The medical school of tomorrow

WE SHOULD redesign the way we teach medical students. Why? Because the traditional methods that most medical schools are still using may no longer be in line with how the brain and hands of “digital-native” students work.

Before the 1980s students had inefficient tools and textbooks and walled-in libraries. Their professors’ main teaching method was stand-and-deliver lectures. However, with the cool tools of Steve Jobs and Bill Gates, modern students no longer have to carry heavy textbooks or hole up inside a library. More importantly, their brain function is not in sync anymore with their teachers who are “digital immigrants.”

In “Google Effects on Memory: Cognitive Consequences of Having Information at our Fingertips” published in Science (8/5/11), Sparrow, Liu and Wegner concluded: “The results of four studies suggest that when faced with difficult questions, people are primed to think about computers and that when people expect to have future access to information, they have lower rates of recall of the information itself and enhanced recall instead of where to access it.”

When I was in pediatric practice in Maine in the United States, my primary source of new information was pubmed.com and UPTODATE online. Before the iPad and tablets, I used to read textbooks and visit our hospital’s library.

The redesign of medical schools should make the electronic medical record (EMR) the hub of learning. Since all students have a tablet or laptop, they should be given an EMR approved by the college. This EMR is unique in that the whole curriculum can be accessed with one click or tap. The present Illness Field has all the questions that should be asked for each of the chief complaints that will figure out the diagnosis. At the Diagnosis Field, a complete differential diagnosis based on the chief complaint will automatically pop out. Each field of the history can be linked with others, so research or an outcome study of a group of patients can be done with a few taps or clicks. For example: A student or resident can look at all his or her patients with asthma and can easily find out the medications given for a certain period, chest X-ray findings, allergies, and even contact information. With all these data easily accessible, research can be done with less time and effort.

If a student wants to see how to examine a patient with asthma or appendicitis, a short video clip of the procedure can also be easily accessed through the EMR 24/7, at his or her convenience.

A number of medical schools in the United States are drastically moving away from lecture-based education and migrating to early immersion in patient-centered care. First-year students at Vanderbilt University School of Medicine are “part of the care team,” doing interviews with patients and helping explain the effects of medications. Second-year students help patients who are being discharged from the hospital return to their homes. They also assist in making discharge and follow-up arrangements.

Stephen Klasko, president and CEO of Thomas Jefferson University Health System, said: “In every other industry—business, aviation, whatever—in order to be more efficient and get good outcomes, you need to take a team approach.” So, medical students of Jefferson are assigned to nursing, pharmacy, physical therapy and other health professions, to work with a “health mentor,” a patient in the community. The team meets regularly to take the medical history and help the patient draw up a wellness plan, including reducing health hazards at home.

At Indiana University School of Medicine, a totally new approach is being implemented: “competency-based” curricula that allow students to acquire a defined skill—a shift from medical education based on the memorization of tons of information. Competency, like “professionalism,” includes respect for patients, families and other professionals. A checklist of professional behaviors is drawn up by preceptors to see if the student has met the desired skill.

At Mount Sinai’s Icahn School of Medicine, there is a supercomputer called “Minerva.” It is under the watch of Jeff Hammerbacher, who is known for launching Facebook’s data science team and, later, cofounding Cloudera, a big-data software company in Silicon Valley. The EMR of Mount Sinai’s hospital is warehoused in Minerva, with 300 million new events in just one year. From these big data, researchers can now study the pattern and behavior of diseases such as diabetes, something which has never been done before. The early finding from Minerva is showing that type 2 diabetes might have three “subclasses.” This finding could lead to different treatment.

Aside from teaching basic sciences and clinical care, progressive medical schools are adding a third-level concept: system science, or how to deliver effective and safer care, including reducing medical and diagnostic errors, understanding and controlling costs, and how healthcare is financed.

My hope is that the medical school of tomorrow will move away from stand-and-deliver lectures and memorization of facts, and migrate to students’ early involvement with patient care, using “Just-In-Time” evidence-based information aided by an “external brain” in their hands—the iPad and the smartphone.

Dr. Leonardo L. Leonidas (nonieleonidas68@ gmail.com) retired in 2008 as assistant clinical professor in pediatrics from Boston’s Tufts University School of Medicine, where he was recognized with a Distinguished Career in Teaching Award in 2009. A 1968 graduate of the University of the Philippines College of Medicine, he now spends some of his time in the province of Aklan.