Challenges in Medical Education: Training Physicians to Work Collaboratively

In an ideal setting, generalists and specialists collaborate to provide quality care to individual patients and patient populations covered by a variety of health care plans. To accomplish this, generalists and specialists must each understand the other's domain and area of expertise. In many managed care settings, generalists must expand competencies. In turn, specialists must understand the extent of care generalists can provide.1 Skills required for both groups include incorporating population-based, cost-effective, and evidence-based medicine into daily practice.2–4 Specialists and generalists must be able to communicate in an efficient and timely manner to optimize consultations between physicians. The referring physician should specify the question and provide essential information to the consultant, while the consulting physician should address the question and participate in monitoring the patient's care to ensure appropriate treatment.2, 3, 5–9 Generalists and specialists collaborate in the care of patients with the most complex problems. Ideally, generalists and specialists would develop consistent referral paths, and be located near one another to permit personal professional relationships. Respect, trust, and the ability to work as part of a team are the foundations for this relationship.2, 3, 9