Robert C. Garrett: Redesigning medical education to create the physician of the future

Medical education must undergo a major transformation if we expect to succeed in moving the needle toward patient-centered, value-based care throughout our nation’s health system.

The physician workforce of the future will face enormous changes including dramatically different patient demographics, a tsunami of chronic illness, care migration to the community and rapid technical advances that will render some of the knowledge learned in medical school obsolete upon graduation.

So where are we in meeting these challenges? The good news is we’re witnessing – and many of us are creating – new approaches to medical education, driven by the urgent demand to address a new state of healthcare and the belief that medicine needs to be less transactional and more human.

New approaches are taking root across the country thankfully as medical school enrollment has grown. In fact, we’re on target to achieve a goal of 30 percent growth the Association of American Medical Colleges called for in 2006 in the next school year.

Many schools are connecting students with patients much earlier in their training. They are doing away the "Sage on the Stage" approach, replacing the sometimes tedious lecture with highly interactive learning.

Some are phasing out the traditional two years of basic science followed by two years of clinical work. Duke University School of Medicine in Durham, N.C. and Boston-based Harvard Medical School, to name a few, have moved to an accelerated curriculum with only one year of core basic science followed by core clinical work beginning in year two.

Innovations in medical education also include interprofessional learning so that future doctors will thrive in practicing team-based care. We know through compelling research that this approach results in improved outcomes and more cost-effective care.

A survey by the Liaison Committee on Medical Education found that the number of schools requiring interprofessional education doubled in less than 10 years – from 44 percent in the 2007-2008 school year to 88 percent in the 2014-2015 school year.

We launched Hackensack Meridian School of Medicine at South Orange, N.J.-based Seton Hall University this year to change the practice of medicine from the ground up. Given the overwhelming evidence of the importance of the social determinants of health in both health outcomes and ultimately lower costs of health care, we are emphasizing the importance of community and behavior in healthcare outcomes and delivery. Our students are connected to families and community organizations throughout their medical school years. We included many of these new strategies in our approach. Our classes are highly interactive and our partner Seton Hall relocated its nursing and allied health programs to our campus to fully support interprofessional education.

Our innovative curriculum connects students with patients in their first year. Students can also graduate in three years to help reduce debt – which is essential since medical school graduates launch their careers on average $180,000 in the red.

Our mission is clear: Our students will play a major role in paving a new path forward, one in which all people in our state, and eventually our country, can realize the same high expectations of health and well-being regardless of race, wealth, zip code or degree of education.

Here's why this is so important: we all know that 5 percent of the population consumes 50 percent of the healthcare dollar. But this is before the nation’s 76 million baby boomers completely retire. This is before our population health strategies fully bloom to blunt the impact of 100 million U.S. adults living with diabetes or pre-diabetes.

So whether we address this for moral reasons or financial ones, it’s imperative that we take a new approach.

The heart of our curriculum is our profound commitment to connecting students with families in underserved communities whom they will follow throughout their entire education.

We will graduate doctor detectives, so to speak, expert clinicians who compile facts from all spheres of patients' lives – their financial issues, transportation or legal matters, their genetics and diet and work life. So they are mindful that someone can't afford a prescription or the bus stop doesn’t connect with their clinic. Or a single mother with two children is the perfect candidate for a virtual visit because she doesn’t have a babysitter.

Atul Gawande, MD, a surgeon, writer, and now CEO of the non-profit health care venture formed by Amazon, Berkshire Hathaway and J.P. Morgan Chase, notes that physicians must open themselves to their patient’s lives and perspectives – to achieve the best outcomes.

"Regarding people as having lives of equal worth means recognizing each as having a common core of humanity," Gawande said in a commencement address at Los Angelest-based UCLA. Medical School this year. "Without being open to their humanity, it is impossible to provide good care for people."

Our class of 60 students will pair up and work in 30 teams assigned to dozens of families. The families have been selected by non-profits who are already working with them and know they are eager for this support

Each team will follow their families closely. In addition to connecting with families, students are required to attend meetings in the towns where their families reside to better under the culture of the community.

Actually, the school’s motto puts it best: The community is our classroom, the patient is our teacher.

Already, in just a few weeks into their first year of medical school, our students have inspired me with their insights.

A young woman who is paired with an elderly patient who has mobility issues put it this way: "What surprised me most about meeting my patient was that I found myself genuinely curious and caring for him as a person. It was amazing to get a picture of this man to see how different aspects of his life had impacted his health.’"

At one immersion event in Asbury Park NJ, students paired up with members of Habitat for Humanity to aid an elderly woman. They mowed her lawn, removed old furniture and trimmed her shrubs. She thanked them profusely and talked a bit about her life, working years as it turns out in one of our network hospitals.

"It made me realize there’s so much more to a patient than what you see in a doctor’s office," a student said.

Indeed. These human-centered programs, combined with traditional rigorous science, will no doubt create a physician workforce up to the challenge of a new state of medicine.

Robert C. Garrett is co-CEO of Hackensack Meridian Health, New Jersey's largest and most integrated health network.

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