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INVITED ARTICLES
PROFESSIONAL DEVELOPMENT
Medical Education: Perils and Progress in Educating and
Assessing a New Generation of Learners
Jill Gilbert, MD, Helen Chew, MD, Charlene Dewey, MD, MED, and Leora Horn, MD, MSC
Tinsley Harrison is well recognized as one of the premier
medical educators in history. 1 However, the social, political,
and cultural forces that shaped the health care landscape
have changed since Harrison’s time. In the mid-20th
century, teaching was an endpoint in and of itself. Patients
were largely indigent, and health care fınancial pressures
were different, allowing teacher and trainee to spend ample
time discussing and dissecting individual patient cases. Bedside
teaching was paramount, and the trainee’s most valuable
learning occurred in the hospital through real-time patientbased
cases. Duty hour restrictions did not exist. Moreover,
students were expected to adapt to the methods of the
teacher, a one-size-fıts-all policy. 2
In the late 20th century, the fınancial landscape of medicine
changed, and with this change an altered view of medical education
evolved. 2 Managed care had substantial effects on
health care delivery and created new fınancial pressures for
academic institutions now emphasizing patient volumes and
rapid turnover to capture clinical revenues. Unfortunately,
medical education, which required substantial amounts of
faculty time and resources, took a back seat. Educators noted
substantial pressure to increase volume and effıciency, eroding
time for educational activities. Although the social contract
of the Harrison-era emphasized patient care, the new
social contract in the managed-care era emphasized cost containment
and effıciency. 2 This ran counter to traditional
medical education that emphasized the slow, methodical development
of compassionate and intellectually thoughtful
providers who could learn in a medical “utopia” regardless of
cost to the patient or institution. 3 These new fınancial pressures
served to drain key resources for medical education and
further eroded the learning environment. Faculty development
in medical education also suffered. Why develop a
medical educator when medical education does not pay and,
in fact, slows down potentially profıtable providers? 3,4
The 21st century has continued to emphasize fıscal responsibility
in medicine with attendant pressures on academic institutions.
Although these issues once stalled medical education, the
new social contract demands medical cost containment and an
emphasis on personalized care. This has created new opportunities
for the medical educator. The public now demands caring,
competent physicians who participate in quality and performance
improvement activities as well as medical training that is
mindful of global medical fıscal responsibility. 2 In fact, one
could argue that the present day social contract, a melding of
Harrison-era and managed-care era, forces to produce a new
physician phenotype. Most importantly, medical educators will
play a key role in the development of this knowledgeable, compassionate,
and fıscally responsible provider. Thus, professional
development of the medical educator in the 21st century is critical
and represents “the personal and professional development
of teachers, clinicians, researchers, and administrators to meet
the goals, vision and mission of the institution in terms of its
social and moral responsibility to the communities it serves.” 5
WHAT IS PROFESSIONAL DEVELOPMENT? WHY IT IS
IMPORTANT?
Professional development is a planned program to encourage
individuals and institutions to improve practice and manage
change, which in turn can lead to improvements in learning outcomes
for students and physicians and, ultimately, improved
patient and community outcomes. 5,6 Professional development
includes any individual involved in undergraduate or postgraduate
medical education 5 and aims to promote the establishment
of communities within academic institutions that value teaching,
learning, leadership, and research in medical education. 5,7 A
successful professional development program can be central to
the growth and prosperity of an academic institution, but can
also attend to the growth of the individual. This promotes a culture
that values both institutional and personal growth. 5
McLean et al have suggested that an institution that values both
the professional and personal development of its staff will nurture
faculty members who are interested in becoming educa-
From the Vanderbilt University School of Medicine, Nashville, TN; University of California Davis School of Medicine, Sacramento, CA; Vanderbilt University School of Medicine, Nashville, TN.
Disclosures of potential conflicts of interest are found at the end of this article.
Corresponding author: Jill Gilbert, MD, Vanderbilt University School of Medicine 2220 Pierce Ave., 777PRB, Nashville, TN 37232; email: jill.gilbert@vanderbilt.edu.
© 2015 by American Society of Clinical Oncology.
asco.org/edbook | 2015 ASCO EDUCATIONAL BOOK 33