To achieve patient safety, lower cost and serve the public’s healthcare needs we need to develop a different model of education and training for our healthcare providers. One that embraces the technology available, provides for the needs of medical educators and medical students alike and can be achieved at a cost that does not cause indebtedness until ages 30 or 40.
“On the pedagogic side, modern medicine, like all scientific teaching, is characterized by activity. The student no longer merely watches, listens, memorizes: he does. His own activities in the laboratory and in the clinic are the main factors in his instruction and discipline. An education in medicine nowadays involves both learning and learning how; the student cannot effectively know, unless he knows how.” Sound familiar? It is a quote from Abraham Flexner, in his report that revolutionized medicine in 1910.
Unfortunately, today’s graduate student has gone back to watching a great deal of the time rather than doing. Therefore, requiring more post graduate work as witnessed by the rise in Fellowships.
Today’s medical students have far less time to learn the skills necessary to ‘effectively know and know how’. As you will read in a number of articles in this issue there are many causes: specialized faculty, work hour restrictions, government regulations, the plethora of medical discovery and the vast amount of materials to cover to attain the necessary knowledge. Therefore, medical school curricula should be enhanced with as much technology as possible to ensure that those trained are proficient in all clinical skills and have demonstrated mastery of the subject matter and the procedure by comprehensive exams and assessment of skills at all levels.
Simulation, virtual and augmented reality, and games all play a vital role in the education process. Many institutions have seamlessly integrated technology into the curriculum but there is no mechanism, to my knowledge, that allows the sharing of these advancements (other than article, papers and presentations) with other institutions so that each school does not reinvent the wheel. If it works, it needs to be shared, not only as a cost saving measure but as a way to begin to standardize the educational process.
Medical education has witnessed a significant increase in the use of simulation technology for teaching and assessment but very few institutions have embraced augmented and virtual reality to enhance the curriculum. The attention focused on medical errors and the paradigm shift to outcomes-based education with requirements for assessment and demonstration of competence will stimulate the use of new technologies but it is far behind other fields.
Using simulation can reproduce a wide variety of clinical conditions on demand; allow novices and experts the practice required to master various techniques - including invasive procedures - before encountering real patients and allows trainees to hone their skills in a risk-free environment where errors can be made without loss of life.
The other issue in medical education is time. If a student can demonstrate excellence at each level should he or she be allowed to continue at a faster or slower pace if proficiency has not been achieved? Dr. Daniel Clinchot, discussed Ohio States intention to go to a set fee for medical education whether it took three or five or seven years; novel, reasonable idea. Will other institutions follow suit? Richard Reznick, Queens College, Canada, is conducting a pilot program with 40 high school students entering medical school directly from high school and participating in a competency based program based on mastery. Those results will certainly be interesting.
To change the quality of our healthcare system we will have to change our methods of instruction and embracing technology is a means to an end.