Florida International University by fjzhxb

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									Florida International University Faculty Convocation—October 1, 2004 Medical Education and the Public University in the 21st Century Jordan J. Cohen, M.D. President, Association of American Medical Colleges  

Pleased to be here I’m aware of FIU’s desire to launch a new medical school, so I’m especially pleased to share with you some of my views about the challenges and opportunities facing the future of American medicine and medical education. The first thing to recall in this connection is Yogi Berra’s famous admonition to forecasters: ―Prediction is a risky business, especially about the future.‖ And that’s especially true of turbulent times like these. In stable times, in times of tranquil acceptance of our customary ways of doing things, universities can pretty much remain on well established paths with the expectation that they will continue to be successful in what they do. But none of you needs reminding, I’m sure, that we are not living in stable times. And the world of medicine is arguably the best example of the turbulence of our times. Virtually all of the comfortable assumptions that have powered medical schools and teaching hospitals for decades are now seen as quite inadequate for the future that is unfolding. o Old assumptions about how best to educate health care professionals are no longer adequate for a time    when individual doctors and nurses can no longer be expected to carry in their heads all the knowledge they need to be effective when all health care professionals must learn how to function in well-coordinated teams to provide optimal care, especially to those burdened with chronic disease and disability, and when our hi-tech hospitals no longer provide adequate learning environments for health professions students, whose careers will be spent increasingly in community settings and in patients’ homes

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o Old assumptions about how best to do medical research are no longer adequate for a time  when the genomics revolution demands new forms of collaborations with individuals trained in such far-flung disciplines as material sciences, applied mathematics, and moral reasoning, and

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when the cost of modern research equipment often exceeds the financial wherewithal of a single institution, necessitating collaboration across historically competitive lines

o And old assumptions about how best to care for patients are no longer adequate for a time   when the costs of health care are rapidly becoming unsustainable, and when our fragmented, uncoordinated health care delivery system has outlived its usefulness.

We have inherited a health care system that may well have been suitable for a past era dominated by acute, self-limited illnesses – such as infections, heart attacks, and strokes. But that system is simply not capable of delivering the continuous, seamless, coordinated care needed for a new era dominated by chronic, unrelenting diseases – such as diabetes, Alzheimer’s, and cancer   Abandoning old assumptions, especially those that have been responsible for so much past success, is an exceedingly difficult challenge for any institution. If you succeed in your quest for a new medical school, I hope you will take the occasion to construct your educational program on a different set of assumptions, rather than assume that existing patterns offer the best blueprint for the future. Irrespective of how you might choose to organize and implement your educational program, however, you will encounter two vexing problems facing all medical schools in the country: the first is how to ensure that your M.D. degree is affordable for your students, and the second is how to close the racial and ethnic diversity gap that still plagues the medical profession. First, the cost of medical education at virtually every medical school in the country continues to rise at a rate faster than inflation. As a result, the debt burden borne by graduating medical students is going through the roof. Among last year’s medical school graduates, over 80% were in debt; the average debt was $100,000 for those graduating from public schools and almost $140,000 for private school graduates. Unless we can find ways to offset the financial millstone we are placing on our students, the medical profession will become the exclusive province of the rich. And we’re well on the way. As things currently stand, over 60% of medical students in this country already come from families in the upper 20% of America’s socioeconomic spectrum. What can be done about this problem? More state and federal support for medical education would certainly be welcome, but seems highly unlikely under present circumstances. Raising more scholarship funds from alumni and other philanthropic sources may be possible, and would clearly help.

