Sure, medical, pharmacy and nursing programs are always re-evaluating their curriculum, and institutions each come out with a new curriculum every so often, just to stay current. However, I’m talking about much larger fundamental changes in how medical education is conducted. These much-needed updates to medical education are already happening all around the world and even here in the U.S., and the final vision that these first-comers are modeling is expected to bring some refreshing changes to important issues such as how learners are evaluated and how prepared learners are after completing their education. These reforms are also addressing student debt and how long completion of a program takes. There’s tons of work still to be done to iron out the details, meaning everyone should stay abreast of future changes, big opportunities and further research.
Attending the Macy Conference
It was an honor as a learner (anesthesia, represent!) to see first-hand and contribute to the June 2017 Macy Foundation meeting in Atlanta, Georgia. Our focus was to discuss the future of competency based, time variable health professions education. We lovingly refer to it as CBTVHPE – yes, that’s a mouthful! Sometimes it’s shortened to competency based medical education – CBME. The conference was a gathering of high-powered educational leaders from multiple disciplines who were focused on improving the learner experience at all levels, with an aim for overall improvement in future abilities to provide quality care and have a positive effect on patient outcomes.
High Stakes Issues
The discussions affirmed many of the frustrating barriers that currently challenge learners. Some of the most important topics that came up include the balance of education versus service in clinical learning environments, the age of current curricular frameworks needing an update, and the ever-expanding list of material shoehorned into syllabi. We also didn’t forget the misalignment of rote learning and multiple-choice question exams with our initial aspirations towards direct patient care that led us into the field. In addition, conferees debated the flaws in current assessment and advancement models that create stifling competition, uncertainty about transitions, and inflexibility in matching learning to the rest of our lives.
With such high stakes issues, and a high-powered attendee list, one might think it would be hard for us learner representatives to speak up and add our proverbial “two cents”, but the collaborative atmosphere was very welcoming and everyone pitched in to make sure we considered every angle.
Teamwork and Vision
It was incredibly exciting to build credible visions of a future that promote interdisciplinary teamwork, restoration of the learner-educator relationship, reworking assessment to support learners striving together rather than against each other, and introducing mechanisms to ease career transitions and shorten training and tuition times to when competency is reached.
The high level of leadership present from many areas of health professions education, all putting in an incredible amount of dedicated thought and effort to examine existing data and consider further applications, made it clear that the final product coming out of this conference is both a roadmap through the next several decades of health profession education innovation, as well as a call to arms with actionable recommendations that could be immediately planned for implementation for the benefit of learners and patients alike.
Next Steps
The official conference recommendations, which can be downloaded here, have a list of the essentials that will be needed to bring this vision to reality for health professions education. Some aspects can be copied or extrapolated from current examples of international programs or U.S. pilots. Others will need further home-grown development before we can truly get underway.
Medical educators at all levels – from longstanding pioneers in the field to medical students and other learners who are interested in the nuts and bolts of teaching and learning – should know there is a lot of rich ground for further research and experimentation.
Call to Action
Members of various academic academies at institutions across the country: what projects seem feasible to start investigating, and how will you plan to get early learners involved to help them start their own medical education careers?
Fellow learners: what big issues or flaws have we missed, and how can we make sure the end result is a product that works for us!?
Dylan Masters is a resident physician in Anesthesia at UCSF. He loves working in the OR and the ICU, but is also very passionate about medical education.