Coproducing Health Professions Education: A Prerequisite to Coproducing Health Care Services?

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.

[1]  T. J. Anderson,et al.  Patient Satisfaction With Medical Student Participation in a Longitudinal Integrated Clerkship: A Controlled Trial , 2020, Academic medicine : journal of the Association of American Medical Colleges.

[2]  J. Bale,et al.  Education in Pediatrics Across the Continuum (EPAC): First Steps Toward Realizing the Dream of Competency-Based Education. , 2017, Academic medicine : journal of the Association of American Medical Colleges.

[3]  Sarah C Snow,et al.  Faculty experience and engagement in a longitudinal integrated clerkship , 2017, Medical teacher.

[4]  R. Phillips,et al.  The Effects of Training Institution Practice Costs, Quality, and Other Characteristics on Future Practice , 2017, The Annals of Family Medicine.

[5]  J. Perlo,et al.  IHI Framework for Improving Joy in Work , 2017 .

[6]  Charlotte Meierdirk.  Developing a growth mindset , 2016 .

[7]  Bridget C. O’Brien,et al.  Learners, performers, caregivers, and team players: Descriptions of the ideal medical student in longitudinal integrated and block clerkships , 2015, Medical teacher.

[8]  B. Lucas.  Getting the improvement habit , 2015, BMJ Quality & Safety.

[9]  Michael Seid,et al.  Coproduction of healthcare service , 2015, BMJ Quality & Safety.

[10]  Zoe Radnor,et al.  The Service Framework: A Public‐Service‐Dominant Approach to Sustainable Public Services , 2015 .

[11]  F. Mullan,et al.  Spending patterns in region of residency training and subsequent expenditures for care provided by practicing physicians for Medicare beneficiaries. , 2014, JAMA.

[12]  Christine A. Sinsky,et al.  From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider , 2014, The Annals of Family Medicine.

[13]  R. Lipner,et al.  The association between residency training and internists' ability to practice conservatively. , 2014, JAMA internal medicine.

[14]  Robert Englander,et al.  Developing the master learner: applying learning theory to the learner, the teacher, and the learning environment. , 2013, Academic medicine : journal of the Association of American Medical Colleges.

[15]  D. Hirsh,et al.  Better learning, better doctors, better community: how transforming clinical education can help repair society , 2013, Medical education.

[16]  Bridget C. O’Brien,et al.  Patient views of continuity relationships with medical students , 2013, Medical teacher.

[17]  G. Boschma.  The Making of the Northern Ontario School of Medicine: A Case Study in the History of Medical Education. Edited by Geoffrey Tesson, Geoffrey Hudson, Roger Strasser, and Dan Hunt. (Montreal/Kingston: McGill-Queen’s University Press, 2009. 229 p. ISBN 978-0-7735-3649-4 $44.95) , 2012 .

[18]  R. Epstein,et al.  The Values and Value of Patient-Centered Care , 2011, The Annals of Family Medicine.

[19]  H. Fineberg,et al.  Health professionals for a new century: transforming education to strengthen health systems in an interdependent world , 2010, The Lancet.

[20]  Rebecca R. Cheezum,et al.  Community-based participatory research: a capacity-building approach for policy advocacy aimed at eliminating health disparities. , 2010, American journal of public health.

[21]  Joan Sargeant,et al.  The Processes and Dimensions of Informed Self-Assessment: A Conceptual Model , 2010, Academic medicine : journal of the Association of American Medical Colleges.

[22]  David M. Irby,et al.  Calls for Reform of Medical Education by the Carnegie Foundation for the Advancement of Teaching: 1910 and 2010 , 2010, Academic medicine : journal of the Association of American Medical Colleges.

[23]  Susan H Steiner,et al.  Creating a Learner-Centered Environment in Nursing Education: An Immersion Experience. , 2010 .

[24]  Bridget C. O’Brien,et al.  Burden, Responsibility, and Reward: Preceptor Experiences With the Continuity of Teaching in a Longitudinal Integrated Clerkship , 2009, Academic medicine : journal of the Association of American Medical Colleges.

[25]  K. Mann,et al.  Reflection and reflective practice in health professions education: a systematic review , 2009, Advances in health sciences education : theory and practice.

[26]  D. Asch,et al.  Evaluating obstetrical residency programs using patient outcomes. , 2009, JAMA.

[27]  D. Hirsh,et al.  Learning Through Longitudinal Patient Care—Narratives From the Harvard Medical School–Cambridge Integrated Clerkship , 2009, Academic medicine : journal of the Association of American Medical Colleges.

[28]  Glenn Regehr,et al.  Self-assessment, self-direction, and the self-regulating professional. , 2006, Clinical orthopaedics and related research.

[29]  Kevin W Eva,et al.  Self-Assessment in the Health Professions: A Reformulation and Research Agenda , 2005, Academic medicine : journal of the Association of American Medical Colleges.

[30]  Kenneth M Ludmerer,et al.  Learner-centered medical education. , 2004, The New England journal of medicine.

[31]  Robyn Tamblyn,et al.  Physician and Practice Characteristics Associated with the Early Utilization of New Prescription Drugs , 2003, Medical care.

[32]  M. Stewart,et al.  The impact of patient-centered care on outcomes. , 2000, The Journal of family practice.

[33]  E. Deci,et al.  Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. , 2000, The American psychologist.

[34]  Richard E. Clark,et al.  Comparison between self-concept and self-efficacy in academic motivation research , 1999 .

[35]  J A Spencer,et al.  Learner centred approaches in medical education , 1999, BMJ.

[36]  R. Tamblyn,et al.  Characteristics of Physicians Who Frequently Prescribe Long-Acting Benzodiazepines for the Elderly , 1997, Evaluation & the health professions.

[37]  R. Tamblyn,et al.  Do medical education and practice characteristics predict inappropriate prescribing of sedative‐hypnotics for the elderly? , 1994, Academic medicine : journal of the Association of American Medical Colleges.

[38]  J. McNally.  Self-Directed Learning, A Guide for Learners and Teachers , 1976 .