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March 25, 1992

Educating Physicians for Population-Based Clinical Practice

Author Affiliations

From the Kaiser Permanente Center for Health Research, and the Department of Public Health and Preventive Medicine, Oregon Health Sciences University, Portland.

JAMA. 1992;267(12):1645-1648. doi:10.1001/jama.1992.03480120083037

Debates about changing the current paradigm of medical education and medical practice have become fairly common in recent years. Based on my experience as a research director of a prepaid group practice program and as chair of a medical school department of public health and preventive medicine, I contend that the traditional one-to-one physician-patient role obligations should be expanded to include a set of "one-to-n" physician-population obligations. The latter include at least three components: (1) a resource allocation component, (2) a component focusing on the epidemiologic nature of clinical practice, and (3) a component focusing on members of the population who are not regularly attended to within the normal context of physician care. Discussing these in turn, I argue for a population-based clinical practice model of medical education that preserves the Hippocratic tradition while better preparing physicians for the complex practice and insurance realities of the 21st century.

(JAMA. 1992;267:1645-1648)