In his First Opinion article on reforming medical education, Akhilesh Pathipati, a medical student at Stanford, invited readers to offer their own recommendations. More than 100 did just that.
Here’s a sampling of recommendations from readers, identified by profession. Their responses fell into six main categories:
- Restructuring medical school
- Improving communication and partnering skills
- Adding business and leadership skills
- Offering more information about nutrition and dying
- Boost training in digital health and medical records
- Improving rounding and rotations
1. Restructure medical school
- Drop the bachelor degree requirement. Make medical school a six-year program after high school that is focused on medicine. We are spending way to much of our young students’ time with college prerequisite courses. Not to mention adding to their debt. (medical educator)
- Early acceptance into medical school with good counseling throughout to allow for exit planning of candidates less suited to medicine would be key. We keep asking students to be more qualified before they arrive, and then treat them as if they haven’t done a single thing prior to medical school. (physician, medical educator)
- Two years of preclinical study is a waste of time and survives only due to tradition and PhD entrenchment and control. The third year is what really counts; the fourth should be more goal-directed but is largely wasted due to the resident match process and interviewing time. (medical educator)
2. Improve communication, partnering skills
- There is no mention about learning how to connect with your patients through excellent communication skills. Students need more time on clinical rotations and more hands-on time dealing with patients and families. (medical educator, physician)
- Teach the skill of empathy. (profession not specified)
- Have medical students do a rotation with a nurse. This will help to humanize their experience and understand how their orders are carried out.
- More training about collaborating with patients, pharmacists, nurses, and other clinicians. (profession not specified)
- As a patient who has, unfortunately, been through many surgeries and specialty treatments in and out of hospitals, I beg the medical profession to get their communication skills honed. Pharmacists, nurses, doctors, dietitians, techs have a hierarchy in which the patient does not have a voice. (patient)
3. Add business, leadership skills
- Introducing an MBA is a good idea in terms of facing the current challenges by doctors. (physician)
- I chose to get an MD/MBA, and I wish more physicians had knowledge about the business and policy environment surrounding medicine … Most physicians don’t even understand how the hospital gets paid! A mini-MBA would be a very good way to start. (physician)
- Maybe one course on the basics of micro-/macroeconomics and leadership. Time lost teaching MBA info cannot be used to teach medicine. (physician)
- An MBA is the last thing med students need. The corporate medical complex is ruining US health care. When money is the bottom line, it’s a drive to the bottom. (medical educator, physician)
4. Talk about nutrition, and dying
- Today’s doctors are woefully ill-equipped to answer their patients’ questions about nutrition or food access. Without this vital understanding, disease prevention is left to the wayside while treating the symptoms of chronic disease (type 2 diabetes, for example) becomes the norm. Classes in nutrition education, agriculture and food systems studies, food policy, and health justice would enrich a stale med school curriculum and better aid medical students in considering food and diet as a part of health care. (profession not specified)
- We must teach physicians-in-training (from early in medical school) that death is not always a treatment failure. The current medical establishment feels compelled to provide invasive, aggressive care to all patients regardless of whether it will benefit them in the end. … We need more physicians who can look at the big picture to provide care to patients that fits their goals and values for how they want to live. (medical educator, physician)
5. Digital health and medical records
- Make digital health a crucial component of curriculum. (physician)
- Incorporate electronic medical record training into the curriculum, since that largely dictates how doctors practice and residents function in the hospital. Today, it is learned on the job, by asking others for tips, leading to gaps in training depending on who is around you, with deficits masking an otherwise medically intelligent trainee. For better or worse, people who know the computer program the best are seen as the best physicians. (medical student)
6. Improve rounding and rotations
- Provide longitudinal patient experiences and education with the same preceptors. Block rotations don’t work. (medical educator, physician)
- Abandon the laborious “verbal presentations” and “rounding” aspect of inpatient care. No patient was ever helped by a glib “resident presentation” (that was largely fabricated on the spot and cited two sources that the trainee didn’t actually read) and took valuable time out of the clinical workday. We are in the 21st century, people, and I’m sure that Osler himself would be ashamed by the time spent on this archaic and useless ritual, given the faster means of communication we are surrounded by. Stop the pantomime and actually do something to treat patients! You aren’t “teaching” anyone this way anymore! (physician)
this is a minimally curated list of random people’s unsubstantiated opinions
Get an MBA, don’t get an MBA. Abandon rounding, spend more time with patients. What is going on.
After dealing with mainstream doctors for three years in some of the top hospitals in the US there is a major VOID in knowledge of environmental illness. Currently sitting in a hospital with my 24 year old chronically ill son and doctors are clueless to environmental illness and effects of mold toxins and Lyme!!
With respect to point 4.2, see my reviews of Ann Neumann’s fine book “The Good Death.” e.g., https://medium.com/@BobbyGvegas/dem-bones-a-billion-tons-of-them-1a7e23f3f058#.zac2k3eww
You might want to interview her.
What about getting some serious morality and integrity education and assessments?
Between, being ridiculously overpaid and way to easily bribed by pharmas (aside misdiagnosis and mistreatments), MDs are the single most significant cause of medical care troubles.
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