HELP THE MEDICINE GO DOWN
Training a new generation of MDs with empathy
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The future of medicine will be team-based, data-based and improvement-based.” — George C. Mejicano MD, MS., Oregon Health & Science University.
students who are thoughtful and reflective, and who demonstrate good communication.
“The ones who get accepted are more holistic in their approach to life,” says Wilkerson.
So what should a teenager interested in medicine do in the ten years before applying for medical school? “Don’t just study science— study whatever you’re interested in,” says Wilkerson. “The ability to pursue deep understanding is what we’re looking for,”
Kids should try to develop a rounded and strong sense of self. “Work with people and study people,” she adds. “Volunteer in the community. Learn another language.”
UCLA is building a simulation center where students can work on anatomically correct manikins. For example, in addition to students learning simple but essential skills such as intubation, they can deliver a rubber baby from inside a rubber woman. Modern medical schools are becoming a lot more hands-on in that sense.
With a store of hopeful Hollywood actors nearby, UCLA also has a large program using “standardized patients.” Actors work from a script and pretend to be patients, including, if necessary, the wearing of bruise make-up. Medical students have to learn to interview, assess and diagnose “patients,” and hone their people skills on the less-cooperative ones.
Similar things are afoot at the prestigious Oregon Health & Science University in Portland, Oregon.
George C. Mejicano, MD, MS, is the senior associate dean for education of the OHSU School of Medicine. As the school revamps its curriculum, the focus is on competency.
“The old model of medical education relied on a steeping process,” says Mejicano. “You leave the teabag in for a set amount of time but you don’t know if it’s done. The thinking now is, time on task doesn’t matter.”
So it’s not important if a student learns best through listening to podcasts, reading or through hands-on tasks, since the school provides multiple learning formats for all levels.
“I asked the CEO of a healthcare system, in 20 years, what kind of doctors will you employ?’” says Mejicano. “He said those with skills in emotional intelligence, and predictive analytics.”
Other things OHSU’s medical school is teaching are leadership and professionalism.
“A lot of the terms make the doctor sound like the captain of a ship. For example, we give ‘orders.’ But said from hierarchical leadership, there is service leadership and team leadership. Encouraging a junior person to speak his mind to prevent an error is leadership,” says Mejicano. “The future of medicine will be team-based, data-based and improvement-based.”
Wilkerson of UCLA recently attended a jam-packed AAMC-led seminar on the so-called flipped classroom. In the flipped classroom, students study lectures in their own time at home on video, and then work on problems with the teacher in the classroom. Thus, homework and class time have been flipped 180 degrees, and many students find this leads to better learning. Students can definitely expect more remote, screen-based learning in the future, and they will have to be able to manage their time well.
Ronald Drusin, MD, vice dean for education at Columbia University College of Physicians and Surgeons, says doctors have to stay abreast of current trends.
“We teach people how to think, to ask questions and to make critical evaluations of the medical literature,” he says.
The students he sees applying to medical school haven’t changed much from doctors past. “They are very bright, interested in discovery, and are committed to service and helping people.”
He adds that the college doesn’t choose only people who have undergraduate science degrees.
“We’re interested in accomplished people — they may have majored in social sciences or humanities,” he says.
Columbia is happily adapting to the “Just Google It” generation. The key is teaching students to ask the right question and search the right database.
“The ability to find answers to questions and to locate new publications now is extraordinary,” says Drusin.
Columbia students can study the emerging field of narrative medicine, which uses reflective writing after a patient encounter. They can be mentored by any good writer at any of the schools. All medical schools now emphasize small group learning as the most-efficient way of mastering theory and practice, problem-solving skills and communication skills.
At Columbia, for example, anatomy just got scarier. Students dissect a cadaver as a team and have to cooperate because they receive a group grade.