One Giant Leap for Family Medicine: Preparing the 21st-Century Physician to Practice Patient-Centered, High-Performance Family Medicine

摘要

id="p1">In my present position as Director of the Medical Education Division for the American Academy of Family Physicians, I spend the majority of my time collecting and sharing information about family medicine graduate education or facilitating communication among our many constituencies and affiliated organizations. In general, my personal biases regarding the direction that family medicine education should take are subjugated to representing current policies, requirements, and official recommendations. This is a unique and welcome opportunity for me to share my personal vision of how I wish family medicine education would evolve. However, I must emphasize from the very beginning that this vision is “firmly cast in Jell-O.” I readily admit that my opinions evolve as I watch the health care environment and the practice of medicine change over time. Nevertheless, there are enduring themes about which I am increasingly confident. I must also admit that, as the reality of aging becomes increasingly apparent to me, I’m inclined to see myself less as a health care provider and more as a consumer of those services; so, the viewpoint of how I want my doctor to function and relate to me in the future is also evolving. With all of these biases and caveats laid out, let me begin by describing the naissance of my current vision for the future of family medicine education. id="p-2">The primary values evolving in family medicine focus on both the wants and the needs of patients. In my opinion, family medicine as a discipline has always been patient centered, and it makes perfect sense to me that our educational framework should be similarly prioritized. But many forces influence the practice of medicine, and I believe that those forces ultimately must change the training of physicians if they are to practice in that future environment. Those trends include such familiar topics as the aging of the US population and shifting generational priorities. They include the outcomes from the Future of Family Medicine project—including the revalidation by family physicians of both hospital and maternity care—and both the current reality and evolving ecology of health care.id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1id="xref-ref-2-1" class="xref-bibr" href="#ref-2">,2 It is clear, for example, that medical education needs to migrate from a hospital-centric to an ambulatory care-focused system. id="p-3">During recent years, interest has grown in new training models such as competency-based education. Policy makers are fostering a culture of patient safety and quality improvement. They are beginning to embrace the patient-centered medical home as the ideal model for ambulatory practice. Certainly during the last 2 years the nation's economic developments have helped focus the public's and the legislature's attention on our currently dysfunctional health care system. Economic concerns have increased the realization that we must move toward a primary care-based health system that will decrease costs and improve outcomes. During the next 10 years I think these dynamics will not fade but will continue to escalate and become even stronger drivers of change.