Medical Professionalism In An Organizational Age: Challenges And Opportunities.

The structure of medical practice is undergoing an extraordinary transformation. The percentage of physicians salaried and employed by hospitals and health care groups has increased dramatically. Growing numbers of patients are using health information technologies that facilitate transparency and enable patients to use the internet and health tracking devices to better manage their health care. This article aims to start a dialogue on how these changes may affect the key responsibilities of medical professionalism: putting patient interests first, maintaining and enhancing physicians' medical competence, and sustaining trust in the doctor-patient relationship. We identify several potentially effective strategies. They include policies to promote an institutional culture committed to professionalism and to enlarge physicians' role in institutional leadership. We also address how the principles of professionalism might guide physician compensation formulas, policies governing transparency, and best practices for strengthening the relationships between physicians and newly empowered patients.

Redesigning the Learning Environment to Promote Learner Well-Being and Professional Development.

There is a high prevalence of burnout and depression among medical students and residents (or learners), which can negatively impact them personally, their professional development, and the patients to whom they provide care. Educators have a responsibility for the system-level factors that influence learners' well-being. In this Invited Commentary, the authors outline strategies institutions and affiliated training sites responsible for educating learners can take to pursue the recommended goal related to learners, their well-being, and the learning environment in the National Academies of Sciences, Engineering, and Medicine consensus study report, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being.

Humanism in Medicine: What Does It Mean and Why Is It More Important Than Ever?

Humanism has been at the core of the medical profession since its inception, and it has been a foundation throughout modern history for political and community values. But today, countries and leaders are increasingly adopting antihumanistic policies and positions. In this Invited Commentary, the author probes whether humanism in medicine can survive in the current culture. The author defines humanism as any system or mode of thought or action in which human interests, values, and dignity predominate. He traces humanism as a philosophical and political movement from the Renaissance through the Enlightenment to the development of liberal democracies in the 20th century. He identifies the humanistic roots of the medical profession and describes efforts to revitalize humanism in medicine in recent decades. He then details antihumanistic behaviors and policies in the current political environment and makes the case that these behaviors and policies threaten humanism in medicine. He calls on the medical profession to renew its commitment to humanism and to oppose antihumanistic behaviors and policies. It will be hard, he concludes, to have humanism in medicine if there is no humanism in the world around us.

Illuminating Graduate Medical Education Outcomes in Order to Improve Them.

Optimizing clinician education is an essential step toward enhancing health outcomes, and graduate medical education (GME)-as the pipeline for producing the nation's physicians-is an appropriate target for improvement. This Invited Commentary focuses on the need to clarify the specific goals of GME and measure achievement of those goals, using consistent metrics. The authors report on an October 2017 National Academies of Sciences, Engineering, and Medicine (NASEM) workshop focused on this agenda. A broadly representative group of participants reflected strong consensus in support of using GME outcomes data to develop better approaches to education and related policy. Implementation challenges include identifying meaningful metrics, minimizing administrative burden, addressing privacy concerns, and recognizing variability in institutional mission and capabilities. The authors recommend creating a national inventory of current data sources and initiating a pilot program to collect and share common metrics, while advancing a national effort via a "neutral" convener, such as the NASEM. The authors assert that measuring and reporting GME outcomes is a professional responsibility that must now be tackled.

Competency-Based, Time-Variable Education in the Health Professions: Crossroads.

Health care systems around the world are transforming to align with the needs of 21st-century patients and populations. Transformation must also occur in the educational systems that prepare the health professionals who deliver care, advance discovery, and educate the next generation of physicians in these evolving systems. Competency-based, time-variable education, a comprehensive educational strategy guided by the roles and responsibilities that health professionals must assume to meet the needs of contemporary patients and communities, has the potential to catalyze optimization of educational and health care delivery systems. By designing educational and assessment programs that require learners to meet specific competencies before transitioning between the stages of formal education and into practice, this framework assures the public that every physician is capable of providing high-quality care. By engaging learners as partners in assessment, competency-based, time-variable education prepares graduates for careers as lifelong learners. While the medical education community has embraced the notion of competencies as a guiding framework for educational institutions, the structure and conduct of formal educational programs remain more aligned with a time-based, competency-variable paradigm.The authors outline the rationale behind this recommended shift to a competency-based, time-variable education system. They then introduce the other articles included in this supplement to Academic Medicine, which summarize the history of, theories behind, examples demonstrating, and challenges associated with competency-based, time-variable education in the health professions.

