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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