Medical Education Then and Now Then and Now Society of Directors - PowerPoint PPT Presentation

Medical Education Then and Now Then and Now Society of Directors of Research in Society of Directors of Research in Medical Education June 28, 2010 ,

Overview Overview � A “very brief history” of American medical education education � Medical education in the � Medical education in the 21 st century � New Reports e epo ts � “Snapshots” 2010 � School Responses � Your assignment

The Flexner Report The Flexner Report Medical Education in the United States and Canada 1910

Flexner’s Ideal Medical School Flexner s Ideal Medical School The Medical School is Properly Equipped • Modern laboratories in each subject M d l b t i i h bj t • Faculty teaching is a RIGHT not a privilege • Medical schools need funds to purchase land, erect and maintain buildings, pay salaries Only academically qualified students admitted • Minimum of 2 years college training in physics, chemistry biology chemistry, biology

Impact of Flexner Report Impact of Flexner Report • Focus was on assuring everyone who practiced medicine be thoroughly trained medicine be thoroughly trained • Transformed reform of medical education into a broad social movement • Explained modern medical education to the public • Showed that principles of progressive education • Showed that principles of progressive education applied to medical teaching

Impact of Flexner Report Impact of Flexner Report • Advocated the most rigorous approach • Did not permit heterogeneous system of medical education • insisted all schools be university based schools

Impact of Flexner Report Impact of Flexner Report Greatest impact on the course of medical education in the United di l d ti i th U it d States Determined the form that medical school ultimately assumed school ultimately assumed

Advocating Change in Medical Education Education “The Rappleye” Report (AAMC The Rappleye Report (AAMC, Assessing Change in Medical Assessing Change in Medical • • • • 1932) Education…the Road to Implementation (ACME-TRI ) Future Directions for Medical • (AAMC, 1992) Education (AMA, 1982) Education (AMA 1982) Tomorrow’s Doctors (General • General Professional Education • Medical Council, 1993, 2008) of the Physician (GPEP) (AAMC 1983) (AAMC, 1983) Medical School Objectives Medical School Objectives • Report I (AAMC, 1999) The New Biology and Medical • Education (Josiah Macy, Jr. Future of Medical Education In • Foundation, 1983) Foundation, 1983) Canada (AFMC, 2009) Canada (AFMC, 2009) Educating Physicians: A Call • Adapting Clinical Medical • for Reform of Medical School Education to the Needs of and Residency (2010) y ( ) Today and Tomorrow (Josiah Today and Tomorrow (Josiah Macy, Jr. Foundation, 1988)

Abrahamson’s Diseases of the Curriculum (1978) Curriculum (1978) 1. Curriculosclerosis 2. Carcinoma of the curriculum C i f th i l 3. Curriculoarthritis 4. Curriculum Diesthesia 5. Iatrogenic Curriculitis 6. Curriculum Hypertrophy 7. Idiopathic Curriculitis Idiopathic Curriculitis 7 8. Intercurrent Curriculitis 9. Curriculum Ossification Curriculum Ossification 9

Why Change is Needed Why Change is Needed We have been evolving from a situation where the medical school was primarily situated in a the medical school was primarily situated in a university, to one where, today it is primarily situated in the health care delivery system. I y y think that the changes going on in the health care delivery system today, with their attendant impact on medical schools and medical impact on medical schools and medical education, are of greater importance in magnitude than any change we have had since th the Flexner era. (Kenneth Ludmerer, M.D.) Fl (K th L d M D )

Educating Physicians: A Call g y for Reform of Medical School and Residency • The New Carnegie Report The New Carnegie Report

Standardization & Individualization * Standardization & Individualization Challenges Recommendations Medical education is: Medical education is: Not outcomes based Standardized learning outcomes through assessment of competencies Inflexible Inflexible Individualize learning process allow Individualize learning process, allow progression when competencies achieved Overly long Overly long Offer elective programs to support Offer elective programs to support the development of skills for inquiry and improvement Not learner-centered *Cooke, M., Irby DM, O’Brien BC Educating Physicians: A Call for Reform of Medical School and Residency. San Francisco, Calif. Jossey-Bass-Carnegie Foundation for the Advancement of Teaching. In press F i C lif J B C i F d ti f th Ad t f T hi I

Integration* Integration Challenges Recommendations Poor connections between formal Poor connections between formal Connect formal knowledge to clinical Connect formal knowledge to clinical experience, early clinical immersion, knowledge and experiential learning adequate opportunities for reflection and study I Integrate basic, clinical, and social b i li i l d i l sciences Fragmented understanding of patient g g p Engage learners at all levels with a more g g experience comprehensive perspective on patients’ experience of illness and care , including more longitudinal connections with patients p Poorly understood nonclinical and civic Provide opportunities to experience roles of physicians broader professional roles of physicians Inadequate attention to skills of effective Incorporate interprofessional team care in complex health care system education and teamwork in curriculum * Cooke, M., Irby DM, O’Brien BC Educating Physicians: A Call for Reform of Medical School and Residency. San Francisco, Calif. Jossey-Bass-Carnegie Foundation for the Advancement of Teaching. In press

Habits of inquiry and improvement Habits of inquiry and improvement Challenges Recommendations Focus is on mastering skills and Focus is on mastering skills and Prepare learners to attain both Prepare learners to attain both knowledge without promoting routine and adaptive forms of knowledge-building and commitment expertise to excellence Limited engagement in scientific Engage learners in challenging inquiry and improvement exercises problems and allow authentic participation in inquiry, innovation, and improvement of care d i t f Inadequate attention to patient Engage learners in initiatives focused populations, health promotion, on population health, quality practice based learning and practice-based learning and improvement and patient safety improvement and patient safety improvement Lack of opportunity to participate in Locate clinical education in settings management and improvement of the management and improvement of the where quality patient care is where quality patient care is health care systems in which they delivered, not just in university work teaching hospitals

Identity formation Identity formation Challenges Recommendations Lack of clarity and focus on professional values Lack of clarity and focus on professional values Formal ethics instruction storytelling and Formal ethics instruction , storytelling, and symbols (e.g. white coat ceremonies) Failure to assess, acknowledge and advance a u e o assess, ac o edge a d ad a ce Address the messages in the hidden curriculum dd ess e essages e dde cu cu u professional behaviors and strive to align the values of the clinical environment Offer feedback , reflective opportunities, pp assessment on professionalism in the context of mentoring and advising Inadequate expectations for progressively higher Promote relationships with faculty who support levels of professional commitments learners and hold them to high standards Erosion of professional values due to pace and Create collaborative learning environments commercial nature of health care committed to excellence and continuous improvement

The Future of Medical Education in Canada Canada * Address individual and community needs 1) E h Enhance admissions processes d i i 2) Build on the scientific basis of medicine 3) Promote prevention and public health 4) Address the hidden curriculum 5) Diversify learning contexts 6) Value generalism 7) Advance interprofessional & intraprofessional practice 8) Adopt a competency-based approach 9) 10) Foster medical leadership * The Future of Medical Education in Canada: A Collective Vision for MD Education Project (phase One) AFMC 2009

A Dual Imperative A Dual Imperative • Defined Outcome • Pedagogy that is Standards Standards individualized individualized • Pedagogy to provide continuous learning continuous learning, feedback and assessment

What are the outcomes w e w ant from the medical school curriculum now ? medical school curriculum now ? A humanistic approach to medicine A patient centered approach to medical care An appreciation of the value of fundamental research for the advancement of medical science h f th d t f di l i A global perspective on contemporary health issues issues An appreciation of the importance of the biological and population sciences for the advancement of and population sciences for the advancement of medicine