New curriculum will graduate collaborative physicians’, leaders who will drive change in patient care, healthcare delivery and scientific discovery

Training Better Doctors through revised curriculum and changed instructional strategy

New curriculum will graduate collaborative
physicians’, leaders who will drive change in patient
care, healthcare delivery and scientific discovery

There will be more emphasis on inter
professional education-Dr Joseph Kolars

Leadership, Path and Community are the
three important strategic pillars

KARACHI: American Medical Association has selected eleven medical schools in United States including Michigan Medical School with one Million US$ grant for change in medical education. This experiment which can also be termed as a US case study is aimed at training better doctors through revised curriculum and changed instructional strategy. It is hoped that the new curriculum will graduate collaborative physicians, leaders who will drive change in patient care and health delivery and scientific discovery. This was stated by Dr Joseph C. Kolars Professor of Health Sciences Education and Senior Associate Dean for Education and Global Initiatives at the University of Michigan Medical School. He was speaking on Training Better Doctors: New Directions in Medical Education at the Aga Khan University on November 21^st 2016.

Dr. Joseph C. Kolars further pointed out that it was in 1869 that first medical school attached with a 1000-bed teaching hospital was established in USA at University of Michigan. During the last hundred years there have been no big changes in medical educaiotn in United States. He then quoted Charles Darwin that those responsive to change can survive better. Continuing, he said, that it was in 1910 that Flexner Report was made public. This commission was formed because of week and absent curriculum. In those days there was lack of scientific basis. There was surge for profit schools without credibility. As a result of this report more than 50% of the medical schools were closed. We are now facing similar problems some of which are unique to United Sates.

The problems that we face in medical educaiotn today he said are:

Growth in knowledge, skills and appropriateness more than can be covered in medical education curriculum.
Integration of learning areas topics is sub optimal.
Assessment tools are disconnected and incomplete what students are expected to do.
Intensity of practice, environment and its associated requirements which are marginalizing our learners.
Society is asking for different kind of health system.

Despite being one of the richest country in the world, our life expectancy, he said, was just in the middle if we compare it with other counties in the world. Cost of care is very expensive. As regards value for care, USA has the 37^th position. Value, he said, is measured by quality of appropriateness divided by cost. At present US healthcare system is struggling. One is the way we educated our doctors. Now we have to educate and train our doctors differently.

He then referred to the traditional US medical school curriculum and said that now we have an explosion of knowledge, lack of training in teams and systems. Lack of opportunities to develop leadership, marginalization in clinical setting and different background of sciences to critical care. There are currently 140 Medical Schools in USA of which AMA has selected just eleven for this experiment. Our vision is that physicians must lead to solve healthcare challenges in the society. We will have competency based education model which will be evaluated through assessment.

This programme Dr Joseph Kolars said is designed to train future leaders in medicine. With forward looking curriculum and strong foundation with ability to adopt to individual professional context and objectives besides advanced professional development for a career in medicine. We have student’s advisory committees and medical student’s council who are consulted. Now from first year foundation will cover clinical Foundation learning and thinking skills. We have a three thousand strong faculty and they wish to teach what they have been teaching so far. It is not easy to convince the faculty to embrace these changes. We now have lot of emphasis in inter professional education. Healthcare is a teamwork and it is important to see how doctors can be part of the team. Clinical decision making should be careful and take into account Discharge safety like physical therapy. Health policy and economics, how they can energize the team.

Continuing Dr. Joseph Kolars said that Path of excellence was Leadership, Pathways and Community which are the three important strategic pillars. We believe that our physicians should improve health and healthcare. Learn leadership development and management skills. They should have Professional and leadership identity, capable of building a team, solving problems, impacting systems, communicating and influencing. We will train people to share values. We do have leadership electives as well. In the new revised curriculum we have eight Paths which include Global health and disparity, Bioethics, Scientific discovery, Patient safety, medical humanities, scholarship and learning and teaching, Health economics and policy.

Community is the third pillar. It covers directed professional development, patients and home care policies, hospital based practice, procedural basic care, diagnostic and therapeutic technology which are major. Every student has a coach. We monitor learner progress, competence. This is the hallmark of excellence in University of Michigan Medical School system. It is a huge challenge. Almost 50% of what we were taught in the past has proved wrong. Now we invite the physiologist in the intensive care unit to discuss physiological reasoning for the disease. Faculty is measures by research output, how many procedures you have done but Medical Education is very difficult to measure. We will learn from this experiment, he added.

His presentation was followed by lively discussion monitored by Mr. Feroze Rasul President of Aga Khan University. Dr. Nasir asked how to attract and retain the Pakistani doctors settled in USA was a big challenge. There is massive brain drain from Pakistan and other countries which is their loss. Dr. Joseph Kolars replied that doctors go for shopping in the best environment. One should look at what to do to improve the environment. We are looking at how technology will help the students. Problems based learning is labour intensive. Now all that is discussed is tape recorded and available later for the students. We have massive online courses for students to watch. Students can take quiz in a week in a given time. We have electronic portfolios.

Prof. Riaz Qureshi pointed out that those countries who gave importance to Family Medicine their health indicators are much better. Society needs more family physicians or primary healthcare physicians. What you intend to do to give importance to Family Medicine? Dr. Joseph responded by saying that almost 36% of US medical students are going in that direction. Our students can see liver transplant more and much easily than cholecystectomy. We will do much more to attract people to those fields.

One of the participants referred to too much reliance on technology. It was stated that neglecting clinical skills was dangerous. The importance of good history taking and physical examination was highlighted and it was said that most often it helps in making diagnosis in most cases. Bedside teaching was not only important but it was also much more cost effective. Dr. Joseph agreed that now when the patient comes, doctor is busy with the computer as he has all the details there and hardly looks at the patient. The doctor patient relationship has suffered. Computer is the biggest disruptor. The physician has no contact with the patient, hence care of the patient suffers. We need to spend more time and listen to the patient, he agreed.

One of the medical students from AKU pointed out that we have best scores and grades but find it difficult to deal with the patient while in the ward. Clinical exposure to the students should be given in early stages. Dr. Joseph remarked that it will be dangerous to undermine the importance of basic sciences. You need to know the basic knowledge. Subjective assessment, he agreed was a problem. It is human nature at play. What we do is we standardize our faculty. We take average score of the faculty. In the old model there was a limited set of role models.

Later responding to a question from Pulse International, Dr. Joseph Kolars said that Medical ethics is influenced by the environment. In Chicago now students on roads as they fear the environment is changing. Sunshine Act has made some difference to check and minimize unethical medical practices as regards physician’s interaction with the Pharma industry. Students are monitoring their colleague. We do not allow Pharma people in the university and take others measures but it is difficult situation to enforce ethics, he agreed.