Because FIPSE is so well known for its support of innovation and reform in numerous other areas, few outside of the education field have appreciated the centrality of its role in sponsoring innovations in the medical and health sciences. These changes have been varied and far reaching, and they have addressed some of the basic concerns about the provision of health services and medical training in this country. Some were motivated by notions that health service providers can be poor communicators or lack empathy. Others focused on the problem of assessing clinical competencies, exacerbated by concerns of the patients upon whom students practiced their new skills. Still others arose from the perception that the specific health needs of some groups were not receiving enough attention.

The demand to better prepare health-care providers in these and other areas collided with a curriculum that has exploded with so much content that it is often unmanageable–even while many are urging the addition of new content and altered pedagogy to provide more relevant learning and to motivate students to become more active participants in the learning process. And all of these demands come at a time when diminished funding within the health sciences has made innovation difficult.

FIPSE’ s role in supporting change has therefore been vital. But why FIPSE? Because no one else offers significant funding for research and innovation in medical and health education. The National Institutes of Health (NIH) has had and continues to have an essential and respected role in funding fundamental and clinical research in medicine and health, but support of education has not been part of its mandate. From its founding onward, the National Science Foundation (NSF) has supported science education, including pre-medical education, but as a matter of policy excludes the applied clinical sciences from all of its funding programs. So there is no agency other than FIPSE whose primary mission includes support for change in medical and health education.

By the end of its first decade, FIPSE was already a major player in bringing about far-reaching changes in medical education. Foremost among several such efforts was a sequence of projects, first funded in 1980, that invented, implemented, and refined a revolutionary new methodology to assess the clinical skills of medical students, physicians, and practitioners in many health disciplines. That technique–the use of standardized and simulated patients (trained lay people or actors who present or simulate particular disorders or symptoms) as expert assessors–is by now familiar to medical students and other would-be health-care professionals throughout the world.

A decade later, in 1993, another watershed was reached when FIPSE funded a series of initiatives to integrate women’s health throughout the medical curriculum, first, and throughout the curricula of the other health sciences later. Before then, research data from male subjects was extrapolated to females–except of course for reproductive differences–and there was thought to be no need for special attention to non-reproductive women’s health in medical training. But FIPSE had the vision and multifaceted experience needed to take on the issue of women’s health in medical education, as it had earlier embraced the new idea that lay people could become skilled teachers and evaluators in medical and health science.

The remainder of this article will discuss in depth these two landmark medical projects supported by FIPSE and will conclude by mentioning a few other significant FIPSE efforts that have been–or still promise to be–influential in the fields of medical and health education.

STANDARDIZED PATIENTS AND THE ASSESSMENT OF CLINICAL SKILLS

The Problem: Traditionally, new doctors’ progress through medical school and entry into the profession have both been governed by paper-and-pencil examinations. Even when advanced computer technology is employed to administer the test itself, the prospective physician is primarily asked to display intellectual skills. How to conduct valid, reliable, and cost-effective assessments of clinical and communication skills has been a perennial dilemma for both medical schools and licensing authorities ever since medicine replaced its original apprenticeship system with formal instruction in organized schools.

Patient Instructors in Arizona: A clever solution using what were first called “patient instructors,” but are now known everywhere as “standardized patients,” was invented by Paula L. Stillman, then a pediatrician on the faculty of the University of Arizona. Her idea, piloted with the help of a small grant in 1977 from the private National Fund for Medical Education (NFME), was fully developed and implemented with support from a 1980 FIPSE grant entitled “Patient instructors: a new methodology to assess clinical competence and ensure quality health care.”

Precursors to this idea did exist. During the 1970s, Robert Kretzschmar, an obstetrician/gynecologist at the University of Iowa, had been using volunteer women as live models to train medical students to do breast and pelvic exams. But these women were passive participants, lending their bodies for this purpose but playing no other instructional role.