Like many aspects of health care, medical education evolves slowly. The modern curriculum is based on the Flexner Report — a review published in 1910. It hasn’t changed much since then.
It needs to.
As a medical student at Stanford, I’ve seen firsthand the limitations of today’s physician training. We can do better. Here are five reforms that I think would prepare doctors for medicine in the 21st century.
Teach skills, not just facts
Every medical school course list includes a slew of classes on physiology, pathology, and pharmacology. All important topics, but the emphasis on scientific information leaves physicians unprepared in a world where today’s facts may be outdated tomorrow.
Schools should instead teach students skills that we can deploy in a shifting landscape.
All students should graduate with a firm understanding of data science and statistics. The advent of electronic health records and the continued march of medical research have generated reams of data that physicians must be able to sift through, synthesize, and act upon. A strong quantitative background will help doctors understand and direct the continued development of precision medicine.
The same can be said for many technologies. For instance, telemedicine is increasingly ubiquitous in the clinical setting, but students receive no training on its applications and limitations. That must change if digital health tools are to reach their full potential.
Incorporate a “mini-MBA” into medical school
In addition to my medical degree, I am pursuing an MBA. I’m often asked why; isn’t 14 years of postsecondary medical training enough?
I would argue that the knowledge and skills developed in business school have never been more relevant. Many doctors are comically uninformed about issues surrounding cost and access. As the regulatory environment grows more complex, this limits physicians’ ability to provide the highest quality care, whether advising patients on cost-effective treatments, interacting with insurance companies, or running a practice.
Physicians would also benefit from dedicated leadership training. Health care is trending toward team-based care with a doctor managing nurses, pharmacists, social workers, and more, each of whom has a distinct role. At present, medical school teaches clinical decision making in silos. A mini-MBA would instill a new mindset.
Make room for new content
Critics of curricular reform often argue there’s no time to add this type of material. We can make time.
The first two years of medical school are typically “preclinical,” where students receive classroom-based instruction. However, courses are often redundant and a lot of what students learn could be covered in undergraduate prerequisites.
The second two years are “clinical,” during which students participate in patient care by rotating through various specialties. Rarely does this require two full years; at Stanford, rotations take approximately 16 months.
Four years of medical school provides enough time to teach what we currently learn and more. Several schools have experimented with condensed curricula without a negative impact on student performance. The saved time should be used to broaden our education.
Promote more than academic research
Alongside coursework, medical schools place a tremendous emphasis on student research, whether lab work or clinical. There are several proposed reasons for this emphasis — it improves critical thinking, stimulates curiosity, etc. — but it largely stems from tradition. Academic medical centers train physicians who are supposed to conduct research, even if it is at the expense of other pursuits.
But the role of a physician has changed over time. Doctors now play an integral part in management, policy, and entrepreneurial ventures, to name a few. It is time for the training system to recognize and promote work that advances medicine — whether or not it is published in a journal.
Nurture teachers who teach
One of the most memorable quotes I’ve heard in medical school came during a grand rounds discussion on education: “Academic physicians are paid to see patients and are promoted for their research. No one cares about teaching.”
In theory, doctors who work in teaching hospitals are instructors; working with students and residents is part of their job. In practice, physicians have little incentive to care about trainees. Of course, many doctors are excellent teachers. But that is by coincidence rather than design.
This incentive problem can lead to a corrosive and occasionally abusive culture. Medical trainees have high rates of burnout and suicide. A recent study found that nearly one-third of residents were depressed. A host of factors play a role, but a lack of effective mentorship and support almost certainly contributes.
Medical schools need to take steps to reward good teachers and help bad ones improve. Neurology is one of the highest rated rotations at Stanford. That is not by chance; the department chair reviews teaching evaluations with every attending and resident. Simply giving faculty a reason to care about teaching can dramatically improve the student experience.
Medicine is a dynamic field that mandates continual innovation and improvement. Medical education must be held to the same standard. These five reforms can help create a physician workforce equipped to meet the challenges of a new era.
Akhilesh Pathipati is a fourth-year student in Stanford’s MD/MBA program.