Medical Education: Lighting a Fire

1. Medical Education:Lighting a Fire

2. Learning Objectives At the completion of this session, the participant will be able to • Describe the history of Medical Education • List the challenges and gaps in Medical Education • Identify the components of the “Ideal Medical Education System”

3. The ultimate goal of medical education is to ensure that students can be transformed into the most effective deliverers of patient care that is possible…

4. Medical education seems to be in a perpetual state of unrest. From the early 1900s to the present, more than a score of reports….have criticized medical education for emphasizing scientific knowledge over biologic understanding, clinical reasoning, practical skill, and the development of character, compassion, and integrity. Cooke, Irby, Sullivan, and Ludmerer, NEJM, 2006

5. History of Medical Education

6. The Flexner Report (1906)“new” vision of medical education • Medical schools within the academic frame of the university • Faculty work in laboratories in proximity to modern, academic clinical teaching facilities • Faculty to provide students with a thorough grounding in the science and practice of medicine in a rigorous environment of scholarship and discovery

7. The Flexner Report • Students must learn by doing, must develop habits of scientific thinking and critical inquiry, and must be able to apply the scientific method to clinical problem solving. [ “competency”] • Tough medical school admission requirements • Physics • Chemistry • Biology • “INTELLECTUAL FOUNDATION • OF MODERN MEDICINE.”

8. Calls for Revision and Reform of Medical Education

9. Rappleye Report (1932)Medical Education. Final Report of the Commission on Medical Education (AAMC) • Develop learning objectives • Institutional and clinical clerkship • Go beyond knowledge acquisition and include “behavioral” elements and to emphasize fundamental clinical skills • Relate student performance assessment to the stated learning objectives • Create sound habits and methods of independent study to equip students for lifelong learning and reflection

10. GPEP: General Professional Education of the Physician and College Preparation for Medicine (AAMC) 1984 • Charge • Develop strategies for improving the general professional education of the physician • Agreement on the knowledge and skills that all physicians should possess to practice medicine in the 21st century • Debate the personal qualities, values and attitudes that those pursuing careers in medicine should possess

11. GPEP: General Professional Education of the Physician and College Preparation for Medicine (AAMC) 1984 • Final Report • All physicians should possess a common foundation of knowledge, skills, attitudes and values • Recommended that each medical school faculty specify the attributes appropriate for students graduating from its school • Adopt learning objectives for the curriculum consistent with those attributes

12. Assessing Change in MedicalEducation: The Road to Implementation (ACME-TRI Report, AAMC 1992) • Charge • Determine how schools responded to the GPEP Panel recommendations • Findings • Few medical schools had delineated a comprehensive set of learning objectives for the medical student education program .

13. Priorities of Medical Schools the Past 50 years

14. Priorities of Medical Schools • Increase in clinical practice • Increase in grants and research • Decrease emphasis on teaching and education

15. Changes in Organization and Orientation of the Basic Sciences New Basic Science Departments U.S. Medical Schools, 1980-2004 • Neuroscience • Genetics • Immunology • Biomedical Engineering • Community and Public Health Sciences • Cancer Biology • Comparative Medicine • Health Evaluation Sciences • Humanities

16. Settings for Medical Education Have Changed

17. Primarily situated in a university health care delivery system (where faculty are expected to teach from the hospital wards)

18. “New Curricula” Constantly Being Designed

19. Biomedical Ethics Human Genetics Evidence Based Medicine Disease Prevention Health Promotion Population Health Communication Skills Cultural Sensitivity The Business of Medicine Patient-Centered/ Family-Centered Care New Curricula for Medical Student Education (2000-2007)

20. If the “tattered social contract between medicine and society is to be repaired,” we believe it is incumbent on the profession to develop and field test new models of medical education. The reform of medical education will surely benefit from broad-based debate. NEJM: Series on Medical Education 2006 Malcolm Cox, MD, and David M. Irby, PhD

21. Quest for the Ideal Medical System

22. Ideal System • Create Diverse Workforce • Attract and successfully educate a diverse group of learners • Produce practitioners that provide high quality health care • Humanistic approach to medicine • Patient-centered approach to medical care • Ensure that doctors provide culturally sensitive and appropriate care, and listen and communicate effectively

23. Ideal System • Ensure learners’ demonstrate they have acquired the learning objectives set forth • Conduct rigorous assessment of learners’ abilities • formative assessment • summative assessment • Base licensure and specialty certification on physicians’ demonstrated ability to provide high quality medical care to patients

24. CHALLENGES IN MEDICAL EDUCATION • Ensuring the adequacy of the overall physician workforce • Keeping the distribution of generalist and specialist physicians fairly even • Securing a uniform distribution of physicians in the country • Increasing the racial and ethnic diversity among medical students • Aligning the curriculum with the needs and expectations of the public

25. Challenges …”major challenge facing medical education in the United States is the erosion of the clinical environment, the loss of clinical revenues and all its attendant consequences, including pressures for increased faculty productivity in an environment that is increasingly managed” Philip O Ozuah BMC Medical Education 2002

26. Initiative to Transform Medical Education (ITME)

27. The Problem • There is a critical need to improve the quality of the physician training process in order to improve patient safety and care. • To improve patient safety and care, medical education must be realigned with recent changes in the health care system.