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But, in the final analysis, we can’t depend on additional outside resources to solve this problem. No one on a white horse is fast approaching with saddlebags full of new money to help struggling medical students. We must find ways to grapple with this dilemma on our own. To do so will require some combination of reallocating resources we already have and implementing less costly modes of instruction, all without compromising the high standards of quality for which medical education in this country is renowned. The task will not be easy. Perhaps, by starting from scratch, as you will have the opportunity to do if your quest for a new school is successful, you will find ways to lead the rest of the country’s medical schools toward a solution to this dilemma.  The second of those vexing problems facing medical schools today, as it has for decades, is how to increase racial and ethnic diversity in our classrooms and, hence, in the medical profession. This is a topic deserving of a great deal more time than I have. Suffice to say that our principal moral obligation as medical educators is to create a future physician workforce that is optimally prepared to serve the health care needs of the public – the whole public. As our country becomes increasingly more diverse - racially, ethnically, and culturally - the need for more diversity among medical students becomes ever more urgent. As the Supreme Court re-affirmed in last year’s historic affirmative action decision, racial and ethnic diversity in the classroom improves the quality of education for everyone. And nowhere is that more true than in medical school. As the Kellogg Foundation’s Sullivan Commission recently observed, ―Today’s physicians, nurses, and dentists have too little resemblance to the diverse populations they serve, leaving many Americans feeling excluded by a system that seems distant and uncaring.‖ Here in Florida, you see the problem up close and personal. The demographic shifts in your population are creating critical disparities in access to medical services, and in the quality of the health care that is available. Medical schools and other health professions schools throughout the country are trying hard to address this mounting problem but are facing barriers that are far beyond their immediate control. I know that this issue is one of the reasons motivating FIU toward the establishment of a new school of medicine and I commend you for recognizing the need.  Having outlined a number of the challenges facing the future of medicine and medical education, let me turn in my last few minutes with you to the enormous opportunities before us

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that make all those challenges seem small in comparison. Let’s not forget how privileged we are—all of us—to be living at a truly unique point in the history of our species. Never before has a generation on earth been presented with such powerful tools with which to secure a better, healthier future for our children and grandchildren. Here at the beginning of the 21st century, we are at the confluence of no less than three—not one, not two, but three—scientific and technological torrents, any one of which is capable of fundamentally transforming the way medicine is practiced and, in so doing, extending the length and the quality of human life.  The first of those three unprecedented scientific advances is in the realm of information technology, which promises to fundamentally transform the doctor/patient relationship. Electronic health records maintained throughout one’s lifetime will ensure that doctors and other healthcare professionals have the all the relevant facts about each patient they see, thereby avoiding unnecessary duplication of effort and, more important, avoiding errors caused by ignorance of past events. Doctors will have the latest guidance from world experts presented to them automatically at the moment of they need it to make the right, evidence-based decisions for their patients. And patients and their families will have ready access to authoritative and understandable information, enabling them to take more control of their own care and to become true partners with their healthcare professionals.  The second of those unprecedented scientific advances is the genetics revolution, which promises to turn medicine completely on its head. Consider that fact that, throughout history, medicine has been a largely reactive enterprise—designed to sit and wait for things to go wrong and then to try to intervene in some way to fix the damage. What the genetics revolution offers is the prospect of medicine becoming a truly proactive enterprise, capable of identifying, through genetic testing, the risk of disease long before it appears. Having that information early on, even at birth, will enable your doctor to prescribe a personalized health maintenance plan targeted at counteracting your individual risks and minimizing the likelihood of disease altogether. The era of preventive medicine will have finally arrived.  As if all that weren’t enough, we also have the incredible potential of yet a third scientific advance, stem cell research, which promises to usher in an utterly new and heretofore unimaginable era of so-called regenerative medicine. If the potential of stem cell research is realized, medicine will be in a position to offer real hope to millions who presently face

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hopelessly degenerative processes that even the genetics revolution will not be able to conquer.  Maximizing the benefits that can derive from these historic scientific advances will depend to a large extent on how well we, as educators, rise to the challenge of preparing future health professionals—physicians obviously included—for their new, more powerful roles as healers and counselors. So, the future of medical education and the public university in the 21st Century is faced with many daunting challenges but is ripe with many more exciting opportunities.

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I wish all of you the very best of luck as you seize those opportunities to contribute still more to the communities your serve.

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