Michael Dowling: The urgency of change

With patient demographics shifting nationwide and new technologies transforming how care is delivered, medical education has yet to receive the thorough review required to keep pace with the dramatic changes affecting our industry.

Physicians of the future need to embrace a more interdisciplinary approach to delivering care than the purely clinical focus our medical schools have cultivated for decades. Thanks to the new wave of medical schools that offer joint medical degrees and other changes in the way we train doctors, new physicians entering our hospitals and other facilities are much more diverse and well rounded than we’ve seen in the past.

Medical schools offering a mix of programs that include business, law, molecular medicine and other advanced degrees in conjunction with medical degrees will continue to become more appealing and diverse in the coming years, as physicians of the future seek more options for professional growth. Of course, diversity not only relates to a physician's course of study but to the increasingly diverse patient populations served by providers.

It is difficult to deliver effective care if you are not attuned to patients' cultural differences, and medical schools must teach physicians how different cultures approach care and perceive physicians. If they do not understand that their patients may react differently to care options as a result of cultural nuances, physicians struggle to form the genuine bond that is at the heart of every clinical interaction. It is imperative medical schools offer this kind of complementary education in conjunction with their clinical curriculum.

Perhaps the most dramatic mindset shift medical schools must embrace to adapt to a changing industry is to acknowledge that memorization is outmoded. It is unbelievable how much time medical students spend memorizing facts and figures, only to forget many of them when it comes time to learn new material for their next exam. Memorization does not imply understanding, and in an age when Dr. Google holds all the answers in a single click of the mouse, it is a waste of time. 

When education focuses solely on the diagnostic or treatment aspects of medicine, physicians are ill-equipped to reconcile that medical care is only one component of health. There are many other factors that contribute to a patient's overall health, including social determinants, geography, diet and a multitude of other lifestyle choices. To create a well-rounded care plan that keeps patients healthy and out of the hospital, it is imperative for physicians to truly understand how to engage patients and learn about all of the factors that impact the health and wellness of each individual. While technology continues to advance at a dramatic pace, it should never provide a substitute for human contact.

At Northwell, we partnered with Hempstead, N.Y.-based Hofstra University to form the Zucker School of Medicine, which welcomed its first class in 2011. In creating a pass-fail curriculum, we identified aspects of traditional medical education that we thought should be retained and modified it to create an entirely new experience for physicians in training.  It began with the concept that students don't have to sit down in a classroom and be lectured at all day by professors. At our medical school, students meet in small groups and engage in facilitated discussions guided by faculty members. However, we did not simply update the way medical students engage with academic material, but changed the very academic structure of medical education.

Usually, medical students sit through two years of classroom instruction before they engage in clinical work. We found this model counterproductive to the ultimate goal of preparing physicians for the unpredictable and challenging job of delivering care. To give them more hands-on experience, students begin training as emergency medical technicians within the first nine weeks of school. They ride in ambulances and travel to patients' homes, helping them to better understand that the patient's personal circumstances have an undeniable effect on their health. Students then follow up with these patients along the entire continuum of care to help develop a holistic understanding of how people interact with our health care system.

Understanding that the majority of care in the future will take place outside the walls of the hospital, our students gain experience in many different care sites, including ambulatory practices and community health centers, giving them practical experience starting on day one of their education. Instead of multiple-choice exams, students utilize small-group assessments to present cases on an individual basis, then test their skills every 12 weeks at our simulation training center.

Though physicians are some of the most highly educated professionals in the world, even after medical school, residency and fellowship training, the most important lessons of their career come from day-to-day experience. Even if providers are not associated with a formal medical school, hospitals and health systems are in the business of education. Organizational leaders should be mindful of the educational nature of their work and provide opportunities for their clinical teams that foster a sense of continued learning throughout their careers.

Long-established medical schools, some of which have been in existence for more than 200 years, may be hesitant to adopt changes that shake their foundations. Some have become slaves to history and tradition within organizations that move at the lethargic pace of bureaucracy. However, during an era when consumerism is spreading into all areas of healthcare, traditional medical schools must be mindful of the outside players that are disrupting so many facets of healthcare. As we have seen with hospitals over the past 15-20 years, if they do not evolve and embrace change, they risk extinction.


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