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A Message to First-Year Medical Students
New York, NY
Last month, Macy President Dr. George E. Thibault spoke at Maine Medical Center to welcome its new class of students. During his talk, Dr. Thibault acknowledged that after several decades of explosive growth in health and health care, including advances in understanding basic science and developing technologies to improve diagnosis and therapy, there remains several areas of needed reform in how we train the next generation of providers.
President Thibault outlined six areas of transformation:
- Change the model of clinical education so that it is more longitudinal and community-based. Since the Flexner report of more than 100 years ago, the model of clinical education in this country has been predominantly hospital-based with rotations of 2-12 weeks duration across different clinical services and specialties. This model does not adequately prepare clinicians to deal with patients with chronic disease, which is the predominant patient population in need of care today. Longitudinal experiences allow for student continuity not only in relation to patients, but also in relation to their teachers and their sites of clinical activity. Continuity between student and teacher facilitates more meaningful feedback and developmentally appropriate coaching. Continuity of site allows students to become meaningful members of teams, to learn teamwork and to participate in care improvement activities.
- Introduce new curriculum content to supplement the basic biomedical sciences. In addition to understanding basic science, the health professional of the future will need to have competence in quality improvement, health systems, population health, informatics and the social determinants of health.
- Prepare the next generation of providers to work in interprofessional teams. There is an increasing body of evidence that care delivered by well-functioning teams leads to better patient outcomes and increased professional satisfaction. Yet our educational model has been to keep the professions apart until they are fully formed, and this has resulted in less than optimal understanding across the professions, poor communication and non-productive stereotypes. In order to prepare all of our health professionals to work together, all students should have some portion of their educational experience with students from other professions. True interprofessional education involves learning about, from, and with the other professions in active learning experiences with a goal of promoting collaborative care.
- Individualize education with a true competency-based approach. Not all learners achieve each required competency at the same pace, and that variability – both faster and slower – needs to be acknowledged in our educational process rather than having time in place be used as a surrogate for competency. We know that we are preparing physicians for different career pathways, so we should encourage and facilitate educational experiences that better prepare students specifically for their future careers.
- Spend more time developing faculty as teachers and as innovators in education. Across the country in medical schools and major academic medical centers, the growth of research and clinical care (both important societal goods) by faculty has squeezed out education. We need to recognize teaching and educational scholarship as equally important academic pursuits.
- Be more engaged and accountable to the public we serve. The ultimate goal of medical education is to improve the health of the public. Health providers of the future are the vehicle by which we achieve that goal. Helping students become great providers is an intermediate goal on the way to improving the health of the public, and we won’t know if we are succeeding or not in this mission unless we have public input. We need the feedback loop from the communities we are serving to guide us in continuing to make necessary changes in our educational process.
Before he left the stage, Dr. Thibault left the students with this message:
“All of these changes will require a culture change for our educational institutions and our profession as a whole. We must move from being profession-centered to being community and patient-centered. We must move from our traditional hierarchical system to one that is truly collaborative across the health professions. And we must bring education and health care delivery closer together united with the common goal of achieving the quadruple aim of better care for individual patients, better health for the public, better use of resources and greater professional satisfaction.”