MD schools call for radical rethink of doctor training

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MD schools call for radical rethink of doctor training

A report by the Association of Faculties of Medicine of Canada calls for

ethnic-minority recruitment and more emphasis on prevention and community

medicine. André Picard. Globe and Mail Update Published on Thursday, Jan. 28,

2010

There needs to be a radical new approach to the training of doctors – with more

emphasis on patient-centred care, preventive health care and working in teams

with other health professionals, according to a much-anticipated new report.

The report, which has been unanimously endorsed by Canada's 17 faculties of

medicine, says these schools must reach out to the socially disadvantaged and

ethnic minorities to create a work force that better reflects the country's

demographics.

It says that doctors need to be trained in the community, not just in the

classroom, and that when it comes to choosing who is admitted to medical school,

being a brilliant student is not enough because good physicians also need a high

" emotional IQ, " compassion and superb communication skills.

The 48-page report, by a committee led by Nick Busing, president and CEO of the

Association of Faculties of Medicine of Canada, sets out 10 recommendations on

how to reform teaching, and five more on how to facilitate implementation of the

recommendations.

" We're going to see tremendous changes in the way we provide care to patients in

the future, " said , the dean of health sciences at Queen's

University in Kingston, Ont. " Our education principles must reflect that

future. "

Over all, the document paints a picture of the doctor of the future as a care

co-ordinator who works in close collaboration with nurses and other health

professionals, is a partner with the patient, and is a key player in shaping

health-care policy.

" I think this is going to change our way of seeing health care by getting

patients to take responsibility for their overall health, " said Réjean Hébert,

the dean of health services at the University of Sherbrooke in Sherbrooke, Que.

The report also places tremendous emphasis on bolstering the basic scientific

knowledge of physicians and the need for valuing generalism.

" There has been a drift from generalist training to specialist training, " said

Albritton, dean of the College of Medicine at the University of

Saskatchewan in Saskatoon. " We have to return to those generalist roots for very

many reasons. "

The report, titled The Future of Medical Education in Canada: A Collective

Vision for MD Education, stresses that medical schools are producing good

doctors now, but says the philosophical underpinning of teaching has not changed

in a century.

It was 100 years ago that a trailblazing report by U.S. educator Abraham Flexner

led to the current method of structured medical training backed up with strict

accreditation procedures. Until then, medical training varied widely from one

institution to another, and virtually anyone could hang a shingle and call

themselves a doctor.

While the recommendations being made in 2010 are not as sweeping on the surface,

they could have as much impact in the long run because they would fundamentally

alter the doctor-patient relationship, some educators predicted.

" This will be the basis for important health-care reform in Canada, " said

Catharine Whiteside, dean of the Faculty of Medicine at the University of

Toronto.

Andrée Boucher, vice-dean of professional development in the Faculty of Medicine

at the University of Montreal, added: " What is going to revolutionize health

care is training in collaborative practice, meaning true inter-professional work

which is not only centred on the needs of sick patients and their families, but

will allow them to be directly involved in the process of care and treatment

decisions. "

One of the most intriguing recommendations is to move the training of medical

students outside classrooms and teaching hospitals into community clinics, rural

hospitals and public health departments.

" The traditional medical school is located in one site, " said Dr. of

Queen's. " Educating a multiplicity of individuals at various levels in

non-traditional contexts will be our greatest challenge. "

The new report focused exclusively on undergraduate medical education, but it

will be followed by a similar exercise on post-graduate medical training.

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