PROFESSIONAL COMPETENCES IN THE CHANGING HEALTH-CARE SYSTEM - PHYSICIANS VIEWS ON THE IMPORTANCE AND ADEQUACY OF FORMAL TRAINING IN MEDICAL-SCHOOL

Purpose. To examine physicians' attitudes toward 16 competencies deeme d essential to the effective practice of medicine in the changing heal th care system. Method. In early 1991 a telephone survey was conducted of 300 physicians from random samples selected as representative of t he physician population in the continental United States. The physicia ns were categorized as general practitioners, surgery specialists, and other specialists, and as belonging to the graduation cohorts of 1960 -1969, 1970-1979, and 1980-1989. The physicians were asked to rate (1) the importance of formal undergraduate training in each of 16 compete ncies and (2) the adequacy of their own undergraduate training in the competencies (these ratings are reported only for the 87 physicians in the 1980-1989 cohort). The competencies were derived from the skills, attitudes, and behaviors defined by the Pew Health Professions Commis sion as necessary for the nation's health care practitioners to meet s ociety's evolving health care needs. Results. Fifty percent or more of the physicians thought that 12 of the 16 competencies were ''very imp ortant'' to include in undergraduate training. Over 75% thought that i t was ''very important'' to include the five competencies involving sk ills traditionally valued in medical practice: diagnosis and treatment , effective communication with patients, problem solving, lifelong lea rning, and counseling on medical ethics. More than 50% thought that un dergraduate training was ''very important'' in some competencies that reflect the changing dynamics of medicine and care delivery over the p ast ten years: health promotion and preventive medicine, involvement o f patient and family in care, management of large volumes of informati on, appropriate use of technology, working on a team with other profes sionals, and consideration of cost in clinical decision making. In rat ing their own training, over 50% felt well prepared (ratings of ''exce llent'' or ''good'') in the five traditional competencies and, in addi tion, in their abilities to promote health, to manage large volumes of information, to work in teams, to understand and respond to diverse c ultures, and to expand access to care. However, a majority felt that t heir training was only ''fair'' or ''poor'' regarding the involvement of patients and their families, evaluation of the appropriateness of c ostly technology, consideration of cost implications in their decision making, and understanding and supporting the community's role in heal th care. Forty percent or more felt poorly prepared to work in managed care settings or to accommodate increasing external scrutiny. Conclus ion. The physicians validated the traditional strengths of medical sch ools, but revealed curricular weaknesses in the teaching of competenci es proposed as important for the emerging health care system, especial ly in the managed care environment.