While many will remember the Covid-19 pandemic as a source of disruption, it is likely that it will also be viewed as a catalyst for the transformation of medical education that had been brewing for the past decade.
Educators across the country recognized that the physician workforce needed to embrace the enduring competencies of professionalism, service to patients, and personal accountability, as well as address the most pressing issues facing the healthcare field today. These emerging competencies include the ability to focus on population and public health issues, design and continuously improve healthcare systems, incorporate data and technology in service to patient care, research, and education; and eliminate healthcare disparities and discrimination in medicine.
Addressing understaffing in healthcare
In the United States, one of the biggest challenges in healthcare pertains to staffing – or a lack thereof. The Association of American Medical Colleges (AAMC) projects a shortage of between 37,800 and 124,000 physicians, with the largest disparities being in the areas of primary and specialty care. One of the biggest concerns for the future of physicians is the rise in clinician burnout, which—intensified by the pandemic—has led workers to cut hours or accelerate retirement. Before the pandemic, in 2019, 40% of U.S. physicians felt burned out at least once a week. According to the AAMC survey, more than two out of every five active physicians in the U.S. will reach the age of 65 or older within 10 years.
Nearly 21,900 students matriculated into medical school for the 2019-20 academic year, continuing an upward trend that has seen enrollments grow by 33% since 2002, according to the AAMC’s annual survey of MD-granting schools. However, the number of residencies available for medical school graduates has not kept pace with the increase in students — a dilemma that threatens to exacerbate the nation’s physician shortage
This all begs the question surrounding whether or not there are enough medical schools and whether they can educate enough physicians to alleviate the coming shortage with only once-a-year admission. To solve America’s MD shortage, public health leaders must welcome internationally trained doctors — particularly because they’re likelier than their U.S.-trained counterparts to serve in the poor and minority communities where access shortfalls are most severe. There are thousands of highly qualified students at international medical schools eager to fill this gap. Many are U.S. citizens who are studying abroad and want to return home to practice.
Improving health equity
As medical knowledge increases, medical school educators have a responsibility to teach a diversity of public health topics that impact patient care and outcomes. Accordingly, they must acknowledge that health equity education is integral to medical education and that these concepts must be reinforced both in the classroom and at the bedside. A thorough, contextual understanding of care disparities is part and parcel of any discussion of health equity. Whenever risk, disease burden or management is discussed, health equity must be integrated into that dialogue. By describing social determinants of health, educators help students consider healthcare in an equity-informed manner.
The relative lack of diversity in medicine is a rate-limiting factor in efforts to eliminate healthcare disparities. Medical schools struggle to matriculate student bodies that reflect the diversity of this country. Active recruiting is one tactic to diversify a medical school’s applicant pool, but in isolation is not enough. Medical educators and their admissions committees should prioritize a number of initiatives that can be undertaken to increase the yield of students from groups underrepresented in medicine who matriculate to medical school.
The use of technologies for undergraduate, postgraduate, and continuing medical education has become increasingly prevalent. There are several educational advantages to this as modalities facilitate knowledge acquisition, improve decision-making, enhance perceptual variation, improve skill coordination, and provide an educational environment that engages the learner and allows learning that does not endanger the patient.
Our nation’s healthcare sector has a history of underperformance in the areas of access, quality, and cost. The Covid-19 pandemic further exposed the frailty and ineffectiveness of the system and pointed to the need to use technology to leverage the healthcare workforce more efficiently. Technology plays an important role in moving the nation toward the healthcare high road, particularly if we are thoughtful in how and to what ends it is deployed.
Technological innovation in medical education will continue to be encouraged as new applications of technology can enhance learning for students and prepare them for a healthcare arena that is capable of embracing a more digital footprint.