left out, says geriatrician and professor of internal medicine Lynne M. Kirk, MD. For the seventh year, faculty have formed mini-colleges within each class, now around 240 students. On day one, stu- dents are assigned to one of six colleges that they stick with throughout their four years of medical school, where they can interact more closely with other students and faculty. In each college, students are broken up into groups of six and assigned a mentor, usually a clinician, so they can discuss, observe, and practice skills such as communication, taking a patient history, and ethics.
“Our classes are very large, and we wanted to make sure that our students had relationships with faculty and that we facilitated as much mentoring as possible,” said Dr. Kirk, who is also a member of the AMA Council on Medical Education.
Focusing on competency Schools may take different approaches to revamping medical education, but they have one thing in common: They all are moving toward competency-based training.
“Instead of assessing whether students can memorize the
different causes of spasms of jaw muscles — as I was asked to do years ago — what we really want to know is, are they able to take care of patients?” AAMC’s Chief Medical Education Officer Carol A. Aschenbrener, MD, said. She believes today’s health care changes aren’t the last ones young practitioners will see in their careers, “so we need them to be able to shift how they practice, and a competency-based approach makes it easier to do that. No physician can practice the same way for a lifetime.”
She says the current century-old Flexnerian model of physi- cian education focuses largely on putting in a certain number of hours, courses, and lectures before getting practical experi- ence to complete a medical degree. Educators say the model served its purpose well in redefining and standardizing medi- cal education since that time. But given the ongoing expan- sion of medical knowledge, technology, and physicians’ role in health care, the model is hard-pressed to keep up. Competency-based training still includes education in basic sciences, but focuses less on memorization and written exams and more on regular feedback during hands-on training in skills like communicating with patients, integrating medical knowledge with practice, and training in teams, Dr. Aschen- brener explains. Given students’ penchant these days for mo- bile technology, for example, some schools have begun to “flip” their classrooms: Lectures are posted on the web as students’ homework, and class time is spent discussing and applying it. And the USMLE may be able to test students’ knowledge about diabetes, but not their professionalism or skills talking to patients about the disease. The big difference, says Dr. Aschenbrener, is that competen- cy-based education “is based on outcomes: What should the physician actually be able to do? And the second big change is, those outcomes are grounded in evidence of what is needed in the population, not what a group of smart physicians or faculty sitting around a table thinks everyone needs.”
32 TEXAS MEDICINE December 2013
The third component, which Dr. Aschenbrener acknowledg- es is tricky, is figuring out the progression of competencies and how to assess them — something her organization is working on defining. In November, AAMC was expected to release a preliminary list of a dozen or so core professional activities that she says “every single medical graduate ought to be able to do the first day of residency.” The organization also is test- ing such activities in a national pilot project with students in- terested in pediatrics.
Competency-based training would then allow schools to tai- lor the length of students’ training, although that’s not the pri- mary focus of the approach. Only as students master the core competencies are they able to advance through their education at different speeds. Drs. Berk and Lieberman also emphasized that key component of their programs.
Collaboration UNTHSC meanwhile recognized that team-based training was quickly becoming a fixture in health care delivery and a core competency for young physicians when it created the Department of Interprofessional Practice in December 2012. It takes after the Interprofessional Education Collaborative, a consortium of six national health professions associations — including AAMC, the American Association of Colleges of Os- teopathic Medicine, and nursing, pharmacy, and public health associations — that developed recommendations for core com- petencies for team-based practice. Several times a year, Dr. Farmer, director of interprofes- sional practice, helps gather 600 first-year students from its medical school and various health professions schools into in- tegrated health care teams. Through exercises like code simu- lation, faculty teach various competencies, including effective team development, communication, and roles and responsibili- ties within a health care team. Traditionally, schools “teach how to communicate with patients, but there’s no time spent on communication with each other. And one of the things that makes teams effective is a common language. We also look at what are those roles and responsibilities for each of the professions, and which stay the same and which shift based on patients’ needs,” he said. “Our philosophy is, if we train them together — which is going to be more commonplace when they get into residency and practice — they will be more comfortable with collaborative practice.” In fact, in the AAMC’s 2013 Medical School Graduation
Questionnaire, nearly three-quarters (73.4 percent) of medi- cal students graduating this year reported that their education included training in teams with other health care profession- als. That’s up from 65.6 percent in 2011, the first year AAMC began tracking the topic. New medical schools certainly have an advantage in that
they can leapfrog into competency-based teaching and other 21st-century education models. Former UT Vice Chancellor for Health Affairs Kenneth Shine, MD, says the new UT medi- cal schools he is helping launch in Austin and South Texas will probably have fewer science departments compared with
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68