September 21, 2012
Distrust and Assessment
I think assessment is the most important aspect of any standards-based education system. But we don't talk nearly enough about the distrust that assessment causes. We know self assessment is wildly inaccurate. So we know there are lots of people who think they're great but bomb a test. Of course they distrust the testers.
How can we build a more relaxed summative testing environment?
September 14, 2012
Doctors in debt
We're not going to get more primary care physicians from our medical education system until medical students can graduate without a staggeringly giant pile of debt. Why would you work at a rural outpatient clinic when you could specialize and pay down your $162,000 debt?
September 10, 2012
International medical education standards
One of the most interesting themes at AMEE this year was the upsides and downsides of international standardization of medical education. China is becoming a medical education powerhouse (we've hosted several Chinese med ed scholars recently and have been working with PUMC. Most of the talk I heard was about med ed life in the UK which, with its increasingly diverse patient and medical student populations, is struggling to balance the reliability of standardization with the validity of variability.
To my ear, it seems a fascinating question: How variable should medical care be? Minimum competency standards are obviously necessary, of course. But beyond that: are communication skills not one-size-fits all? How about risk management and the aggression of treatments? The amount of high-cost testing and aversion of false-positive vs. false negative diagnoses? Our quest for finding an "optimal" approach to these things and trying to line all the doctors up on the global maximum may be wrong-headed: perhaps a culturally-diverse patient population requires a medically-diverse medical culture.
"Malaysia requires the services of healthcare providers who are well trained and well mannered. They must be beyond reproach. They must be professionals who are ethical and put the welfare and care of their patients above everything else," he said.
Standards are good. But obviously not everything.
Plus I love the "beyond reproach" part. We can dream, can't we?
September 03, 2012
What's going on in India?
I know I have no readers (yet!) and that I'm mostly doing this to gain a wider perspective on the current state of medical education in the world. But somehow I can't bring myself to begin to write about what's happening in India. Why? Well, here's what I know:
1) a lot of doctors have gone on strike for higher wages
2) the government is really mad and doesn't want to give them higher wages
Who is right? What is going to happen to public health in India? Are doctors holding health hostage? Is the government blocking well-deserved payment? Can anyone with a clear perspective through the argument provide a coherent summary?
September 01, 2012
Pay too little
Aligning the need for primary care with the sharp increase in healthcare workers is crucial. We need more primary care. We don't need (a lot) more specialists. Lots of good research might address what makes students specialize the say they do, but certainly pay has something to do with it. The lifestyle choice between family medicine and cardiac surgery is stark. We need more family medicine docs. We should pay them more.
What's the best way? I hear a lot about how we should pay based on health outcomes instead of number of procedures. I need to read about the tactics that support that strategy.
Pay too much
Kevin Drum's take on overspending on healthcare in the U.S. is right. We spend too much on healthcare which means healthcare workers earn too much. Here at MedEduBlog, I like to celebrate the recent increase in the number of medical students and to cheer for more more more. But more more more doctors will mean that they earn less less less. That's a national savings, which is good. But it's a lifestyle crunch for physicians, which will be tough.