“Surely, We Can Do Better”

Abstract

To the Editor: A paradigm shift is under way in medical education—or so the myriad responses to Academic Medicine’s 2011 Question of the Year1 suggest. The central argument made by the authors of those responses: The academy must broaden the societal reach of academic medicine to prepare trainees for today’s health care system. To paraphrase Porter and Teisberg2: Surely, we can do better. The challenge is determining how to achieve their collective aim. How do we move from the white paper to the white coat? We believe there needs to be real-time integration of the authors’ varied solutions into a cohesive whole, one that emphasizes translational action. And we need evidence to prove that this transformation is both attainable and desirable. To achieve these goals, we offer a potential model: the VA Connecticut Center of Excellence (COE) in Primary Care Education, established in 2011 by the Veterans’ Health Administration (VHA) Office of Academic Affiliations as one of five national centers focused on interprofessional medical education. We maintain that the principles within this model, stated below, offer potential answers to the challenge before us. First, the foundation of efforts to broaden the societal reach of academic medicine must rely on interprofessional collaboration—a rich and essential component of modern U.S. health care. Second, the curricula for this effort, taught in medical schools, must emphasize the unique skill set that enhances such collaboration, with frontier concepts in public leadership, health policy and economics, negotiation, conflict resolution, improvement science, and political advocacy key to that effort. Third, the education must be immersive, with the longitudinal exposure to meaningful clinical and didactic experiences necessary to equip trainees with skills to generate broad social impact. Team-based delivery models—such as the COE’s clinical practice in the VHA’s Patient Aligned Care Teams, supported by the integrated electronic medical records and global payment systems inherent to the integrated delivery system—may add value. Fourth, modalities linked to improved clinical outcomes, including shared decision making and sustained application of performance and systems improvement strategies, must be integral components of such efforts. Finally, these models must serve as “exemplary care and learning sites,” intended for replication with the potential for rapid, dramatic scaling upward. Achieving the paradigm shift we seek in medical education demands evidence-driven, patient-centered results. Restructuring of traditional medical and nursing education models away from a “siloed” approach toward collaborative learning experiences—within meaningful educational homes—may be the first step. This shift must also include integration of improvement science into all actions and deliberate skill development in policy, management, leadership, and public service. Critics may suggest that it is impossible to integrate these disparate elements into medical education. Our initial experience with the COE model argues otherwise. The societal challenges of our time demand action. Educational models that transform interprofessional education while simultaneously preparing trainees to meet those challenges may be the solution. Disclaimer: The views expressed in this letter are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. Ali M. Khan, MD, MPP Resident director, VA Connecticut Center of Excellence in Primary Care Education, West Haven, Connecticut, and clinical resident in medicine, Yale School of Medicine, New Haven, Connecticut; [email protected] Theodore Long, MD Resident director, VA Connecticut Center of Excellence in Primary Care Education, West Haven, Connecticut, and clinical resident in medicine, Yale School of Medicine, New Haven, Connecticut. Rebecca Brienza, MD, MPH Codirector, VA Connecticut Center of Excellence in Primary Care Education, West Haven, Connecticut, and assistant professor, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.