... Greater understanding is needed of why prior efforts at modifying clinical education have not had the desired impact and of the supportive strategies needed to overcome such barriers. CLINICAL EDUCATION AND TRAINING To achieve the six aims proposed in Chapter 2, additional skills may be required of health professionals not just physicians, but all clinicians who care for patients.
From page 209...
... . Identify errors and hazards in care; understand and implement basic safety design principles, such as standardization and simplification (Institute of Medicine, 2000)
From page 210...
... Although curriculum changes are essential in providing new skills to health professionals, they are not sufficient by themselves. It is also necessary to address how health professional education is approached, organized, and funded to better prepare students for real practice in an information rich environment.
From page 211...
... Although there was great interest and innovation in multidisciplinary training during the 1960s, little lasting change resulted (Pew Health Professions Commission, 1993~. The ability to plan care and practice effectively using multidisciplinary teams takes on increasing importance as the proportion of the population with chronic conditions grows, requiring the provision of a mix of services over time and across settings.
From page 212...
... ; and (3) the relationship between medical schools and external organizations (including integration of accreditation processes, assessment of readiness for graduate training, and use of licensing exams)
From page 213...
... Still others have called for new relationships between medical schools and academic health centers that would permit the latter to focus on making the best decisions for patient care and allow medical schools to control education and its location (Thier,1994~. In such a circumstance, academic health centers might be affiliated with several medical schools and medical schools might be affiliated with multiple health centers to allow for greater flexibility by the partners.
From page 214...
... Separation of clinical training programs and dispersed oversight of training programs, especially across the continuum of initial training, graduate training, and continuing development, inhibit the types and magnitude of change in clinical education. For example, various aspects of medical education are affected by the policies of the Liaison Committee on Medical Education, the Association of American Medical Colleges, the Accreditation Council for Graduate Medical Education, 27 residency review committees, the American Board of Medical Specialties and its 24 certifying boards, the Bureau of Health Professions at the Department of Health and Human Services, the American Medical Association, the American Osteopathic Association and its 18 certifying boards, the American Association of Colleges of Osteopathic Medicine, and various professional societies involved in continuing medical education.
From page 215...
... Scope-of-practice acts can include provisions that inhibit the use of nonphysician practitioners, such as advanced practice nurses and physician assistants, for primary care (Pew Health Professions Commission, 1993; Safriet,1994~.
From page 216...
... In response, some have proposed nationally uniform scopes of practice (O'Neil and the Pew Health Professions Commission, 1998) or, at least, more coordinated, publicly accountable policies (Grumbach and Coffman, 1998~.
From page 217...
... A second approach has been suggested, involving an additional level of oversight in which teams of practitioners, in addition to individuals, would be licensed or certified to perform certain tasks (Pew Health Professions Commission, 1993~. For example, an individual receiving care for diabetes could go to a "certified" diabetes team that would ensure specific competencies and resources within the delivery team.
From page 218...
... Delivering care that is patient-centered, evidencebased, and systems-minded has implications for traditional methods of accountability, particularly with regard to patients' participation in their care, efforts to define standards of care consistent with the evidence base rather than local traditions, and the responsibilities of individual practitioners who deliver care within larger systems that have the capacity for improvement. Innovations in care can contribute to increased threats of litigation because, by definition, innovation implies a change from previous practice, and medical advances are often imperfect when first applied in clinical practice.
From page 219...
... But clinical practice guidelines probably have had some effect on prelitigation decisions, since surveys show that medical malpractice attorneys consider guidelines in making decisions about whether to take on malpractice cases and conducting settlement negotiations (Hyams et al., 1996~. Alternative approaches to liability, such as enterprise liability or no-fault compensation, could produce a legal environment more conducive to uncovering and resolving quality problems.
From page 220...
... It is not sufficient to ask how many health professionals are needed; one must also ask what types are needed (Pew Health Professions Commission, 1993~. Ultimate assessments of supply depend on how responsibility for patients is divided among licensed clinicians, as well as on society's expectations (Cromwell, 1999~.
From page 221...
... , what are the implications for the needed supply and mix of health professionals? REFERENCES Abraham, Kenneth S
From page 222...
... Strengthening Consumer Protection: Priorities for Health Care Workforce Regulation. San Francisco, CA: Pew Health Professions Commission, 1998.
From page 223...
... San Francisco, CA: University of California, San Francisco - Center for Health Professionals, 1993. Regan-Smith, Martha G
From page 224...
... Although there was great interest and innovation in multidisciplinary training during the 1960s, little lasting change resulted (Pew Health Professions Corurnission, 1993~. The ability to plan care and practice effectively using multidisciplinary teams takes on increasing importance as the proportion of the population with chronic conditions grows, requiring the provision of a mix of services over time and across settings.


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