But the recent and more rapid changes in health care
delivery demand a wholesale shift, says Vice Speaker of the AMA House of Delegates and former TMA President Susan R. Bailey, MD, of Fort Worth. That’s the idea behind the AMA’s Accelerating Change in Medical Education initiative, which seeks to facilitate “innovative structural change that prompts a significant redesign of undergraduate medical education that can be duplicated across the country.” Still, while medical educators tend to agree with the need for change in medical education, they acknowledge it won’t happen overnight. “All of these innovations have rarely been tested in a re-
search model,” cautions Stephen B. Greenberg, MD, dean of medical education at Baylor College of Medicine and a member of TMA’s Ad Hoc Council of Medical School Deans. He says medical education research is more prepared now with the technology to test whether the new approaches are working. “But it’s not easy.”
Bright ideas in Texas It may not be easy, but it’s necessary, Dr. Berk says. AAMC predicts a national shortage of 90,000 physicians
across various specialties by 2020; primary care alone will see a shortage of 45,000 physicians. Texas still ranks near the bottom at 43rd in the state ranking of patient care physi- cians per 100,000 population. (See “Texas Needs More Doc- tors,” page 33.) Meanwhile, the confluence of health care reform and an exponential growth in the Texas population continue to stress the physician pipeline in the state. “When you talk about the future of health care, there are a lot of patients, especially in Texas, who need a primary care physician. That’s the most cost-effective way of tak- ing care of people,” Dr. Berk said. “As medical schools, it’s our problem and our responsibility to produce more primary care physicians,” which his F-MAT program aims to do in three years instead of four.
The modified curriculum, modeled after a 1990s Accredi- tation Council for Graduate Medical Education (ACGME) pilot, is faster paced: The program condenses students’ courses by eliminating summer breaks and electives in favor of exposing them to clinical training sooner. Students begin a concentrated family medicine clerkship in year two — a year earlier than in the traditional four-year curriculum — and spend their third year doing rotations and a sub-intern- ship to prepare for residency. “That’s where the program really exceeded and succeeded
in preparing me,” Dr. Buchanan said. “I got to see patients sooner, do more clinical training sooner, and have continu- ity with my patients. [In four-year programs] it’s usually all first-time exposures somewhere in the arc of care, and you don’t get the whole picture.” Whereas students typically spend the fourth year of medi- cal school in electives and extra rotations to choose their specialty and applying for residency slots, that step is un- necessary for F-MAT students. Dr. Berk says there were challenges to starting the pro-
December 2013 TEXAS MEDICINE 27
BOB DAEMMRICH
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