Medical Schools and their New Training Emphasis

The AMA Rounds points out that:

Modern Healthcare provided an update on the progress at the NYU School of Medicine at NYU Langone Health and other medical schools “that received $1 million grants in 2013 through the AMA’s Accelerating Change in Medical Education Consortium.” That effort “advocates teaching students about health system science, which emphasizes the role of human factors in value-based care delivery, collaboration throughout systems, leadership and patient improvement strategies.” Susan Skochelak, MD, group vice president of medical education at the AMA, said, “We think about teaching the science of medicine, but we have some students leaving medical school who don’t know the difference between Medicaid and Medicare – and that’s not on them, it’s on us.” AMA President David O. Barbe, MD, said. “Once upon a time, the physician could get away with focusing on patient care and letting someone else worry about insurance and the economics of it.” Dr. Barbe added, “Those times are way past.”

How does that sit in your belly?

  • Teaching value-based care, which is unproven
  • Patient improvement strategies, which is unproven
  • Learning the difference between Medicaid and Medicare, which takes 3 seconds and who gives a crap
  • Learning about insurance, which is a broken model

The rest of the Modern Healthcare article is a treasure trove of nausea so take some Zofran before you read it. See how students are studying:

  • EHR platforms
  • How to be patient navigators
  • How to work in teams and with social workers, nurses and other non-clinicians to grasp how the system is interconnected and to best use community resources to keep patients healthy

In a perfect world, we could teach students EVERYTHING but I have seen students who don’t know how to do physical exams, do a SOAP note, or actually communicate with another human.  They are lacking the basic power of observation (“How did you not see the tobacco stains on his fingers” or “Did you not notice she was demented and confabulating?”).  But at least we are teaching them EHR platforms and insurance models.

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  5 comments for “Medical Schools and their New Training Emphasis

  1. Steve O'
    October 16, 2017 at 9:25 pm

    Every Dark Ages has its hermits and scholars who retreat to the fringes and preserve the ancient lore. Recall, the works of Aristotle and Plato barely survived the Dark Ages in Europe. Hundreds of creative and brilliant works by classical authors of Rome and Greece did not. They are only known by reference.

    One cannot teach medicine without developing a personal relationship between teacher and student. Computer-based learning manufactured by Medical Educators conveys a smattering of knowledge; but the human chain of teaching goes extinct.

    An entire paragraph of the oath is dedicated to medical education:

    To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician’s oath, but to nobody else.

    Of course, medicine is no longer a hereditary art reserved to the family of physicians; but the spirit of the oath is broken when the teaching of medicine becomes a profit-making burden for the University. The lay public does not know or point this out. They are delighted to point out “do nothing wrong,” the new mantra of the bureaucratic medical civilization – “do nothing that can lead a trace of blame to you.”

    We have already joined the value-based, data-driven insight-oriented club of busybodies who insinuate themselves into every medical decision, but scatter when responsibility is considered. It’s not our fault.

    (By the way, the phrase “primum non nocere” is proven to date no earlier than the 17th century. So much for the study of the history of medicine. And “Practice two things in your dealings with disease: either help or do not harm the patient” is attributed to HIppocrates, but dates to a Dr. Inman in the 1800’s)

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  2. Bill Ameen MD
    October 16, 2017 at 1:11 pm

    Dr. Doug,
    And I’ll add to that many medical students I’ve observed don’t know how to suture and have no interest in learning, because they can always refer it out…unless, oops, they go into EM residency.

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    • Steve O'
      October 16, 2017 at 9:29 pm

      The problem is that suturing requires a decision to be made, and a selfish and arrogant one. The doctor and none other decides that suturing is indicated, in rebellion against the principles of team-based decision-making,, and claims the skill to do it. The dangers implicit in such decisiveness far exceeds simple septic shock, wound infection and abscess.
      Hey, let’s call modern medicine SEPTIC SCHLOCK. I just thought of it.

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  3. Pat
    October 16, 2017 at 1:07 pm

    Had I known this is what health care is really all about, I never, ever would have gone to med school.

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  4. October 16, 2017 at 10:46 am

    I’m glad I’m out of med school. They should be ‘disruptive’ and teach that health insurance ≠ health care (i.e. doctors, nurses, treatment of disease).

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