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Rethinking the Medical Education Pathway for Primary Care

By Katie Ni
Education & Outreach Coordinator, AMSA Health Policy Action Committee

In light of healthcare system reforms, the need for primary care physicians is greater than ever. However, the time-intensive nature and high-cost of medical education in the US have been often-cited issues that may deter medical students from pursuing primary care, and may even deter undergraduates from pursuing medicine at all. Some programs do exist to encourage medical students to enter primary care. For example, programs like the National Health Service Corps Scholarship as well as some institutional programs offer repayment or scholarships for students looking to go into primary care. In their recent article in “Health Affairs” (Nov 2013), the American Osteopathic Association and the American Association of Colleges of Osteopathic Medicine have tried to address this issue through the actual structure of medical education. They established a blue-ribbon commission to suggest a new model that expedites medical training for potential primary care physicians, specifically in osteopathic schools.

The proposed “Pathway” programs would have school-specific curriculums all centered upon 5 principles:

1. The programs will incorporate traditional osteopathic principles and practices, but also train physicians for tech-savvy, team-based patient care.

2. The curriculum will be designed according to specific competencies. These competencies include not only areas of knowledge but also personal attributes, and the accomplishment of competency determines the time it takes to complete one’s training.

3. There will be continuous, longitudinal clinical experience starting from the first year of medical school.

4. The programs will be administered by the Colleges of Osteopathic Medicine (COMs) in collaboration with their residency program partners. Teamwork between medical schools and residency programs are crucial.

5. The programs will focus on health care delivery issues, including health policy, technology, quality assurance, patient safety, and others.

Although the AOA and AACOM-headed blue-ribbon commission has created a framework that certainly reflects relevant goals facing current physicians and physicians-in-training, in osteopathic and allopathic institutions alike, these guidelines remain relatively vague in light of the huge amount of work needed to make this program into reality.

Perhaps the most interesting aspect of this proposal is the competency-based curriculum. The competency-based curriculum would be a significant departure from the current model. In this system, students would progress through medical school and residency as he or she achieves benchmarks in particular competencies, versus progressing based on the duration of each experience. The competencies listed include things like “Osteopathic principles”, “Health care management, health care financing, and health policy”, and “principles of population health”, as well as personal attributes like “altruism and patient advocacy” or “leadership skills”. The authors imply that this system will cut down the necessary amount of time spent in medical education and training, but it is unclear how this would work practically. How would competencies like “altruism” be assessed? Would students moving at a slower pace face even longer period of training than the current 4 years of medical school plus 3+ years of residency?

If this proposal could indeed reduce the amount of time spent in school (and consequently the amount of student debt), then perhaps it could be successful in drawing more students into primary care. However, at this point in its development it is unclear whether the program would be able to accomplish this. It remains to be seen when the first pilot osteopathic schools will be able to create a Pathways program as envisioned by this commission, and if the program will in fact help turn out a greater number of primary care physicians.

Despite the somewhat amorphous nature of the program proposed by the AOA and AACOM committee, thinking about reform in medical schools is an encouraging first step to improving the practice of medicine and closing the primary care physician gap

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