Time to "rethink models of medical education," ACMC meeting told.

Faculties of medicine must play a lead role in guiding the changes sweeping the health care system, says the principal and vice-chancellor of McGill University. During the recent annual meeting of the Association of Canadian Medical Colleges (ACMC), Association of Canadian Teaching Hospitals and Canadian Association for Medical Education in Halifax, Bernard Shapiro urged medical educators to help chart the course of Canada’s health care institutions. “In an environment of rapid change, nothing fails like success,” he pointed out. “The very success of academic health centres and the health system [has] predisposed those most able to move us forward into the future to often be those least inclined to do so.” He said faculties of medicine should prepare to relinquish some power in the process and “rethink models of medical education” to embrace allied health sciences. “The priestly function of the physician is to be shared by others on the health care team.” That reality is reflected in the transformation of Canada’s hospitals. “It has become increasingly clear that the restructuring of the hospital network is not a question of size or simply building a new facility or acquiring new technology or saving money,” said Shapiro. “The real challenge is to engage in a major revision of the role of hospitals in society.” He said the first step is to rethink the role of hospitals, including tertiary care centres. They should be considered “not as the sole object of the instruction process but rather as a significant component of the public health care network” that will guide the continuity of care as patients move through the system. “It is possible that . . . academic health centres will have to accept that responsibility and will need a far more robust communications system travelling with the individual receiving care. I don’t think the public is going to put up with the incapacity of the profession to talk to each other.” He said hospitals will also have an obligation to help patients readjust after treatment — a function that requires a commitment to specialties like occupational or rehabilitation medicine. “This is where the health profession can really lead by helping people like me understand that the system isn’t simply composed of acute care hospitals and general practitioners,” he said. But continuity of care doesn’t stop there. It also involves following patients through their life cycle and engaging multidisciplinary teams of health professionals. Tertiary care centres, Shapiro predicted, will benefit from “this synergy” of ideas. “At the centre of this is the faculty of medicine. Universities . . . should be able to extend their expertise to continuing professional and community education. Most important, members of faculty should be responsible for developing the health care 14828 August 1/97 CMAJ /Page 304