February 29, 2012
One hundred years ago Abraham Flexner introduced a radical new approach to medical education and prioritized the nature of medicine as a service to the public. At that time he used the introduction of the physical sciences in combination with a novel educational method to revolutionize medical education in America and ultimately raise the overall quality of care in the US.
We are again at a similar time where the introduction of information technologies such as simulation can revolutionize medicine. However for this to work the basic paradigm, the educational process must mirror the changes coming in the delivery of care. One without the other will not work just as it was with the combination one hundred years ago. Flexner changed the methodology of education of physicians and clearly defined the goals of the contract between the physicians and society. The key element to success is a new kind of physician trained and educated with tools for the 21st century. This will not change the fundamental contract between the physician and the patient. It will rather enable the physician to once again provide personal care in a direct manner to the patient as close to their home as possible in an economically feasible manner. We have clearly drifted in the past one hundred years from a system that held the contract to the service to the public as its cornerstone to a system that has fallen into disrepair.
We now have the opportunity to use technology to improve many parts of the system. We need to enable the physician to use evidence based medicine to deliver the right care to the patient based on the best clinical research information available. Telemedicine, augmented by imaging technologies and robotics can give the physician tools to enhance medicine. We need to use simulation to train the physician. Simulation in addition to the ability to revolutionize medical education can be used as a performance enhancer to interface between the physician and the patient to improve the quality of care. Other technologies like the surgical robot can create no fly zones that prevent the surgeon from doing harm. But the same paradigm can be applied across medicine for the prescription of drugs to the delivery of basic care and information.