the future of medical education - johns hopkins university
TRANSCRIPT
![Page 1: The Future of Medical Education - Johns Hopkins University](https://reader030.vdocuments.us/reader030/viewer/2022012418/61734fd966d8a77976690082/html5/thumbnails/1.jpg)
The Future of Medical Education
David G. Nichols, MD Johns Hopkins University
School of Medicine
“Moving Academic Medicine Forward” - A Conference in Honor of Edward D. Miller, MD
June 11, 2012
The Translational Discipline
![Page 2: The Future of Medical Education - Johns Hopkins University](https://reader030.vdocuments.us/reader030/viewer/2022012418/61734fd966d8a77976690082/html5/thumbnails/2.jpg)
Medical Education of the Future The Translational Discipline
• Input: Philosophy and Content
• Output: Clinical Quality and Assessments
2
![Page 3: The Future of Medical Education - Johns Hopkins University](https://reader030.vdocuments.us/reader030/viewer/2022012418/61734fd966d8a77976690082/html5/thumbnails/3.jpg)
Medical Education of the Future The Translational Discipline
• Input: Philosophy and Content
• Output: Clinical Quality and Assessments
3
![Page 4: The Future of Medical Education - Johns Hopkins University](https://reader030.vdocuments.us/reader030/viewer/2022012418/61734fd966d8a77976690082/html5/thumbnails/4.jpg)
Biochem. J. (2009) 424: 317
Biomedical Publications in the Age of Information Overload
Structures Sequences Sequences Publications Sequences
4
![Page 5: The Future of Medical Education - Johns Hopkins University](https://reader030.vdocuments.us/reader030/viewer/2022012418/61734fd966d8a77976690082/html5/thumbnails/5.jpg)
5
• Current Taxonomy • Based on signs & symptoms • Information overload
• New Taxonomy based on
Precision Medicine: • Information Commons
• Data repository on all patients
• Knowledge Network • Integration of data from
all levels of biology
![Page 6: The Future of Medical Education - Johns Hopkins University](https://reader030.vdocuments.us/reader030/viewer/2022012418/61734fd966d8a77976690082/html5/thumbnails/6.jpg)
Information Commons analogous to a layered Geographical Information System (GIS)
6
Transportation
Land Use
Census Tracts
Structures
Postal Codes
Raster Imagery
Google Maps: GIS Layers Organized by Geographical Positioning
Information Commons Organized Around Individual Patients
![Page 7: The Future of Medical Education - Johns Hopkins University](https://reader030.vdocuments.us/reader030/viewer/2022012418/61734fd966d8a77976690082/html5/thumbnails/7.jpg)
Medical Education: …translating the bench to the bedside…
7
![Page 8: The Future of Medical Education - Johns Hopkins University](https://reader030.vdocuments.us/reader030/viewer/2022012418/61734fd966d8a77976690082/html5/thumbnails/8.jpg)
Genes-to-Society Principle I: Phenotype is determined by internal and external factors
Society
Environment
Phenotype
Organ physiology
Cell biology
Genomics
45 y.o w/ bone pain 60 y.o. w/ urinary dysfunction
75 y.o. w/ no symptoms, ↑PSA
![Page 9: The Future of Medical Education - Johns Hopkins University](https://reader030.vdocuments.us/reader030/viewer/2022012418/61734fd966d8a77976690082/html5/thumbnails/9.jpg)
9
Genes-to-Society Principle II: Disease expression segregates along a continuum depending
on risk.
