Topics in medical education have historically been somewhat
separated or fragmented, and future progress hinges on our
appreciation and development of important new synergies and
interconnections. In my experience over the past 30 years, for example,
medical education has been medicine-content-focused. That is, we
teach students “here’s the kidney, here’s what we need to know about the
kidney, here are things that can go wrong in the kidney,” and so forth.
But if medical students are to succeed and lead in today’s highly-complex,
rapidly-changing healthcare environment, they need to learn a wide
range of additional skills—such as leadership, educational technologies,
experiential learning in diverse settings, and the whole dimension of
healthcare delivery science.
In that regard, I am struck by the connections and synergies among
and between those new dimensions of medical education, which need
to be embedded into the curriculum. We can no longer train students
just to be doctors because we are no longer focused on just the heart,
lungs, or the kidney. If we are going to reform the healthcare system, we
must simultaneously reform the educational system. We have to prepare
doctors to be able to practice in the new environment. These realities
make the curriculum more complicated, but at the same time more
interesting.
The new themes that increasingly have to be part of medical education
raise a host of interesting questions. For example, what does it mean to
be a leader—whether you are in solo practice, a large group practice,
or a large academic health center? How do you measure how you are
doing in your practice? How do you provide the best care of the highest
quality at the lowest cost? We need to be attuned to the importance of
training students in measurements—including critical appraisal skills,
quantitative analysis, and systems design and improvement—as well as
in the contextual elements of medicine, such as policy, economics, and
disparities.
One interesting challenge for medical schools is that faculty may not be
experts in these areas. For example, our students have repeatedly asked
for content on resilience: How do you rebound from bad news or a bad
outcome? Most medical schools have to turn to experts outside their
faculty to get that kind of information. Similarly, many schools have to
turn to their business school for leadership training. We often also have to
look outside for expertise in such areas as teaching technology.
There is a need to create infrastructures that allow for better alignment
of medical education inside the professional nature of healthcare. The
data is pretty clear that we need learning platforms, contexts, and opportunities for medical students to learn together with nursing students,
pharmacy students, residents, and other practitioners; patient care is
now entirely team-based. It may sound obvious, but how do you create
the infrastructure to do that? How do you do that when you don’t have a
nursing school?
Another implication, of course, is funding. How can we afford to change
medical education in the ways that it needs to be changed in an era
when traditional sources of revenues—such as tuition, indirect costs
from grants, support from hospitals, and reimbursements—are flat or
even in decline? Related questions concern how we pay faculty. If, for
example, we expect faculty to generate a certain level of Relative Value
Units (RVUs), what about research faculty? Is there a research RVU
equivalent? What happens if someone loses their grant? How do you
compensate teaching faculty? How do we compensate clinical faculty?
These complicated questions will continue to challenge leaders as we
move ahead.
Wiley W. Souba, MD, ScD, MBA
Former Vice President for Health Affairs
Former Dean of the Geisel School of Medicine
Emeritus Dean
Professor of Surgery
Dartmouth College