Report: Better training needed for medical workers
One hundred years ago, medical schools were often more like trade schools. Most of the programs in the United States and Canada required only a high school diploma for admission. Much of the instruction involved long lectures and exhaustive memorization of the signs and symptoms of various diseases, often delivered by physician-instructors who themselves had received little scientific training.
There was little or no laboratory or clinical practice. Some new medical graduates emerged with “degrees” after two or three years, having never actually examined a patient.
Reforms recommended by the American Medical Association, the Association of Medical Colleges and a landmark Carnegie Foundation report by educator Abraham Flexner set new standards for scientific medical training that were enforced by state medical boards early in the 20th century.
The result has been that almost every physician trained in the Western medicine tradition of treating disease has received the same sort of academic, scientific training for the past 80 years or more, centered on teaching hospitals and supervised time with patients as upperclassmen.
This model guides the training of about a million new doctors, nurses, public health workers and allied professions at more than 2,400 medical schools, nearly 500 schools and departments of public health and thousands of nursing programs worldwide each year.
But many experts are arguing that this relatively rigid, standardized system leaves the next generation of health providers poorly-prepared to serve patients in a rapidly changing medical world.
One new report, prepared by 20 scientists and educators from around the world and published in the journal Lancet ahead of a recent Harvard Medical School symposium, argues that it’s time for a major shakeup.
“It’s not as though there have not been other reforms in the past century, but all of the problems facing the health professions are more complicated, and more than ever require understanding and cooperation among the various professions,” said Julio Frenk, dean of the Harvard School of Public Health and co-author of the report.
“Most of the reform proposals deal with just medicine or just nursing, but we tried to look at all of the health professions together and with a global outlook. For instance, a quarter of all the doctors working in the U.S. are trained overseas, which has implications both here and in their home countries,” Frenk said.
There are issues that are universal – training that doesn’t meet patient needs; too much time spent in hospitals rather than in community-based care; poor appreciation of the need for teamwork, and a lack of training in leadership, along with gender barriers and other cultural factors. And there are problems related to over-specialization and delivering the right level of care to patients in both the developed and developing world.
Frenk acknowledges that many medical training programs here and abroad are innovating, with attempts to get students real-world experience and interaction with other types of health workers throughout their studies.
“One of the biggest gaps, though, is still not training people to manage across different health care systems.
“Doctors in the U.S. don’t understand the economics and intricacies of the system they’re supposed to guide and public health leaders in many less developed places don’t appreciate the need to support the efforts of workers in villages in the field,” he said.
Innovations in teaching tools and settings need to be better supported by accrediting bodies, government agencies and corporate health care entities, the panel noted.
And more money needs to be devoted to training the health care workforce: only about 2 percent of health spending worldwide (estimated at $5.5 trillion this year) goes toward professional education, “which is not only insufficient, but unwise,” the report says.