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Kenneth M. Ludmerer

Other affiliations: University of Washington
Bio: Kenneth M. Ludmerer is an academic researcher from Washington University in St. Louis. The author has contributed to research in topics: Graduate medical education & Managed care. The author has an hindex of 19, co-authored 61 publications receiving 3187 citations. Previous affiliations of Kenneth M. Ludmerer include University of Washington.


Papers
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Journal ArticleDOI
TL;DR: This article introduces a series of reports on medical education, outlining the main areas of success and the problems that have arisen since the Flexner report was issued.
Abstract: This article introduces a series of reports on medical education. It outlines the main areas of success and the problems that have arisen since the Flexner report was issued.

875 citations

Book
01 Jan 1999
TL;DR: Time to Heal as discussed by the authors provides a landmark account of American medical education in the twentieth century, concluding with a call for the reformation of a system currently handicapped by managed care and by narrow, self-centered professional interests.
Abstract: Already the recipient of extraordinary critical acclaim, this magisterial book provides a landmark account of American medical education in the twentieth century, concluding with a call for the reformation of a system currently handicapped by managed care and by narrow, self-centered professional interests. Kenneth M. Ludmerer describes the evolution of American medical education from 1910, when a muck-raking report on medical diploma mills spurred the reform and expansion of medical schools, to the current era of managed care, when commercial interests once more have come to the fore, compromising the training of the nation's future doctors. Ludmerer portrays the experience of learning medicine from the perspective of students, house officers, faculty, administrators, and patients, and he traces the immense impact on academic medical centers of outside factors such as World War II, the National Institutes of Health, private medical insurance, and Medicare and Medicaid. Most notably, the book explores the very real threats to medical education in the current environment of managed care, viewing these developments not as a catastrophe but as a challenge to make many long overdue changes in medical education and medical practice. Panoramic in scope, meticulously researched, brilliantly argued, and engagingly written, Time to Heal is both a stunning work of scholarship and a courageous critique of modern medical education. The definitive book on the subject, it provides an indispensable framework for making informed choices about the future of medical education and health care in America.

534 citations

Journal ArticleDOI
TL;DR: Time to Heal is a landmark account of American medical education in the twentieth century, concluding with a call for the reformation of a system currently handicapped by managed care and by narrow, self-centered professional interests.
Abstract: Already the recipient of extraordinary critical acclaim, this magisterial book provides a landmark account of American medical education in the twentieth century, concluding with a call for the reformation of a system currently handicapped by managed care and by narrow, self-centered professional interests. Kenneth M. Ludmerer describes the evolution of American medical education from 1910, when a muck-raking report on medical diploma mills spurred the reform and expansion of medical schools, to the current era of managed care, when commercial interests once more have come to the fore, compromising the training of the nation's future doctors. Ludmerer portrays the experience of learning medicine from the perspective of students, house officers, faculty, administrators, and patients, and he traces the immense impact on academic medical centers of outside factors such as World War II, the National Institutes of Health, private medical insurance, and Medicare and Medicaid. Most notably, the book explores the very real threats to medical education in the current environment of managed care, viewing these developments not as a catastrophe but as a challenge to make many long overdue changes in medical education and medical practice. Panoramic in scope, meticulously researched, brilliantly argued, and engagingly written, Time to Heal is both a stunning work of scholarship and a courageous critique of modern medical education. The definitive book on the subject, it provides an indispensable framework for making informed choices about the future of medical education and health care in America.

