Report on ACMC Annual Meeting: Introduction
George D. Sweeney, MB, ChB, PhD
Clin Invest Med 1997;20(6):397-8.
Dr. Sweeney is professor emeritus of medicine at McMaster University, Hamilton, Ont., and editor of Clinical and Investigative Medicine.
Reprint requests to: Dr. Stuart M. MacLeod, St. Joseph's Hospital, 50 Charlton Ave. E, Hamilton ON L8N 4A6
This issue and the August issue of Clinical and Investigative Medicine carry reports devoted extensively to education. In August, the journal reported a retreat on Training and Career Development of Clinician Scientists; in this issue, we return to a theme embracing education and research with the report from the 1997 Annual Meeting of the Association of Canadian Medical Colleges, the Association of Canadian Teaching Hospitals and the Canadian Association for Medical Education. Change is putting great pressures on all health care and related professions; this meeting was about change, what is changing and what we should do about it.
Debate over undergraduate medical education has been raging for almost 50 years; there is now, perhaps, a tendency to blame problems in the practice of medicine on undergraduate education. Is there really evidence for this? Schools provide some basic tools, which we may liken to a genetic endowment. Whatever tools are provided, subsequent nurture of the professional influences how these tools are used and honed. Much of this is beyond the control of medical schools and is the responsibility of society, its political leaders and various professional bodies. Perhaps we should look less to the genes and more to the environment as we seek to improve the physicians of the future.
Dr. Stuart MacLeod has summarized the meeting ("Change and the academic health science centre: a 1997 perspective," page 399). He emphasizes the protean manifestations of change, acknowledging roles played by fiscal policies, corporate forces and the rapid global distribution of information on health care and health care workers. He comments on the diminishing respect accorded physicians with passing time. Academic centres cannot afford to ignore these changes and, to borrow his terms, these may be times when strategic thinking is more important than strategic planning.
Fiscal matters are also uppermost in Dr. John Ruedy's mind. In his invited editorial (page 405), he decries the poor record of government in Canada in funding health care research. In contrast with other developed nations, support for this activity has declined substantially over the past 10 to 15 years.
North American medicine flowered after Abraham Flexner's report of 1908, which emphasized the dependence of clinical medicine on its scientific underpinnings; without basic science research in our schools, education in the scientific basis of medicine is also threatened. The situation is worst for research driven by the curiosity of individuals, and it undercuts career prospects for clinician scientists. Dr. Ruedy's words echo much that was reported in the August issue on Training and Career Development of Clinician Scientists. If health care professionals are not encouraged to question (because there is little prospect of having the funds to look for answers), this will be a severe blow to the critical assimilation and use of new knowledge.
Richard L. Cruess and Sylvia R. Cruess address professionalism, that intangible spirit that persuades individuals to give more to the job than they get out of it (page 407). "Golden days" may have existed for physicians in the past, but they certainly did not for those members of society who could not afford their services. Universal health care has changed this, but has increasingly made health care workers into public servants. That surely is the intent -- to serve the public -- but one must ask whether there is room for all the ethical and moral values that characterize "professionalism" in a modern, egalitarian society where medical care is a right, not a privilege.
If Richard L. Cruess and Sylvia R. Cruess tended to look back to days that have passed, Dr. Bernard Shapiro takes a much more rocky road, looking forward to a future swept by change (page 414). "Elite" has increasingly come to be pejorative. Such drift in the meaning of words is common in language. We have no trouble with athletes who strive to be "the elite." Elitism is properly pejorative when people who are not the best pretend they are, or abuse the privileges accorded them. As Dr. Shapiro puts it, "dumbing down" is occurring because the profession of medicine is losing the confidence of the public and of public policy-makers. If physicians wish to retain a privileged position in society, they must strive to serve society's best interests in an increasingly competitive field of health care providers. We do not like to talk about it, but this will certainly affect our wages. The education of physicians should support the goal of being an elite, but this status should be earned, rather than seen as an entitlement.
There are many references to the impact of technology and information handling on education, but we needed the views of an expert. For this reason Dr. Rolf Sebaldt was asked to contribute the article entitled "Information technology and the future of medical education" (page 419). If, as Cruess and Cruess suggest, our professional status was tied to our control of medical information, then it is already lost. Everyone who wishes has access to information, and health care professionals must learn to build on this as a strength, not see it as a threat. What Dr. Sebaldt tells us is that the rate of change in the field of computation is faster than any previous technological change, and that the only certain prediction is that this blistering rate of change will continue.
It is no good looking only 5 to 10 years ahead; it takes 5 years to change anything substantial in medical schools. (For example, we still are not graduating computer-literate physicians.) Much more energy is needed to plan, and implement plans, for 10 and 20 years ahead. But who has the time for this? Are we developing leaders with wisdom (as opposed to publications) in our academic centres? A society that loses wisdom and the ability to make wise decisions will surely founder. The debate that follows is about this.
