AUSTIN — There have been few changes to medical education since Abraham Flexner established the two years of sciences and two years of clinical cirriculum in 1910. With emphasis on value-based care, managing populations and chronic diseases, this shift in care must start with reimagining medical education for future physicians.
A panel of physicians gathered during a morning session at the SXSW Conference to discuss the need to redesign medical curriculum, and that starts with a realization that “the competencies physicians need to be good health care providers and leaders are different now than they were ten or twenty years ago,” said Susan Cox, M.D., executive vice dean for academics, chair, department of medical education, Dell Medical School, the University of Texas at Austin.
She opened up the panel discussion, which included Bon Ku, M.D., associate professor and the assistant dean for health and design at the Sidney Kimmel Medical College at Thomas Jefferson University, Erin Kane, M.D., physician, department of emergency medicine, Johns Hopkins, and Sarah Kim, M.D., associate professor, University of California San Francisco, by asking the panel what trends in health care will affect students and residents the greatest?
How much does that cost, doc?
Kane raised an issue that was discussed during other health sessions, and that is the lack of information physicians have about cost to patients. Many want to know how much a scan will cost or which pharmacy has the cheaper price for their prescription. She offered an analogy on the problem.
“If you took your car to the shop and the mechanic told you, ‘I’m going to keep your car for three days, it’s going to cost a lot, but I can’t tell you exactly how much, and at the end of that it may or may not run better — that’s basically what we do in health care today,” she said.
Giving medical students the building blocks to think about value is needed. That starts with educating about health insurance, underinsured versus uninsured, co-pays, and co-insurance, she said. And being able to inform the patient why a specific recommendation will be valuable to them will go a long way in demonstrating quality and value to their health.
A heavy portion of the move to value includes a shift from managing acute care to chronic conditions, but many medical schools aren’t incorporating that shift into their curriculum. Greater interaction between providers and patients is required to manage these conditions, something shared-decision making and communication skills can help with, said Kim.
Though she does see more medical schools educating future physicians on how to better collaborate with patients, there’s not enough emphasis on teaching how to overcome the disconnect between the medical outcomes physicians strive for, say reducing hemoglobin a1c under a certain threshold and what patients are hoping to achieve, such as getting through the workday without a sever hypoglycemic event.
“Physicians need to work more toward looking at the world through their patient’s eyes and really collaborate with them, because if you don’t do that, you’ll never get anywhere,” said Kim.
During medical school and in practice many interactions are done in clinics, and physicians or students often fail to see the “human behind the patient,” said Ku. Therefore, at Sidney Kimmel Medical College, where Ku works, they have started human-centered design programs to understand that point of view, and often include patients when designing a new process or intervention.
Late in the session, Cox asked the panel what still needs work in regards to preparing medical students for the real world? A top priority should be training future docs to address the health of their community, Ku said.
“I’m an emergency room physician, so I wasn’t trained to think about making my community healthier … and it’s just this revolving door of the same patients who come in and out.”
Educating physicians on how to collaborate with members, and organizations in the community should be incorporated in curriculum, suggested Kim. Having students work with local governments to change local policies even for something simple like keeping the lights on in parks for patients to exercise at night would help fight obesity, she said.
But, if we want to see these changes in care, it’s not going to happen overnight, and will require a fundamental reimagining of medical education.
“The future of health care won’t be changed unless medical school is redesigned,” stressed Ku.