ChangeMedEd Initiative

What students wish they were learning in med school


It’s no secret that today’s medical students will be part of a health care system that is vastly different from just a decade ago, and more rapid changes are expected. So what are current students hoping to learn to prepare them for their future careers?

At a recent meeting of the AMA’s Accelerating Change in Medical Education initiative held at Oregon Health and Science University, a panel of 10 medical students from across the country shared their views. The group told academic physicians the topics they wish were a more integral part of their schools’ curricula.

An informal survey among the panel of students identified the following topics as high priorities for tomorrow’s physicians.

First-year University of California Davis School of Medicine student Ian Kim didn’t take a traditional path to med school, and his unique perspective flagged the need for formal leadership training for medical students. Kim has an MBA and worked for the past decade in the advocacy sector.

“I got to learn from amazing leaders,” he said. “Through my life experience, I understand the importance of leadership and why we can’t just sit on our hands. We need to manage the changes.”

Some of the schools in the AMA’s consortium are developing purposeful leadership programs. The University of Michigan Medical School, for instance, hosted a retreat for first-year students to help them understand how to be leaders in team-based care.

The student panel indicated they needed to know more about the political and regulatory forces shaping health care.

“If we’re going to be agents of change, you have to have an understanding not only of the basic laws and rules of how health care works but the external forces that shape it,” said Nate Friedman, a second-year medical student at Vanderbilt University School of Medicine. “What we get [in school now] tends to be a little drier or a little bit more down in the weeds. We know labs are expensive—but why are they expensive? How did we get there?”

Friedman also said more information on health policy could instill a sense of urgency in students that the current system needs to be fixed.

“We’re going to be entering a system that is critically ill and needs true fixing, not in 20-25 years, but in five to 10 years,” he said. “I’d love to [learn] more about that. The students I talk to about this have a vague conception that we’re in trouble, but not a sense of urgency.”

Pennsylvania State University College of Medicine is moving in this direction with its new systems navigation curriculum. The first part of the two-pronged curriculum will incorporate systems-based practice topics, including health policy, over a 17-month period.

For Varun Shahi, a third-year student at Mayo Medical School, a big need for tomorrow’s physicians is information about how much their work will actually cost patients.

“It’s interesting that we don’t fully understand the costs related to what we’re providing,” Shahi said. “Having a solid economic foundation pushes the student to take on more economic roles.”

Mayo is incorporating aspects of health systems education and economics in its Science of Health Care Delivery program, which covers specific content with a combination of face-to-face education and online modules. The school is developing tools to document student achievement in this new topic area, including surveys, quality improvement reviews, patient safety knowledge assessments and checklists.

Health economics and policy are part of a new, larger area of learning called health care delivery science. The consortium is investigating innovative ways to teach this new “third science.”

Students want fewer hours in lecture halls and more time learning by doing, the panel said.

“If you give students ownership of something related to a topic and delve into experiential learning versus just lectures, I think you would have more uptake,” said Grayson Armstrong, a fourth-year medical student at the Warren Alpert Medical School of Brown University and chair of the AMA Medical Student Section. “I believe experiential learning is what we should move toward in general. Learn because it’s necessary, not because it’s going to be tested.”

The Brody School of Medicine at East Carolina University is moving toward a more practical-based curricula, with a special program that will enroll 10 students per year. These students will complete advanced coursework and experiential activities, allowing them to obtain a special “distinction in health care transformation and leadership” designation in addition to their MD degrees.