Medical schools aim to make curriculums mirror the real world

Dr. John Raymond, CEO of the Medical College of Wisconsin in Milwaukee, thinks there is an critical element sorely missing in the training of aspiring physicians: compassion.​

Since there is an assumption that all doctors are inherently compassionate and caring individuals, traditional medical education doesn't outright address its importance in patient care, he argued.

But recently compassion seems to be getting lost as doctors face more administrative burdens and an increased emphasis on clinical productivity. "These pressures can dehumanize medicine," he said.

Raymond isn't the only one concerned that the growing burdens doctors face are harming their crucial relationships with patients. Leaders from six other medical schools have joined the Medical College of Wisconsin to form a network aimed at addressing this conundrum well before doctors begin their careers.

Through the National Transformation Network, which officially launched in June, the schools will work together to develop a curriculum focused on three components: character, competence and caring. The network was established with the help of a $37.8 million grant from the Kern Family Foundation, a not-for-profit that funds educational initiatives. The other participating schools include the Mayo Clinic School of Medicine, Geisel School of Medicine at Dartmouth, UCSF School of Medicine, Vanderbilt University School of Medicine and the University of Wisconsin-Madison School of Medicine and Public Health.

Raymond quickly acknowledged that clinical competence isn't lacking in medical education, emphasizing that medical schools do an excellent job of equipping future doctors with the scientific background and clinical skills needed to treat patients. What's lacking is making sure aspiring doctors have the right intentions and mindset to care for the nation's vulnerable or sick.

The lack of focus on these qualities during medical school ultimately hinders efforts in the healthcare industry overall to provide care that is more patient-centered. "We need to make (medical school) feel more real and more directly related to the patient," Raymond said.

How exactly the National Transformation Network will change curriculums is still being worked out, but there will be a strong emphasis on ensuring students appreciate and understand the importance of compassion to patients, Raymond said. This will likely take the form of more one-on-one time with patients and an emphasis on personal wellness and burnout, which plagues a majority of physicians today.

The transition won't be without challenges since it requires not only a change in curriculum but a change in mindset. "You really can't change students without changing the faculty and curriculum and even the culture, which is probably going to be the hardest part," Raymond said.

The network isn't the only major collaborative aiming to revamp medical education. Medical schools across the nation are re-evaluating how they prepare future doctors for their careers. Yet the leaders behind this push readily admit change isn't easy. Because there is so much upheaval in healthcare—whether it's new payment models, increased use of technology, the push to consumerism, and more—faculty members have a hard time keeping up with it all and finding the best ways to teach new concepts. At the same time, traditional mentalities on what medical education should look like can be tough to break.

"There is this feeling of, boy you're impeding on my territory," said Dr. Jed Gonzalo, associate dean for health systems education at Penn State College of Medicine, regarding how some faculty react to reforms in medical education. Gonzalo has been working with the American Medical Association to drive more innovation in medical education curriculum. He said he hears from skeptical professors who say change isn't necessary. But Gonzalo argues that it is. When he was in medical school roughly 15 years ago, less than eight hours of his education was dedicated to working with electronic health records and informatics. And, he admitted, he only truly understood the difference between Medicare and Medicaid after nearly 10 years of schooling. "We are not preparing physicians," he said.

Penn State is one of 32 schools that are part of the AMA's Accelerating Change in Medical Education Consortium, which launched in 2013. The AMA has given about $12.5 million in grants to the schools to fund their innovative approaches to curriculum reform.

The participating schools also embrace an evolving discipline dubbed health systems science by the AMA. The association recently released a textbook aimed at helping schools that are not part of the consortium adapt the new curriculum, which focuses on aspects of healthcare delivery not currently addressed in-depth during traditional medical education. Topics range from population health management, healthcare financing and reform, to behavioral and social determinants of health.

The approach is intended to be applied along with the scientific and clinical competencies already established in medical education, said Dr. Susan Skochelak, group vice president for medical education at the AMA. She co-authored the textbook with Gonzalo and four others.

