Generalism and the need for health professional educational reform.

Powerful forces are intensifying change in health care delivery: population-based thinking about health care, especially emphasis on prevention; the reemergence of the biopsychosocial mode of thinking in health care; the need to increase capacity for health services research; and the knowledge that reductions may be needed in the use of high-priced physicians, the number of acute-care hospital beds, and the duplication of expensive equipment. Academic health centers are being forced to adjust their educational offerings to these realities of the service sector. Yet, institutional obstacles stand in the way of needed education reform: fragmentation of the sense of community in health professions schools, turf-related forces that separate various health professions, inflexible institutional structures that prevent adequate responses to a changing environment, an increasingly acute shortage of money to support education, and the devalued status of teaching within our institutions. Universities must develop centers to determine regional and local workforce needs and subsequently establish regionally based educational networks of academic and community health centers. Further, academic centers must demonstrate a real commitment to multiprofessional, interdisciplinary team approaches to a patient-centered system. In parallel, the institution must create a student-centered value system.

Institutional obstacles to educational reform.

For the full implications of health care reform to be implemented in health professions education, there will need to be a radical rethinking of educational missions and goals, as well as a careful analysis of the obstacles to educational reform that are currently extant within our academic centers and health professions schools. A series of steps should be taken to encourage the development of a collegial spirit among faculty and students across the major health professions. As costs of education become distinct from those of service and research, certain organizational steps will become apparent, such as: 1) developing separate postgraduate and undergraduate medical schools; and 2) forming a regional educational network to respond to the workforce demands of the region.

Letter from the Interest Group on Health Services Research, Association of Academic Health Centers.

Although guidelines have existed in various forms for many years, increased interest in guidelines has sparked myriad concerns among health care professionals, policymakers, and the broader public. Among these concerns are a number of legal questions that to date have not received sufficient notice or study.