Asymptomatic-Latent Symptomatic- Sick
Risk factors:
•Genotype
•Post-transcription events
•Environment
•Behavior
![Page 10: The Future of Medical Education - Johns Hopkins University](https://reader030.vdocuments.us/reader030/viewer/2022012418/61734fd966d8a77976690082/html5/thumbnails/10.jpg)
The Genes to Society Curriculum Years III and IV
• Basic Clerkships in Year 3 • Electives • Preclerkship Educational
Exercise (PRECEDE) • Translational Science
Intersessions • Required Advanced Clerkships
– Physiology and technology (ICU)
– Chronic care (Palliative Care, Geriatrics, Rehabilitation Medicine)
• Capstone course: Transition to Internship, Residency and Life (TRIPLE)
10
Years I and II
• Scientific Foundations
• GTS Systems Biology
• Longitudinal Clerkship
• Scholarly Concentrations
• Intersessions
![Page 11: The Future of Medical Education - Johns Hopkins University](https://reader030.vdocuments.us/reader030/viewer/2022012418/61734fd966d8a77976690082/html5/thumbnails/11.jpg)
Medical Education of the Future The Translational Discipline
• Input: Philosophy and Content
• Output: Clinical Quality and Assessments
11
![Page 12: The Future of Medical Education - Johns Hopkins University](https://reader030.vdocuments.us/reader030/viewer/2022012418/61734fd966d8a77976690082/html5/thumbnails/12.jpg)
Educationally Sensitive Patient Outcomes from Kalet, Acad Med 2010
12
Admissions data
Clerkship performance
Program director
evaluation
Unannounced standardized
patients
Patient satisfaction
QI data
![Page 13: The Future of Medical Education - Johns Hopkins University](https://reader030.vdocuments.us/reader030/viewer/2022012418/61734fd966d8a77976690082/html5/thumbnails/13.jpg)
Barriers to linking medical education to patient outcomes
• Short-term focus – Test scores
• Inadequate sample size – Studies confined to single institutions
• Disconnected research teams – Medical education vs. from health services researchers
• Inadequate methodologies – Confounding variables – Long time course
13
![Page 14: The Future of Medical Education - Johns Hopkins University](https://reader030.vdocuments.us/reader030/viewer/2022012418/61734fd966d8a77976690082/html5/thumbnails/14.jpg)
Emerging Solutions for Outcomes Assessment
• eFolio: – National longitudinal data commons of
medical learning
• Case-control studies
14
![Page 15: The Future of Medical Education - Johns Hopkins University](https://reader030.vdocuments.us/reader030/viewer/2022012418/61734fd966d8a77976690082/html5/thumbnails/15.jpg)
Aliki: Decreased heart failure readmission rate (Record, Arch Int Med 2011)
Prob
abilit
y of
NO
T be
ing
read
mitt
ed
Days after Discharge for Heart Failure 15
ALIKI Team
Standard Resident Team
![Page 16: The Future of Medical Education - Johns Hopkins University](https://reader030.vdocuments.us/reader030/viewer/2022012418/61734fd966d8a77976690082/html5/thumbnails/16.jpg)
What makes learning stick?
• Spacing Effect – Repeated exposures
longterm memory (Pagani MR, Cell 2009)
• Vividness effect – Vividness hippocampal
activation and episodic memory (Moscovitch, Curr Opin Neurobiol 2006)
• Stress effect – Mild acute stress
neuronal survival. Chronic stress neuronal survival. (Snyder JS, Hippocampus 2006) Ruge H, Cerebral Cortex 2010
16
![Page 17: The Future of Medical Education - Johns Hopkins University](https://reader030.vdocuments.us/reader030/viewer/2022012418/61734fd966d8a77976690082/html5/thumbnails/17.jpg)
• 609 studies
• 35,226 trainees
Conclusion: •“Technology-enhanced simulation training is associated with improved outcomes … across a range of clinical topics, including large effects on clinician behaviors and moderate effects on patient care.”
17
Cook DA, JAMA 2011
![Page 18: The Future of Medical Education - Johns Hopkins University](https://reader030.vdocuments.us/reader030/viewer/2022012418/61734fd966d8a77976690082/html5/thumbnails/18.jpg)
The Medical Education Translation Cycle
18
![Page 19: The Future of Medical Education - Johns Hopkins University](https://reader030.vdocuments.us/reader030/viewer/2022012418/61734fd966d8a77976690082/html5/thumbnails/19.jpg)
A Dean’s Legacy
19
“Today’s medical students are the seed corn for tomorrow’s medicine. For the sake of the future of healing, we must help them flourish.”
Edward D. Miller, M.D. Summer 2000
3,414 Graduates