The textbook can help medical schools that want to revamp curriculum but don't know how or where to start, Skochelak said. A big challenge is that teachers are still learning and adapting to changes in the industry. This learning curve can make it hard to know the best ways to teach students new skills, she said.

The Brody School of Medicine at East Carolina University, one of the schools in the AMA consortium, used its $1 million, five-year grant to prepare its faculty for curriculum changes before they were adopted.

In 2013, the school implemented an education program for faculty called the Teachers of Quality Academy. The faculty participated in group and online courses that addressed quality improvement strategies, population health, interprofessional team work and leadership.

"We recognize that healthcare is changing and we need all of our faculty to understand the basics of health system science to lead change," said Dr. Luan Lawson, assistant dean of curriculum, assessment and clinical academic affairs at Brody.

The movement doesn't stop with large, multi-school collaborations. Medical schools new to the scene have also adopted innovative curriculum. These schools have the advantages of a fresh perspective and the opportunity to learn from their more established peers.​

These efforts by East Carolina, Penn State and the Medical College of Wisconsin are no longer unique. "There is no school that hasn't change their curriculum substantially," said Alison Whelan, chief medical education officer of the Association of American Medical Colleges, which represents all 147 accredited U.S. medical schools.

Take the Cooper Medical School of Rowan University in Camden, N.J., for example. The school, which opened in the summer of 2012, researched and reached out to the most forward-thinking medical schools across the country to establish a curriculum they hope will prepare its students for the future of patient care, said Dr. Annette Reboli, interim dean of the school.

During their first two years at Cooper, students only have about six hours of lectures a week. The rest of their time is spent in small groups where they work together to solve a fictitious patient case meant to mimic a real-life scenario. The students not only work together to determine the diagnosis and best treatment for the patient, but social determinants of health are also addressed. A case might feature an uninsured diabetic patient with poor access to transportation. "The students learn how to navigate the healthcare system," Reboli said.

Teamwork is embedded throughout the curriculum. As part of the ambulatory clerkship program, medical students work with the pharmaceutical, nursing and social work students to run a clinic that's within Cooper University Health Care, the health system affiliate of the school.

Reboli said the Cooper Medical faculty felt it was important for medical students to be exposed early on to different healthcare professionals and their roles because that's where the industry is headed. Doctors increasingly find themselves working in teams with nurses, pharmacists and others to achieve coordinated care, yet that experience is sorely missing in traditional medical education.

The school also emphasizes the importance of population health by requiring each student to complete 40 hours of community service a year. This can take many forms, Reboli said. For example, one student coached a soccer team while another helped teach English as a second language. The experiences allow students to understand their patients and the community of Camden better, Reboli said.

At the Kaiser Permanente School of Medicine, slated to open in 2019, students will be asked to come up with solutions to a variety of complex health issues such as low immunization rates or falls in the inpatient setting.

"Part of what we have to do is show medical students how to be leaders of change," said Dr. Edward Ellison, board member of the school and co-CEO of the Permanente Federation, a Kaiser subsidiary connected to its medical groups.

The students will also benefit from the school's affiliation with Kaiser Permanente, the not-for-profit health system based in Oakland, Calif., Ellison said. Students are expected to shadow doctors, work in the more than 30 safety-net clinics that are part of the Kaiser system, and visit patients in their homes after discharge.

Kaiser's move to open a medical school represents a growing trend in medical education. Health systems are increasingly working with their affiliate medical schools to brainstorm how students should be trained, said Leah Gassett, a principal at ECG Management Consultants with an expertise in medical education.

"Health systems are recognizing they would like a seat at the table so the graduates are prepared to be effective clinical leaders of their systems," she said.

But Ellison said Kaiser's foremost goal wasn't to foster a pipeline of future doctors to work at the system—though they expect some students to stay at Kaiser to pursue their residency. Instead, the main driver was a desire to be part of the changes happening in medical education.

"We want to contribute to the broader evolution of medical education," he said. "We see this as a way to learn and share outside our system."