R. Englander is associate dean, undergraduate medical education, and professor, pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota. E. Holmboe is chief, research, milestones development and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois. P. Batalden is emeritus professor, Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. R.M. Caron is professor, Department of Health Management and Policy, College of Health and Human Services, University of New Hampshire, Durham, New Hampshire. C.F. Durham is professor and director, interprofessional education and practice, and director, education-innovation-simulation learning environment, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. T. Foster is professor of obstetrics and gynecology and of community and family medicine, Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. G. Ogrinc is senior associate dean for medical education and professor of medicine, Dartmouth Institute of Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. N. Ercan-Fang is associate director for medical education for primary and specialty care services, co-director, the VA longitudinal integrated clerkship, and associate professor of medicine, Minneapolis VA Health Care System and the University of Minnesota Medical School, Minneapolis, Minnesota. M. Batalden is interim chief quality officer, Cambridge Health Alliance, and assistant professor of medicine, Harvard Medical School, Boston, Massachusetts.
Acad Med. 2020 Jul;95(7):1006-1013. doi: 10.1097/ACM.0000000000003137.
In 2016, Batalden et al proposed a coproduction model for health care services. Starting from the argument that health care services should demonstrate service-dominant rather than goods-dominant logic, they argued that health care outcomes are the result of the intricate interaction of the provider and patient in concert with the system, community, and, ultimately, society. The key notion is that the patient is as much an expert in determining outcomes as the provider, but with different expertise. Patients come to the table with expertise in their lived experiences and the context of their lives.The authors posit that education, like health care services, should follow a service-dominant logic. Like the relationship between patients and providers, the relationship between learner and teacher requires the integrated expertise of each nested in the context of their system, community, and society to optimize outcomes. The authors then argue that health professions learners cannot be educated in a traditional, paternalistic model of education and then expected to practice in a manner that prioritizes coproductive partnerships with colleagues, patients, and families. They stress the necessity of adapting the health care services coproduction model to health professions education. Instead of asking whether the coproduction model is possible in the current system, they argue that the current system is not sustainable and not producing the desired kind of clinicians.A current example from a longitudinal integrated clerkship highlights some possibilities with coproduced education. Finally, the authors offer some practical ways to begin changing from the traditional model. They thus provide a conceptual framework and ideas for practical implementation to move the educational model closer to the coproduction health care services model that many strive for and, through that alignment, to set the stage for improved health outcomes for all.
2016 年，Batalden 等人提出了医疗服务的共同生产模式。他们从医疗服务应该体现服务主导而不是商品主导逻辑的论点出发，认为医疗保健结果是提供者和患者与系统、社区以及最终与社会协同作用的复杂相互作用的结果。关键概念是，患者在确定结果方面与提供者一样是专家，但具有不同的专业知识。患者带着自己生活经验和生活背景方面的专业知识来到谈判桌前。作者假设，教育应该遵循服务主导逻辑，就像医疗服务一样。就像患者和提供者之间的关系一样，学习者和教师之间的关系需要每个嵌套在其系统、社区和社会背景中的综合专业知识，以优化结果。然后，作者认为，不能在传统的、家长式的教育模式下教育卫生专业的学习者，然后期望他们以与同事、患者和家庭优先建立共同生产伙伴关系的方式进行实践。他们强调有必要将医疗服务共同生产模式应用于卫生专业教育。他们不是在问在当前系统中共同生产模式是否可行，而是认为当前系统不可持续，也没有培养出理想的临床医生。一个来自纵向综合实习的当前例子突出了共同生产教育的一些可能性。最后，作者提供了一些实际的方法来开始从传统模式转变。他们因此提供了一个概念框架和实用的实施思路，以更接近许多人所追求的共同生产医疗服务模式，通过这种一致性，为所有人的健康结果的改善奠定基础。
