On October 4 – 5, 2013, the American Medical Association hosted the “Accelerating Change in Medical Education Conference” in Chicago, IL., bringing together leaders in the realm of medical education for discussions aimed at “closing the gap between current physician training and the needs of our evolving health care system.”
$11 million over the next five years to fund selected innovations.
Progress on any aspect of medicine requires innovation. Innovation takes us where we have never been before. Imagine where we could be if we applied it to medical education.
Ardis Dee Hoven, AMA President
Those of you in medical school have without doubt observed the many changes implemented by your school every year. There are new systems of evaluation and new curriculum initiatives. Perhaps you have been the benefactor of a newly designed course, or maybe a course you took a year ago changed dramatically for the following year. Where are these changes going, and what is the future of your education in medical school? The AMA Medical Education Conference in Chicago highlighted such discussions, covering issues ranging from sweeping curricular changes to the impact of these changes on residents and faculty.
On the global stage, 1.8% of health expenditure funds are spent on health professional education. In contrast, the United States and United Kingdom only spent 0.5% of total health expenditure funds on medical and nursing education. Why is there such a large disparity between the United States, the United Kingdom and other nations when it comes to training health professionals? How do these differences affect the education you receive?
The discussions at the AMA Med Ed Conference emphasized that, in order for there to be a national transformation of the medical education curriculum, schools need resources. This is one reason why the AMA spearheaded a pilot study called Accelerating Change in Medical Education, giving a grant of $11 million to 11 medical schools across the nation to explore bold changes in education. The schools involved in this project include Indiana University School of Medicine, Mayo Medical School, New York University School of Medicine, Oregon Health & Science University School of Medicine, Penn State College of Medicine, Brody School of Medicine at East Carolina University, Warren Alpert Medical School of Brown University, University of California Davis School of Medicine, University of California San Francisco School of Medicine, University of Michigan Medical School and Vanderbilt University School of Medicine.
The proposals put forth by these schools call attention to a basic discord in medical education: while the needs of the health care system have changed over the past few decades, the medical education curriculum has not changed in parallel. The original Flexnerian approach from 1910, which is two years of academic learning followed by two years of clinical experience, is still applied in most medical schools around the country. Now, many medical schools and educators are challenging the concept that this is the best approach for education future physicians.
I sat down with Dr. Sherine Gabriel, Dean of Mayo Medical College, to discuss how the university plans to implement new ideas using their AMA grant. Gabriel discussed how the current medical school paradigm is isolated—each medical school develops its own curriculum and objectives. The current curriculum focuses on didactic classroom based courses and a disease based approach to medicine, which is overall a costly endeavor.
Through the AMA grant, the new plan is radically different, allowing collaboration between the 11 universities in a consortium to share resources. There is a focus on innovative delivery, using educational technology and blended learning to bring change to the system. There is a drive towards introduction of nontraditional courses, like the “Sciences of Healthcare Delivery” and “Wellness.” These classes will focus on teaching health policy and understanding the health care system,vital issues encountered by physicians on a daily basis but which are not taught in any depth during medical school. These changes are of high value and will be of lower cost to both the student and the university.
Dr. Stephanie Starr, a pediatrician at Mayo Medical Center, discussed the changes that will be made to clerkships. Usually, third- and fourth-year rotations are segmental; once a student completes the course, they move on to the next clerkship. Instead, Starr talked about introducing continuity to rotations by adopting longitudinal clerkships. One example of this integration involves alternating months of internal medicine and pediatrics (one month inpatient pediatrics, one month inpatient internal medicine, one month outpatient pediatrics, one month outpatient internal medicine). This continuity gives students a consistent role on the medical team and provides a stronger learning environment.
How do these changes affect osteopathic medicine? Associate Executive Director James Swartwout of the American Osteopathic Association explained that, “The environment is impacting both MD and DO programs … There are changing needs. Science is changing.” Swartwout added that population demographics are changing and social media outlets that did not exist 20 years ago are impacting education, requiring educators to look for innovative ways to address how people learn. The AOA is collaborating with AMA to create more cohesive strategies to save time and improve education. Some initiatives include a three-year accelerated DO program for physician assistants and a new learning model at the A.T. Still University School of Osteopathic Medicine in Arizona, where first- and second-year medical students are split into small groups and receive early training in community health centers.
The current medical education system is antiquated and is in dire need of reevaluation. Acknowledging that the changing needs of future health care workers must be reflected in their training, the very definition of an “ideal medical graduate” is being reevaluated. The current model of knowledge acquisition in a medical culture of an influx of information is not sustainable. Thus, competency-based medical training is gaining popularity over the current structured four-year medical school program, and earlier clinical exposure to the health care system is seen to be vital in giving students an edge in their education and in preparing them for their residencies.