Training on the wards

To ensure that residents are given opportunities for patient encounters that will be more meaningful to their future practice, Kenneth Flegel and Anita Palepu1 recommend that trainees spend more time in the outpatient or community setting. Clearly, that is vital, but how is it to be accomplished, given that universities do not seem willing to address this point in any meaningful way?

Traditionally, the training of medical students and specialists has depended on volunteer clinical faculty, who donate their time and often their offices to the cause. However, with increasing workloads and rising overhead costs, clinical faculty are becoming reluctant to reduce their incomes by seeing fewer patients, which is the inevitable result of mentoring residents.

Western society can no longer depend on this model and must accept the financial responsibility associated with medical training. The massive subsidy that clinical faculty have been providing, in the form of both time and facilities, can no longer be sustained, and, as is the case with all subsidies, its disappearance could end in the collapse of the system. The true costs of a medical education are as yet unknown, but eventually they must be recognized — by paying clinical teachers for their time and by providing the facilities needed for appropriate training.

Flegel and Palepu have identified the problem. It is now up to the universities, which are responsible for medical education, to develop realistic solutions.

George Price Physician Vancouver, BC