Recommendations for medical education in Taiwan.

Biomedical research performed in Taiwan is published in top medical journals, and the latest therapeutic innovations, such as biopharmaceuticals, cardiac electrophysiology and robotic surgery are available in Taiwan. However, primary medical care in Taiwan currently is inadequate, and as the population of Taiwan ages, the need for primary care will increase. Good primary care is necessary to ensure that diseases such as hypertension, diabetes and cancer are detected and treated early, to identify people who might benefit from the latest therapeutic innovations, and to identify rapidly and respond effectively to emerging health threats such as multidrug-resistant pathogens. Here, we report briefly a pathway of accelerated medical education that reduces the time spent in the classroom and increases the time spent learning clinical fundamentals. We propose widespread adoption of similar educational pathways and reform of other aspects of medical education in Taiwan, to facilitate the training of doctors who can provide the primary care needed by the people of Taiwan. Six aspects of medical education in Taiwan contribute to the poor preparation of doctors to provide primary care. (1) Insufficient training in clinical fundamentals including humanism, history taking, physical examination and the biopsychosocial model of medical care. (2) Insufficient training in quality improvement, including how to recognize improvement opportunities, how to motivate change, and how to improve quality by making systemic changes. (3) No formal training in teamwork. Teamwork is essential for quality medical care, but medical students are graded on individual performance. Similarly, teamwork is disregarded at more advanced levels of medical training. Consequently, teamwork is neglected in medical practice, which results in poor coordination among health professionals and therefore poor medical care.1 (4) Insufficient outpatient primary care training. Current medical training primarily is hospital-based. Doctors have the knowledge and skills to provide highintensity, high-technology, high-cost and acute medical interventions, but not to provide primary care. (5) Early specialization. When trainees specialize early, they truncate their education in fundamental clinical skills and focus on acquiring the knowledge and techniques of a narrow field of practice. As a consequence, they never gain the knowledge or the skills needed to provide primary care, or to teach it. (6) Finally, faculty physicians depend on fee-for-service National Health Insurance for their income, but this