Medical training and education
The quality of health care in a society depends on the quality of its physicians. This country once had the best health care in the world because it had the best physicians, who were trained in a system that went back to William Osler, the father of modern medicine. However, that system damaged a lot of physicians and produced post traumatic stress disorder in some. To protect doctors during training, reforms were instituted.
Traditional postgraduate medical training began with an internship. By being present in the hospital constantly, the intern was exposed to a maximum number of cases and training experiences. If a physician specialized, then a residency was done in that specialty.
Reforms reversed this trend by markedly decreasing the number of cases and training experiences doctors were exposed to during their internship and residency. This resulted in interns and residents not becoming well trained and competent. The problem was further exacerbated by medical schools becoming businesses to stay financially viable. Their focus shifted from producing well-trained, competent physicians toward being successful healthcare plans with good patient retention and earnings.
Next, the advent of technology changed medicine. Order the right test and imaging studies to get the correct diagnosis then use the best practice guidelines to institute the proper treatment. The role of the physician was diminished to that of a provider. This resulted in the electronic chart being treated and the patient being neglected.
It has all culminated in a marked decline in quality of doctors and consequently a decrease in the country’s overall quality of health care. By all the rating agencies we are 11th … or worse.
Changes can be made to medical education and training to improve physician quality. Medical school curriculum could be modified to eliminate the majority of courses in the basic sciences by pushing them down to the college level and making them prerequisites for medical school. That would free up the senior year to become the internship year. Medical school would be three years instead of four. That would add an extra year for postgraduate training without extending the total training period.
The specialties could be further subdivided and therefore require fewer cases to become adequately trained in a narrower scope of practice.
Medical schools are not only about education and training; there is a rite of passage involved to weed out the unworthy and a baptismal for those who make the grade. It is the foundation a doctor stands on for their entire career. That foundation must be solid for a society to have good physicians and good health care depends on good physicians.
DALE COCO, MD