Med ed from cover them manage or overcome their medical problems. Sometimes we provide insight into why our jointly created prevention and treatment plan is important; at other times we diagnose and treat medical and mental conditions. The overall experience is still rewarding and a reason to be thankful to practice medicine. In my role as a teacher and administrator, I continue to see class after class of bright, energetic, idealistic medical students, residents, and fellows. My teaching colleagues and I remain excited about our daily job of helping them expand their knowledge and build new skills as they grow to their full potential in their medical careers. That challenge and responsibility are still before us every day. Also still with us are the challenges and frustrations of providing medical, dental, and mental health care services for underserved, undereducated, and disadvantaged citizens. These patients who have had poor access to education and
routine health services, those who have never experienced longitudinal family and community support, and those with chronic overlapping medical and behavioral health conditions are still often unable to find well-coordinated, accessible care. And those of us providing that care are usually struggling with underfunded systems of support. What’s different?
Student diversity: Our students, residents, and fellows are more diverse in ethnicity, and more women are joining the ranks of medicine. For the fifth year since 2001, women have outnumbered men in University of Minnesota Medical School, Twin Cities campus, entering class. Compared to medical students of the past, our current students have more international experience and are more willing to spend an added one or two years in medical school to gain research experience or earn a master’s degree in public health or business. Some spend a full additional year working for organizations serving the under-
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MINNESOTA PHYSICIAN OCTOBER 2012
served in Africa, India, Asia, or Latin America. They enter residencies with new skills, which stimulate their residencies to expand learning options for these talented residents. Teaching methods: Our teaching practices are better than in the past. We insist on more active supervision of all trainees, are more concrete about learning objectives in clinical settings, and use more simulations in teaching surgical and interviewing skills. Increasingly, we work more collaboratively with other disciplines, such as pharmacy, nursing, and a variety of mental health disciplines that help create interprofessional educational and clinical teams. In Minnesota, most family medicine residencies work from a base practice which is now a certified health-care home. Residents almost always work side by side with mental health clinicians, pharmacists, care managers, and social work staff. Therefore, current training is more often interdisciplinary, and the learning is more often in the direct line of patient care, providing information health professionals need when they need it, so they can deliver more effective and efficient care. Practice methods: I am encouraged that new patientcentered health care homes, complex care assessments, and interdisciplinary clinics are being created to meet the needs of the underserved; and that we are learning more about the important role of more efficient and effective interdisciplinary teams in doing so. New funding models are being tested, though balancing the need for highquality, accessible, coordinated care with available resources remains a formidable challenge. Electronic medical records (EMRs) were new to most of us a decade ago and only a distant fantasy 30 years ago. Now we can almost always find our past care notes, lab results, and consultants’ reports if we share access to the same record or can find compatible electronic methods of communication. In our digital age, we can also see images immediately and share them across distances. Unfortunately, one dimension of our
new electronic charts is that physicians and other providers often spend significant additional hours every week documenting all sorts of details, not just care plans, in the EMR. I am confident that this added task will become simplified and streamlined as we become more proficient. But after five or more years dealing with this challenge, I am among the most eager for improved documentation methods. I am eager to see more of the efficiency that is so often heralded in discussions of EMRs. At this point, the efficiency gain still comes at the expense of a longer workday for most physicians. In addition to changes in student diversity, teaching methods, practice models, and technology, I feel a new level of economic uncertainty about almost everything in health care and higher education. The tension over how to fund both health care and higher education in Minnesota and the nation has nearly always been present. But now these questions of how to achieve our educational and clinical missions with fewer resources seem to be coming to an inflection point where things we have often taken for granted must change. For example, can medical students at the University of Minnesota Medical School continue to carry an average debt of $170,000+ as a personal burden? Will we lose the middle-class students who have carried most of the weighty challenge of entering primary care and other less remunerative medical careers? For that matter, what will happen if other bright, dedicated college students cannot find entry-level jobs after earning their baccalaureate degrees? Past generations of premed students sometimes spent a year or two in graduate school earning more degrees and improving their probability of further advancement. Those options may become less viable as the added student debt passes a risky threshold equivalent to a home loan so early in a young professional’s life. Among the positive changes are new enthusiasm and graduMED ED to page 38