existing schools, and right off the bat, the schools’ curricula will emphasize factors such as flipped classrooms, small group learning with other health care professionals, and elements of the TIME initiative.
Moving mountains Whether starting from scratch or revamping existing curricula, putting such innovations into practice isn’t easy. Part of the reason it has taken this long, says Dr. Shine, is “medical education is very expensive, very complicated, and it involves huge numbers of people.” Dr. Farmer says the sheer logistics of coordinating with oth- er schools and making sure 600 students get the experience they need posed certain obstacles. And students should get those experiences throughout all years of their education. It also took some work to train faculty and find practicing physi- cians versed in competencies that were not a part of earlier teaching models or everyday medical practice. That’s where TMA and other medical professional organi-
zations can play a role, says Dr. Kirk. “In my own career, I had very little training, for example, in interprofessional teams when I was doing inpatient rotations. TMA and AMA have done a lot of work around how physicians can facilitate teams to help patients get the best care. So those are skills we can really be building the groundwork for in medical education.” A September New England Journal of Medicine commentary also warned that shortening medical education could mean shortchanging students and the public, but agreed that over- all reforms are necessary. According to the article, 33 schools had three-year MD programs in 1974, most of which disappeared until now. The reasons for creating such programs then were the same that some schools put forth now in that they sought to address predicted physician shortages. However, “given the growing com- plexity of medicine, it seems counter- productive to compress the curriculum into three years,” the authors wrote. “The limited opportunity for students to participate meaningfully in patient care in their undergraduate careers is the problem that needs correction; the solution is not to rush students into resi- dency after allowing them even less in- volvement with patients.” Baylor abandoned a three-year medi-
cal degree program it started 30 years ago after students found it too rigor- ous, and most ended up opting for the four-year track, Dr. Greenberg says. But whether students who completed a three-year medical degree are better or worse off, “no one has studied it, and there’s no data on what the outcomes
have been,” which he says is a sticking point with implement- ing many of the medical education innovations proposed today. Part of the problem, he says, is there are few cooperative studies among medical education institutions to find best practices. To fix that, this year, he and TMA for the first time brought together a group of Texas schools interested in such research. Their first project was surveying Texas medical stu- dents on how to use social media in medical education. They planned to present their experiences cooperating on the study at AAMC’s annual meeting in November. “If we can get a consortium of Texas schools to agree, some of these questions can be answered” about the feasibility of new medical education approaches, he said. That includes factors such as what tools should be used to evaluate students’ performance in various competencies, some- thing no one has quite figured out yet. Until now, “achievement has been defined by passing a written exam. It’s not the same with the core competencies we are seeing now. It’s easy to do a written test on medical knowledge. It’s difficult when you’re evaluating things like professionalism and communication,” Dr. Greenberg noted. Meanwhile, the cost of new technologies or other resources schools would need to implement many of these ideas remains an unknown. Dr. Kirk says her training at a three-year medical school was “a challenge, I must admit, but I came out the other side. So it can be done. But we do have to make sure that if we truncate, we are not shortchanging the public.”
TEXAS NEEDS MORE DOCTORS
As Chapter 1 of TMA’s Healthy Vision 2020 (
www.texmed.org/ healthyvision/) points out, Texas has a shortage of both primary care physicians and other specialists, ranking behind the other most- populous states in the number of patient care physicians per capita. To evaluate this shortage across specialties, TMA devised a metric
that compares the number of Texas physicians per 100,000 popula- tion with the U.S. average. It’s called the “Texas Specialty Ratio.” The closer this ratio is to 100 percent for a given specialty, the closer Texas is to the national average. Other points worth noting:
• Texas has fewer physicians per capita than the national average for 36 out of 40 medical specialty groups.
• Texas needs both more primary care physicians and more other specialists. A number of specialties have acute shortages.
• Psychiatry and child/adolescent psychiatry are among the spe- cialties with the lowest Texas Specialty Ratio.
December 2013 TEXAS MEDICINE 33
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