Fredric D. Burg

Managing Change: A Case Study of Implementing Change in a Clinical Evaluation System

Changing an educational system is a difficult process. Successful reform requires planning on the part of the educational innovator to ensure that the changes become incorporated into the actual functioning of the system. A case study is presented using Lewinian Force Field Analysis as a framework from which to consider educational change in a medical school. This permits a detailed examination of the process of reforming a clinical evaluation system over an 8‐year period and highlights the complexity facing medical educators as they embark on various reform efforts in the medical school environment. We propose prospective use of Force Field Analysis by medical educators as an organizational tool to assist in the planning and implementation of reform efforts through the identification of resistance to proposed changes.

Supporting primary care medical education

A number of fundamental issues must be considered in preparing the education system to produce more primary care physicians. Governmental controls and redirection of resources will force significant changes in the structuring of approaches to both undergraduate and graduate education in primary care. Particularly challenging will be restructuring and funding medical student programs in primary care, given a nearly certain requirement that more than 50% of medical school graduates enter primary care disciplines. Institutions will need to make strategic resource allocations to compete for the funding once the allocation process begins. Educational institutions will also face a cultural adaptation to primary care as an educational priority. This paper presents a model to study costs and funding for residency programs as they move from the traditional inpatient orientation to an outpatient focus. The authors suggest that for medical student education, the development of large academic health care systems may make funding primary care education more feasible.

A consumer/medical educator conference - New objectives for the medical curriculum

The authors discuss the development and proceedings of a highly structured conference at which 17 representatives from diverse non-medical groups and 14 medical educators from one medical school identified objectives needing greater emphasis in the medical curriculum. The conference emulated industry’s use of consumer advisory panels. Using the nominal group technique, a group process used in business, the non-medical group developed independently a priority list of areas in which physicians might be better educated to serve society. The medical educators then joined the non-medical group to discuss and clarify the concerns given highest priority. The authors describe subsequent initiatives by the medical school to address aspects of the general concerns raised by the non-medical group. The conference represents an approach to seeking input from non-traditional sources in the development of the medical curriculum.

Objectives of recertification

Recertification of physician competency is a major topic of discussion and debate in the U.S.A. today. Nearly all graduates of U.S. medical schools are eventually certified by an approved American Medical Specialty Board. Since the mid-1970s all of these Specialty Boards have endorsed the concept of recertification. This paper defines what is meant by periodic assessment of physician competence, why such an assessment is becoming a reality, and the principles which should be followed in implementing a system for the periodic assessment of physician competency. The evaluation of physician competency is a task of enormous proportions when one recognizes the difficulty of reliably and validly measuring all aspects of the skill and abilities of the practicing physician. The evaluation of intellectual capabilities is feasible, but somewhat limited with regard to the spectrum of abilities expected of the physician. In the U.S.A., both the public and the medical profession have placed pressure on physicians to implement programs of recertification. Unlike most of the other professions, medicine has taken upon itself to develop and implement programs for recertification of the medical specialist. To develop recertification programs of value, they should meet certain standards. These include: the need for clear specification of the criteria by which qualification for recertification will be judged or measured; the need to attempt to coordinate programs of recertification with programs of continuing medical education; the need to design evaluation tools that accurately reflect the skills and abilities needed by the physician in the practice of the medical specialties; and the need to be certain that all who participate in such a program have the opportunity to successfully complete the program (that standards for passing tests be absolute rather than normative).