Oct 8 2012
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Improving Medical Education to Focus on Delivering Value to Patients

The Robert Wood Johnson Foundation Human Capital Blog is asking diverse experts: What is and isn’t working in health professions education today, and what changes are needed to prepare a high-functioning health and health care workforce that can meet the country’s current and emerging needs? Today’s post is by Mitesh Patel, MD, MBA, a Robert Wood Johnson Foundation Clinical Scholar and senior fellow at the Leonard Davis Institute for Health Economics at the University of Pennsylvania, a member of the AAIM-ACP High-Value, Cost-Conscious Care Curriculum Development Committee, and a practicing physician at the Philadelphia Veteran Affairs Medical Center.  He is also the author of Clinical Wards Secrets, a guide for medical students transitioning from the classroom to hospital wards.

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Health care costs continue to escalate.  Concurrently, the amount of published medical research has increased 10-fold over the last decade.  Each of these changes combined with recent health care reform has led to a rapidly evolving health care system.  Unfortunately, medical education has been unable to keep pace with these changes. 

Health care professionals find themselves searching for ways to deliver better value for their patients.  They are looking for an opportunity to become a part of the solution to stemming the rising costs while still providing high-quality, evidence-based care.

The American College of Physicians (ACP), the Accreditation Council for Graduate Medical Education (ACGME), and the Medicare Payment Advisory Commission (MedPAC) have each recognized these deficits among the health care workforce.  They’ve called for a restructuring of medical education to address these issues.  However, teaching hospitals and medical educators lack a common strategy to accomplish this daunting task.  To address these issues, my research team and I studied approaches to transforming medical education to help prepare providers to assess and deliver value-based care for their patients.

To better prepare a high-functioning health and health care workforce, we must start by gaining a better understanding of the problem.  In 2009, we published the first study that shed light on this issue on a national scale.  We found that among U.S. medical students, less than half felt they were appropriately trained in topics relating to the practice of medicine such as medical economics.  In addition, we found that a higher intensity curriculum in health care systems resulted in a payoff, not a tradeoff.

In 2011, we proposed a national curriculum in health policy and outlined suggestions to overcome the three major barriers to advancing medical education.  First, we have to move past the conventional wisdom that a curriculum in health policy would put undue stress on the current curriculum.  In fact, we now had evidence to suggest that the opposite was true.  Second, we need to overcome the fact that a multidisciplinary faculty is needed to teach these topics but is not readily available at most institutions.  Third, we need to conduct more research on how to best design and implement such a curriculum.  Each of these suggestions addresses the problem from a top-down approach that restructures medical education beginning as early as the first days of medical school.

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Recently, we proposed the VALUE framework.  It’s a simple and concise method that enables health care professionals to provide value-based care for their patients.  The framework stands for: Validation and variability, affordability and access, long-term benefits and less side-effects, utility and usability, effectiveness and errors.  While each of these components is important to consider, many get left out or forgotten when it comes time to make medical decisions.  By leveraging this resource, providers can use the mnemonic device as they make decisions at the bedside.  In addition, we provided teaching hospitals and residency programs with more than 20 suggestions to incorporate elements of the VALUE framework into their training programs.  One example is to find two published studies on topics relating to a patient case.  By examining the strengths and weaknesses of the study, you can learn whether an intervention is validated and if there are patient variability characteristics that might affect its outcome.

As health care costs continue to rise, we must look for ways to reduce unnecessary spending while continuing to provide high-quality care.  Basing medical decisions on evidence and utilizing a structured method such as the VALUE framework can help to accelerate this change.  Creating a culture that embraces these efforts on a daily basis will not be easy, but the VALUE framework is a simple, yet powerful tool that we hope will motivate discussions among care providers and lead to more research that further enhances the way we practice medicine.

Tags: Cost of care, Value-based purchasing, Health education, Human Capital, Voices from the Field, A Closer Look at Health Professions Education, Research & Analysis