The UME-21 project: connecting medical education and medical practice.

From the Department of Pediatrics, Wright State University (Dr Pascoe); the Department of Internal Medicine, University of Vermont (Dr Babbott); KLPye Associates, Landenberg, Pa (Ms Pye); Department of Family Medicine, Jefferson Medical College (Dr Rabinowitz); Philadelphia College of Osteopathic Medicine (Dr Veit); and the Association of Colleges of Osteopathic Medicine, Chevy Chase, Md (Dr Wood). Early in the 21st century, the organization, delivery, and financing of health care in the United States continue to undergo dramatic changes. A major area of emphasis within the issues being debated on redesigning that system is improving health care quality while controlling health care costs. In the mid-1990s, leaders within the Division of Medicine and Dentistry (DMD), Bureau of Health Professions, Health Resources and Services Administration recognized the important redesign issues and the accelerating pace of change. They also noted that medical students were not being adequately prepared to provide high-quality health care within the new health systems. Therefore, with the unanimous endorsement of member organizations from the Primary Care Organization Consortium (Table 1), DMD leaders created a national medical education demonstration project, Undergraduate Medical Education for the 21st Century: a demonstration of curriculum innovations to keep pace with a changing health care environment (UME-21). The purpose of the project was to implement and evaluate innovative curricula for medical students, primarily in their clinical years, that would provide them with the knowledge, skills, and attitudes to provide high-quality health care to their patients within the health care systems of the 21st century. This 5-year (1997-2002), $7.6 million project focused on bringing medical schools together with organizations (external partners) that were also concerned with health care but were external to the medical schools. There were more than 50 UME-21 external partners, and they included managed care organizations, health plans, community health centers, community-based primary care networks, and local health departments. The UME-21 project funded a total of 18 US medical schools (about one eighth of osteopathic and allopathic schools). In 1998, eight US medical schools (public and private) were selected competitively to undertake comprehensive projects as partner schools. Each partner school received $125,000 a year for 3 years (1999–2001). In addition, 10 medical schools were competitively funded as associate partner schools at $20,000 a year for the same 3-year period to implement more focused curricular innovations (see Table 2 for partner and associate partner schools). The eight partner schools were required to include innovations and learning objectives within each of the nine content areas: (1) health systems finance, economics, organization, and delivery, (2) practice of evidence-based, epidemiologically sound medicine, with particular emphasis on a population-based perspective, (3) development of effective patient-provider relationships and communication skills, (4) ethics, (5) medical informatics, (6) leadership, (7) quality measurement and improvement, Section I: Introduction