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Change the Model → Change the Curriculum (02:23)

If we’re going to change the health care payment model, how much do we need to change medical school curricula and how we train physicians?

Michael McWilliams, an internist at Brigham and Women’s Hospital, answers this question in relation to the utility of measures in a management context. “Do we really need measures to change physician behavior?” he asks. McWilliams, who supervises medical residents, says that his students aren’t measured on how many MRIs for back pain they do, for example, and then told they’re doing too many. Instead, they’re taught not to do a test unless it will change their management. “Be thoughtful, and then let’s work out how we apply this to every clinical context,” he says. Students complete their training with this principle, which later affects various Choosing Wisely–like measures.

But that’s where the training ends, other than studying for one’s boards. “It’s kind of crazy that we don’t retrain clinicians and we don’t really manage them either,” McWilliams says.

It’s easy to say, “We should add this to the curriculum,” adds Griffin Myers, Co-founder and Chief Medical Officer for primary care provider Oak Street Health. “So the first question is, what are we going to take away to be able to add this stuff in?”

“I don’t think that people graduating today finish unequipped to take care of patients,” Myers says. But there is extra to learn. He describes Oak Street’s approach to addressing new knowledge. “There’s a bunch of stuff here that is contextual, important to your practice. Do you know this stuff? You don’t? Okay, then we’re going to invest in teaching it.”

From the NEJM Catalyst event Navigating Payment Reform for Providers, Payers, and Pharma, held at Harvard Business School, November 2, 2017.

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