Knowing the Science Is Not Enough: Integrating Health Care Delivery and Services Into GME

The current US health care system is expensive,1 provides an uneven quality of care,2 and leaves about 40% of US adults uninsured or underinsured.3 The medical education system in the United States may contribute to these problems through its emphasis on the treatment of disease rather than addressing patient safety, cost-effective health care delivery, and population health. Graduate medical education (GME) occurs at the fulcrum of clinical care delivery and medical school, and could play an important role in altering medical education to better address features of clinical quality, health care costs, and access to health services. In the process, GME could bring about needed improvements in the delivery of health care services and prevention of disease and injury. To accomplish these goals, GME will have to build bridges between the clinical and educational enterprises. GME could begin a radical reconceptualization of the medical education continuum through the blending of health services concepts and competencies with traditional biomedical, bioscience models. In doing so, the prioritization of time and effort for residents and faculty would have to change to allow excellence in clinical quality to become the driving force for GME, and ultimately for the continuum of medical education.