Family medicine
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The health care delivery system is experiencing enormous flux. The knowledge and skills sets required of today's physicians include expertise in competency areas that have not been included in the traditional medical curricula. The Undergraduate Medical Education for the 21st Century (UME-21) project was designed to develop innovative curricula that addressed the training necessary for medical students to gain skills required to provide high-quality, accessible, and affordable care in the modern health care environment. One of the nine UME-21 content areas, leadership and teamwork, has historically received relatively little attention in medical education. ⋯ There is little past experience in teaching leadership and teamwork in medical school. The UME-21 project supported the design and implementation of several curricular innovations in this content area, which were well received by learners. These eight leadership and teamwork curricula are described, a lexicon outlining the specific content that was addressed in this content area is presented, and lessons learned are included in this report. Further efforts to demonstrate the mastery of new skills in this important content area, based on curricula such as these, are needed.
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Review Comparative Study
Health care economics, financing, organization, and delivery.
The US health care system is in a state of rapid evolution, with changing payment, organizational, and management structures. To learn how to function optimally in a system in which care is increasingly managed and competitive, today's medical students must understand the structural and economic underpinnings of the system within which they will practice. At the outset of the Undergraduate Medical Education for the 21st Century (UME-21) project, the great majority of medical school curricula were lacking in areas of health care financing and organizational structure. The institutions involved in the UME-21 project sought to address curricular deficiencies in two broad areas: (1) the structure and financing of the US health care system ("health policy") and (2) the manner in which this system is reflected in the organization and activities of health care providers ("care delivery"). This article discusses the development, implementation, and evaluation of the first of the two areas. ⋯ Health policy should be incorporated into both the preclinical and clinical years. The former emphasizes health care economics as one of the foundations of medical practice, whereas the latter provides the opportunity for its use on a daily basis in clinical settings. However, like any new curriculum, to achieve equal status with the traditional biomedical curriculum, it must be presented in a scholarly, rigorous, and reasonably comprehensive fashion. Mounting a scholarly health policy curriculum requires a wide-ranging, interdisciplinary faculty. If it is to become a central component of the medical school curriculum, creative approaches to faculty recruitment and development will be needed. This will require both careful educational policy formulation and new investment.
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Medical teachers are expected to be proficient at teaching students and residents about the changing health care system. The University of Wisconsin established a faculty development fellowship program to better prepare clinical teachers in family medicine, general pediatrics, and general internal medicine. This paper describes our fellowship program, presents data on program accomplishments, and discusses what we have learned. ⋯ To obtain high ratings, faculty must apply adult learning and active learning principles; lectures were not well tolerated. Initial technology skills were often low; computer labs needed many helpers. Participants needed extensive faculty support on their projects. It facilitated coordination and learning to have a core group of fellowship faculty who did most of the teaching. Graduates have become enthusiastic recruiters for new fellows. Our 5-weekend program has proven to be an effective faculty development model.
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Although competencies for managing care are often described in the medical literature, educators have been slow to integrate these competencies into clinical curricula. Backlash against managed care has created a skeptical educational environment. Many faculty feel unprepared to teach the competencies in clinical settings. ⋯ By the end of the program, participants believed that they had learned content (knowledge) and gained practical teaching skills. To be successful in effecting curriculum change around new topics, such as the managing care competencies, faculty need to not only master new content and methods but also learn how to be change agents in their schools. Because this work can be lonely, faculty need support within the school and connections with others, locally and nationally, who have similar ideas.