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Step 2 Clinical Skills Exam Set for June 2004 Pipeline Programs: Looking Forward to Promote Diversity A Word From the President: Ten Unstoppable Trends Viewpoint: Educating for Professionalism in Medicine Portraits of Medical Education
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A Word From the PresidentTen Unstoppable Trends
I had the privilege of speaking to the group this year and took the opportunity to lay out some external realities that I thought were essential to bear in mind while mapping a strategic course for future internists - but not just for internists. Reality, after all, is just as real for non-internists as it is for internists. All too often, when we try to envision a future course for some aspect of medicine - including academic medicine - we focus too tightly on the problems of the here and now without taking into account the macro trends that will inevitably shape the future, no matter what. Unless we discipline ourselves to root our strategic thinking in the immutable realities impinging on medicine, we risk deluding ourselves with what we wish could be, while never grappling with what can be. So, I constructed the following list of "Ten Unstoppable Trends" that I thought would help inform the group's discussion.
If these are, indeed, some of the unstoppable trends that are shaping the future of medicine, we can envision several predictable consequences. The most fundamental and disquieting, it seems to me, is the demise of the historical model of care, which is focused on individual, autonomous physicians. That model simply cannot prevail if we are to afford the miracles of modern medicine; if accountability for the costs and quality of care becomes the norm; if extreme, non-evidence-based variations in the processes of care are to be eliminated; if chronic illness is to be managed effectively; if system-based medical errors are to be reduced; and if effective, life-long preventive strategies are to be implemented and monitored. Only systematic, evidence-based strategies, empowered by information technologies and implemented with the enthusiastic use of non-physician healthcare professionals, can hope to accommodate these unstoppable trends. An inescapable consequence is that the unit of accountability for performance and payment must inevitably switch from individual physicians to the small, often informal organizational arrangements in which physicians and others work - what's been termed the "microsystems" of care. Individual physicians, no matter how well trained and well meaning, cannot meet the shifting expectations of patients and payers by acting alone or even by aggregating in small groups. Which is not to say that the individual doctor-patient relationship or the performance of individual physicians will be any less critical in this new reality than at present. It is to say, however, that the quality of physician performance will be measured by the degree to which patient outcomes meet quality standards. And that will increasingly depend on the performance of the microsystem in which the physician works. Physicians will be held accountable not only for applying their knowledge and skills to individual patients but for leveraging that knowledge and those skills to enhance the performance of the system. In other words, the role of physicians must expand to include effective management of Microsystems to attain achievable objectives. The implications of all this for medical education are clear and profound. A first order of business is to anticipate these unstoppable trends by transforming the clinical care settings - the Microsystems - where medical students and residents learn so that those settings are focused on continuous, measurable, evidence-based improvement. To use the IOM's listing of characteristics required to cross the quality chasm, our learning environments must be patient-centered, efficient, effective, equitable, safe, and timely. Simultaneously, we must equip our students and residents not only with the time-honored knowledge, skills, and attitudes required of competent doctors but also with the knowledge, skills, and attitudes required to systematically advance the quality and cost-effectiveness of patient care. That means, at minimum, taking full advantage of information technologies, constructing and leading fully collaborating arrangements with nurses, pharmacists, social workers, and others, and engaging patients and families as full partners in planning and delivering appropriate, evidence-based care. Ignoring unstoppable trends is a recipe for failure. Seizing clearly foreseeable trends as guides to the future is a formula for success.
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Contact Us © 1995-2008 AAMC Terms and Conditions Privacy Statement |
Every
summer the American Board of Internal Medicine Foundation hosts
a forum to address some contemporary issue affecting the profession
of medicine, with a particular emphasis, of course, on internal
medicine. This past summer, the topic was Health Care in the 21st
Century: What Is Internal Medicine's Role in the New Health Care
Environment? Roughly a hundred people - representing internists,
other physicians, and non-physician stakeholders - are usually invited
to attend these yearly forums, and the discussions have been among
the liveliest and the most provocative occurring anywhere. 