Are we training medical students to be high-quality health care providers?

When I started medical school, a wise professor likened the amount of new information I was about to learn to trying to drink water from a fire hose.  It didn’t take long until I understood exactly what he meant.  After sitting through the seemingly endless hours of lecture, lab and small group sessions required in the first two years of medical school, my head was spinning from information overload.  The next step was to sit at a computer screen and take the USMLE Step 1 exam, which (no pressure) was going to produce a score that would probably determine which residency program I would get into two years down the road.

This leads to the question:  Are we training students to be high-quality health care providers or high-scoring test takers?

Let me offer complete disclosure. I am a former medical student mandatory lecture participant turned medical school faculty lecturer.  I converted from sitting in middle-to-back third of the lecture hall, to walking around the front of the room, trying my hardest to engage the students in enticing subjects like community-acquired pneumonia and fibrocystic change of the breast.

But are we teaching students what they need to know to make much needed positive changes to the U.S. health care system?  A constantly increasing volume of cutting-edge medical knowledge combined with regulatory pressures to decrease the number of lecture hours makes introducing new medical school courses very difficult.  With so few U.S. medical schools currently offering formal health care delivery, quality and policy education, it’s difficult to imagine where such a course would fit in.  In order to add course hours, you have to take some away from someone else (look out, urea cycle!).

Medical schools need to get creative about how to include health care delivery improvement education into their curriculum.  The information needs to be presented to students in an engaging way, beginning in the first two years with the foundations of health care delivery, quality improvement methodology and data analytics, with application of those teachings in the clinical years.

Another inevitable hurdle is finding faculty (specifically physicians) who have the training, teaching skills and time to devote to developing and delivering this material.  Arming students with the knowledge and tools of how to implement continuous quality improvement into their practices doesn’t help if they are not reinforced during clinical rotations because attending physicians and residents are not themselves trained in understanding their importance.

In the U.S., our health care costs are topping 2.5 trillion dollars.  We need to position our front-line health care providers to be able to reduce this cost through education and access to actionable data.  Where better to introduce these important concepts than early on in medical school?

I think most medical schools agree these changes need to happen, but questions like, “What does it look like?”, “Where does it fit in?”, and “How will it be translated and sustained?” remain to be answered.

Alexandra S. Brown is associate director, Healthcare Delivery Institute, HORNE LLP.

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  • QQQ

    One thing new MD’s need to do is stop paying their dues to the AMA. The AMA is the organization that supported ObamaCare. The AMA has been taken over by
    bureaucrats and socialists that don’t actually practice medicine

    • rbthe4th2

      The second reason, and the fact they really don’t represent doctors any more, is why they should get out of the AMA.

  • PoliticallyIncorrectMD

    Willingness to take responsibility, the ability to make decisions based on incomplete database and thinking outside of the box are very crucial. Instead we are selecting those who can follow orders and regurgitate meaningless information.

    • Ali Shaye Brown

      It’s not all meaningless, but it is definitely a different world from the actual practice of medicine. The first 2 years are more like college on steroids. We need to integrate more practical knowledge into undergraduate medical education (like what is medicare / medicaid, how do hospitals bill, how does quality control cost…).

      • PoliticallyIncorrectMD

        Respectfully, I disagree… Doctors do not need more knowledge … It is endless and you will newer learn everything. They need tools to get the right knowledge when they need it… They need wisdom to separate real knowledge from agendas… They need courage to apply that knowledge when appropriate… They need passion for Medicine and patients … The garbage they definitely do not need is ever changing billing regulations, coding techniques, insurance rules, cost saving strategies, etc. Your role is to help those in need, nothing else should be concern you!

  • rbthe4th2

    One of the reasons that missed and delayed dx’s are a problem.

  • HJ

    I didn’t have the most common bug and my doctor couldn’t think outside the box to make a timely and accurate diagnosis. She probably finished medical school 30 years ago.

  • Ryan Gray, MD

    Dan, I think you missed my point. You said “make sure med students learn AND understand the material taught in the first two years.”

    I think what some, not all, students do is learn and understand step 1 material.

    Yes, we learn integrating it all later, but with as much information as we need to learn, doing that from day one is critical.

    • Ali Shaye Brown

      I don’t think studying to score well on Step 1 makes anyone less of a good doctor in the future. I do think we need to help prepare medical student to function in the healthcare models of the future, but in general we never have been good at teaching the business/ policy side of healthcare.

  • Ali Shaye Brown

    Is a physician not a health care provider?

    • PoliticallyIncorrectMD

      Physician is calling, commitment, mentality and
      way of life. Provider is just another

      • NPPCP

        Nice statement doctor. Reminds me of some of the locum jobs I have taken in the past. Get in there and get out of there! Then, when you do what you love – care for people on shared terms – theirs and yours; it’s a completely different world. Thanks for that.

  • Ali Shaye Brown

    Apparently, there is going to be more of an emphasis on quality and patient safety in Steps 2 and 3. It will be interesting to see how this manifests and the changes it will have on medical school curricula. Also, the ACGME CLER visits look closely at resident involvement in quality and patient safety on an institutional level and will in part supplant the traditional residency program inspections in the future.

  • PoliticallyIncorrectMD

    “We help more of those in need by offering them better healthcare in a better system.”

    We help more by staying Physicians and not becoming Administrators (there are plenty of those). Stop worrying about YOUR autonomy, YOUR compensation, YOUR status and start thinking about THE PATIENT. This is the kind of
    physicians we desperately need! And this is exactly what medical education fails to achieve.

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