This week we're delighted to feature an article written
by our US colleague Harry Greenspun – MD, Director, Center
for Health Solutions. In his 'my take' Harry discusses medical schools
and their ability to prepare doctors for the new world of
My oldest son Benjamin and I have shared a lot of great
experiences, including playing in a rock band together. When he
decided long ago that he wanted to follow in my footsteps and be a
doctor, I knew what was in store for him. He worked incredibly hard
through high school and then tirelessly in college. He suffered
through organic chemistry just as I did, and, now nearing the
finish line, awaits his MCAT scores. Relatively unchanged from when
I took them in 1985, he will be judged on his knowledge of biology,
physics, psychology, reasoning, and other pre-med requirements.
With his scores in hand, he will apply, interview, and (hopefully)
be accepted to medical school.
Strikingly, while the process for vetting potential medical
students has changed little in the 30 years since I applied, the
practice of medicine has changed dramatically. Doctors must now
understand population health and value-based payment models. They
must work in care teams and be able to utilize a dizzying array of
new technology tools. More importantly, they must also learn to
operate in a system that will not revolve around them, but will
instead be consumer-centered.
We discussed this in a recent report, Preparing the doctor of the future: Medical school
and residency program evolution. The expectations of physicians
are changing. Instead of simply providing the highest possible
quality care, many hospital CEOs want innovative leaders and
clinicians, as well as employees with technology and data analytics
skills. Consumers expect to partner with doctors instead of relying
passively on them to make treatment decisions. And with the health
care system moving toward a value-based model, physicians
anticipate needing new business, health information technology
(HIT), and communication skills to practice effective value-based
So how are medical schools evolving to prepare the physician of
To prepare physicians to practice in a VBC world, medical
schools like the Mayo Clinic are incorporating contemporary
"health systems" education into curriculum, teaching
policy, the basics of health insurance, VBC, the Affordable Care
Act (ACA), and government programs.
Other schools are experimenting with new ways to integrate tech
tools. Hofstra Northwell School of Medicine has students use
testing and imaging tools in the traditional anatomy class to
better teach how technology can enhance clinical practice. While
cadavers are still used to help students evolve into professionals,
looking at organs from the inside helps students learn about
anatomy in practice, rather than in theory. Many schools have also
been looking for ways to harness and utilize "big data"
in medical education. For example, one New York University Medical
School initiative, "Health Care by the Numbers,"
emphasizes the use of big data and technology for patient and
population management. The program also allows students to track
their own performance in quality improvement, safety, and
Finally, the practice of medicine is moving beyond the
traditional individualistic mentality and leveraging other
clinicians' skills. Integrating patients' and
caregivers' perspectives will be key to success in the future.
Some schools are adjusting their curricula to incorporate more
team-based learning experiences. For instance, at Hofstra Northwell
students spend their first eight weeks of medical school training
to become certified emergency medical technicians (EMTs) and then
spend time working alongside EMTs in the community. Doing this
gives them opportunities to learn how to work in teams, communicate
with patients, better understand social determinants of health, and
gain a greater appreciation for the different roles and
responsibilities comprising the health care system.
Many medical schools are using new ways to teach about the
health care system, integrating technology into the practice of
medicine and helping physicians learn the leadership and
communication skills required to effectively connect with patients
and team members. These changes may improve quality of care while
also improving the experience of receiving care.
As Benjamin awaits his scores, I can see myself in him, checking
the mailbox each day. Soon he will be donning a lab coat and
heading into a gross anatomy lab, just as I did. However, for him
to be successful in the future, our paths will have to diverge. At
some point, he will call me to tell me about something he is
learning and I hope to say, "Wow, we never did that."
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guide to the subject matter. Specialist advice should be sought
about your specific circumstances.
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