Changes in Medical Education -- 50 Years Ago,Today and Tomorrow

Looking Back and Ahead

CONGRATULATIONS TO OUR NEW MEMBERS

• “ There are two kinds of people; those who do the work and those who take the credit. Try to be in the first group; there is less competition there.” – Indira Gandhi

GOALS OF THE ACADEMY OF MASTER EDUCATORS

• RECOGNIZE AND REWARD OUTSTANDING EDUCATORS

• Support faculty development for education • Promote the academic advancement of educators • ENCOURAGE IMPLEMENTATION OF INNOVATIVE

EDUCATIONAL PROJECTS • Promote curriculum design and reform; • Foster educational scholarship and research

In this talk I aim to ……

• Reflect on medical education when I was in medical school

• Contrast my experience with our current educational program

• Think about medical education of the future• Provide a few ideas for innovations in hopes that

they will stimulate you to --• Develop your own ideas and help put them into

practice working through your Academy

Think back to1951

TIME MAGAZINEJuly 16, 1951

Korean War continues

Harry Truman was President

Will there be a polio epidemic in 1951? The National Foundation for Infantile Paralysis said the U.S. must raise its idea of “normal” polio incidence from about 10,000 a year to perhaps 30,000”. (Actually 28,000 new cases were reported.)

8Freshman Class at UTSW, 1950

10Freshman Class at UTSW, 1950

12Freshman Class at UTSW, 1950

14Freshman Class at UTSW, 1950

http://utswlibrary.contentdm.oclc.org/cdm4/item_viewer.php?CISOROOT=/p13044coll6&CISOPTR=348&CISOBOX=1&REC=2

Medical Education 50 Years Ago and Now

Then

• Lectures all morning , six days a week

• Laboratories all afternoon , (only 4 days a week) including “dog labs” as well as anatomy, biochemistry and others

• No clinical experiences until physical diagnosis at end of 2nd year

Now• Fewer lectures – streaming!• Fewer laboratories• Clinical approach to basic

sciences• Several small group sessions• Problem-based learning• Team based learning• Introduction to Clinical

Medicine

Medical Education 50 Years Ago and Now

THEN• Long clinical rotations

filling 3rd and 4th years (e.g. 5 months of Medicine in the 3rd year

• More direct hands-on experiences such as first assistant at surgeries

• No electives• Summer vacations

NOW• Evidence based medicine• Standardized patients and

simulations• Scholarly concentrations• Emphasis on competence • Shorter required clinical

rotations• Many electives including

one in 3rd year

“New Flexner Report” 101 Years Later General Recommendations

1. Standardize learning outcomes but individualize processes

2. Provide early clinical immersion and later revisiting of the basic sciences

3. Develop habits of inquiry and self-improvement4. Address professional identity formation

explicitly (Cooke, Irby and O’Brien)

Some Possible Ways for the Academy to Support Expanded and

New Educational Efforts

PARTICIPATION IN ONGOING EFFORTS Curriculum Integration

A. Students are the only ones who know our educational program in detail. Develop a presentation to inform faculty about the content of our curriculum

B. Curriculum mapping (see Len Cleary) C. Fostering interactions between pre- clerkship courses and clinical years

Participation in Ongoing Efforts (cont.)

Support scholarly concentrations. Increase the number of them; assist the faculty in developing appropriate learning objectives.

Develop a scholarly concentration in medical education. (MU)

Provide your own ideas about how you can support these ongoing educational efforts

DEVELOP BRAND NEW INITIATIVES

“Every really new idea looks crazy at first” Alfred North Whitehead

_______________________________________ Develop a longitudinal clinical experience

throughout the four years . For example students follow a family from matriculation until graduation

Innovations (continued)

Imagine (and implement) an educational program with no or few lectures(JMcM)

Encourage students to develop pathophysiology learning modules centered on real patient problems(JMcM)

Innovations (continued)

• Following the lead of other medical schools

develop 4 to 8 student academic societies to provide a smaller community where everyone feels heard. These societies could provide academic and personal advising, career planning and a social unit.

Innovations (continued)

Evaluate and improve the teaching of evidence-based care :Determine and assure the appropriate use of the electronic medical record by studentsAssess the educational advantages and disadvantages of computerized decision support systems

Innovations (continued)

Define and explore the role of “critical thinking’ in medical education

It’s a hot topic in medical education and is the has been a topic of a recent Millenium Conference sponsored by the AAMC and the Shapiro Institute in Boston

One Definition: “Doctors thinking about how doctors think using the formal approaches of logic”

Innovations(concluded for now)

MOST IMPORTANTLY: Develop and share your own ideas.

HINT “The best way to have a good idea is to have a

lot of ideas and throw the bad ones away” --Linus Pauling

What next?

Join with other members of the Academy to share your ideas and develop ways to implement them.

Contact Margaret Uthman who chairs the Development Committee or Gary Rosenfeld our President to find out how the Academy can help implement your ideas.