Powerful medical education improves health care quality and return on investment

Abstract

Introduction

Powerful medical education (PME) involves the use of new technologies informed by the science of expertise that are embedded in laboratories and organizations that value evidence-based education and support innovation. This contrasts with traditional medical education that relies on a dated apprenticeship model that yields uneven results. PME involves an amalgam of features, conditions and assumptions, and contextual variables that comprise an approach to developing clinical competence grounded in education impact metrics including efficiency and cost-effectiveness.

Methods

This article is a narrative review based on SANRA criteria and informed by realist review principles. The review addresses the PME model with an emphasis on mastery learning and deliberate practice principles drawn from the new science of expertise. Pub Med, Scopus, and Web of Science search terms include medical education, the science of expertise, mastery learning, translational outcomes, cost effectiveness, and return on investment. Literature coverage is comprehensive with selective citations.

Results

PME is described as an integrated set of twelve features embedded in a group of seven conditions and assumptions and four context variables. PME is illustrated via case examples that demonstrate improved ventilator patient management learning outcomes compared to traditional clinical education and mastery learning of breaking bad news communication skills. Evidence also shows that PME of physicians and other health care providers can have translational, downstream effects on patient care practices, patient outcomes, and return on investment. Several translational health care quality improvements that derive from PME include reduced infections; better communication among physicians, patients, and families; exceptional birth outcomes; more effective patient education; and return on investment.

Conclusions

The article concludes with challenges to hospitals, health systems, and medical education organizations that are responsible for producing physicians who are expected to deliver safe, effective, and cost-conscious health care.

Keywords:

• Medical education
• science of expertise
• mastery learning
• translational outcomes
• cost-effectiveness
• return on investment
• narrative review

Authors contributions

All of the authors contributed to the design, draft authorship, draft review, and final version of the manuscript.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Additional information

Funding

This work was supported by Northwestern Simulation, the Baum Family Foundation, and the Gordon Center for Research in Medical Education of the University of Miami Miller School of Medicine.

Notes on contributors

William C. McGaghie

William C. McGaghie, PhD, is Professor of Medical Education and Preventive Medicine, Northwestern University Feinberg School of Medicine, USA.

Jeffrey H. Barsuk

Jeffrey H. Barsuk, MD, MS, is the Robert Hirshtick Professor of Medicine, Professor of Medical Education, and Executive Medical Director, Northwestern Simulation, Northwestern University Feinberg School of Medicine, USA.

Diane B. Wayne

Diane B. Wayne, MD, is Professor of Medicine and Medical Education, Northwestern University Feinberg School of Medicine, USA.

S. Barry Issenberg

S. Barry Issenberg, MD, is Professor of Medicine and Medical Education and Director, Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, USA.