Supporting primary care medical education.

A number of fundamental issues must be considered in preparing the education system to produce more primary care physicians. Governmental controls and redirection of resources will force significant changes in the structuring of approaches to both undergraduate and graduate education in primary care. Particularly challenging will be restructuring and funding medical student programs in primary care, given a nearly certain requirement that more than 50% of medical school graduates enter primary care disciplines. Institutions will need to make strategic resource allocations to compete for the funding once the allocation process begins. Educational institutions will also face a cultural adaptation to primary care as an educational priority. This paper presents a model to study costs and funding for residency programs as they move from the traditional inpatient orientation to an outpatient focus. The authors suggest that for medical student education, the development of large academic health care systems may make funding primary care education more feasible.

Resident, faculty, and residency program development. An integrated approach through annual retreats.

Retreats during residency training have evolved as an escape from the daily routine. Recognizing that the retreat format could also be used as a foundation for program design and personal development, we have designed annual retreats for each of the 3 years of pediatric residency training. The sessions vary in length and agenda, but serve as the basis for an ongoing effort fostering growth and maturation of the department and its component participants. The effectiveness of the program (and the morale of the residents) is greatly influenced by this program.

Competency requirements. A new approach to medical school admissions.

The faculty of the University of Pennsylvania School of Medicine, Philadelphia, have substituted definitions of knowledge and skills for course requirements as requirements for admission. The school expects that this action will allow students more flexibility in the development of their undergraduate academic programs, while guiding them specifically to the necessary preparation in the sciences. It is further hoped that this action will encourage the faculties of undergraduate schools to examine the way in which they prepare students for careers in medicine. This article describes the approach used for bringing about this change in policy and presents the new admissions requirements.

Types of medical writing and teaching of writing in U.S. medical schools.

U.S. medical schools were surveyed to determine which types of medical writing are most important for physicians, house officers, and medical students to learn and whether such types are formally taught. According to the responding schools, the five most important types were: write-up of the patient history and physical examination, progress note and discharge summary (tied), peer-reviewed published paper (of either clinical or laboratory research), and grant proposal. Certain types, however, were considered more important for some categories of physicians and trainees than others. Although these major types of writing represent complex and diverse writing tasks, they are not taught extensively in medical schools or thoroughly explained in the literature on medical writing.

A consumer/medical educator conference: new objectives for the medical curriculum.

The authors discuss the development and proceedings of a highly structured conference at which 17 representatives from diverse non-medical groups and 14 medical educators from one medical school identified objectives needing greater emphasis in the medical curriculum. The conference emulated industry's use of consumer advisory panels. Using the nominal group technique, a group process used in business, the non-medical group developed independently a priority list of areas in which physicians might be better educated to serve society. The medical educators then joined the non-medical group to discuss and clarify the concerns given highest priority. The authors describe subsequent initiatives by the medical school to address aspects of the general concerns raised by the non-medical group. The conference represents an approach to seeking input from non-traditional sources in the development of the medical curriculum.

Managing medical education at the University of Pennsylvania.

In meeting the challenge of educating students to be physicians in the 21st century, schools of medicine must develop management systems that promote change and encourage innovation. In this paper, the authors describe the approach used by the University of Pennsylvania School of Medicine over the past five years for managing its programs. The major elements of this management scheme are centralization of administrative functions concerned with medical education; networks for communication about education problems and issues; a system for obtaining consensus among the institution's constituencies on the goals of the school's educational programs; a system for including information on teaching performance as an element in the promotion process; and multiple systems for providing the faculty, students, and administration with information about the quality of the school's educational activities.

Competence in medicine.

During the past decade, medical educators have spent time discussing and attempting to define medical competence. There appears to be some confusion as to why definitions of competence are important and how one might describe in a logical fashion the elements of competence for physicians. Here, we try to clarify what is meant by competence, to describe how definitions of competence are of value to students, educators, institutions and the public, and to provide a conceptualization of the elements of a definition of competence in medicine.

Objectives of recertification.

Recertification of physician competency is a major topic of discussion and debate in the U.S.A. today. Nearly all graduates of U.S. medical schools are eventually certified by an approved American Medical Specialty Board. Since the mid-1970's all of these Specialty Boards have endorsed the concept of recertification. This paper defines what is meant by periodic assessment of physician competence, why such an assessment is becoming a reality, and the principles which should be followed in implementing a system for the periodic assessment of physician competency. The evaluation of physician competency is a task of enormous proportions when one recognizes the difficulty of reliably and validly measuring all aspects of the skill and abilities of the practicing physician. The evaluation of intellectual capabilities is feasible, but somewhat limited with regard to the spectrum of abilities expected of the physician. In the U.S.A., both the public and the medical profession have placed pressure on physicians to implement programs of recertification. Unlike most of the other professions, medicine has taken upon itself to develop and implement programs for recertification of the medical specialist. To develop recertification programs of value, they should meet certain standards. These include: the need for clear specification of the criteria by which qualification for recertification will be judged or measured; the need to attempt to coordinate programs of recertification with programs of continuing medical education; the need to design evaluation tools that accurately reflect the skills and abilities needed by the physician in the practice of the medical specialties; and the need to be certain that all who participate in such a program have the opportunity to successfully complete the program (that standards for passing tests be absolute rather than normative).