August 15, 2018

Educating the Doctor of the Future Now

Chandana Fitzgerald

Medical education needs a bit of shaking up, and medical schools are beginning to innovate to prepare new physicians for the emerging new model of care. Gone are the days of medicine being simple knowledge acquisition. The explosion of medical knowledge no longer allows physicians to keep in their mind all knowledge that is necessary to provide quality patient care. It is estimated that more than 600,000 articles are published in biomedical literature every year. If a student attempted to keep up with the literature by reading 2 articles per day, in 1 year this conscientious individual would be more than 800 years behind!

Medical education has had the same basic structure for almost 100 years: two years of studying anatomy and pathophysiology followed by two years of clinical, mostly hospital-based training. But how will this work in the current environment where care will be available outside the traditional doctor’s office or hospital setting, in home-based, retail, and virtual settings?

A survey of over 500 US Physicians by Deloitte in 2014 clearly highlights the need for training in health IT which is explained by the influx of digital tools in the training of med students and residents; and communication skills that have become more important in the consumer driven market that is healthcare today. Patients now want to engage in an equal, informed relationship with their doctors rather than relying passively on them to make treatment decisions.

Design Thinking for Value Based Care

Traditionally, design thinking is matching a user’s needs with what is technologically feasible and a viable business model. There’s no doubt that value based care is here and how. And if we as an industry are anticipating VBC to upend traditional business models, talent that sits at the intersection of expertise in medicine and business acumen is critical. VBC will affect day-to-day factors like physicians’ financial risk, profit sharing, etc. Educating physicians about new payment models is imperative, and can perhaps be carried out more easily by hospitals/ universities that are already participating in ACO initiatives. For eg, Mayo Clinic are incorporating contemporary “health systems” education where faculty teach about policy, the basics of health insurance and value based care. Cedars-Sinai offer a Master's Degree in Health Delivery Science where students are taught some of the new, real subjects such as digital health science, mobile health, health technology assessment, data analytics, and health economics.

Creating Physician Leaders and Collaborators

Collaborative, adaptive leadership abilities and generative thinking skills promote systems improvement. Today’s physician leader can connect as a peer with other physicians in the organization and help drive culture change. UCSF School of Medicine, University of Michigan Medical School and Dell Medical School at the University of Texas have modules embedded in the curriculum that teach medical students the skills they need to become physicians who are able to lead in multiple capacities. The NHS Digital Academy has started a year long digital health training course to Chief Clinical Information Officers, Chief Information Officers and aspiring digital leaders from clinical, and non clinical backgrounds so they can hone skills and behaviours required for a transformational change project within their organisation. Commissioned by NHS England, the Academy is delivered by a partnership of Imperial College London, the University of Edinburgh and Harvard Medical School.

Despite the fact that many physicians may be good communicators, they do not necessarily have the time or incentive to make communication with stakeholders a top priority. Some medical schools are partnering with other schools inside their universities—business schools, nursing schools, social science programs—in order to expose students to a greater range of care perspectives. Harvard Medical School and Harvard Business School run a joint MD-MBA program to nurture physician leaders, skilled in both medicine and management, to take positions of influence through which they will contribute substantially to the health and well-being of individuals and society.

Integrating technology into medical education

Indiana University School of Medicine cloned its existing EHR system and scrambled patient data to create the teaching version, or tEHR. The tEHR is enriched with educational content, in the form of videos, text or links to other material and by using this, students can get a sense of the value and limitations of EHRs.

The Anatomage Table is a virtual dissection surface to teach anatomy - more engaging, and less time consuming than dissecting a cadaver. Case Western opens its new health education campus in collaboration with the Cleveland Clinic in 2019, where students will use Hololens to visualize the human body and learn anatomy through virtual reality. Pediatric emergencies are high stake, low frequency. Based off actual case studies conducted and provided by the doctors of Children’s Hospital Los Angeles, Bioflight has created virtual scenarios featuring various outcomes, dialogue and events that keep students under realistic workplace pressure.Septris is a game created by a team of experts at the Stanford School of Medicine to assist health care professionals in learning to identify and treat patients with sepsis and septic shock. After playing Septris, both pre- and postgraduate groups improved their knowledge on written testing in recognizing and managing sepsis. Retrospective self-reporting on their ability to identify and manage sepsis also improved.

Recommendations from the AMA over the last few years has supported reducing the barriers for use of telemedicine in medical school education. In their 2016 annual meeting, the AMA took a firmer stance on telemedicine — encouraging medical schools to incorporate it as a core competency in their curriculum. University of Texas Medical in Galveston offers a telemedicine elective to fourth-year medical students for four weeks. The curriculum for this course addresses important issues in telemedicine: equipment and staff requirements,patient privacy, cost savings, etc. UTMB also offered the students of the course an opportunity to visit telemedicine sites and gain perspective of patients interacting remotely with providers.

Change has its limitations

Ethics: Plenty of serious ethical questions and concerns arise due to these innovations - who takes responsibility when tech fails?Limited teaching expertise: in order to successfully educate new physicians about costs, public policy, technology and leadership, medical schools need to have faculty with expertise in these areas. Do we have that in the same scale as we have students entering med school?This laundry list of interesting digital initiatives can only be applied at scale to medical practice if they are included in medical education. While these subjects are increasingly being offered as elective, short courses and discussion topics in medical school, it remains to be seen if and when they will become more mainstream.

Many of us reading this blog are doctors, doctors working in health tech, healthcare leadership, or work closely with doctors. Are you teaching or learning any of these skills and values? How is your organization prepared for healthcare as we see it today? We'd love to hear from you.