medical education for the future we haven’t invented yet (or flying the plane while building it)...
TRANSCRIPT
Medical Education for the Future We Haven’t Invented Yet (or flying the plane while building it)
Wisconsin Association of Osteopathic Physicians and Surgeons May 29,2015
Lisa Grill Dodson, MD Campus Dean, MCW Central Wisconsin [email protected]
Disclosure
I certify that I have no material personal
or professional conflict of interest to disclose
Objectives
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What do we want?
Doctors
• In the right numbers (supply)
• In the right places (maldistribution)
• In the right specialties (overspecialization)
Safer care
More effective care
More patient centered care (“nothing about me without me”)
More teamwork4
Pop Quiz: How do we get the doctors we need?
A. True or False: Educate the smartest students (MCAT and grades) and they will have all the skills needed
B. True of False: Educate students in the best universities and they will become the doctors we need.
C. True or False: Medical schools routinely follow best practices in adult education techniques, with “no hidden curriculum”
D. True or False: Allowing market forces to determine specialty choice ensures the right specialty mix
E. True or False: Current payment policies favor a correct mix of physician specialties
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Results
“Good doctors, trained and rewarded for doing too many of the wrong things in the wrong places in the wrong system, unsafely”
•
Anonymous
• Keep the good doctors
• Change the healthcare system and it’s reward system
• Address payment system
• Triple aim (better quality, better experience, lower cost)
• Build an education system for the future6
Start with the end in mind (a few examples)
What would a perfect medical education system look like?
• All students have clear motivation for becoming a physician
• All interested students have a shot at becoming a physician
• Students (doctors) are representative of all aspects of society
• The admissions process rewards character as well as intellect and test taking
• Students would not be subjected to a “hidden curriculum” re: career choice
• Curriculum would match what is needed for practice
• Medical specialty mix would match societal need
• Patients would not be disadvantaged by income or geography
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What now? The “new Flexner report”Cooke et al. Educating Physicians: A call for reform of medical school and residency 2010
Goals Challenges Recommendations
Standardization and Individualization
Medical education is: • Not outcomes based• Inflexible• Excessively long• Not learner centered
• Standardize through competency based assessment
• Individualize learning• Support development of skills for
inquiry and self improvement
Integration Poor • connections between formal
knowledge and experiential learning• understanding of patient experience• understanding of nonclinical and
civic role of MD
• Early clinical experience• Time for reflection and study• Integrate basic, clinical, social sci• Comprehensive focus on patient
experience(incl longitudinal connection)• Experience broader MD roles • Interprofessional and teamwork exper
Habits of Inquiry and improvement
• Focused on todays skills/knowledge, not long term excellence
• Inadequate attention to populations, practice based learning/improvement
• Insufficient participation in improvement activities
• Prepare for routine and adaptive expertise
• Engage learners authentically• Population health, QI and pt safety exp• Locate in many settings of quality care
delivery not only Univ teaching hosp
Professional formation • Failure to assess, and advance professional behaviors
• Inadequate expectations for progressive involvement
• Erosion of professional values due to pace and commercialization
• Formal ethics instruction• Address hidden curriculum• Longitudinal mentoring/advising• Promote relationships with faculty• Collaborative learning environments
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What now? The “new Flexner report”Cooke et al. Educating Physicians: A call for reform of medical school and residency 2010
Goals Challenges Recommendations
Standardization and Individualization
Medical education is: • Not outcomes
based• Inflexible• Excessively long• Not learner
centered
• Standardize through competency based assessment
• Individualize learning
• Support development of skills for inquiry and self improvement
9
What now? The “new Flexner report”Cooke et al. Educating Physicians: A call for reform of medical school and residency 2010
Goals Challenges Recommendations
Integration Poor • connections between
formal knowledge and experiential learning
• understanding of patient experience
• understanding of nonclinical and civic role of MD
• Early clinical experience• Time for reflection and
study• Integrate basic, clinical,
social sci• Comprehensive focus on
patient experience(incl longitudinal connection)
• Experience broader MD roles
• Interprofessional and teamwork exper
10
What now? The “new Flexner report”Cooke et al. Educating Physicians: A call for reform of medical school and residency 2010
Goals Challenges Recommendations
Habits of Inquiry and improvement
• Focused on todays skills/knowledge, not long term excellence
• Inadequate attention to populations, practice based learning/improvement
• Insufficient participation in improvement activities
• Prepare for routine and adaptive expertise
• Engage learners authentically
• Population health, QI and pt safety exp
• Locate in many settings of quality care delivery not only Univ teaching hosp
11
What now? The “new Flexner report”Cooke et al. Educating Physicians: A call for reform of medical school and residency 2010
Goals Challenges Recommendations
Professional formation • Failure to assess, and advance professional behaviors
• Inadequate expectations for progressive involvement
• Erosion of professional values due to pace and commercialization
• Formal ethics instruction
• Address hidden curriculum
• Longitudinal mentoring/advising
• Promote relationships with faculty
• Collaborative learning environments
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MCW-CW Mission: Address the shortage of primary care and psychiatry in northern and central Wisconsin.
