Special Feature

Are we preparing today's physicians for tomorrow's medical practice?

Medicine is changing rapidly. Is our system of medical education changing fast enough to keep pace? And are the products of that system—new physicians—emerging from residency training with the requisite skills, knowledge, and behaviors needed for the demands of tomorrow's practice environment?

These are two of the significant questions that are raised by a new study in Health Affairs. The study's authors interviewed Kaiser Permanente's clinical department chiefs for internal medicine, pediatrics, general surgery, and obstetrics/gynecology "to ascertain their views of the perceived gaps in the readiness of newly trained physicians." Some of the deficiencies cited by the respondents:

• Nearly half of chiefs who responded noted "deficiencies in the management of routine conditions or simple procedures in office-based practice."
• One third noted "skill deficiencies in the area of care coordination."
• More than two thirds "expressed concerns about attitudes and practices . . . that affected the continuity of patient care."

Other concerns cited were lack of exposure to and understanding of cost-effective care, preventive care and community health, and quality improvement. The most common concern was that newly trained physicians were deficient in certain procedural and technical skills "that all physicians had if they had completed their residency 10 or more years ago."

Some of these gaps may be due simply to changes in technologies or procedures that obviate the need for learning skills that are, or are becoming, outmoded. In addition, newly trained physicians have new sets of skills that may compensate for some deficiencies—such as a greater affinity for teamwork and ability to obtain and use information from a variety of sources.

Nonetheless, the study is a clarion call for more attention to and research on gaps in medical education and training that may affect the quality of future physicians. The authors also call for changes to the funding and accreditation of graduate medical education to promote flexibility and a better match between education and practice.

AMA policy and activities support new ideas and innovations in GME. For example, our May 2011 webinar and educational session at the 2011 Interim Meeting of the Section on Medical Schools meeting call for state-based solutions to the GME funding crunch, and our brochure outlines some of the AMA's key recommendations in this regard.

What do you think? How can we better prepare physicians for the "independent practice of medicine?" Or are we doing well enough already? Log in now and express your opinions via our New Horizons in Medical Education online community.