Accelerating Change in Medical Education

How students are affecting med ed transformation

Medical educators have recognized the need to transform medical education, and many schools are working on innovative ideas for medical student training. But what do medical students think about so many changes?

“Our current curriculum doesn’t do enough to frame the issues facing health care, help with personal development of students’ existing leadership strengths, or even break down barriers for students, as future physicians, who are willing to engage in systems changes,” said Jesse Burk-Rafel, a second-year medical student at the University of Michigan Medical School. “Our new curriculum will address these shortcomings.”

Burk-Rafel is part of a team of students involved in Michigan’s curricular transformation. As one of the 11 schools in the AMA’s Accelerating Change in Medical Education initiative, the school is spending its $1 million grant on a make-over of its undergraduate medical education program, including a new approach to incorporating leadership training and interprofessional education pilot programs.

But before the university could truly transform its entire curriculum, it had to gain buy-in from everyone involved—faculty, staff, administration and, perhaps most important, students.

“We chose to include and embed our students so deeply in our project because of the strengths they bring to the table—insight, leadership, engagement—and they help us understand what is realistic,” said Rajesh Mangrulkar, MD, associate dean for medical student education at Michigan. “They also can empower faculty to thinks about what is possible, which is sometimes hard for us to do.”

“Students may say things we don't necessarily want to hear, but it's critical to dialogue openly with them about curricular change,” Dr. Mangrulkar said. “We didn't have to include them—many other schools have not. But it's our culture at Michigan, and we're very proud of that.”

The school gathered more than 300 members of the medical school community in a campus-wide retreat with an open discussion on the impending changes, and leaders also are using change management techniques to aid in the transformation.

“Broad student engagement at all levels of this transformation will ensure we build on Michigan’s strengths to create a student-centric program that provides streamlined preclinical training, rigorous leadership and mentorship, and earlier career exploration,” Burk-Rafel said. “Student input also ensures the transformation doesn’t lose sight of its consumer—future students.”

Second-year medical student Korie Zink is part of the school’s student advisory committee, which is tasked with keeping all stakeholders up to date on the transformation project.

“There are a million different ways for students to get their questions answered [about the project],” she said. “We’re a resource for students. I get emails and questions all the time. People can submit questions online. We send a newsletter to each class.”

Communication throughout the school is crucial, Zink said. With strong student input, the curriculum change will be as comprehensive as possible.

“We want to make sure that these big, brilliant ideas are actually possible when it comes down to the level of a med student learner,” she said. “If it just comes from an administrative view, you’re going to miss that component of students saying, ‘We don’t know that much yet.’”

While Zink and Burk-Rafel won’t immediately benefit from the overhaul, they aren’t involved in the project for personal gain.

“Many of the changes we are making will largely affect future classes, so I won’t get to see many of the benefits,” Burk-Rafel said. “It’s a bit of a pay-it-forward proposition. … I’m trusting that the work we’re putting in, and the things we’re piloting will pay dividends in terms of future patient care and health system change.”

The new curriculum will help future students be much better prepared for residency and beyond, Zink said.

“[Future students] will have much better integration of their clinical skills with basic science,” she said. “They’re going to be able to think about things more critically. They’ll be working toward diagnoses and teamwork in a way that we have the ability to do now, but just isn’t built in to our curriculum.”

Heading into 2015, the work of Michigan and the other 10 schools in the initiative will continue to advance, and new schools will be adopting the best practices they are putting forward. Additionally, the initiative will be working toward changes in graduate medical education to improve physician education across the learning continuum.