Radically Rethinking Medical Education : Shots

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Katherine Streeter for NPR

Poor old Dr. Krebs. His painstaking Nobel-winning work on cellular metabolism, called the Krebs cycle, has made him the symbol for what's ailing medical education.

"Why do I need to know this stuff?" medical students ask me.

"How many times have you used the Krebs Cycle lately?" senior doctors jokingly reminisce.

For decades, first-year medical students have had to cram the details of the Krebs cycle into their heads. Now the biomedical model of educating doctors, based largely on a century-old document called The Flexner Report, is coming under fire.

From one end, our long-standing medical education model is attacked as out of tune with the information age. By some estimates, our entire body of medical knowledge doubles every three or four years.




Critics say med students can't possibly master so much
information, which quickly becomes outdated anyway. Instead, the new
theory goes, students should be taught and evaluated on their ability to
find, assess and synthesize knowledge. And they should be educated in teams to help prepare them for what goes on in the real world.

From
another angle, critics of the Flexner model correctly point out that
Flexner himself, an educational theorist with no medical training, was
silent on issues such as poverty, housing, nutrition and other factors
that we now call the social determinants of health.

We now know these factors collectively affect our overall health more than even the $3 trillion health care industry.

Many
times I've seen patients and found the tools I was trained to use
aren't nearly enough to provide help. No physical exam or X-ray can find
a homeless person a bed. No lab test or medication can provide a
laid-off worker with job training or education.

It took more
than a decade for me to learn to ask patients about hunger. I found out
that many of the people I've cared for suffer from food insecurity – not
knowing where their next meal will come from.

"But what can I do about those problems?" my students ask. "Isn't that just social work?"

The answer may surprise you.

In my role as a medical educator, I attended the Beyond Flexner conference in Albuquerque, N.M., in early April. The main theme of the meeting, sponsored by the W.K. Kellogg Foundation and others, was this question: "What is the social mission of medical education?"

The conference came about as an outgrowth of a 2010 paper that ranked medical schools by their social commitment rather than their research dollars or U.S. News and World Report
scores. It began as something of a shot across the bow to organized
medicine, challenging orthodoxy, such as making students memorize the
Krebs cycle.

Over the years since then, more research has shed light on the economic and health impact of social determinants. The media has caught on to this as well.

Nearly
400 medical educators, activists, policymakers and students turned up
to share ideas, hash out strategy and plan a road map for changing
medical education.

Our hosts from the University of New Mexico
demonstrated that medical schools that are serious about community
engagement build strong partnerships that take social determinants into
account. We heard how community health workers and a re-imagination of
the agricultural extension model for health education are improving the health of New Mexicans.

To
me, the most surprising aspect of the meeting was just how many medical
schools are now getting serious about the importance of social
determinants.

Many of the sessions at the conference explored
obstacles that stand in the way of a culture change in medical
education. At the top of the list: How to deal with a payment system
that still prioritizes the quantity of medical care over quality? A decision
by Medicare earlier this year to base a large proportion of future
payments on quality and value has convinced many of us that the health
system is on the path of change.

I left the conference with new
ideas and fresh energy. I also was left wondering what will replace the
Krebs cycle in the medical education pantheon.

My bet? It will
be a team of students finding ways to break the vicious cycle of
poverty that contributes to so much suffering, illness and early loss of
life.

John Henning Schumann is a writer and doctor in
Tulsa, Okla. He was recently named interim president of the University
of Oklahoma, Tulsa. He also hosts Public Radio Tulsa's Medical Matters. He's on Twitter: @GlassHospital

 : NPR