By Aliye Runyan, MD
AMSA Education and Research Fellow
I recently attended the America's medical education meeting and IFMSA general assembly. There was very interesting and often passionate discussion on the importance of primary care, and how it is practiced in various countries in the Americas. There is consensus that quality of care is important, and that culturally sensitive standards for quality of medical care must be developed. Most agree than universal curricula are not the answer. The point was made that primary care is a critical part of comprehensive health care services, and not an end in itself – there is obvious need for specialists in many cases. The point was made that primary care must be incentivized, respected, and treated with the same standards as any other specialty, as well as taught (and experienced by students) from the first year of medical school. Using evidence based medicine was brought up multiple times – as this may not be the cultural norm.
Some of the faculty brought up criticisms of the Alma Ata declaration of 1978 (the first international declaration to underline the importance of primary care for all) by stating that it prompted some countries to focus on only the most basic health care needs ( in the name of “primary care”) while not pushing resources to develop comprehensive health care services.
Out of this conversation came the overwhelming sentiment of the need to “teach learners how to learn” – meaning to train physicians to adapt to our changing health care world by teaching them how to problem solve, navigate issues other than just strict science, to understand their accountability to the society at large, and to respond to the needs of society.
Competency based medical education
This was a wonderful segue into the discussion around competency based education, which is becoming the norm in the US and Canada. The themes behind competency based education include greater accountability, training relevant to society, supporting students learning at their own pace, and adjusting for “new competencies” such as teamwork, patient safety, humanitarian needs, and social justice. There is more focus on evaluation and outcomes of learning. One speaker presented a continuum from societal health needs à competencies à curriculum à evaluations, to highlight how competencies might determine curriculum, which is then evaluated for constant improvement. Assessment methods, such as 360 feedback, where an individual is evaluated by peers, supervisors, and colleagues on the health care team, come into play as the value of subjective judgment and observation is considered. The higher number and more diverse the observations, with open ended questions like “would you send a family member to see this doctor?” provide a larger picture of a physician’s abilities than a multiple choice test or standardized exam. They also take into account humanistic qualities and professionalism.