THE IMPORTANCE OF PREPARING MEDICAL-STUDENTS TO MANAGE DIFFERENT TYPES OF UNCERTAINTY

Price competition and other aspects of the changing health care enviro nment are threatening many academic health centers (AHCs) and causing them to reassess their education and research missions. In order to de sign effective AHCs for the next century, medical leaders must define the unique competencies need by tomorrow's physicians and describe the educational enterprises required to produce physicians with these com petencies. Two of the most important of these competencies are the abi lity to manage the uncertainty associated with creating clinical parad igms and the ability to manage the uncertainty associated with the man aging care delivery. Creating clinical paradigms involves (1) developi ng knowledge about disease categories and (2) developing knowledge abo ut the most appropriate therapy for a disease in a particular category . Both these tasks involve uncertainty. The second type of uncertainty is associated with managing care delivery and is largely a matter of optimizing current clinical paradigms. The challenges are (1) to corre ctly assign patients' diseases to existing disease categories, and (2) to correctly choose and manage the delivery of the most appropriate t herapies to these patients. Currently, AHCs are more competent in mana ging-and educating students to manage-the uncertainty involved in crea ting clinical paradigms. But there is an increasing demand for physici ans who manage the second type of uncertainty associated with care del ivery. The authors conclude that in order to remain viable, AHCs, and particularly their medical schools, must broaden their educational goa ls so that students can learn to manage both forms of uncertainty.