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    Friday, September 05, 2014

    Apprenticeship in America

    Recently, Cathay Pacific instituted a program titled "I Can Fly," which hopes to give juniors and seniors in high school 8 weeks of direct experience to aviation. Not flying, but aviation - learning about everything from passenger sales to airports, cargo to catering. This is a Canadian program, partnering Toronto with Cathay Pacific.

    America lost it's apprenticeship culture years ago. Sure, we all read of our Founding Fathers learning watchmaking, or silver smithing, or printing at the hands of someone else. But by the end of World War II, America's government-subsidized public high school network was robust enough to provide basic education. People graduated, applied, and got jobs. Then they received on-the-job training.

    As the economy developed and higher education became more important, that model persisted. Now, some companies are going back to Europe to study their apprenticeship systems. The hope is that large companies, like Siemens in Germany, can help counterparts in the USA close a gap where 4 million jobs sit unfilled although 10 million people are unemployed.

    The problem is, this hasn't extended to one sector of the economy gravely hit by this labor shortage - health care. Physician training, specifically, is woefully inefficient - a byproduct of this stage-by-stage top-down, myopic, it's-always-been-done-this-way approach. Since the Flexner report in 1910 (see pdf), American medical education time has been seen as an empty cardboard box to be filled with whatever is possible until the timer dings. As medical knowledge advances, we try to shove more and more into the box faster and faster, without stepping back and reimagining the box itself, or the method of pouring.

    "Then I wised up and got out while I still could."

    It is time for a serious look at the ACGME, AAMC, and LCME - the accreditation bodies of American medical education. They are bloated dinosaurs that do not move fast enough to deal with the times. With expected shortages of up to 52K physicians by 2025, it's past time to look at other ways of educating future medical professionals.

    We need to shorten medical education by at least 2 years. We need to decrease debt incurred by physicians in training. We need to change the culture to make medicine more family friendly. We need to increase responsibility given trainees to help them progress to self-sufficiency faster.

    Perhaps we could learn something from Cathay Pacific. We should at least look.

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