It Is Time to Reinvent the Wheels of Medical Training

To the Editor: Traditional medical training focuses on the basic sciences, the biogenetic model of disease, and available interventions based on this model. Such training is not always sufficient to effectively impact the health outcomes of patients, especially of those who face significant socioeconomic predicaments or are high utilizers of medical care. Physicians may view such patients as those who suffer the consequences of poor personal choices, while patients may view physicians as lacking in empathy. Over the years, we have learned as a profession that health outcomes are in fact a result of complex interplay between genetics, health behaviors, and other social determinants of health, yet we have made little progress in mitigating the social determinants that drive health disparities. We suggest three broad changes for academic medicine that may improve equitable patient outcomes. First, medical school and postgraduate curricula should put more emphasis on the principles of public health and social medicine throughout the medical education continuum, rather than merely as introductory courses. The appreciation for a “holistic” approach to health and patient care is a skill that requires time to build. Second, the focus of medical school pedagogy should transition from memorizing facts to solving problems. While some memorizing is essential, developing the skill to translate knowledge into action should not be delayed until the trainee is out in the “real world.” Academic medicine can learn valuable lessons from many successful industries that train professionals in a stepwise process of problem solving to achieve desired goals. Third, research priorities should include tackling important social health determinants in a multidisciplinary fashion using the expertise of social scientists, basic scientists, and community organizations. Recent efforts by institutions such as the Patient-Centered Outcomes Research Institute to involve patients and community stakeholders in research processes are exemplary efforts. We have evidence that health outcomes are a result of complex interactions between biological determinants and social determinants. Despite great medical advances, health care disparities continue to widen, and patients remain dissatisfied with the current health care system. With health care reform at our doorsteps, now is a good time to go back to the drawing board and scrutinize our conventional training, research, and practice styles and redesign them to meet the needs of our patients so that they may achieve their highest potential for a healthy life. Sosena Kebede, MD, MPH Assistant professor of medicine, Department of Medicine, Johns Hopkins University School of Medicine, and joint faculty, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; [email protected] Peter Pronovost, MD, PhD Professor of anesthesiology and critical care medicine and director, Armstrong Institute for Patient Quality and Safety, Johns Hopkins University School of Medicine, Baltimore, Maryland.