Many students in the health professions find little support for the passions that drove them into health careers. In May 2016, a group of 20 health professions students, clinicians and organizers assembled on the lower level of a Chicago hotel during the Lown Institute’s annual conference to talk about new pathways. The discussion focused on right care, empathy and the social determinants of health, and further conversations led to the Beyond Illness Roundtables. This initiative seeks to more formally “Define the New Clinician for a New Century” and, in doing so, better understand the goals for curriculum reform as voiced by students. Facilitators were asked to lead open discussions centered on envisioning the “new clinician” at their individual institutions. Following are reflections from this student-centered pilot project that included over 30 participants in three different cities.
Mike Pappas and Jack Penner, two medical students at Georgetown, gathered a group of students and educators for a 90-minute discussion. Simply encouraging dialogue improved connections between students and educators, created “a space for a new dynamic to emerge,” and increased enthusiasm about ushering in a new moral era of medicine. As a result, the conversation encompassed a range of topics, spanning from student wellness to community health. For example, the Roundtable participants voiced a need to improve “community and camaraderie,” in part by rejecting the “high-achieving, score-oriented culture” of medical school. This group also touched on a critical aspect of the triple aim, investing in patient empowerment and value-based care instead of a bureaucratic or paternalistic approach. Importantly, as this Georgetown Roundtable argues, we must not simply discuss; we must also strive to definitively dismantle the “overly standardized, bureaucratic structure” of medical education with tangible action, spurring on a new paradigm in which “the fringe becomes the norm.”
A second essay from Yuli Zhu at the University of Illinois College of Medicine speaks to the need for students to better understand delivery of nuanced patient care and patient empowerment. Her group, consisting exclusively of third-year medical students, sought to move beyond the “canned answer” when trying to describe the ideal clinician, settling on the word “nuance” as a unifying ingredient. Yuli’s essay, like Mike and Jack’s, speaks to the need for increased training in patient empowerment, in which the physician fades into the background, functioning as an advocate and shared decision-maker for each patient rather than the dominant player. Educating the 21st-century clinician, it seems, involves a rebalancing of the traditional patient-physician dynamic.
In another passionate Roundtable, Dorothy Charles, leader of the White Coats for Black Lives movement and third-year medical student at the University of Pennsylvania, assembled student-organizers from different schools in Philadelphia. Dorothy also expresses her relief at having space to carry on unhinged conversation, free from the restraints imposed by the traditional medical school setting. She touches on the need for “diversity of voices and perspectives” in moving towards a definition of the “new clinician,” and her Roundtable reflects that inclusive attitude. Major focus is placed on social justice and joint action as key components of the 21st-century clinician’s efforts, channeling the ethos of Virchow while recognizing that: “This sort of education cannot be learned with a social medicine course here and a doctoring course there; it must be fully integrated throughout our education and training and remain central to our mission and practice throughout our careers.” This group further emphasizes the need for “radical action” following careful deconstruction of issues such as the “skill-hoarding” and revenue-generating models. That is, the socially-conscious clinician is more than the aware clinician, she is also the involved and active clinician who is totally dedicated to “collective, rather than individual, well-being.”
Despite the personal and unique perspective adopted in each essay, all three validate the notion that traditional medical education is lacking in key and common areas. What is consistently evident is the urgency to transform medical education — that real change must occur, and occur quickly — and we believe the onus is on us, the students and educators, to take the matter into our own hands until national medical curricula adapt to the needs of students. Students must be educated in a way that is consistent with providing 21st-century care, formally learning the nuances of social justice, cultural competency and patient empowerment. These topics are currently mere buzzwords in medical education, frequently spoken but rarely understood. We must provide students with action-based, concrete tools for filling these gaps in education, rejecting the “outside the scope of the discussion” attitude and offer students who ask “what’s next?” a foundation for accelerated action. Students and educators desire a revised and revitalized system, and their future patients deserve it.