463 citations

Journal ArticleDOI
01 Sep 1999-JAMA
TL;DR: Empirical evidence that formal instruction alone enhances professionalism is lacking is lacking, but the study does document that at this critical time in American medicine, most medical schools acknowledge the need to address professionalism as an essential element of the education of their students.
Abstract: PROFESSIONS HAVE LONG BEEN RECOGNIZED TO CONsist of 3 essential characteristics: expert knowledge (as distinguished from a practical skill), selfregulation, and a fiduciary responsibility to place the needs of the client ahead of the self-interest of the practitioner. In recent years there has been renewed recognition among medical leaders of the particular importance of the third, or altruistic, characteristic in medical professionalism. For instance, in 1994 the American Board of Internal Medicine defined the “core of professionalism” as “constituting those attitudes and behaviors that serve to maintain patient interest above physician self-interest.” In recent years, market forces have posed an unprecedented threat to medical professionalism—particularly the physician’s obligation to serve the needs of patients. For all its defects, the fee-for-service system that long dominated medicine had one great advantage: it allowed physicians easily to do what was necessary for patients. In contrast, today’s managed care environment has undermined physicians’ ability to provide patients with needed care. Many managed care organizations, whether seeking to control costs or maximize profits, have created strong financial incentives for physicians to restrict care. Some managed care organizations have even urged that physicians be taught to act in part as advocates of the insurance payer rather than the patients for whom they care. This has caused some critics to raise the specter of physicians becoming “double agents” who would purportedly serve the patient but in fact limit care for the financial benefit of the employing organization. In this context, the article by Swick and colleagues in this issue of THE JOURNAL is timely and encouraging. Of the 116 US medical schools that responded to their survey, 104 reported that they offer some type of formal instruction related to professionalism. The nature of this instruction varied widely, from a single “white coat” ceremony for matriculating students to a component of 1 or multiple courses. Most of the instruction occurs during the first 2 years of medical school. The authors emphasize that current strategies to teach professionalism need to be enhanced, as do methods for assessing educational outcomes. However, the study does document that at this critical time in American medicine, most medical schools acknowledge the need to address professionalism as an essential element of the education of their students. Are formal courses sufficient to instill a sense of professionalism among medical students? In another article in this issue of THE JOURNAL, Epstein argues that they are not. Epstein’s article invokes concepts from cognitive science, philosophy, and adult learning theory to describe a state of awareness he calls “mindfulness.” In Epstein’s view, the “mindful” physician possesses the mental qualities necessary for both good clinical decision making and proper professional behavior. What is especially notable is the author’s contention that the cultivation of mindfulness requires mentoring and guidance, not formal course work. According to Epstein, “[E]ach of us can identify practitioners who embody these attributes, learn from them, and identify unique ways of being self-aware. Educators can take on the task of helping trainees become more mindful by explicitly modeling their means for cultivating awareness.” Formal studies assessing the relative influence of didactic teaching and role-modeling on the development of professional values have not been conducted. However, there is reason to believe that both approaches are important, just as environment and heredity both influence the phenotype of living organisms. A number of concepts from history, the social sciences, and the humanities are central to understanding and internalizing professionalism. However, empirical evidence that formal instruction alone enhances professionalism is lacking. For more than 30 years, public charges that physicians are impersonal, self-serving, greedy, and occasionally dishonest have been increasing—despite the expanded teaching of the medical humanities and ethics at medical schools during this period. (Similarly, there is no evidence that the introduction of ethics courses in business schools in the 1980s and 1990s has produced more ethical behavior among business executives.) Sociologists have criticized medical educators—and educators in general—for their commonly held belief that formal course work can serve as “intellectual magic bullets” to shape human attitudes and behavior. Such crit-

139 citations


Cited by
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Journal ArticleDOI
Rita Charon1
17 Oct 2001-JAMA
TL;DR: By bridging the divides that separate physicians from patients, themselves, colleagues, and society, narrative medicine offers fresh opportunities for respectful, empathic, and nourishing medical care.
Abstract: The effective practice of medicine requires narrative competence, that is, the ability to acknowledge, absorb, interpret, and act on the stories and plights of others. Medicine practiced with narrative competence, called narrative medicine, is proposed as a model for humane and effective medical practice. Adopting methods such as close reading of literature and reflective writing allows narrative medicine to examine and illuminate 4 of medicine's central narrative situations: physician and patient, physician and self, physician and colleagues, and physicians and society. With narrative competence, physicians can reach and join their patients in illness, recognize their own personal journeys through medicine, acknowledge kinship with and duties toward other health care professionals, and inaugurate consequential discourse with the public about health care. By bridging the divides that separate physicians from patients, themselves, colleagues, and society, narrative medicine offers fresh opportunities for respectful, empathic, and nourishing medical care.

1,522 citations

Book
01 May 2011
TL;DR: This paper aims to demonstrate the efforts towards in-situ applicability of EMMARM, which aims to provide real-time information about the physical and emotional impacts of infectious disease on a variety of patients over a period of years.
Abstract: Harvard School of Public Health, Boston, MA, USA (Prof J Frenk MD); China Medical Board, Cambridge, MA, USA (L Chen MD); Aga Khan University, Karachi, Pakistan (Prof Z A Bhutta PhD); George Washington University Medical Center, Washington, DC, USA (Prof J Cohen MD); Independent member of House of Lords, London, UK (N Crisp KCB); James P Grant School of Public Health, Dhaka, Bangladesh (Prof T Evans MD); US Institute of Medicine, Washington, DC, USA (H Fineberg MD, P Kelley MD); School of Public Health Universidad Peruana Cayetano, Heredia, Lima, Peru (Prof P Garcia MD); Peking University Health Science Centre, Beijing, China (Prof Y Ke MD); National Health Laboratory Service, Johannesburg, South Africa (B Kistnasamy MD); School of Nursing, University of Pennsylvania, Philadelphia, PA, USA (Prof A Meleis PhD); University of Toronto, Toronto, ON, Canada (Prof D Naylor MD); The Rockefeller Foundation, New York, NY, USA (A Pablos-Mendez MD); Public Health professionals for a new century: transforming education to strengthen health systems in an interdependent world

984 citations

Journal ArticleDOI
TL;DR: This article introduces a series of reports on medical education, outlining the main areas of success and the problems that have arisen since the Flexner report was issued.
Abstract: This article introduces a series of reports on medical education. It outlines the main areas of success and the problems that have arisen since the Flexner report was issued.

875 citations