What medical schools can expect in the future
A special consortium of medical schools has spent the last year developing and implementing innovative ideas to transform the way future physicians are trained, and soon the medical education environment will experience the benefits of their efforts. In year two of its work, the consortium is testing and tweaking curriculum changes that other medical schools will be able to implement.
“We’re shaping the physician of the future,” said Susan Skochelak, MD, group vice president for medical education at the AMA. “We’re creating the components of the medical school of the future, and our beacon that we’re working toward relates to readiness for practice. We want our physicians to hit the ground running.”
In January 2013, the AMA announced its intent to fund five to 10 medical schools to implement bold innovations in medical education. More than 80 percent of the country’s 141 eligible medical schools submitted proposals, a sign that schools were eager for widespread change. The AMA chose to fund 11 schools, each receiving a $1 million grant over five years in its Accelerating Change in Medical Education initiative.
After initial planning, the 11 schools began to implement new tools and ideas in September 2013. Since then, each school has worked both autonomously and with the input from the other consortium schools and the AMA, sharing new ideas and methods with one another in special meetings. The schools first convened in October 2013 at the AMA’s Accelerating Change in Medical Education conference in Chicago, and have also come together at the University of Michigan Medical School and Vanderbilt University Medical School.
So far, schools have taken deep dives into specific education areas and are working on new ways to test and evaluate future physicians. Overall, the initiative seeks to ensure learner readiness to succeed in the health care system of today and tomorrow, and to implement sustainable medical education transformation. As their work continues, the schools will make their discoveries available to other medical schools, making it easier to enact widespread change.
The consortium’s work is focused in a few areas:
- Competency-based assessment. New assessment frameworks will allow students who show competence earlier in certain areas to move ahead more quickly or focus more time on other areas that need more instruction. Oregon Health and Science University School of Medicine is moving toward a learner-centered, competency-based curriculum, with progress based on predetermined milestones. The University of Michigan’s trunk-and-branches model is giving students a foundational “trunk” of knowledge, with different “branches” for students to pursue different courses of study that appeal most to them. Students’ pace through their program is based on achievement of specific milestones.
- Systems-based practice. Students will learn to navigate systems of care, quality improvement and population health—all which fall under the umbrella of the science of health care delivery—to optimize outcomes and cost. Pennsylvania State University College of Medicine will give students a 19-month program in systems-based practice topics, beginning in the first months of medical school and ending just before students enter clinical rotations. Students at Penn State also will become patient navigators linked with local clinics to gain experience in actually dealing with the health care system.
- Adaptive, lifelong learners. The health care system is constantly changing, and new information is available every day. In the future, physicians will need to be adaptable and flexible, and to think critically about where and how to find information. Vanderbilt is instilling these qualities in its medical students with a special learning platform that lets students set their own learning goals, complete self-assessments and track their performance data.
- Team-based care. Future care delivery systems will require physicians to work on interprofessional teams. The Warren Alpert Medical School of Brown University incorporated interprofessional care into its curriculum, pairing medical students with students from other health profession schools to create patient care plans in special workshops. The workshops give medical students the chance to negotiate the role they play on teams and learn when to take the lead.
- Diversity and health care disparities. Diverse physicians will be necessary to meet the needs of underserved communities and address workforce gaps. The University of California Davis School of Medicine is choosing students from economically challenged backgrounds in the hopes that these students will work in underserved communities.
- Technology. Schools will use mobile apps, learning platforms, databases and more to give students instant access to information. New York University School of Medicine used large, open clinical data sets to create virtual patient panels, giving students access to information about the health care system and de-identified patient data. Indiana University School of Medicine created a teaching electronic health record, populated with de-identified patient data that updates in real-time.
Curriculum changes alone aren’t enough for transformative change. Medical school faculty must be prepared to teach and develop these new ideas, and that’s why faculty development also is a core part of the consortium’s work. The Brody School of Medicine at East Carolina University and Mayo Medical School are educating faculty on new competencies and working on how to incentivize faculty development.
Finally, large-scale change is enormously difficult, so some schools are looking at how to smoothly transition to new curriculum at their institution and across the medical education environment. The University of California San Francisco is taking the lead in change management, applying principles of business organizational change to medical schools.
There’s been much progress in a year of implementation—but there’s a lot more to do. Heading into 2015, the schools will increase activation and adoption of their new curriculum models so other schools can begin enacting change, too.
The consortium will also be moving on to new challenges, including how to involve graduate medical education.
“Students are asking, ‘Is this going to get me the residency I want?’” said Bonnie Miller, MD, senior associate dean for health sciences education and associate vice-chancellor for health affairs at Vanderbilt. “I think we need to make sure that along the continuum, our efforts are focused on improving care delivery. … To sustain our successes, we need to think about other phases of education.”
Read more about the Accelerating Change in Medical Education initiative at AMA Wire®.