http://www.unmc.edu/Community/ruralmeded/FM_GP/measures_and_expectations.htm
One of the great challenges in medical education is setting
objectives and standards without compromising innovation. The connection between
education and training and real life is a real problem for all professionals.
Somehow allopathic medical education has become very rigid in this area,
teaching to the boards and emphasizing resources over process and outcomes.
Accreditation and Demands of Rural Practice
As others have pointed out, the problem is us. In primary care, we have allowed
others to set the standards and objectives and outcomes expectations.
Academic Impacts on Family Physicians
In primary care we still want to be accepted by academics to get in the way of the kind of preparation that our students and residents need so that they can serve their patients better. (see FFM project critique and still desire to earn respect despite decades and little success in this. Character, Color, Admissions, and Physicians )
Amiables like us hate conflict, and without conflict there cannot be discipline, or growth. One of the key reasons that we allow this to happen is our own vain attempts to get along. We in family medicine are amiables, kind to people, and leaders. We act much like some child of alcoholic or workaholic parents.
We have not always behaved this way. Before generalism was replaced by chaos as a focus of medical education (see generalism ) this was not a problem. Generalists had not only the respect of academic medicine, we were academic medicine. In the past 50 years this has slowly changed.
Even in recent decades, this process has been reversible. Again one of the ways to reform medical education was to change the measurements. (Verby Articles on reform, evaluation) Jack Verby spent 20 years as a rural physician. He then spent 20 years initiating and developing the RPAP program (link). In the beginning he had the support of the legislature, but this would not last forever.
St Paul Pioneer Press Dispatch Friday February 22, 1974 State Senator John Milton of White Bear Lake says he is willing to amend his proposal to take away a $14 million medical building if UMN officials are willing to make a greater commitment to health care delivery. Milton said he is willing to allow the university to keep all $14 million of the appropriation but half of the money should be put into health care programs rather than construction. Noting that "there is sufficient time for compromise from all sides. If one side goes for broke, there is the possibility they will do just that!"
Verby's initial attempts to spread the good news about RPAP were not accepted, much like other innovators in medicine (Delays in recognition have not been uncommon in medical developments ). However Jack was not a whiner, he just dug in and learned about evaluation, research, and publication. His articles demonstrated the value of RPAP and rural medical education Verby Articles. He also introduced new ways to measure primary care, looking at behavioral and procedural categories beyond just the cognitive.
Rabinowitz pushed admissions committees to look beyond the cognitive MCAT and GPA to rural background and interest in Family Medicine. Admissions Package
Others like Maudlin with Rural Training Tracks and Stageman with the Accelerated Rural Training Program have demonstrated outcomes in training and location that have outdistanced the limited measurements of the ACGME and RRC. Accreditation and Demands of Rural Practice
We have a role to increase the expectations, not only of
faculty and programs, but also of students, residents, and those who fund
medical education. They are not getting the best bang for their buck. Of course
when they get up in arms and demand changes, allopathic medical education tends
toward becoming more defensive and entrenched. What we can do in academic
circles is measure and study and analyze. The problem is that we are not
measuring the right things, and this has everything to do with what we get in
terms of outcomes.
We need studies that have more broad measures, the kind of measures that are
likely to raise expectations. AAMC is not one of the best at flexibility, but I
have to complement them on keeping up fairly well on the kind of measures that
need to be tracked so that they can have an influence on those designing medical
school curricula and those that help implement these changes. Each year AAMC
adds topics to the AAMC GQ survey that graduating senior medical students fill
out. It is clear that many of the topics and questions that they have recently
added, are in this category (culturally appropriate care, underserved,
continuity of care, problem solving, nutrition, physician-patient
communications, geriatrics, OSCE)
We get very little feedback from our graduates as a whole in family medicine.
Our FP leadership has not chosen to be innovative regarding how we get this
feedback. We get nothing in such categories as minority and gender. Even though
we do track where residents go, we do a bare minimum in this area. We have
several data sources and integrating them to get meaningful studies is a real
pain.
Without better information, without innovative changes in how we measure, and
without changes in the attitudes of our leadership, we will not serve our
patients well, or our discipline, or our profession.
As departments and faculty, we should also be held to high standards.
Measurements on a statewide level would help us meet the needs of states or the
federal government, which would also help us retain current sources of funds and
attract new ones. See evaluating statewide
Evaluation of RME
Evaluating State Efforts in Rural Medical
Education
Robert Bowman, M.D.
rbowman@unmc.edu
Just a hint of what happens when a student sees beyond the usual limitations is what John Klein is doing with PRIME John Klein: PRIME Developer
See also Hope at Hope: Students From the Underserved, For the Underserved
Status of Rural Health and Rural Medical Education
Side Effects of Selecting for Family Medicine