- Paul Di Capua (paul.dicapua) [Forum Discussion]

Introduction

In a cohort of 80 undiagnosed patients presenting to a primary care center, the medical interview alone yielded the correct diagnosis in 76% of visits.¹ Another study found that while diagnostic imaging was accurate in only 35% of cases, the combination of the medical history and physical examination produced the right diagnosis in 70% of cases.² Physicians facing malpractice claims are less likely to use patient‐centered interviewing than are physicians without malpractice claims.³ Moreover, patients are significantly less satisfied with their visits when physicians ignore psychosocial aspects of their care.⁴ As Holmboe argues, clinical skills, defined as the medical interview, physical examination and counseling, “remain the most important and effective diagnostic and therapeutic tools.” ⁵ The most important change required of health care education is ensuring all providers are equipped with high quality clinical skills; this can be achieved by the implementation of a quality improvement mechanism in health care education.

Quality improvement is the fundamental driver of this proposal. Lessons from industrial manufacturing on quality teach us the value of observation and feedback in continually improving quality. However, the current system of health care education lacks structure and yields graduates with low quality clinical skills. This essay proposes the implementation of a system of observation and feedback as means of assessing and improving providers’ clinical skills. For medical education, this can be achieved through the implementation of the mini‐CEX, a validated evaluation tool discussed in greater detail below. I support my argument by describing my own experience of implementing the mini‐CEX at a student‐run clinic at my medical school. A significant shift towards quality improvement in education may result in a cultural change in medicine in which providers continually help each other improve their care of patients.

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Thanks Jbassiri for notifying us regarding the following:

For the 19th Better Government Competition, Pioneer seeks innovative proposals to improve health care.

Health care spending currently accounts for almost 15% of Gross Domestic Product and, according to the Congressional Budget Office, is projected to grow to over 30% by 2035. Public sector programs account for a significant portion of this growth, with Medicare projected to grow from 3% to more than 7% of GDP over the same period.

Health care reform efforts are underway across the country, especially at the state level, but the goal of affordable, clinically appropriate, and broadly accessible health care remains elusive.

Pioneer encourages entries that involve public sector policies, programs, or practices, which can be implemented, reformed or eliminated in order to:

• Control Health Care Costs
• Deliver Services More Efficiently
• Increase Health care Quality
• Improve Clinical Outcomes
• Lower Administrative Costs
• Decrease Waste and Unnecessary Treatment
• Increase Access to Services

Guidelines for this year’s Competition can be found here.

To enter the 2009 Better Government Competition, download and fill out a Better Government Competition entry template [DOC file]. You may either print the attached form and mail your entry or complete the form electronically and e-mail it to us.

By mail, return to:
Better Government Competition 2009
Pioneer Institute for Public Policy Research
Attn: Shawni Littlehale, Director
85 Devonshire Street, 8th floor
Boston, MA 02109

or by e-mail to:
bgcpioneerinstitute.org

All questions regarding the competition should be directed to Shawni Littlehale at 617-723-2277 or to slittlehalepioneerinstitute.org.

DEADLINE: To be considered for a 2009 Better Government Competition award, all applications must be postmarked or e-mailed by April 13, 2009, 4:30pm et.

http://www.pioneerinstitute.org/get_involved_enter_bgc.php