Medical Education and Societal Needs A Planning Report for Health Professions (1983) / Chapter Skim
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1. Introduction
1. Introduction
Pages 1-14
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New technologies were developed to improve diagnosis; new drugs and surgical procedures were introduced to improve treatment; an understanding grew of risk factors for disease; systems of life support were perfected to take over for failing organs. But, as infectious diseases became less of a threat, chronic diseases moved into the ascendancy; as newborns were led unscathed through the illnesses of childhood, they lived to incur the diseases of adulthood, including those related to environmental factors and personal habits; as techniques improved to sustain life, concern arose about the quality of that life; and as physicians became more scientific, complaints were heard that they were less compassionate.
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0 The growing numbers of physicians, the expectations of expanded roles of non-physician health professionals, the desire to assure equity of access to health careers, and the continued presence of medically underserved populations (defined geographically, socioeconomically, or ethnically) raise complex questions which must be dealt with by educational institutions, governments, and society as a whole.
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Means to enhance clinical research interfaces between clinical practice and laboratory research need thoughtful consideration. o Questions of responsiveness to the community, and possible conflict of university missions and community missions, arise in many contexts, but appear especially pressing for academic health centers.
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Work of the Planning Committee The 18~ember committee undertook a number of activities in order to understand more fully the contexts in which medical education takes place, in which decisions are made about medical education, and in which health goals for the nation are defined. These activities also were intended to help identify national, regional, and local concerns in medical education, to identify further knowledge needed and feasible approaches to acquiring it, and to help develop priorities among the many study issues proposed.
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provided valuable assistance, which is gratefully acknowledged. Consultants and Institute staff prepared background papers on subjects selected for detailed examination by the committee.
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But specif ic system-wide inadequacies exist today, such as steadily rising health care costs and the persistence of medically underserved populations.6 And even if the system were optimal for the present, it would not necessarily be optimal for the future. In the not-too-distant future, with the population aging and the rise of chronic disease, maintenance of maximal possible function, rather than cure, is likely to be the physician's best effort (Chapters 4, 6~.7 Multiple interacting risk factors', rather than straightforward cause-effect relationships, will have greater roles in determining health status.~9 Such trends must be accommodated within medical education, but time is needed until the effect of educational changes will be seen at the level of the health care system.
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, in Future Directions for Medical Education,1O examined the concepts and principles governing education for medical practice. However, this report, which offers valuable analysis of medical school and teaching hospital concerns, cautions that it has not addressed in depth "cost and f inancing of medical education; changing ethical principles resulting from new knowledge and technology; interrelationships between government agencies and higher education; .
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1980 reportl8 was concerned with aspects of supply and distribution of physicians, as were On the Status of Health Professions Personnel in the U S., Third Report to the President and Congress, -Y On the Status of Medical School Faculty and Clinical Research Manpower 1968-1990, and Personnel Needs and Training for ~ .
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Without the leverage of money or regulation, power to implement changes must derive from the shedding of light, from the persuasiveness and intellectual rigor of the presentation of the problems and approaches to their resolution. Proposed Plan The ma jar recommendation of this committee is that an Agenda Group on Education of Health Professionals be established to deliberate on how the health professions education system helps or hinders progress toward f uture health goals of our country; to consider the social ~ economic, political, scientific, and educational f orces in our society that act on health professions education; to tell when these forces can be enlisted to implement constructive changes in the education 9
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It also is our expectation that as the Agenda Group deliberations proceed, with a scope expanded beyond medical education to include health professions education, additional priority topics for study will be identified. The priority sequence presented here, which was determined by a vote of the planning committee, should not be considered immutable.
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Valid outcome measures would be needed to determine which selection procedures and which innovative approaches to medical education are most likely to produce physicians well suited to their various future roles. The Cultures of the Medical Education System Behind each of these issues are questions of power and decisionmaking wi thin the educat ion sys tem.
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The committee believes that all of these topics deserve priority consideration and clarification; some will need new research; all require thoughtful attention and considered action. The topics differ considerably in terms of their susceptibility to various research methodologies.
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6. Department of Health and Human Services, Public Health Service, Health Services and Resources Administration, Bureau of Health Professions.
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Third Report to the President and Congress on the Status of Health Professions Personnel in the United States. DHHS Publication No.
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