The Medical School of Tomorrow

Posted by Pamela Leonard

The clinical simulation center of today will be the medical school of tomorrow. To address physician and nursing shortages, across the next 10-15 years, we will see an unprecedented growth in healthcare education. The question remains whether the quality of education will change with the increased volume. We think so.

Transforming medical and nursing school curricula is an imperative. The model of modern medical education was set by the Flexner Report of 1910 and has since gone virtually unchanged at many top medical schools: two years of foundational science — gross anatomy, biochemistry, cell biology, virology, pathology and the like — followed by two years of clinical studies.

The use of advanced simulation and online technologies will increasingly play a role in preparing the clinician of tomorrow. Today, we have the ability teach using authentic medical scenarios and authentic roles in “modeled” clinical settings. We can quickly organize and reorganizing the learning space to accommodate team training, a diverse set of tasks, and real-world medical problems.

With the advent of widespread electronic health records (EHR) adoption, future doctors and nurses will need to assimilate two orders of magnitude more patient bioinformation. Dynamic, simulation-driven, learning spaces offer a “safe” environment to apply personalized insight to medical procedures. Given that EHR’s usability is a key barrier to adoption, training in a simulated environment is imperative to workplace performance.

“Section 3001 of the stimulus law charges the National Coordinator for Health Information Technology with overseeing the “development of a nationwide health information technology infrastructure that allows for the electronic use and exchange of information” that, among other things, “reduces health care costs resulting from inefficiency, medical errors, inappropriate care, duplicative care, and incomplete information” and “provides appropriate information to help guide medical decisions at the time and place of care.” Under the stimulus law, each person in the United States will have an EHR by 2014.

Interestingly, the two years of foundational science, from biochemistry to gross anatomy, can be taught within the context of EHR and their use as diagnostic tools. Authentic patient data — just as data has replaced scientific theory — needs to drive the study of medicine.

Clinical Experience from Day One

For generations, medical students have spent two years in classrooms and laboratories, memorizing body parts and dissecting specimens, eagerly anticipating the triumphant third year when they would be immersed in working with actual people who have actual diseases.

Upending that century-old tradition, the aspiring doctors who started their training at New York University School of Medicine last week got to meet real patients on their very first day. But not to worry — they were armed only with laptop computers, not scalpels.

“I am possibly the worst patient in the world to have,” an H.I.V.-positive tuberculosis patient told the 162 first-year students in a cavernous lecture hall in Midtown Manhattan, as they diligently jotted down notes. “I thought I had the common cold. It went on for months.”

But in the last few years, medical schools including those at N.Y.U. and Harvard University have been doing some soul-searching about whether this lock-step curriculum creates doctors who lack humanity, who see patients as diseases rather than as whole people and who have what the medical literature calls “ethical erosion” — a loss of idealism, empathy, morality.

The result has been an increasing focus on clinical studies and, in a curriculum introduced by N.Y.U. last week, on fostering from the beginning more personal relationships between medical students and patients.

More than a year in the making, the N.Y.U. curriculum makes connections, professors say, between the relatively abstract science being taught in the classroom and the way it plays out in real life. It brings the progressive “hands-on” approach to education from kindergarten into higher education, said Dr. Steven B. Abramson, the medical school’s vice dean for education: instead of playing with blocks, the medical students are, with all due respect, learning to play well with patients.

By advancing some of the clinical component into the first two years, the new curriculum also gives students more time in their third and fourth years to study popular public health issues like nutrition and how diseases might affect people differently depending on race, ethnicity and socioeconomic status. For a few ambitious students, Dr. Abramson said, the new curriculum might make it possible to earn both an M.D. and a master’s degree in public health or administration in four years instead of five.

Many medical schools have experimented with providing earlier clinical experience, but such efforts may be gaining traction now because of incentives to promote primary care in federal health-care reform, said Dr. Atul Grover, chief advocacy officer for the Association of American Medical Colleges.

Medical Schools Are in Full Expansion Mode

Propelled by common themes of improving access to health care, producing more physicians, boosting local economies, and advancing team-based medicine, several new and proposed schools have recently received preliminary accreditation or are in some stage of development.

“One of the reasons for many of these schools is to try and produce more physicians, physicians who can respond to the changing needs of society, including those who can take care of an aging population with many chronic or complex conditions, and physicians skilled at working in inter-professional teams,” Anderson said.

“More has to change than just new medical schools, but these new institutions are really going to address both national needs, and the medical needs of their communities.”

FURTHER READING

Flexner Report

The End of Theory: The Data Deluge Makes the Scientific Method Obsolete

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