Implementing the patient-centered medical home is not enough to improve health care quality – physician education also needs to change, emphasizing team-based approaches to medical care, participants said at a summit to discuss training gaps in primary care, behavioral health care, and health promotion.
The summit, held at The Carter Center in Atlanta Oct. 5-6, examined whether medical students are being trained appropriately to function efficiently and effectively in the newly reformed health care environment.
“Purchasers are actively choosing to buy different kinds of care” because they can’t find the types of health care they need in the current system, said Dr. John Bartlett, senior adviser for the Primary Care Initiative at The Carter Center.
“Private purchasers are getting tired of paying the price of poor-quality medical education,” Dr. Bartlett told reporters in a conference call convened Oct. 6 to discuss the meeting’s conclusions.
Meeting participants identified several key deficits in the U.S. medical education system, according to Dr. Michael Barr, senior vice president for medical practice, professionalism, and quality at the American College of Physicians.
“We train people separately and expect them to work together,” Dr. Barr said. “The current education system doesn’t seem to value that type of training environment.”
In many programs, physicians-in-training don’t meet actual patients until relatively late in their training, and many curricula don’t emphasize the types of mental health issues that primary care physicians will need to practice, he added.
Some medical schools have implemented educational programs worth emulating, although implementing those programs on a large-scale basis might require changes in medical school accreditation requirements and regulatory requirements, Dr. Barr said.
For example, the University of Wisconsin, which uses patients as educators, introduces medical students to patients on their first day in class, Dr. Barr said. This helps to sensitize medical students very early in their careers to issues that will arise in primary care.
Dr. Barr pointed out several changes in medical education that could be implemented relatively quickly:
• Providing more training for medical students with nonphysician mental health professionals.
• Emphasizing wellness and prevention.
• Developing faculty members who can teach within the patient-centered medical home model of care.
Dr. Bartlett added that medical schools also need to focus on ambulatory mental health issues, such as mild to moderate depression, that primary care physicians are most likely to encounter in practice, as opposed to providing only experience on the psychiatric ward.