Commentary: what if high-quality care drove medical education? A multiattribute approach

The current medical education model is based on the assumption that students progress from a mastery of basic mechanisms of human structure and function to an understanding of a variety of pathologies and treatments using sound scientific principles. In this commentary, the authors suggest another approach to developing medical school curricula. Starting with the major desired outcome of medical education, which they suggest should be high-quality medical care, educators can work backward using the attributes of quality as the basis for developing new medical curricula. The authors present, as an example, the Institute of Medicine definition of quality care--care that is safe, timely, effective, efficient, equitable, and patient-centered. These objectives and their attributes then can be useful for mapping current and future curricula in medical education and identifying deficits or possible excesses. A result of this approach might be the inclusion of such topics as epidemiology, process engineering, or aspects of the humanities or social sciences that build skills and knowledge in patient-centered care or safety while maintaining a balance with the need to preserve biomedical topics. Use of quality objectives and attributes to drive medical education should lead to improved alignment of the clinical and educational missions of academic medical centers, which, in turn, should lead to safer and higher quality care for patients.