This week we're delighted to feature an article written by our US colleague Harry Greenspun – MD, Director, Center for Health Solutions. In his 'my take' Harry discusses medical schools and their ability to prepare doctors for the new world of healthcare:
My oldest son Benjamin and I have shared a lot of great experiences, including playing in a rock band together. When he decided long ago that he wanted to follow in my footsteps and be a doctor, I knew what was in store for him. He worked incredibly hard through high school and then tirelessly in college. He suffered through organic chemistry just as I did, and, now nearing the finish line, awaits his MCAT scores. Relatively unchanged from when I took them in 1985, he will be judged on his knowledge of biology, physics, psychology, reasoning, and other pre-med requirements. With his scores in hand, he will apply, interview, and (hopefully) be accepted to medical school.
Strikingly, while the process for vetting potential medical students has changed little in the 30 years since I applied, the practice of medicine has changed dramatically. Doctors must now understand population health and value-based payment models. They must work in care teams and be able to utilize a dizzying array of new technology tools. More importantly, they must also learn to operate in a system that will not revolve around them, but will instead be consumer-centered.
We discussed this in a recent report, Preparing the doctor of the future: Medical school and residency program evolution. The expectations of physicians are changing. Instead of simply providing the highest possible quality care, many hospital CEOs want innovative leaders and clinicians, as well as employees with technology and data analytics skills. Consumers expect to partner with doctors instead of relying passively on them to make treatment decisions. And with the health care system moving toward a value-based model, physicians anticipate needing new business, health information technology (HIT), and communication skills to practice effective value-based care (VBC).
So how are medical schools evolving to prepare the physician of the future?
To prepare physicians to practice in a VBC world, medical schools like the Mayo Clinic are incorporating contemporary "health systems" education into curriculum, teaching policy, the basics of health insurance, VBC, the Affordable Care Act (ACA), and government programs.
Other schools are experimenting with new ways to integrate tech tools. Hofstra Northwell School of Medicine has students use testing and imaging tools in the traditional anatomy class to better teach how technology can enhance clinical practice. While cadavers are still used to help students evolve into professionals, looking at organs from the inside helps students learn about anatomy in practice, rather than in theory. Many schools have also been looking for ways to harness and utilize "big data" in medical education. For example, one New York University Medical School initiative, "Health Care by the Numbers," emphasizes the use of big data and technology for patient and population management. The program also allows students to track their own performance in quality improvement, safety, and value-added care.
Finally, the practice of medicine is moving beyond the traditional individualistic mentality and leveraging other clinicians' skills. Integrating patients' and caregivers' perspectives will be key to success in the future. Some schools are adjusting their curricula to incorporate more team-based learning experiences. For instance, at Hofstra Northwell students spend their first eight weeks of medical school training to become certified emergency medical technicians (EMTs) and then spend time working alongside EMTs in the community. Doing this gives them opportunities to learn how to work in teams, communicate with patients, better understand social determinants of health, and gain a greater appreciation for the different roles and responsibilities comprising the health care system.
Many medical schools are using new ways to teach about the health care system, integrating technology into the practice of medicine and helping physicians learn the leadership and communication skills required to effectively connect with patients and team members. These changes may improve quality of care while also improving the experience of receiving care.
As Benjamin awaits his scores, I can see myself in him, checking the mailbox each day. Soon he will be donning a lab coat and heading into a gross anatomy lab, just as I did. However, for him to be successful in the future, our paths will have to diverge. At some point, he will call me to tell me about something he is learning and I hope to say, "Wow, we never did that."
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