Innovative Approaches to Educating Medical Students for Practice in a Changing Health Care Environment

Abstract

In today's continually changing health care environment, there is serious concern that medical students are not being adequately prepared to provide optimal health care in the system where they will eventually practice. To address this problem, the Health Resources and Services Administration (HRSA) developed a $7.6 million national demonstration project, Undergraduate Medical Education for the 21st Century (UME-21). This project funded 18 U.S. medical schools, both public and private, for a three-year period (1998-2001) to implement innovative educational strategies. To accomplish their goals, the 18 UME-21 schools worked with more than 50 organizations external to the medical school (e.g., managed care organizations, integrated health systems, Area Health Education Centers, community health centers). The authors describe the major curricular changes that have been implemented through the UME-21 project, discuss the challenges that occurred in carrying out those changes, and outline the strategies for evaluating the project. The participating schools have developed curricular changes that focus on the core primary care clinical clerkships, take place in ambulatory settings, include learning objectives and competencies identified as important to providing care in the future health care system, and have faculty development and internal evaluation components. Curricular changes implemented at the 18 schools include having students work directly with managed care organizations, as well as special demonstration projects to teach students the knowledge, skills, and attitudes necessary for successfully managing care. It is already clear that the UME-21 project has catalyzed important curricular changes within 12.5% of U.S. medical schools. The ongoing national evaluation of this project, which will be completed in 2002, will provide further information about the project's impact and effectiveness.

Student‐Run Health Clinic: Novel Arena to Educate Medical Students on Systems‐Based Practice

“…2 -4 Quality and cost of medical care are and will continue to remain the predominant stressors of the current US healthcare system. 5,6 Both directly affect the access to care for disadvantaged populations and necessitate dramatic changes in the current organization and delivery of healthcare to make it fair and unbiased. In response, the seminal 2001 report by the Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21st Century, urged medical training programs to change the way in which physicians are educated to meet the ''six aims for improvement'' and the ''ten rules for redesign of the healthcare system'' necessary to fundamentally improve the equitability of healthcare for US residents.…”

“…5,9 Eighteen schools participated in this project through a competitive selection process; 8 of these schools undertook comprehensive roles over 3 years. The innovative part of this project was the collaboration and incorporation of external healthcare organizations including managed healthcare organizations and other community-based settings outside the traditional teaching hospital.…”

Use of epidemiological data as the basis for developing a medical curriculum

“…21 However, the content was not taken into consideration. On the other hand, a recent study describing the process used for curriculum development stated that the disciplines chosen to run through the course were retrieved from associations of medical specialists.…”

A Ubiquitous Reflective E-Portfolio Architecture

“…The focus of curricula has shifted from the acquisition of knowledge to the achievement of competence [1]. This new scenario has increased the relevance of clinical practice in the learning process and, by consequence, the use of Reflective E-Portfolios.…”