Opportunities to Improve Medical Education

What are the most important questions in medical education? Here are some to consider. “How can we best help our medical students and residents achieve procedural competency?” Or, “What is the impact of medical education upon the quality of care our physicians provide to patients?” Or, “How can we disseminate the knowledge and expertise of our specialist physicians to assist primary care providers in managing patients with complex illness?” In Academic Medicine’s January issue, expert authors address these questions and share their answers.

Ericsson discusses the importance of deliberate practice with a focus on those aspects of a procedure that are most difficult to master. He  explores the possibility of use of simulation and video technology to capture critical elements of a procedure for review by a student so that the student can concentrate on improvement in the areas of greatest  need. He emphasizes that it is not just the hours of practice that are important; it is what we practice and how we practice, as well as the assistance of a coach who can provide feedback and help the learner focus on what areas are most important.

Asch and colleagues extend their work on the relationship between the quality of care that obstetricians provide and the training programs  they attended. These authors discuss the effect of experience over time and whether differences in quality identified during residency remain during the years of practice. Nasca  and colleagues from the ACGME provide a commentary related to Asch’s commentary and discuss how it has influenced their thinking about the accreditation of residency programs and in particular the importance of the learning environment for resident education.

Arora and colleagues describe the challenge of an ever increasing amount of medical knowledge that has become critical for optimal treatment of complex disease. They explain that access to knowledge about specialty care typically has been restricted to a limited group of specialists who are concentrated at academic medical centers requiring patients to travel to the specialists for their care. In his program these  specialists share their knowledge with  primary care providers and assist in the management of patients with complex illnesses such as hepatitis C or HIV in the local community through telemedicine. This model of knowledge transfer has also provided meaningful continuing education for the primary care providers who learn relevant information that improves the quality of care they provide.

As I think about these articles they remind me of the opportunities we have to improve our education. On a recent evening I was working in the Emergency Department when several patients from a two-car crash arrived. It was somewhat chaotic and a resident and another faculty member were caring for one particularly badly injured patient. Out of the corner of my eye I noticed that they were having difficulty with the intubation of this head injured patient. Fortunately they were ultimately successful. I heard the faculty member tell the resident, “It’s these tough cases that you need to   really learn about how to manage an airway.” He was referring to the concepts enumerated by Ericsson in his Commentary. Imagine if we were able to take advantage of such cases with a video recording as Ericsson suggests and review them with the resident and other residents in the same program. They could all learn from the case rather than having the experience restricted to that one resident and that one situation. I suspect we would also get closer to creating the type of learning environment that Nasca and colleagues endorse. Eventually we may be able to share this expertise with practicing physicians or with residents who are located in different locations through telemedicine, as Arora and colleagues describe. The commentaries in our January issue are provocative and informative, and I hope this brief introduction to them whets your appetite for a thoroughly enjoyable experience when you get to read them.

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