Resident Empowerment as a Driving Theme of Graduate Medical Education Reform.

Through a series of six recent conferences, the Josiah Macy Jr. Foundation wanted to try to change the discussion about graduate medical education (GME) reform to one that is about the innovations needed to better prepare residents for the changing world of practice they will be entering and for meeting the needs of the patient population they will serve. These conferences featured some of the encouraging innovations in GME that are occurring at local and regional levels. An ongoing theme from many of these reforms is the empowerment of residents. The author examines what it would mean for health care systems, residency programs, and residents themselves to pursue empowerment for this significant portion of the health care workforce. Residents should be seen as a valuable component of the health care workforce with the ability to contribute to institutional and societal goals. The author highlights examples of existing programs that use residents in this way, but to accomplish this more broadly will require culture change and greater flexibility on the part of GME and institutional leadership.

Women in Academic Medicine.

More than a decade ago, women achieved parity with men in the number of matriculants to medical school, nearly one-third of the faculty of medical schools were women, and there were some women deans and department chairs. These trends were promising, but today there are still significant differences in pay, academic rank, and leadership positions for women compared with men in academic medicine. Though there has been progress in many areas, the progress is too slow to achieve previously recommended goals, such as 50% women department chairs by 2025 and 50% women deans by 2030.The author points to the findings presented in the articles from the Research Partnership on Women in Biomedical Careers in this issue, as well as research being published elsewhere, as an evidence base for the ongoing discussion of gender equity in academic medicine. More attention to culture and the working environment will be needed to achieve true parity for women in academic medical careers.

Reforming health professions education will require culture change and closer ties between classroom and practice.

The size, composition, distribution, and skills of the health care workforce will determine the success of health care reform in the United States. Whatever the size of the workforce that will be required in the future to meet society's needs, how health professionals are educated merits additional attention. Reform of health professions education is needed in the following six critical areas: interprofessional education, new models for clinical education, new content to complement the biological sciences, new educational models based on competency, new educational technologies, and faculty development for teaching and educational innovation. Institutional and public policies need to support these innovations and the closer integration of education reform and health care delivery reform.

The role of private foundations in addressing health care workforce needs.

There is an increased awareness among policy makers, providers, and educators that the size, composition, geographic distribution, and skill mix of the health care workforce is of great importance in determining the likelihood of success in achieving our societal goals for health care reform. As academic and governmental institutions work to address these pressing questions, private foundations can and should play an important role in supporting the design, execution, and evaluation of innovative educational programs that will address these needs. Foundations also can and should play a role in generating information that will better inform health care workforce policies and in convening thought leaders to make recommendations that will advance the field of workforce studies.The author details current efforts by the Josiah Macy Jr. Foundation and other private foundations to address health care workforce needs. Foundations can play important roles as catalysts for change in our educational processes, and they can serve as important links between education and health care delivery systems. Partnerships among foundations and between private foundations and federal agencies can be powerful forces in helping to better align the skills of future health professionals with changing patient demographics and a changing health care system.

Interprofessional education: an essential strategy to accomplish the future of nursing goals.

The Institute of Medicine's Future of Nursing report has called for broad changes in the nursing profession for the benefit of society. Interprofessional education is one strategy to improve nursing education and enhance the role of nurses as collaborative leaders in the health care system. These are important lessons that have been learned from recent interprofessional educational initiatives and some encouraging examples of successful initiatives that are breaking down barriers across professional schools. The ultimate beneficiary of these changes will be our patients, who will receive better care.