AMA: A significant redesign of undergraduate medical education

AMA: A significant redesign of undergraduate medical educationA guest column by the American Medical Association, exclusive to KevinMD.com.

To close the gaps between how medical students are educated and how health care is delivered now and in the future, the American Medical Association (AMA) has awarded $11 million to 11 U.S. medical schools to fund their bold proposals that support a significant redesign of undergraduate medical education. This is just one part of the ambitious three-part strategy the AMA is pursuing to improve the health of the nation.

Medical students continue to receive the majority of their training in hospital settings, but the majority of patients are cared for in an out-patient setting by physician-led health care teams. Today’s medical schools typically provide minimal instruction about the business of medicine and the workings of health care systems, but future physicians must know how health care is financed and how health systems work so they are prepared to function effectively in rapidly changing settings to continue to provide the best possible care for patients.

The proposals encompass many educational innovations, including models for competency-based student progression, total student immersion within the health care system from the first day of medical school and the increased use of health IT and virtual patients. Many of the proposals also emphasize team-based care, patient safety, quality improvement and intensive training in primary care. Here are short descriptions of each proposal.

Project funding has been awarded to the following 11 U.S. medical schools:

  • Indiana University School of Medicine
  • Mayo Medical School
  • NYU School of Medicine
  • Oregon Health & Science University School of Medicine
  • Penn State College of Medicine
  • The Brody School of Medicine at East Carolina University
  • The Warren Alpert Medical School of Brown University
  • University of California, Davis School of Medicine
  • University of California, San Francisco School of Medicine
  • University of Michigan Medical School
  • Vanderbilt University School of Medicine

The AMA will provide $1 million to each school over five years to fund the educational innovations envisioned by each institution. A critical component of the AMA’s initiative will be to establish a learning consortium with the selected schools to rapidly disseminate best practices to other medical and health profession schools across the country.

Of the 141 eligible medical schools, 119 – more than 80 percent – submitted letters of intent outlining their proposals earlier this year. This tremendous response was a clear sign that medical schools are eager to implement the transformative changes needed to respond to the evolving medical environment, enhance innovations in health care and prepare tomorrow’s physicians to thrive. Just this month, a national advisory panel worked with the AMA to select the final 11 schools.

We look forward to working with medical schools over the next five years and beyond to identify and widely disseminate the best models for transformative educational change to ensure that today’s medical students are prepared to care for patients in the health care environment of tomorrow.

Jeremy Lazarus is president, American Medical Association.

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  • AMS

    And what happens when the money you give them runs out? Are the schools going to charge students even more money? The AMA and the LCME needs to stop trying to re-invent the wheel. We are constantly switching between systems or traditional curriculum based on who’s in charge and now this crap to add on to it. When is the AMA going to do something about the actual cost of medical school? And by doing something, I don’t mean just asking congress to give us more loans at lower rates, I mean actually getting schools to lower the price. Did you know we actually have 6 states where the highest paid employee is a medical school dean or faculty member? The medical education establishment needs to be reined in.

    • ninguem

      The medical school will need a million-dollar-a-year annual grant, just to teach the students how to take vital signs.

  • Daniel

    Indiana University School of Medicine – They want to create a health care system simulation with a simulated electronic medical record. By the time students graduate, the simulated EMRs will be obsolete. Then they’ll need another $1 million to update it all? I want physicians who are able to adapt to any system they’re put in. Out in the boonies, paper will do. In an old hospital that hasn’t been updated since the 80s, that DOS-looking app works. In an HMO that spends more money on technology than it does patient care, no problem flipping through records on an iPad.

    Mayo Medical School – Mayo throws out words like “innovative”, “science”, “teams”, “communities”, and “outcomes”. Everyone says “oooh” and “aaah” in admiration. They’re probably going to have early clinical rotations or more simulations labs (“experiential learning”). Doesn’t seem particularly “innovative” to me. They’re also planning to spend some money on “wellness and resiliency resources”. I suspect the focus will be resiliency >> wellness.

    NYU School of Medicine – A three-year curriculum. Students have a hard enough time doing this in four years, and they want to do it in three. Plus, they’re going to teach the three-year students more than they teach the four-year students. How? They’re going to create a simulated medical environment, and somehow it’s going to be “a real world clinical setting.” Huh? Not only that, but they’re going to develop an “ePortfolio” to push students through the three-year curriculum. (Putting ‘e’ in front of words in so 1990…)

    Oregon Health & Science University School of Medicine – They don’t give any hints about what they’re going to do. They’re going to “develop and implement” something “innovative”, but we don’t know much about it other than that it will be “learner-centered”, “competency-based”, and “individualized” with “pre-determined milestones.” They will also have some type of portfolio system. Maybe it’s to help the students finish “in less than four years”.

