health care workforce, including difficulties in retention of personnel, the impending crisis in nursing supply, and the need for strong leadership within the health care system to guide and support what will be a very difficult transition. When clinicians are under stress themselves, it is difficult to take care of patients who are ill and stressed. Indeed, this was one of the key transitional issues identified during the committee’s deliberations. It is a broad topic that can only be introduced here, but the committee emphasizes the need for additional study to understand the effects of the changes recommended herein on how the workforce is prepared for practice, how it is deployed, and how it is held accountable.

Recommendation 12: A multidisciplinary summit of leaders within the health professions should be held to discuss and develop strategies for (1) restructuring clinical education to be consistent with the principles of the 21st-century health system throughout the continuum of undergraduate, graduate, and continuing education for medical, nursing, and other professional training programs; and (2) assessing the implications of these changes for provider credentialing programs, funding, and sponsorship of education programs for health professionals.

Recommendation 13: The Agency for Healthcare Research and Quality should fund research to evaluate how the current regulatory and legal systems (1) facilitate or inhibit the changes needed for the 21st-century health care delivery system, and (2) can be modified to support health care professionals and organizations that seek to accomplish the six aims set forth in Chapter 2.

This chapter briefly examines three specific issues: clinical training and education, regulation of the health professions, and legal liability issues. Clinical training and education is seen as particularly important for changing the culture of health care practice to support achievement of the aims set forth in Chapter 2. Greater understanding is needed of why prior efforts at modifying clinical education have not had the desired impact and of the supportive strategies needed to overcome such barriers.


To achieve the six aims proposed in Chapter 2, additional skills may be required of health professionals—not just physicians, but all clinicians who care for patients. Prior chapters have identified a number of changes affecting health care delivery, including a shift from acute to chronic care, the need to manage a continually expanding evidence base and technological innovations, more clinical practice occurring in teams and complex delivery arrangements, and changing patient-clinician relationships. The need to balance cost, quality, and access in

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