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Accelerating Change in Medical Education Student Discussion Questions

The AMA is initiating a national discussion on narrowing the gap between medical training and the continuously changing health care landscape.

We invite medical students to share "best practices" at your medical school and brainstorm new ideas on these topics:

  • What are the activities, classes, educational tools, clerkships, medical education structural changes, etc., going on at your school that you think are innovative?
  • How can medical students prepare to meet the future needs of diverse patient populations with complex, costly problems in a new and continuously evolving healthcare system?
  • How can medical schools move from time-based (e.g., 4-year curriculum) to competency-based (e.g., demonstrating achievement of milestones) education?
  • How can medical students prepare for residency while learning how to learn throughout their professional lives (assess their own needs, find what they need when they need it, evaluate their own performance)?
  • What are other ideas you’ve heard about, perhaps from other schools or articles about medical education, that you think are exciting?

You may tweet your ideas @AmerMedicalAssn using #ChangeMedEd hashtag. Or tell us what you think on the AMA Medical Student Section Facebook page.

If you prefer, just email us with ideas on the above questions.

Your tweets and Facebook posts will then be integrated into the right rail of this page. Thanks for your participation.

Learn how the AMA is funding bold innovations in medical education.

Ideas to #ChangeMedEd

Tweet your ideas @AmerMedicalAssn using #ChangeMedEd hashtag. Or comment on the AMA Medical Student Section Facebook page.

Facebook question:
How can medical schools move from time-based (e.g., 4 year curriculum) to competency-based (e.g., demonstrating achievement of milestones) education?

Facebook Benjamin Fedeles: I don't think there is any substitution for time, experience, and exposure. Electronic resources are the norm already in school and while taking care of patients. Medical schools are already competency based - if you don't achieve the milestones you receive remediation until you can move on. In an educational climate favoring patient centered care and emotional intelligence, shortening time with preceptors, teachers, and patients, removes additional opportunities to mature, grow wiser, and truncates development of team-based interactions and learning.

However, as I believe more schools will head this direction (and not necessarily for the better) I believe students choosing a school that offers a 3-year/competency-based curriculum (eg. NYU) should be tracked into a family medicine/PCP role as there is going to be an increased demand for these physicians.

Facebook Rory Bradley: Competency based testing - College of Physicians and Surgeons (C); Licensing exams for Medical students, board exams for Residents and Fellows. Examples - Medical students can challenge licensing exams at anytime during clerkship upon approval of medical school. Surgical residents can challenge board exams after # of surgeries completed to satisfactory level of preceptor and College of P&S...very preliminary examples that are just for conversation sake.

Facebook Devon Taylor: The major obstacle is tradition. Since the Flexner Report and the subsequent closing of many nonconforming schools, medical education has been entrenched in the four-year, post-college dogma. This system was designed around learning everything there is to know about medicine in four years, which is impossible today because of the sheer size of today's knowledge base. This results in rationing of medical education based on the notions of importance that are largely dictated by curriculum committees and deans. For instance, I attend one of the very top (by reputation and US news ranking) medical schools, and we don't even teach embryology. I, for one, don't think I will need a full course in embryology to be a good neurosurgeon, but I do think I would benefit greatly from a course in neuroembryology. The problem we face is that there is too much information to learn about my own field in four years, never mind all of medicine. I believe that the change should be BOLD and FUNDAMENTAL. My suggestion: shift the residency selection process to the beginning of medical school. Make the first year a very general introduction to medicine that highlights the fundamentals of medicine (perhaps anatomy, basic physiology, biochemistry, social aspects of medicine, epidemiology, etc.). Then, students should be educated according to what their individual specialties will be. This education would still involve basic sciences, but it would be tailored to the individual needs of each specialty. After some measure of competency, a student could begin residency as it exists today. This would dramatically shorten the length of residencies, as students would gain expertise earlier through early exposure, thereby reducing costs of medical education while improving the performance and knowledge of specialists. The responsibility for setting these standards of competency-based advancement could be left to credentialing organizations (i.e. boards). The residency coordinators and department heads would be responsible for ensuring the students had the education necessary to perform well on these competency-based exams. I understand that changes this bold will turn some people off, but we must make adjustments for the rate of innovation and overall health care costs. We have to get better at our jobs, and this is where we start - day 1 of medical school.

