Assuming the existing paradigm of medical school education is tired and in need of replacement, the next question is why hasn’t it happened? Technology change is all around us. Students have replaced memorization and note cards with the EHRs, phones, laptops and Google. Yet the system is relatively unchanged. How come?
A review of creative destruction is helpful. The original theory
of creative destruction (replacement of old with new) was that
downturns in the economy spurred such destruction. This “liquidation
model” proposed that when things go bad people revisit resource
allocation and come up with novel solutions. The application of this
model to medicine would infer that the unending growth and riches of
healthcare is the problem. Additionally the ability to dump more and
more debt onto medical students [thus forcing students to choose high
paid specialties focusing on procedures] has further enhanced the
riches of the industry. The end result of all this largesse is that
the healthcare aspect of the economy has been protected from from the
risks (and destructive value) of recession. Without downturn there is
complacency and thus stagnation.
So for us to move out the current "Normal Science" and shift the paradigm we would then need something bad to happen in terms of health care. Now since health care is 17% of GDP you can argue either way.
Option #1: No way can that happen; our entire economy will crash.
Option #2: It is inevitable. How much longer can the US remain competitive when it spends twice what any other country spends and still does not provide health care to everyone?
I wish I had the magic ball to predict which one will win. Sadly, based on the above theory we lose either way. If everything stays rosy then medical student changes. If health care in the US crashes then medical student training changes but the system is in chaos.
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