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The interview

Fueling Change in Medical Education

05.01.13 by Paul Barr H&HN Senior Writer

A Q&A with Susan Skochelak, M.D., who's leading the American Medical Association's $10 million hunt for ways to change physician education for the better.

SUSAN SKOCHELAK, M.D., is one of the leaders of a $10 million American Medical Association project seeking ideas from medical schools on how to remake their education process. Skochelak, who is both AMA group vice president of medical education and director of the association's Center for Transforming Medical Education, sits on a 13-member panel overseeing the initiative. The effort recently invited 31 of 119 interested medical schools or medical school consortia to complete detailed applications on how they would fulfill the mission of the project, called Accelerating Change In Medical Education. | Interviewed by Paul Barr

Why is this project necessary? Why couldn't medical education just transform itself naturally?

Skochelak: Medical education is changing all the time. It's not like nothing has happened. However, most of the changes that occur are around the things that have to do with curriculum, or certain content areas, but the American Medical Association joins a number of other groups that know that there are gaps occurring in the way we train our physicians. The American Hospital Association, through its Physician Leadership Development Program, put out a white paper talking about those gaps. Physicians are not ready to enter the practice world when they finish training. They don't have enough understanding about how to work effectively in teams. They don't understand enough about the health care finance system; what their role is vis-à-vis generating charges, those kinds of things. So, for about 10 years now, there's been general agreement that changes are desired; they just haven't happened yet.

The effort seems a little open-ended. Is that the intention or is there some direction you'd like to see the suggested transformations go?

Skochelak: There are very clear directions that we've set forward to work in partnership with the medical schools. So you can imagine there are lots of ways that you could think about changing. But, we selected dimensions that make sense for our strengths and the strengths of the schools and their readiness for change. An example would be the fact that students get very little information about understanding quality improvement, performance improvement, enhancing patient safety. Physician-led health care teams — how do you really work? You're not alone, you're with the whole team all the time. How do you be an effective leader? How do you enhance the opportunities for patients' outcomes to be the best that they can be? We're selecting schools based on criteria that we told them before the 119 submitted their applications. Now they're developing those ideas in a more sophisticated way, so we can select the best of those.

What would you expect to be the biggest obstacles to getting these changes to work?

Skochelak: Medical schools want to change. It's not [as though] you have to put a stick out there and say you're not doing a good job — they are doing a good job. I think the ideas that they came forward with were very exciting. From their standpoint, one of the biggest obstacles is the opportunity to develop, and we're providing the funding so that they have, over five years, the time to design, implement and develop the programs, get them all in place. On the macro level, some of the challenges have to do with regulation and funding of medical education in general — how many slots we have for residencies, how you enter a residency — and some of those things we also will be working on.

Will possible federal funding cuts to medical education affect the project?

Skochelak: No, this project is very much independent from that in terms of our funding, and the federal funding cuts that would be affecting medical schools and health care centers are very important, but not directed in this area.

How did the AMA come up with the number of $10 million? That seems like a lot of money for this kind of project.

Skochelak: We did research and benchmarked to see what other foundations or other organizations are doing. I did a number of interviews over six months with deans and other leaders of health systems and health care as a way to say, "What's the right amount that would help you get to where you want to be?" And it's a five-year award for each school, so we'll have about eight to 10 schools, and each of them would receive funding for of about $200,000 a year.

What about population health?

Skochelak: That's very much a part of this project and it has to do with understanding different systems of care. Physicians need to understand within the system of care how they can improve the health of populations. It's not just one patient at a time. That patient-doctor encounter is important, but what we're all working on together with the patients — physicians, nurses, hospitals, everyone — is to improve everyone's health.

You've invited medical students to submit their own ideas using social media.

Skochelak: It's been exciting, because the American Medical Association has the largest medical student organization in the United States, and they're very involved, very active. Many are outstanding leaders; in fact, we have two medical students on our selection panel to ensure that the voice of the students and their viewpoints are well-represented. . They're in the middle of the education and I think they have a viewpoint that is unique and needs to be listened to.

Why is the AMA focused on medical schools?

Skochelak: We started in our history focused on medical schools, and we continue to have a role with medical schools through the accreditation process. Our organization and our sister organization, the Association of American Medical Colleges, together sponsor the accreditation group that makes sure that all medical schools in the United States and Canada are up to the standards that we've set. So, our history is with medical schools but, as importantly, we work across the continuum. We represent the practicing physician, we work with residents and residents-in-training, so this initiative starting at medical schools spans in both directions. It will affect the kinds of students who are admitted to medical schools, and it will change the way in which, now that they're prepared differently, they're leaving medical school, entering residency, and then, ultimately, being well-prepared to practice as they go out into their full career.


THE SKOCHELAK FILE

C.V.: A former associate dean of academic affairs at the University of Wisconsin School of Medicine and Public Health, Skochelak led major innovation designs in the school's curriculum. AShe is a family and preventive medicine physician, she has led or co-led and has done research in medical education, minority health and health disparities.

SORRIDI!: In her spare time, Skochelak has learned how to speak Italian and also enjoys photography. "I'm drawn to architectural structures, natural scenery and interesting people."

ON THE TRAIL: She loves to ride her bicycle through the hilly woods of Wisconsin, which she enthusiastically endorses. "You haven't lived 'til you've done the "Cheesehead Trail."

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