Facebook Richard Bruno: The way I see it the first two years of med school need to be online standardized courses. Study for a month and take step whatever. Choose which hospital you want to rotate at for clerkships. Completely cut out fourth year. And just stay on or apply to another hospital for residency.

Facebook Jason Green: How can they? That's a great question, but as someone that will enter medical school next year that also worked over 10 years in surgery, it sure would be nice to go to a competency-based education. There is a dramatic difference from those that have already dedicated part of their lives to medicine prior to medical school than those that haven't.

Facebook Darlene C. Matthews: More on the job vs classroom training opportunities. For those who have core training as an RN or NP , and maybe some others, with patient based experience , they could test out of many courses.

Twitter question:
Students: How can med schools move from time-based to competency-based education?

Twitter Gamaliel J Roca: Start interdisciplinary work in medschool. Team simulations w/ nursing students, pharm students, PT/OT, etc. #ChangeMedEd

Twitter Paolo Spinetti: #ChangeMedEd like any other profession req'in competency. Apprenticeship based learning. Theory with large portion of training on the job

Twitter Julia Schulkers: Programs that integrate student-centered learning right up front and deviate from standard clsrm lecture are on the rt path.

Twitter The Art of Studying: Having real life situations where we use info learned in first two years helps with retention. #ChangeMedEd

Twitter HealingHandsUC: relax a bit, let students gain practical skills to make better clinicians rather than stressing & overloading #ChangeMedEd

Twitter The Art of Studying: Adjust Step 1 to be more clinically-oriented - allows schools to get students in clinical setting sooner. #ChangeMedEd

Twitter N. Pitaphoros: On 1st day of school pair each student with a clinical mentor who can give emotional support & career guidance #changemeded

Twitter HealingHandsUC: medstudents are human, prone to mistakes, eager to learn; treat them as such so they can be compassionate docs #ChangeMedEd

Twitter question:
Students: Reply w/thoughts on classes, activities at your school that are innovative.

Twitter traviscambronne: Putting more emphasis on educating students how to effectively utilize others within the hlthcare community #changemeded

Twitter traviscambronne: This will not only help to meet demands of a diverse pt. population, it also improves quality of pt care #changemeded

Twitter The Art of Studying: Working with an interprofessional team in sim labs & clinical setting. Thanks @UToledo CoM! #ChangeMedEd


Katherine L. Harvey, MD, MPH

Not being a current medical student, but having a bit of distance and perspective, here are some things that I think worked really well from my medical school experience at the University of Connecticut School of Medicine.

-- Starting first year medical students in the clinical skills program, where we got instruction in physical exam and patient interview techniques, then practiced them while being videotaped.  We then reviewed the videotapes in our groups and got to give and receive feedback.  Being forced to watch yourself, you notice quirks you have, or pick up on things you do well or could do better.  This set the stage for greater confidence at our weekly continuity clinic as well as third year clinical rotations.

-- Continuity clinic one afternoon a week in a primary care office (FP, IM, or peds) from near the beginning of first year through at least third year, fourth year if we wanted to continue it as one of our electives.  It was a chance to practice our exam, see the clinical reasoning skills in action, and further develop interview techniques.

I still remember three particular patients I was able to counsel to quit smoking as a first year, and they stayed off cigarettes as long as I knew them.

-- Organ-based curriculum in first and second years.  First year focused on the normal processes, second year on disease processes.

Anatomy lab first year was coordinated with the organ system we were currently studying.  It was much easier to relate the information to what we needed to know clinically.

-- Clinical reasoning weekly case discussions really helped going through the reasoning process, differential diagnoses, and digging a bit deeper into the related disease topics.