28. Phase 1: Identification of strengths and gaps in physician preparation

29. Strengths in physician preparation • Physicians are knowledgeable and technically proficient • especially for acute disease, but less so for chronic conditions • Physicians wish to do what is best for their patients • strong commitment by the physician to the care of his/her individual patients • Patients respect physicians as credible sources of information

30. Gaps in physician preparation Physicians are NOT currently prepared to: • Self-evaluate • Assess the quality of their own practices • Be social advocates • Provide effective patient care • Be “team players” • Communicate effectively • Convey uncertainty to patients Physicians are NOT currently able to: • Make mid-career changes (specialty/practice)

31. Phase 2: Solutions to address the 11 gaps in the preparation of physicians

32. ITME: Recommendations for change in the medical education system

33. Recommendations • Change admission process • Applicant qualities: • Lifelong learning • Team orientation • Service orientation • Course requirements: • Humanities • Social Sciences • Economics • Create alternatives to the current sequence of the medical education continuum

34. RecommendationsNew Curriculum • Develop integrated curriculum • Humanism, Ethics, Professionalism • Basic and Clinical Sciences • Develop core competencies • Teamwork and Communication • Information acquisition • Self-assessment • Professionalism • Community service

35. Recommendations • Introduce new methods of evaluation appropriate to assess the core competencies • Ensure that faculty are prepared to teach • Ensure tangible values and rewards for participation in education • Support enhanced funding for medical education research, planning and delivery across the continuum

36. What’s Missing from the Ideal Medical System?

37. JAMA 2004

38. Why Don’t Professors Profess? • Lack of adequate reimbursement for teaching • Requirements for the attending physician to personally perform patient care services • Malpractice liability involved in the care clinical faculty provide • Decreased likelihood of promotion

39. Tribulations and Rewards of Academic Medicine — Where Does Teaching Fit?Jerome P. Kassirer, MD NEJM 334:184-185, 1996 “….teaching has been the Cinderella of academic medicine. As a stepchild, it has garnered little respect in comparison with that accorded its sister tasks of research and patient care. “

40. Where Does Teaching Fit?NEJM 334:184-185, 1996 • Most faculty members continue to be enthusiastic about teaching • Many have taken courses designed to improve their teaching skills • New curriculums stimulate excitement • New courses in problem-solving and decision-making promise to better prepare students

41. Where Does Teaching Fit?Rewards of Academic Medicine • Prestige of professorial appointments • Opportunity to interact with bright students, house officers, and colleagues • Exposure to the most challenging clinical problems • Involvement in important research • Recognition for one’s expertise, scientific achievements and leadership abilities

42. Our challenge: Light a fire in our colleagues … what it takes for professors to be motivated to profess. Our members (i.e., YOU) must pass on to the next generation the organized body of Ob-Gyn knowledge if the profession is to be preserved. Hence, for the profession to survive and flourish, the professors of Ob-Gyn must profess!

43. How to light a fire?

44. One way is to become Gung Ho !!!!!

45. “Gung Ho” is: • Chinese for “working together” • Slogan of WWII marine raider division • Term describing boundless enthusiasm, energy and dedication applied to a task • Recent business book by Blanchard and Bowles • All the above

46. Gung Ho!Three Principles Spirit of the Squirrel Way of the Beaver Gift of the Goose Gung Ho by Blanchard and Bowles

47. Spirit of the SquirrelWorthwhile Work • Knowing we make the world a better place • Everyone works toward a shared goal • Values guide all plans, decisions and actions

48. Way of the BeaverIn control of achieving the goal • Playing field with clearly marked territory • Thoughts, feelings, needs and dreams are respected, listened to and acted upon • Able, but challenged

49. Gift of the GooseCheering each other on • Active or passive congratulations must be TRUE • Timely • Responsive • Unconditional • Enthusiastic • No score, no game and cheer the progress

50. Are we (you) Gung Ho?Can you take that spirit back to your colleagues?