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Date: April 8, 2003
Contacts: Christine Stencel, Media Relations Officer
Andrea Durham, Media Relations Assistant
Office of News and Public Information
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Health Professionals' Education Must Be Overhauled
To Ensure Safety, Quality of Care

WASHINGTON -- Doctors, nurses, and other health professionals are not being adequately prepared to provide the highest quality and safest medical care possible, and there is insufficient assessment of their ongoing proficiency, says a new report from the Institute of Medicine of the National Academies. The report is part of the IOM series on improving the quality and safety of health care, which includes a 1999 landmark study on reducing the high rate of medical errors.

"Reforming the education of health professionals will require a collective effort across all the health care disciplines, focusing on a set of core competencies that they all embrace," said Edward Hundert, M.D., co-chair of the committee that wrote the report, and president, Case Western Reserve University, Cleveland. "We owe it to our patients to change the way we are educated in order to improve quality and safety."

All programs that educate and train health professionals should adopt five core competencies: the abilities to deliver patient-centered care, work as a member of an interdisciplinary team, engage in evidence-based practice, apply quality improvement approaches, and use information technology. The report calls on accreditation, licensing, and certification organizations to ensure that students and working professionals develop and maintain proficiency in these core areas.

These oversight groups should take the lead in improving health professionals' education because they can implement change at the national and state levels, the report notes. In particular, organizations that accredit health education programs should assess what students know and are able to do in a clinical setting -- not, for example, the number of semester hours they take of a particular subject. And all licensing boards should require doctors, nurses, and other health care workers to demonstrate their clinical skills and understanding of medical advances, rather than allow them simply to take a class and pay a fee to renew their licenses. In addition, all certifying organizations should use rigorous tests to evaluate the ongoing proficiency of health professionals instead of just requiring continuing medical education, which is not a reliable way to measure ongoing competency. Consensus on what constitutes evidence of proficiency and the most effective methods to assess competence will have to be reached, the committee acknowledged.

In addition, report cards on the quality of health professions training programs should be issued to give policy-makers and educational leaders a way to assess and compare academic institutions. Also, leaders from different health disciplines should meet at biennial summits to promote reforms in health education and evaluate the progress of these reforms, said the committee, whose own work was informed by more than 150 leaders from medicine, nursing, pharmacy, and allied health who attended an IOM forum in June 2002. Their ideas for how to integrate the core competencies into health professions education are included in the report.

"Schools for health professionals generally are not interdisciplinary, but practice environments increasingly are, which poses a serious disconnect," said Mary Wakefield, Ph.D., R.N., committee co-chair and director, Center for Rural Health, University of North Dakota, Grand Forks. "Ideally, collaboration among clinicians in practice settings draws upon each profession's strength and optimizes care for patients. We believe that the same can be true for health professions education and that it's high time to embrace a collaborative approach to reform."

Significant funds and other resources will be necessary to develop and implement this new evidence-based approach to evaluation. The new evaluations may need to be phased in, the report says.

The study was sponsored by the Health Resources and Services Administration, Agency for Health Care Research and Quality, ABIM Foundation, and California HealthCare Foundation. The Institute of Medicine is a private, nonprofit institution that provides health policy advice under a congressional charter granted to the National Academy of Sciences. A committee roster follows.

Read the full text of Health Professions Education: A Bridge to Quality for free on the Web, as well as more than 2.500 other publications from the National Academies. Printed copies are available for purchase from the National Academies Press; tel. (202) 334-3313 or 1-800-624-6242 or on the Internet at Reporters may obtain a pre-publication copy from the Office of News and Public Information (contacts listed above).

Board on Health Care Services

Committee on the Health Professions Education Summit

Edward M. Hundert, M.D. (co-chair)
Case Western Reserve University

Mary Wakefield, Ph.D., R.N. (co-chair)
Center for Rural Health
School of Medicine and Health Sciences
University of North Dakota
Grand Forks

J. Lyle Bootman, Ph.D.
Dean and Professor
College of Pharmacy
Arizona Health Sciences Center
University of Arizona

Christine K. Cassel, M.D.
School of Medicine
Oregon Health and Science University

William Ching
Joint M.D.-Ph.D. Student
School of Medicine
New York University
New York City

Marilyn P. Chow, D.N.Sc., R.N., F.A.A.N.
Vice President
Patient Care Services
Kaiser Permanente
Oakland, Calif.

Stephen N. Collier, Ph.D.
Director and Professor
Center for Health Policy and Work-Force Research
Towson University

John D. Crossley, Ph.D., M.B.A., R.N.
Vice President for Operations and Nursing Practice, and
Division of Nursing
M.D. Anderson Cancer Center
University of Texas

Robert S. Galvin, M.D.
Global Health
General Electric Co.
Fairfield, Conn.

Carl J. Getto, M.D., M.B.A.
Senior Vice President
Medical Affairs
University of Wisconsin Hospital, and
Associate Dean for Hospital Affairs
University of Wisconsin Medical School

Robin A. Harvan, Ed.D.
Office of Education
Health Sciences Center
University of Colorado

Polly Johnson, M.S.N., R.N.
Executive Director
North Carolina Board of Nursing

Robert L. Johnson, M.D.
Professor and Interim Chair of Pediatrics;
Professor of Psychiatry; and
Division of Adolescent and Young Adult Medicine
University of Medicine and Dentistry of New Jersey

David Leach, M.D.
Executive Director
Accreditation Council for Graduate Medical Education

Judy G. Parker, Ph.D., M.S.
Department of Nursing
East Central University
Ada, Okla.

Joseph E. Scherger, M.D., M.P.H.
College of Medicine
Florida State University

Joan Shaver, Ph.D., R.N., F.A.A.N.
Dean and Professor
College of Nursing
University of Illinois

David Swankin, J.D.
President and CEO
Citizen Advocacy Center
Washington, D.C.


Ann Greiner
Study Director