Looking Ahead: Futures Planning for Medical Education

Abstract

In 1998, I participated in a project with a group of colleagues to consider the future of the specialty of emergency medicine. We had been through 20 years of struggles to describe our specialty to the medical community and the public, develop training programs to prepare residents for practice of the specialty, create assessments of competence, and become recognized as a distinct specialty within the house of medicine. Our motivation for futures planning was to pause for a moment, as if we had just crested a hill during a long run and could now look across the next valley to the higher mountains rising ahead and plan for the coming challenges. We decided to develop scenarios that differed in their perceived likelihood of occurring and their potential consequences, similar to an approach previously used in industry and government and recently summarized by Amer et al.1 I can laugh now at some of the predictions we made,2 such as “Computerization will allow emergency physicians to spend less time record keeping.” Little did we know how time-consuming the electronic medical record would become and how much more documentation would be required for billing requirements. We also anticipated the continued growth of managed care, which was then spreading across the country, and fewer visits to the emergency department, leading to overall declines in reimbursement and the closing of hospitals. We did not anticipate the backlash against managed care and primary care gatekeepers that occurred shortly after our article was published, the explosive growth of our specialty, or the increasing volume of visits to emergency departments, nor did we foresee the scientific advances in treatment of conditions such as myocardial infarction, stroke, and sepsis that require rapid identification and treatment in the emergency department because of the time-sensitive nature of their pathological processes. While futures planning has inherent uncertainty, the effects on medical education of changes in health care delivery, with new treatments such as those described above, will likely continue to direct many priorities. But sometimes the recognition of new threats to health, such as those from climate change described by Wellbery et al,3 can create a sense of urgency to include new information in the curriculum. At other times, the appearance of new technology, often with associated new procedures, may become the driving force. Ultrasound, which now is used at the bedside to help physicians perform nerve blocks, vascular procedures, and a variety of diagnostic tests, is just such an example. Bahner et al4 have described how ultrasound has gradually been integrated into undergraduate curricula in U.S. medical schools and become a required skill in many residency programs. To engage our education community in futures planning efforts relevant to medical education, I decided to focus this editorial on themes from published futures planning documents relevant to medical education that were written by expert groups and organizations. Three themes that stood out were (1) information systems and other technology, (2) the increasing costs of health care driving reform of health care delivery, and (3) an evolving global professional identity. While we have published articles on these topics in Academic Medicine in the past, in this editorial I use a futures orientation to consider these topics and their influence on medical education. Information Systems and Other Technology New technology will continue to influence all specialties of medicine and medical education, transforming how information about patients and their health conditions is gathered, analyzed, and used for disease management. Imaging modalities will continue to change diagnostic approaches as the ability to peer inside the body will become fast, accessible, and low-risk and will yield rich information. Artificial intelligence modalities will be able to analyze the data from imaging and other sou