Innovative approaches to educating medical students for practice in a changing health care environment: The National UME-21 project

today's continually changing health care environment, there is serious conc ern that medical students are not being adequately prepared to provide opti mal health care in the system where they will eventually practice. To addre ss this problem, the Health Resources and Services Administration (HRSA) de veloped a $7.6 million national demonstration project, Undergraduate Medica l Education for the 21st Century (UME-21). This project funded 18 U.S. medi cal schools, both public and private, for a three-year period (1998-2001) t o implement innovative educational strategies. To accomplish their goals, t he 18 UME-21 schools worked with more than 50 organizations external to the medical school (e.g., managed care organizations, integrated health system s, Area Health Education Centers, community health centers). The authors de scribe the major curricular changes that have been implemented through the UME-21 project, discuss the challenges that occurred in carrying out those changes, and outline the strategies for evaluating the project. The participating schools have developed curricular changes that focus on t he core primary care clinical clerkships, take place in ambulatory settings , include learning objectives and competencies identified as important to p roviding care in the future health care system, and have faculty developmen t and internal evaluation components. Curricular changes implemented at the 18 schools include having students work directly with managed care organiz ations, as well as special demonstration projects to teach students the kno wledge, skills, and attitudes necessary for successfully managing care. It is already clear that the UME-21 project has catalyzed important curricular changes within 12.5% of U.S. medical schools. The ongoing national evaluat ion of this project, which will be completed in 2002, will provide further information about the project's impact and effectiveness.