Doctors, nurses, and other health professionals are not being adequately prepared to provide the highest quality and safest medical care possible, and there is insufficient assessment of their ongoing proficiency, says a new report from the Institute of Medicine of the National Academies. The report is part of the IOM series on improving the quality and safety of health care, which includes a 1999 landmark study on reducing the high rate of medical errors.

"Reforming the education of health professionals will require a collective effort across all the health care disciplines, focusing on a set of core competencies that they all embrace," said Edward Hundert, M.D., co-chair of the committee that wrote the report, and president, Case Western Reserve University, Cleveland. "We owe it to our patients to change the way we are educated in order to improve quality and safety."

All programs that educate and train health professionals should adopt five core competencies: the abilities to deliver patient-centered care, work as a member of an interdisciplinary team, engage in evidence-based practice, apply quality improvement approaches, and use information technology. The report calls on accreditation, licensing, and certification organizations to ensure that students and working professionals develop and maintain proficiency in these core areas.

These oversight groups should take the lead in improving health professionals' education because they can implement change at the national and state levels, the report notes. In particular, organizations that accredit health education programs should assess what students know and are able to do in a clinical setting not, for example, the number of semester hours they take of a particular subject. And all licensing boards should require doctors, nurses, and other health care workers to demonstrate their clinical skills and understanding of medical advances, rather than allow them simply to take a class and pay a fee to renew their licenses. In addition, all certifying organizations should use rigorous tests to evaluate the ongoing proficiency of health professionals instead of just requiring continuing medical education, which is not a reliable way to measure ongoing competency. Consensus on what constitutes evidence of proficiency and the most effective methods to assess competence will have to be reached, the committee acknowledged.

In addition, report cards on the quality of health professions training programs should be issued to give policy-makers and educational leaders a way to assess and compare academic institutions. Also, leaders from different health disciplines should meet at biennial summits to promote reforms in health education and evaluate the progress of these reforms, said the committee, whose own work was informed by more than 150 leaders from medicine, nursing, pharmacy, and allied health who attended an IOM forum in June 2002. Their ideas for how to integrate the core competencies into health professions education are included in the report.

"Schools for health professionals generally are not interdisciplinary, but practice environments increasingly are, which poses a serious disconnect," said Mary Wakefield, Ph.D., R.N., committee co-chair and director, Center for Rural Health, University of North Dakota, Grand Forks. "Ideally, collaboration among clinicians in practice settings draws upon each profession's strength and optimizes care for patients. We believe that the same can be true for health professions education and that it's high time to embrace a collaborative approach to reform."

Significant funds and other resources will be necessary to develop and implement this new evidence-based approach to evaluation. The new evaluations may need to be phased in, the report says.

The study was sponsored by the Health Resources and Services Administration, Agency for Health Care Research and Quality, ABIM Foundation, and California HealthCare Foundation. The Institute of Medicine is a private, nonprofit institution that provides health policy advice under a congressional charter granted to the National Academy of Sciences. A committee roster follows.

Copies of Health Professions Education: A Bridge to Quality will be available this summer from the National Academies Press; tel. (202) 334-3313 or 1-800-624-6242 or on the Internet at http://www.nap.edu.