Barriers: Geography
Social/cultural
Educational (K-premed)
Financial
Curricular
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MCW- Central Wisconsin features
Regional campus of Medical College Wisconsin
• Bi-directional digital classrooms, basic sciences
• Regional clinical classrooms, clerkships
Mission: meet workforce needs of central and northern WI
• Primary care (FM, IM, Peds), Psychiatry, General Surgery
Different mission, different students, different delivery model
25 students per year
134 week curriculum (154 week in Milwaukee): accomplish in 3 yr
Longitudinal integrated clerkship model for clinical
Scholarly Pathway: “Physician in the Community”
Community partners, regional clinical exposure
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Triple threat
Regional campus
3 year curriculum
Longitudinal integrated curriculum
Facilities update
Aspirus Wausau Hospital: • Administrative, classrooms
• Under construction, anticipated occupancy October 1, 2015
Northcentral Technical College:• Anatomy labs, simulation
• Demo Summer 2015, construction Winter 2015-16
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Faculty : M1 and M2 year
• MCW faculty: basic science lectures
• Local/regional faculty opportunities: • Clinical integration sessions (classroom, weekly)
• Mentoring
• Anatomy/procedure tutors
• Foundations of Clinical Medicine ( M1 July/August)
• Clinical apprenticeship: ½ day/wk primary care office ( with specialty exposures)
• Scholarly pathway project mentors
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Faculty Development
Begin Fall/Winter 2015
• General information sessions
• Faculty 101
Targeted Faculty development based on role and interest
• Monthly sessions: in person with video archive
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Faculty: M3 (clinical year)
Longitudinal Integrated Clerkship
Competency based, NOT time based
PT faculty navigator for each health system
Core primary care faculty over 9-12 months
Specialty and hospital experience to achieve competencies
Student driven, flexible
MCW-CW staff do the tracking and monitoring
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M2 summer and M3: What’s a Longitudinal Integrated Clerkship?
Students:
• Participate in comprehensive care of patients over time
• Develop longitudinal, continuity relationships with faculty
• Address core clinical curriculum competencies across multiple disciplines simultaneously
• Source: Cooke, Irby and O’Brien. Educating Physicians: a call for reform of medical school and residency. 2010
• and Consortium of Longitudinal Integrated Clerkships (CLIC)
Clerkship Models
Traditional Block
Longitudinal Ambulatory Track
Hybrid Block & LIC
Longitudinal Integrated
Source: Janet Lindemann, University of South Dakota Sanford School of Medicine
DRAFT sample LIC schedule
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Longitudinal Integrated Clerkship
Data on LIC: [equivalent or better on most measures] Equivalent test scores, better retention, better patient interaction, less burnout, more enter primary care residencies, better residency director ratings
SAVE THE DATE:
LIC Consultation visit
Friday October 16 , 2015 (afternoon)Janet Lindemann, MD
Dean of Medical Student Education
University of South Dakota Sanford School of Medicine,
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