Medical Schools Reboot For 21st Century
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Medicine has changed a lot in the past 100 years, but medical training hasn't kept up with modern needs. To train doctors equipped for today's fast-paced environment, medical schools around the country are tearing up the textbooks and starting from scratch. Julie Rovner of Kaiser Health News paid some of these new medical classrooms a visit.
JULIE ROVNER, BYLINE: In a windowless classroom at the University of Michigan Medical School, a small group of second-year students are hard at work. They're not studying anatomy or biochemistry or any of the traditional sciences. They're polishing their communication skills. In one exercise, Jesse Burk-Rafel and a classmate are trying to settle on who should get credit for an imaginary medical journal article.
JESSE BURK-RAFEL: I was thinking, kind of given our background and approach, that I would be senior author. How does that sound to you?
ROVNER: It may seem like an odd way for medical students to be spending their class time, but Burk-Rafel says it's a serious topic for students, who'll have to communicate life-and-death matters to patients and medical colleagues during their careers.
BURK-RAFEL: We're trying to pilot some new approaches to leadership, and that's one of them.
ROVNER: It's also a far cry from how medical students have traditionally been taught. The longtime model is known as two-plus-two; students spend their first two years in the classroom memorizing facts and the last two shadowing other doctors in hospitals and clinics. It was devised in 1910 by an educator, Abraham Flexner.
Raj Mangrulkar, the associate dean at Michigan who's spearheading the medical school's new curriculum, says it's persisted even as medicine has changed.
RAJ MANGRULKAR: I think the vast majority of medical schools still have more of a Flexnerian model.
ROVNER: But today, says Mangrulkar, the two-plus-two model simply doesn't work. For one thing, there's too much medical science for anyone to learn in two years; and for another, medicine is constantly in flux. What Michigan and many other schools are trying to do instead is prepare doctors for the inevitable changes they'll see over their practice lives.
MANGRULKAR: We shouldn't even try to predict what that system's going to be like, which means that we need to just give students the tools to be adaptable, to be resilient, to problem-solve, to push through some things, accept some things, but change other things.
ROVNER: One big change at many schools is a new focus on learning not just about how to treat patients, but about how the entire health system works.
Susan Skochelak is a vice president with the American Medical Association. The AMA is funding changes to med school programs at about a dozen schools around the country. She says the new focus on looking at the system has had an added benefit; faculty members are learning right along with the students about some of the absurdities in health care today.
SUSAN SKOCHELAK: The faculty themselves said do you know that when I schedule an MRI for my patients, we have a 24/7 scheduling. And one of my patients had to come and get their MRI at three in the morning? How do they do that? They have kids.
ROVNER: And sometimes it's not even doctors who are the best teachers about how this system works.
SKOCHELAK: If you hook them up with the clinic manager when you want them to learn about the system and what does the system do, then the clinic manager focuses on the system.
ROVNER: Another big emphasis is making sure the next generation of doctors is ready to work as part of a team, rather than the unquestioned leaders. In another classroom at the University of California, San Francisco, several groups of students are practicing teamwork by working together to solve a genetics problem.
UNIDENTIFIED WOMAN: How confident are you that that's what it is?
JOE DERISI: OK, there's been a request over here for the normal...
ROVNER: That's Joe Derisi, who heads the biochemistry and biophysics department at UCSF. Right now, he's more guiding than teaching.
DERISI: You know, I would argue that it may, you know, not be as useful as you think, but, you know, I'm obliging.
ROVNER: Onur Yenigun, one of the students in the class, says that working with his peers is good preparation for working as part of a team when he's a doctor.
ONUR YENIGUN: When I'm in a small group I realize that I can't know everything. I won't know everything. And to be able to rely on my classmates to, you know, fill in the blanks is really important.
ROVNER: The medical schools that are part of the AMA project are already sharing what they've learned with each other. Plans are in the works to begin to share some of the more successful changes with other medical schools around the country as well. For NPR News, I'm Julie Rovner. Transcript provided by NPR, Copyright NPR.