Accelerating Change in Medical Education

How students spark change at University of Nebraska Medical School

A Spotlight on Innovation post with R. Logan Jones, a third-year student at University of Nebraska College of Medicine (UNMC).

AMA Wire®: What’s one project that UNMC is pursuing within their work in the AMA’s Accelerating Change in Medical Education Consortium that you’re particularly excited about?

Jones: One project with which I’ve been excited to work is UNMC’s Interprofessional Experiential Center for Enduring Learning, otherwise known as iEXCEL℠. This is the campus entity that represents the collaborative efforts among the various colleges to enhance interprofessional education across the continuum of medical education through the adaptive use of cutting-edge technologies.

As part of iEXCEL, UNMC Is planning to start construction on the Global Center for Advanced Interprofessional Learning—a 125,000 square foot facility that will house immersive virtual reality environments, simulated clinical environments and tele-education capabilities to link the center’s resources with students and providers across Nebraska and around the world.  

I imagine iEXCEL offering a future in which medical students have the opportunity to participate in “virtual-reality rounds” with nursing students, pharmacy, PT/OT and other professional students as they work collaboratively to care for a census of virtual patients. This would afford students a safe, simulated learning environment in which they are able to expand their professional knowledge through experiential learning, refine the various skills of their profession and develop the professional attitudes necessary to deliver highly effective team-based, patient-centered care.

As a student in the throes of my third-year clerkships, if nothing else, I have learned that no one person has the ability to fully address a patient’s needs and that it takes a team of people to truly care for their whole person. Furthermore, as our medical system increases in complexity and the patient care demands become more specialized, the reliance on teams of people to provide total patient care can only increase from here. Thus, efforts like UNMC’s work in the AMA’s Accelerating Change in Medical Education Consortium to enhance interprofessional education and practice are poised to play a large part in training the next generation of health professionals.

AMA Wire: What are some of the barriers students face when trying to spark change at their medical school, and how is UNMC’s work within the AMA’s Accelerating Change in Medical Education Consortium helping to break down those barriers for students?

Jones: I think that there are two big barriers that stop students from feeling empowered to pursue a course of change at their medical schools. The first of these is a shortage of time. Medical students are an extremely busy bunch of people. Take your average medical student: Type A personality, extremely bright and very goal-driven. These attributes coupled with the constant pressure to succeed in class and obtain a good spot in the Match leaves what little free time is left at the end of the day rationed off to participate in CV building activities, such as research, interest group involvement or volunteer work.  While UNMC’s involvement with the consortium has done little to ameliorate the time crunch students are constantly struggling with, it has helped immensely with the other barrier—opportunity awareness.

At the start of the academic year, I believe that most students had very little insight into the numerous ongoing curricular reform efforts taking place on campus. Those students who had been involved with such efforts were typically on class governing councils, student senate and other leadership positions which facilitated easy participation in efforts. Despite the usual means of information dissemination, the calls to garner student participation often fell on deaf ears.

However, with the announcement of UNMC joining the AMA’s Accelerating Change in Medical Education Consortium came a spark of student interest and curiosity of what was going on behind the scenes. Furthermore, the recent AMA medical education innovation challenge took the call of action directly to students and culminated in at least three UNMC based proposals.

More than ever in my experience are students talking about what UNMC is doing to change and how they can get involved. I am hopeful that as UNMC continues to collaborate with the other consortium members to refine our project and slowly unveil it to the campus, the barrier of opportunity awareness for students on how to get involved will become a thing of the past. 

AMA Wire: Is there a particular project from a consortium school that especially inspires you?

Jones: My first exposure to the AMA and subsequently its Accelerating Change in Medical Education Consortium took place at the 2014 AMA Annual Meeting in Chicago. I sat in on a presentation about Oregon Health and Science University School of Medicine’s project using a flexible, learner-centered, competency-based curriculum model. Their project has been especially inspirational for me as it has been one of the more ambitious in terms of revolutionizing the medical education timeline in addition to really challenging the Flexnerian status quo.

There are three main aspects that most intrigue me about their project. First is the opportunity it provides students to take direct ownership of the education timeline. I believe that this should incentivize students to better develop skills of self-directed learning, and I am hopeful that this hypothesis will hold up over time.

Second, the flexible training times may offer some students the opportunity to reduce their overall cost of medical education by finishing sooner than traditional programs would have them.

Finally, medical students bring a vast array of past life experiences when they step into the classroom, but all too often, students find themselves conforming to their education instead of the other way around. I am excited to see where this project will be in five to 10 years, what lessons were learned and if their model can be a sustainable new paradigm for medical education in our country.

AMA Wire: What should be the result of true innovation in medical education?

Jones: Many of the thought leaders in medicine have been indicating that the physician’s role in health care is changing. No longer will the epitome of health care be the direct care of a patient by a single physician; team-based care is where the compass rose is pointed. As such, if the medical profession and the federation of organized medicine truly support the notion that our society is best served with physicians leading our health care, then our medical education must seek to train agents of change equipped with the knowledge, skills and attitudes to approach any problem.

Innovative medical education should aim to train medical graduates who can effectively make decisions in collaboration with the other professionals charged with caring for their patients—decisions that leverage all the strengths of the medical team to attain the best health outcomes while doing so in a cost conscious manner. Medical education should strive to produce graduates who look at health care systems not as barriers but as tools and methods to improve and streamline their ability to deliver care.

Innovation in medical education should strive to incorporate cutting-edge technologies into teaching, not just for the sake of technology, but to use it in meaningful ways to enhance and accelerate the learning process. It should also instruct students on how to use technology to augment their clinical practice without sacrificing the ability to practice medicine in the absence of technology. 

If we can pursue personalized medicine, why can’t we pursue personalized medical education? Innovation in medical education should allow for the educational process to complement each student’s individual strengths and weaknesses. It should afford students the ability to shorten or lengthen their training while confidently assuring that each graduate is a physician who society can be assured is fully competent and capable of assuming care of our populations.