Journal Club

Hirsh DA, Ogur B, Thibault GE , Cox M. "Continuity" as an Organizing Principle for Clinical Education Reform. NEJM 2007:356(8);858-866.

Reviewed by Kathy Previll; East Carolina University

Authors from the Medical Education Section of the New England Journal of Medicine promote a call to arms in this article on medical education reform. They describe the present system of clinical teaching as the same model used since Osler's day. We are challenged to break down the walls between clerkships and integrate teaching across disciplines. Medical Education needs to respond to the health care needs of society and promote better patient sensitivity. Patient-centered care can be linked to learner-centered needs by allowing students the opportunity to establish a continuity relationship with the patient, but also with the same mentoring faculty (continuity of supervision).

The authors discuss horizontal and vertical integration of curriculum realizing everyone would be challenged to compromise and coordinate goals and objectives.

Patient and faculty preceptor continuity opportunities could best be presented in the ambulatory setting over an extended period of time.

The ability to model evidence-based care and positive patient relationships would allow faculty to take back their role as teachers which in the present model has been relegated to residents on the inpatient services. Continuity of care, curriculum, and supervision holds promise to produce the kind of doctors our health care system needs.

Editorial Comment: This article is part of a series being published by the NEJM that highlights important, and sometimes controversial, aspects of medical education. It is exciting to see this prestigious journal routinely publishing articles on medical education (see also the review of Epstein RM. Assessment in Medical Education. N Engl J Med 2007;356:387-96 in this edition of the Pediatric Educator). While many schools have abandoned departmentally based basic science courses, it has been much more challenging in the clinical arena. Susan Bannister