10 Megatrends in Medical Education

In 1982, John Naisbitt, a self described “social forecaster” and business consultant, published his bestselling book, Megatrends. The book forecasted the end of the industrial economy and the beginning of the global information and service age. He developed his list of trends by monitoring what was going on locally in the newspapers, small businesses, towns, and cities of America and discerning patterns. Recently, the Steering Committee for the Generalists in Medical Education developed a similar list of megatrends in medical education as the theme for the organization's most recent annual conference. Over the two-day period, a diverse group of participants from the United States, Canada, the United Kingdom, and several other countries shared new ideas and strategies for addressing the following 10 medical education megatrends. Globalization The increasing interconnectedness among the world's population has implications for global health. For example, shortages of physicians in one part of the world may affect other areas. The shortage of physicians in the United States is currently being solved by drawing practicing physicians from developing countries into training in the US, leading to a decrease in capacity of those countries to meet the needs of their own citizens. Alternatively, increased collaboration between international medical education institutions can help address workforce shortages around the world. This trend includes exporting of medical education and educational participation from the US and Canada to other countries around the world in the form of educational programs and curricula, technology, teaching methods, faculty, learners, and increased use of distance learning and e-learning technology to bridge the physical distance between teachers and learners. Simulation Models of body parts, advanced inanimate patient simulators that can simulate a patient with symptoms of illness, and the use of live simulated patients who are trained to behave and act like real patients are developing at a rapid pace for training and assessing medical students and physicians on technical procedures and patient-physician interaction skills. This has led to improved formative and summative performance assessments and accountability measures (standardization for validity and reliability) for teaching and testing technical procedures, for teaching and testing interpersonal communication and physical exam skills, and for using models and simulations to avoid problems inherent to novices learning on live patients. These teaching methods and curricula can be presented in a format that more closely resembles the medical care setting and incorporate more interactive and self-directed learning. Rising Cost of Medical Care & Medical Education The continued unchecked rise in the cost of health care has implications for medical education. Physicians need to learn how to deliver care in the most cost-effective way without jeopardizing patient safety, the effectiveness of the care, or the efficiency of the delivery. Rapid improvements in technology, both in patient care and in teaching and learning tools, require more investment in medical education. As an example of a more efficient, timely, and effective model of educating future physicians, there have been increases in cross-institutional collaboration for medical education, such as repositories for teaching materials that tap into the best teaching practices (HEAL, MedEdPORTAL). The rising cost of medical education and the impact of student debt on specialty choice and practice location are serious concerns. Redefinition of Desired Physician Traits & Skill Set There is continuing recognition that a major influence on a physician's effectiveness rests on his or her ability to interact with a patient on a personal level. As the focus of medicine shifts from disease and treatment to prevention and health maintenance, there is a need for increased training in nutrition, fitness, and lifestyle education. Redefining the physician from an authoritarian model to one of collaboration is seen as a major step in improving effectiveness. This requires selecting or developing physicians who have strong interpersonal communication skills. This shift from physician-centered to patient-centered practice means viewing the patient not as a problem to be solved, but as an individual in need. There is also increasing emphasis on teaching new ways to practice to improve patient safety, timeliness of health care delivery, efficiency, and effectiveness. Need for Continuity & Cooperation across the Timeline The introduction of a competency-based framework has facilitated thinking about the need to connect the pockets of formal medical education along the timeline of physician development. This includes increasing the emphasis of the humanities, interpersonal communication skills, and volunteerism in the premedical education curriculum and efforts to apply predictors of success to the selection process. Educators at all levels are being challenged to introduce new methods of evaluation for measuring the core competencies throughout the medical education curriculum. There is renewed emphasis on improving the standards and accountability for continuing medical education and decoupling this activity from commercial industry. The change in the composition of the gender and career expectations for current students means creating alternatives for physician licensure so that physicians can reenter, retrain, or modify their practice throughout their careers. This requires increasing interconnectedness and coordination among accreditation, licensing bodies, and educational institutions. Interdisciplinary & Interprofessional Education To promote the ability of physicians to work as part of a health care team, medical educators must promote cooperation and collaboration in education and training of all providers across the health care spectrum. This involves multidisciplinary cooperation and collaboration in education and training at all levels (premed, undergraduate and graduate, and continuing medical education) and the use of teaching methods and curricula that are presented in a format that more closely resembles the practice of medical care in teams (such as team-based learning) and simulations requiring the collaboration of all personnel. Recognition of Medical Education as Part of the Health Care Enterprise Medical education is a fundamental part of the health care enterprise with its own need for specialists with an important skill set. As class size expands, and the number of medical schools increase, there is a need to develop specialists among medical school teaching faculty and provide tangible rewards equivalent to rewards for research and patient care roles. This includes developing rewards for community-based preceptors and community-based institutions for their role in educating medical students, residents, and practicing physicians. There will be an increased emphasis on educational research and scholarship, including support for enhanced funding. Need for Life-Long Learning & Medical Professional Support Learners will need strategies for knowledge maintenance rather than retention of fixed facts that become outdated. There is decreased emphasis on memory-based learning because of the rapid expansion of knowledge and availability of memory support tools and resources used at the point of care. It will be necessary to address the divide created by four generations of practicing physicians, each of whom has gone through very different medical education programs. This will require physician- and student-centered supports for learner development that include fostering positive learning environments and systems that promote individual physician well-being. Changes in Medical Education Setting There is a continuing shift from education in the hospital environment to more education delivery in the ambulatory setting. This means increased involvement of community-based medical institutions and private physician offices and increased teacher training and rewards for community-based preceptors. Technology The rapid improvements in medical, informational, and educational technology over the past decade have vast implications for medical education. Technology in the delivery of health care and advances in biomedical informatics and communication technology have implications for the way physicians are taught to manage their patients and their practices. These include electronic health records, access to information at point of care (e.g., PDA programs), and memory and decision support tools. Advances in genetics, immunology, imaging, and molecular, cellular, and nanotechnology have implications for the medical education curriculum and the need for life-long learning skills. Published originally in ‘Academic Physician & Scientist’ (1/09), another of the publications in Wolters Kluwer Health/Lippincott William & Wilkins' Targeted Publications group

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