Changes to medical education prescribed

Canada's medical schools need to adapt to reflect changes in how doctors now work, according to a new report.

The Association of Faculties of Medicine released a report titled, The Future of Medical Education in Canada: A Collective Vision for MD Education, on Thursday — 100 years after the last major report looked at medical education.

The review project was launched to address the complexities of new scientific discoveries, people living with chronic illnesses for longer times, changing practices in light of new teaching tools, such as online learning and virtual patients, and the broad range of jobs that physicians do, from family medicine to trauma to policy work.

"This will focus on medical schools training the right number of general physicians and specialists," said Dr. James Rourke, chair of the board of directors of AFMC and dean of medicine at Memorial University of Newfoundland and Labrador.

"Our goal is so that every Canadian can get the kind of care that they need for whatever their medical problem and wherever they come from. This is a roadmap to do that."

The report includes 10 main recommendations and five enabling recommendations designed to be guiding principles for medical schools:

1. Address individual and community needs, including social responsibility and accountability, so doctors reflect on their responsibility not only to individual patients but also to their region, nationally and internationally.
2. Enhance the admissions process to assess the communication skills, interpersonal and collaborative skills of future doctors, such as "emotional IQ" as well as cognitive abilities. Medical schools should focus on attracting a representative mix of medical students, including First Nations, lower income and diverse groups.
3. Build on the scientific basis of medicine.
4. Promote prevention and public health.
5. Address the hidden curriculum that supports hierarchies of clinical domains, such as valuing generalists as the foundation of medical training without devaluing specialties. This includes how teachers and mentors act toward other professionals.
6. Diversify learning contexts to take learning out of universities and hospitals and into community settings.
7. Value general medicine, including family medicine, given mounting evidence that a strong primary care health-care system leads to better population health.
8. Advance intra- and inter-professional care, such as collaboration with advance nurse practitioners and physician assistants in team settings.
9. Adopt a competency based approach instead of the current time-based approach. The goal is to help learners gain knowledge, skills attitudes and abilities in a consistent manner while increasing flexibility to allow students to pursue their own interests.
10. Foster medical leadership, including in health-care management and administration.

The collective vision was unanimously approved by all deans of medicine.

"We are developing a system of medical education that addresses not only clinical competence but addresses medical education as a whole and, as a result, responds to diverse societal needs," said Lewis Tomalty, vice-dean of medical education at Queen’s University in Kingston, Ont.

Medical schools will now work on implementing the recommendations and share their approaches.

The next step will be to review examinations and accreditation standards for medical schools, which must provide evidence they are addressing the recommendations, Tomalty said.