Whether they are part of undergraduate (UME) or graduate medical education (GME), educators training future physicians have the same goals for the next generation of doctors. They want, among other things, physicians to work in teams, see their patients in a social context, advocate for their patients and challenge authority so improvements can be made to the system.
So why then is there often such a disconnect between UME and GME, and how can educators better align the two phases of physician education? That is the key question George Thibault, MD, president of the Josiah Macy Jr. Foundation, focused on in a recent talk titled “The UME and GME Continuum: Aligning Education with the Needs of the Public.” The lifelong medical educator of both medical students and residents spoke at the AMA Accelerating Change in Medical Education Spring Consortium Meeting in Scottsdale, Arizona.
“We set up false dichotomies and barriers,” he said. “We should think of this as a common mission that we share, a noble mission, to create the doctors of the future. UME is no more noble than GME. Neither one can exist without the other.”
He said medical education needs greater flexibility and must move away from a fragmented model. “It does not serve us well,” he said.
Dr. Thibault noted this is the right moment to better align the two steps to become a physician, and he said looking at the changes coming in medicine can help transform the education system. For example, he said, doctors know the delivery system is dramatically changing. Although not all the features are known, he said physicians know that care will be more team-based, that there will be more patient and community partnerships, and that everything will be part of a system. Physicians, he said, also know the patient population is older and more diverse and that patients want to be more involved in their care.
Team focus from start to finish
To meet these emerging needs, medical schools and residency programs need to make changes such as encouraging and allowing earlier differentiation, Dr. Thibault said. They need to allow students and residents to be more involved in patient care earlier on in their training in a developmentally appropriate way.
Teamwork—including interprofessional teamwork—needs to take place across the education continuum. And it needs to be taught just as anatomy or other skills are taught, rather than thought of as something students and residents will just pick up along the way, Dr. Thibault said. Physicians in training also need to learn to develop relationships with patients, families and medical staff, which is not something that can be accomplished by being in clinic just once a week.
Dr. Thibault noted that some schools have piloted or even incorporated programs that accomplish some of these changes, including projects at schools that are part of the AMA Accelerating Change in Medical Education Consortium. He said GME and UME programs must keep looking for ways to innovate, and leaders must bring people who have different perspectives to the table to work together with the understanding that health care education and health care delivery have the same goal—serving the patient. He also encouraged educators to engage patients in the community for their advice and opinions.
“If we have a shared vision of what the health care system should look like,” he said, “it creates a vision of what the education system should look like to produce people to be successful.”
More on the trends in medical education
- Not your grandfather's med school: Changes trending in med ed
- The “structure” of the medical school of the future
- Determining costs to define value in medical education
- Health care and population health: A team sport
- Med students deliver patient care in homes, communities
