When medical education and health policy meet: Will we find our leaders there?

Abstract

Health systems globally are finding themselves in a once-in-a-generation state of crisis. Health human resource challenges, including both workforce shortage and suboptimal distribution, have contributed to ever increasing wait times and poor access to primary, specialty and surgical care.¹ The ongoing health system challenges are also contributing to high rates of health care workforce burnout and subsequent attrition.^{2, 3} Globally, there is contentious debate on the best steps forward. While it is critical that the discourse centres around promoting health equity and increasing patient access, the implications of the current health crises on physician training deserve further attention. As such, medical education senior leaders must recognise and articulate the impact that health policy decisions have on the formation of tomorrow's physicians.

McOwen et al. recently published a laudable effort trying to delineate the boundaries of medical education through the lens of its leaders.⁴ The authors find that medical education sits at the intersection of three domains: clinical medicine, university administration and hospital administration. Navigating through these worlds is an exercise in harnessing positionality and agency in order to realise their self-described fiduciary responsibility to the public—‘to produce doctors’. Indeed, it is telling that the figured world of health policy did not feature in the participants' reflections. Do medical education senior leaders see themselves as having agency, improvisation, discourse, positionality and power in this world? And if so, are they willing and able to use the affordances it provides them in their quest to train high quality physicians of the future?

One interviewed leader discussed how they collaborated with the local health system during the COVID-19 pandemic to integrate learners into virtual care settings given that public health restrictions did not allow for traditional face to face clinical encounters. In doing so, the participant reconsidered ‘their own positionality and power at the local level’ to mitigate the potential negative impacts the newly implemented policy measures had on clinical learning. Although not underscored in the article, their advocacy was a demonstration of how a public health policy shaped the learning environment. Furthermore, as another participant noted, teaching medical students how to use telehealth helps make the case for more widespread use of virtual care as a sustainable health care delivery modality as the future health care workforce would have been trained in its use—an example of how medical education can influence future health policy. These two anecdotes illustrate how health system and medical education transformation go hand in hand. As McOwen et al. state, ‘medical education is shaped by and shapes the clinical learning environment’. However, health policy too shapes and is shaped by medical education, and the dance between the two domains deserves further exploration.

One of the main ways in which the relationship between medical education and health policy has been described in the literature is in the context of physician workforce planning. A 2018 study by the Association of Faculties of Medicine of Canada found that a mismatch between the number of medical student positions and the number of government-funded postgraduate medicine positions contributed to an uptick in the number of medical graduates who did not match into a residency program.⁵ As a result, many medical trainees could not complete their journeys towards independent medical practice, raising significant health human resource concerns. Additionally, Bates et al. described areas where the alignment between medical education and health policy priorities could be improved including measures to make careers in generalist specialties more attractive to medical students and the role that regional medical school campuses could play in addressing physician supply challenges in rural and remote communities.⁶ Although published in 2008, many of the issues and lessons described remain salient more than a decade later, suggesting slow progress at best in high priority areas for both medical education and health policy.

How then can medical education senior leaders be more effective in the policy space? Ultimately, it is crucial that we more clearly recognise medical education as a vehicle to promote public good. We believe that a true understanding of how the figured world of medical education intersects with health policy could help medical educators determine how to best engage in important policy discussions that are sure to impact their work. It could ignite their research efforts into how specific health system policies may affect medical learners. It could also help medical education leaders become comfortable with more direct, proactive conversations with policymakers. Most importantly, it could empower them to view themselves as essential players in the field of health policy.

Whether it is the surprise of a pandemic that triggers a paradigm shift in how we educate medical students or how such a shift in medical training changes health care delivery for the better, medical education shapes and is shaped by health policy. If medical education senior leaders do not fully recognise and harness their own power within the world of health policy, this could mean that medical education will perpetually play ‘catch-up’ with health policy changes. If their fiduciary responsibility is to create quality physicians of tomorrow, medical education leaders owe it to the public to be clear about how health system changes may hinder or facilitate this goal. Medical education leadership would thus do well to leverage these realities especially at the current time when governments are actively looking for answers to solve some of the most pressing health care challenges in a generation.

Henry G. Annan: Conceptualization; investigation; writing—original draft; writing—review and editing. Victor Do: Conceptualization; writing—review and editing.