Accelerating Change in Medical Education

How to equip new doctors for the digital health frontier

As health technology booms, medical schools must prepare students for the associated complex cultural change and increasing physician demands. But new technology doesn’t necessitate a departure from patient-centered care—technological innovations can advance this kind of care. Here’s how Bob Wachter, MD, author of New York Times science bestseller The Digital Doctor, recommends schools help students chart this new digital health frontier.

From the pervasive use of electronic health records to tablets that monitor patient outcomes from afar, health care technology is a pillar of practice that is here to stay. These platforms have both ushered in advancements in modern health care and spurred new expectations that physicians deliver “the highest quality of care at the lowest available cost,” Dr. Wachter (pictured right) said during a special med ed session Sunday.

The session was part of a collaborative design shop during which medical educators and informatics experts worked on plans for the future digital curriculum for med schools. Hosted by the AMA’s Accelerating Change in Medical Education initiative and the University of California, San Francisco School of Medicine, participants included representatives from the 11 U.S. medical schools the AMA awarded $1 million grants to reshape the way physicians are trained.  

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Navigating pressures

Dr. Wachter said today’s tech-savvy students must navigate considerable expectations that weren’t at-play during his training: Imminent pressures to meet accreditation competencies, an increased need for transparency in practice and rapidly changing payment models that place more value on physician performance.

Still, educators must prepare physicians in training to overcome these demands while using technology to keep patients at the center of care.

And the road to implementing this isn’t necessarily a linear one, Dr. Wachter explained.

“You can’t just make this all happen by rules and edicts and checklists and embedding standards in your IT system,” he said. “You actually need people to understand these issues and get engaged, and the only way that will happen is by starting this at the trainee stage.”

This is where the work of innovative educators and medical schools like those in the AMA consortium becomes essential, he said. Instead of molding students into “informatics experts,” he advises educators to “train [students] to use all digital tools [and know] how to diagnose when these tools are not working or give misleading information.”

“We have to use these tools, but we have to reimagine how they’re positioned in the larger geography of team-based care, health systems and practice work flows,” he said.

Developing new skills

Dr. Wachter realized the crucial need for such adaptive skills while conducting research for his book The Digital Doctor, which required him to interview physicians, health care innovators and care teams about their most honest observations using technology in practice.

Through his research, he learned of instances when patient care teams admitted to giving patients fatal prescription dosages or physicians failed to properly treat patients as the result of an over-reliance on technology instead of their own medical know-how.

Considering these digital entrapments, Dr. Wachter recommended schools take a critical approach to creating informatics curricula that will streamline health systems without displacing patients.

Educators have to ask, “How does the work flow change with digital tools, and how do we use those tools to create or reestablish relationships with [care teams]?” This isn’t for the sake of nostalgia, Dr. Wachter noted, but to spur the “reimagining” of health care technology in the modern era.

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Making it all about the patient

A 2012 JAMA op-ed underscores the importance of this issue and the impact of technology on the patient perspective. When asked to draw her pediatrician, a seven-year-old’s depiction resulted in a colorful mesh of squiggly lines all pointing to a physician who appears more engrossed in his computer than the actual patient seated on the bed behind him.

This is the very perception of physicians that schools must teach students to avoid, Dr. Wachter said. To mitigate this issue, he urged educators to mold students into adaptive learners who are nimble enough to use technology in practice without compromising the fundamental elements of an effective patient-physician relationship.

He said schools can accomplish this by educating students about emerging issues that will change the culture of medicine and clinical practice as health care continues to modernize. Some of these ever-evolving issues include:

  • The potential risk of “de-skilling,” or becoming overly reliant on computers for patient diagnosis and treatment
  • Managing “big data” to advance patient care or potentially work with new care team members who specifically analyze data for physicians
  • Teaching students how to effectively avoid “alert fatigue” from copious automated alerts in practice
  • Educating students about the use of technology in health care delivery science, and its impact on work flows, specialty culture and patient communication

No matter the technology, Dr. Wachter said the goal of medical educators should invariably stay the same: “It’s up to all of us to figure out how to socialize and professionalize our trainees so they know that even though they’re getting data off a computer, that’s not who they’re treating. They’re treating a real person.”

Want to learn more about this new curriculum? Stay tuned for a special informatics series from AMA Wire®, in which experts will break down the top competencies, tools and assessment strategies every educator needs to effectively create an informatics curriculum for physicians in training.