Medicine is “no longer what the doctor wants,” Dr. Lynn Crespo said. “It’s what the patient wants and needs.”
Crespo, Associate Dean for Education at the University of South Carolina School of Medicine-Greenville (USCSOM-Greenville), believes that medical education should reflect this change. USCSOM-Greenville, which opened its doors to students in 2012, is one of many new medical schools that is changing the way that physicians-in-training learn their profession.
For decades, teaching medical students in the United States has relied on a tried-and-true method: two years of lecture-based classes in the basic sciences followed by two years of clinical learning. It is a method that is based on the reasonable assumption that students must learn the basics before applying their knowledge.
However, some schools have recently been challenging that traditional system in favor of newer ones with a slightly different focus: coaxing eager minds into becoming not only knowledgeable, but also compassionate and team-oriented.
This new focus comes as a result of the changes in health care delivery around the country. It is an effort to shape the future of medical education and anticipate what will become standard for US medical students.
“I think much more about how care is delivered and how it will change and continue to change,” said Dr. Paul Katz, Founding Dean of Cooper Medical School of Rowan University (CMSRU), which opened in 2012. “We can’t educate people to practice the same way we have been before. Now, it’s about value rather than volume. It’s not just about doing things; it is about doing them the right way.”
Many schools have embraced the theory that much of “doing things the right way” is dependent on the ability of their students to empathize and connect with patients. At USCSOM-Greenville, Crespo said that they are trying to impart this understanding of patients through a new type of program.
“Our students undergo EMT training and certification before starting the rest of the curriculum,” Crespo said. “Throughout the first two years, they serve a shift per month as EMTs to the community.”
Although the knowledge that comes with the training is practical and useful to a medical student, Crespo states that there is a more important reason that the students are involved in this program.
“We want the students to understand that patients don’t start at the door of the hospital, and you’re not done with them when they leave the hospital,” Crespo said. “They get to see the environments in which the patients got sick and where they’re going back to.”
At CMSRU, students serve at a free clinic once a week, seeing patients under supervision of resident and attending physicians. Through this program, students are meant to draw more close connections with their patients and come to an understanding about the community they serve.
Aside from compassion for patients, the programs at both USCSOM-Greenville and CMSRU incorporate another important teaching point that they hope their students will embrace: team-based learning.
“It used to be that the physician was the captain of the team,” said Katz. “Now the physician is a member of the team, along with other health professionals. When you see how care is developed, it’s becoming less hierarchical. Now it’s important to have a team approach to problem solving.”
Although team-based learning has been growing slowly in popularity, newer medical schools see the team approach as the future of medical education, and they are putting an emphasis on that particular teaching style. At CMSRU, Katz is enthusiastic about the Active Learning Groups (ALG) that base learning on the team-based approach. Students are divided into groups of eight and are given a case per week through which they discuss the basic sciences that they learn in the first two years.
“It’s not about individual success; it’s about collective success. Small groups foster that,” Katz said. “It’s about learning to work with people who come to the table with different skill sets and knowledge.”
USCSOM-Greenville uses a similar case-of-the-week format, but Crespo said that a lot of emphasis on teamwork is also elicited through the EMT service program.
“It helps students learn to work as a team because EMTs and paramedics actively work together,” Crespo said, “and it also helps with the type of communication for handoffs, dealing with people and being comfortable with patients and patients’ families.”
As medicine becomes more of a patient-centered, team-provided service, medical education must adapt to adequately prepare medical students. New information delivery methods are necessary to help students themselves adapt to a changing professional environment. And, although schools are trying to do this in a variety of ways, there are many obstacles to overcome.
Although Katz and Crespo are both enthusiastic about the changes that their respective schools are enacting, they both admit that as new schools with new methods, they have something to prove. Without long-term measures to determine the success of new curricula, their methods cannot be confirmed as a step forward, a step back, or just as successful as traditional methods.
Crespo argued that one downside of these new formats is that “when things get tough, it’s easy to say ‘people are surviving doing it this other way so easily’ and to fall back on the old ways. You have to constantly motivate and stay motivated.”
However, students are responding positively to these different ways of learning the art and science of medicine in the United States, and that has encouraged schools like CMSRU and USCSOM-Greenville to continue chasing their desire for innovative and progressive learning formats. According to educators in these environments, new schools are arguably the bellwethers of the future of medical education. In conjunction with the adaptations of well-established schools, medical education is in the process of a big change.
On the horizon, Katz said he expects massive open online courses (MOOCs) to take off in the coming years. Medical students around the country are already using some MOOCs such as Khan Academy videos to supplement their study materials.
“Do you think we need 141 medical schools teaching the Krebs cycle differently from one another?” Katz asked. “If we can get the best Krebs cycle person doing the best Krebs cycle lecture, then why shouldn’t we all use that one?”
Crespo agreed with the sentiment that “flipping the classroom” is going to become something that is used around the country. Both CMSRU and USCSOM-Greenville use this format to some degree already.
“Online self-learning modules with abbreviated didactic information allow students to interact and help each other,” Crespo said.
Additionally, Crespo added that there will be a movement to develop a smoother continuum of undergraduate and graduate medical education. Crespo argued that these two phases of medical education cannot be seen as “snapshots in time.” That traditional view has led to an environment where “we really haven’t prepared [students] to enter residencies, so day one of residency is a whole different experience than medical school,” Crespo said.
Perhaps these new schools represent a window into the future of medical education. Their efforts are in the name of progressiveness, and their methods aim to prepare students to be doctors in the health care environment of tomorrow instead of the one that is experiencing so much stress today. Well-established schools have also begun to adapt and introduce innovative changes into their curricula.
Though the system of training doctors that has been in place for decades has sufficed so far, many would argue that it is not sustainable in a profession that is so quickly evolving. Time will tell which new teaching formats will succeed and which will fall by the wayside.