Blog | Thursday, January 12, 2012

Four Ts to transforming medical education: Trust, time, teams and technology


I was able to reflect on the always jam-packed and inspiring Association of American Medical Colleges 2011 Meeting that took place in Denver in November. The theme of the meeting was transformation. It was certainly an interesting theme with the undertones of economic recession and the Graduate Medical Education funding crisis, and that was before the failure of the Supercommittee to reach a resolution.

So, how does medical education need to transform? In more ways than one, it turns out. So here are just four that were the recurring themes of the meeting and being a fan of alliteration, they all begin with "T."

Trust. It was clear that we need to restore the Americans people trust in physicians and in the medical education process. While students enter medicine to make a difference, something that they see in their journey to becoming a physician makes them jaded and they sometimes lose sight of their initial intention.

Is it debt, burnout, role models, or likely some combination of the three? It does not matter, because we have to restore their faith in teaching. Yes, teaching. Teaching is the heart and soul of our medical education and it is sometimes the easiest to lose in an academic health center focused on National Institutes of Health dollars or U.S. News & World Report rankings.

In addition to teaching our students, it is time to teach another constituency, our patients and Congress about the critical need for medical education. Advocacy is something we need to be teaching our own trainees so they can engage in the dialogue regarding the future of healthcare.

Time. Perhaps the most radical proposal advanced was by Victor Fuchs, who suggested that we radically redesign medical school to have medical students specialize two years after medical school and enter specific pathways like they do in many other countries and in other fields. I'm all for shortening dwell time for our medical trainees, but I am not so sure that young people are ready to make a serious commitment about what they want to do at such an early age. There has to be a middle ground, since at the same time, one of the most well attended sessions was "Who cares about the fourth year of medical school?" which included many insightful comments about the need for reflection and consolidation of core skills. So, clearly not all time is easily tossed aside.

Teams. Given the projected shortage of over 90,000 physicians by 2020, it is important to reorganize care into teams. While there is a lot of controversy about what to call nurses who have PhDs, that was not the focus of the meeting. It was about how can you encourage everyone to practice to their highest level of certification.

Team based competences have actually been developed by several groups and have been advanced by many schools with inter professional learning. One difficulty we face at home is that we don't have allied health professions, but we are brainstorming how to involve actual nurses and pharmacists in training medical students.

Technology. There was a lot of discussion about technology to boost medical education. There was even a technology in medical education abstract session that included podcasts, iPads and social media in medicine.

Perhaps the most interesting speaker was Chuck Friedman at the University of Michigan. He is the former technology czar of the U.S. and eloquently highlighted the need for moving medical education from rote memorization to a distributed knowledge, where the most important information future physicians will need to know is not what the information is off the top of their head but rather how to access information.

He went so far to say testing would move to "unassisted testing" followed by "cloud-supported testing," which would then merge into a pass or fail based on performance on both. I know all of us who certified or recertified recently would welcome assistance from the cloud. It is, after all, the closest approximation to real medicine. However, my hands down favorite moment of this session was when someone astutely asked what about these physicians when the power goes out or when the computer system fries. His response was simple and so spot on: "Don't get me started on the state of IT in our teaching hospitals."

It is now time for medical educators to transcend the traditional status quo and instead test novel techniques to transform medical training, not only to restore public trust but so we can also train the trainees who will treat us in the future.

Vineet Arora, MD, is a Fellow of the American College of Physicians. She is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist, supervising internal medicine residents and students caring for general medicine patients, and serves as a career advisor and mentor for several medical students and residents, and directs the NIH-sponsored Training Early Achievers for Careers in Health (TEACH) Research program, which prepares and inspires talented diverse Chicago high school students to enter medical research careers. This post originally appeared on her blog, FutureDocs.