    Penn State College of Medicine – They want to get basic science and clinical faculty to work together. (As if they weren’t already supposed to be doing that.) Somehow, this new cooperative atmosphere will “prepare students to work within all aspects of the complex health system”.

    The Brody School of Medicine at East Carolina University – More innovation that isn’t innovative. Can I also get a million dollars if I write a proposal that says “innovative” enough times? They also say “rural and underserved populations will be featured”. I suspect they’re just going to send some students out to rural or high-crime sites to complete a rotation or two. Maybe the money will be spent on printing costs, because students get certificates for completing this program. (What happened to the practice of medicine being it’s own reward?”)

    The Warren Alpert Medical School of Brown University – “We’re going to give our students dual degrees. Give us money.” … “Uh, okay.” … How does that make sense? Maybe it’s those buzzwords again, like “teamwork” and “leadership”. They’re also going to change the admissions process to include working with standardized patients. So, premeds are now supposed to learn medicine before they go to medical school?

    University of California, Davis – Looks like a way to get students into residency without having to go through the match. Industry gets involved in the curriculum, and the school gets a million dollar grant. win-win.

    University of California, San Francisco – Another “accelerated” program. “I do more in less time. You pay me money!”

    University of Michigan Medical School – Med school RPG. There’s a skills and knowledge tree. You get experience points that you can put into the “foundational ‘trunk’”. Once you’ve developed that enough, you can move on the “professional development ‘branches’”. You can choose your “developmental tracks” based on the character class you want to “cultivate” (like, family doctor or surgeon or anesthesiologist). You can track your stats in the “M Home” as you develop your “advanced skill sets within clinical domains”.

    Vanderbilt University School of Medicine – They plan to “embed students in the health care workplace”. Probably just early clinical rotations, and somehow “some students will be able to complete medical school in less than four years.”

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    $1 million over 5 years is not a lot of money for an entire medical school. Certainly not enough to affect fundamental change of any type. It is a cute little grant for somebody though, so expect a bunch of computer programs to be written and a bunch of papers to be published, and a bunch of kids to be pushed around into some shiny extracurricular activities and maybe get their name to be the fifth or sixth on that paper.
    Are there any medical schools left where they teach kids how to care for sick people, instead of how to be a political manager of virtual populations of standardized patients (or something like that)?

    • Dr. Drake Ramoray

      “Are there any medical schools left………..”

      =============

      No. My school in the 1990′s warned us when we filled out our evaluations of the touchy feely and managemnt stuff that they would list our remarks on our Deans letter. (The Deans letter is a summary of your time at the institution sent to all the residency programs to which you apply.) Great way to suppress constructive criticism of what was essentially a waste of time.

      A coulple people going into surgery who didn’t understand the game were “encouraged” to re-write their evaluations.

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        Thanks. Perhaps a different “redesign” is in order….

    • azmd

      We need fewer doctors writing about how to take care of patients, researching how to take care of patients, managing how to take care of patients, interfacing with corporate suits on how to take care of patients and accepting government appointments to create paperwork to monitor taking care of patients.

      We need more doctors actually taking care of the damn patients, but the problem is that once you commit to doing that, you are so busy that you don’t have time to stand up for yourself against all the aforementioned categories of doctors. So the smartest medical students are electing to avoid clinical care, since that’s the best way to avoid being managed by someone who doesn’t actually do what you do.

      • buzzkillerjsmith

        Well put. Years ago when I worked at Kaiser I realized there were 2 types of docs there: The oppressed, who did the work, and the oppressors, who did not but who rather told the others how they should be doing things. The oppressors were actually not the smartest docs there but rather the most self-serving ones for the most part.

        One oppressor actually called what he did “scam time.” A bit too honest. They put him back on the line.

  • Abbydoodle

    You can see the politics behind the decisions just by the list of names. Shame on the AMA as usual –stuck to Obama.

  • ninguem

    My medical school, in the early 1980′s, I was assigned a new-fangled computer-assisted “virtual patient”.

    My virtual patient had abdominal pain, started central-upper abdomen, localized to right lower quadrant, with anorexia, fever, and when allowed by the software to order labs, the CBC showed an elevated white count.

    “What’s your diagnosis doctor?”

    My response: “Appendicitis”.

    I failed the test.

    “Sorry, doctor. Your patient has ACUTE appendicitis”.

    I suppose the new educational innovation will find a different way to be inadequate to the task.

    • buzzkillerjsmith

      My virtual pt started to irritate me so I killed him with an overdose of potassium. I don’t think anyone ever found out.

  • buzzkillerjsmith

    2013: The majority of patients are cared for in an out-patient setting by physician-led health care teams.

    1910: The majority of work horses, which can only increase in number, are shoed by farriers whose occupational futures brighten daily.