Preparing physicians for the world as it is

Patrice A. Harris, MD, MA , Former President

The mission of the AMA is to promote the art and science of medicine and the betterment of public health. At its very core, this means medical education and training must yield physicians who understand how our patients’ health is shaped and influenced by factors outside the walls of our offices, hospitals, laboratories and clinics. 

The ethical principles that guide our profession compel us to act whenever our patients’ health and well-being is jeopardized, whether it’s from a measles outbreak, the threat of gun violence, the heavy burden of chronic disease or the climate change crisis.    

Physicians bear witness to the consequences of inequities every day through our patients’ lives, experiences, and health status. Therefore, the effort to understand which conditions foster optimal health —and which conditions create and maintain inequities—must begin early, must be reinforced in medical school and extend throughout a physician’s career. Health equity is crucial if we are going to improve the health of the nation. 

The AMA strongly disagrees with colleagues who believe that a medical education that includes study of broader public health issues and public polices detracts from other essential medical school curricula.   

Importantly, medicine and social justice are not mutually exclusive; in fact, just the opposite. Our goal is to improve health outcomes for all patients, a goal we cannot reach if we fail to acknowledge and address the clinical and social contexts of our patients’ lives. A person’s health often depends on the policies, conditions, resources and opportunities to which they are exposed. 

The next generation of physicians are counting on us to adequately train and prepare them for the profession they’re about to enter which is a far more complex, diverse and divisive environment than ever before. 

Emerging technologies, the rise of chronic disease, the public health crises of opioids and gun violence, and the demands of caring for increasingly diverse patient populations, have and will continue to have impact on the medical landscape. But for far too long in the U.S., the way we have taught and trained medical students has failed to fully prepare them for historical and contemporary injustices and realities. 

Simply put: we have trained them for the world as it was, not as it is, or as it will be going forward. 

This impetus led the AMA six years ago to create a national community of forward-thinking educators, faculty and students tasked with reinventing medical school education to be more relevant for physicians in the 21st century. 

The AMA’s Accelerating Change in Medical Education consortium now encompasses 37 medical schools and some 24,000 undergraduate students, whose instruction builds on traditional core competencies with expanded learning about the determinants of health and their impact over a lifetime, technology trends, hands-on experience working with electronic health records, population health and chronic disease, structural competencies, and navigating the complexities of our health care system. 

This critical training is about improving the health of our patients and our nation on a broad scale.       

Naturally, not everyone is comfortable with the pace of change today. Some like to characterize the dangers of gun violence or the growing threat of climate change as somehow not the business of healers.   

This is shortsighted. Physician leaders at the AMA are committed to improving health outcomes for patients and shaping the health system of the future. We advance those goals mindful of history and cognizant of the political, social, environmental and economic pressures that impact the health and wellness of our patients.  

The very ethical standards that guide our profession instruct us that we have a “responsibility …[to] participate in activities contributing to the improvement of the community and the betterment of public health.” 

This mission cannot be achieved without a deeper understanding of all that contributes to health and inequities, without recognizing the changing world around us, and without the courage to break free from the past.