Is medicine ready for a complete overhaul of the system? Those in healthcare hear regularly how inefficient the system is and even how corrupt it has become. Between insurance companies and pharmaceutical prices, we have plenty of bad guys to point the finger at. Politicians rant and rave, but often have little conceptual grasp of the problems involved and how to solve them.
Some newer medical experiments, such as telemedicine and Direct Primary Care clinics (see our interview with Dr. Alison Edwards), offer potentially lower costs for common ailments and maintenance. Cooperative insurance plans claim to offer discounts to those within their communities. But is this really where the focus must lie? Should we tackle to tsunami head-on, or would a preventative approach (much like in medicine) be more beneficial?
I argue that the best manner to tackle future problems rests in the educational institutions in which the propagation of future medical paradigms begins. In order to do so, however, large changes must be considered, from costs associated with medical education to the tools and changing trends of course room design.
The Current Medical Education System
Tuition Cost- It is no surprise to anyone that medical students go into significant debt while in school. The average US medical student collects over $200k in debt for their education and only makes $50-60K/year for the duration of their residency. With student loan interest rates creeping up every year, and currently higher than most bank loans, students are basically stuck with the equivalent of multiple mortgages to pay each month.
Not only is student debt a serious concern that weighs heavily on many shoulders – often for decades while trying to pay them off – it also means that medicine also follows many of the defining tenants of classism. Strong words? Yes. But cost paid for tuition does not correlate to a better physician. The system is broken from the ground up.
Course Limitations- The average medical school has also failed to embrace aspects of higher education that are now commonplace in most other fields. Even a JD can be earned online (with significant restrictions), but medicine has not pushed the envelope in decades if not centuries. We have failed to incorporate much of the technology and entertainment aspects of modern education into medicine.
We still have the paternal, teacher-centered, lecture-based viewpoint of education. We need to formulate a more autonomous, student-centered, and advanced learning environment to move away from the current inefficiencies. We need to look outside of our norms and expectations and see what is working in other fields, why, and how we can utilize this in our educational materials. The “this is how I was taught so this is how you will be taught” mentality bleeds over from basic sciences to clinical sciences as well.
Many schools still have an attendance policy despite it being based on a heavily flawed and disproven design. Educational sciences and cognitive psychology, one would think, could be a great benefit to both instructors and students in the medical academic world. Despite this, many in academic medicine isolate themselves from colleagues or continue to hold old-school views.
This may be due to tribalism, or simply being unaware of the strides being made outside of their profession. Either way, this segregation of educational ideas only causes more stress on instructors and often causes more work for students. Though some are striving for improvement, they seem to be in the vast minority.
Learning Environments- The advent of the lecture hall in medicine began with the French Schools, and was later adopted by the rest of western medicine. Before that, it was very much based on apprenticeship-like settings with one or several students following around the physician. There was a need for classrooms as the wealth of medical knowledge began to grow. However, we now have great alternatives and technologies that allow for more dynamic and participatory learning environments.
Many schools have been offering unsynchronized course lectures via pre-recorded lecture archives. Some even offer the occasional online course, though these are usually very limited in scope. Problem-based learning (PBL) has been advocated by Maastricht University for many years in a wide scope of fields and disciplines. Some schools are even starting to implement clinical education in the first and second years of medical school as opposed to the usual limitations to third and fourth-year students.
Despite these options and the occasional change here and there, the majority of medical schools are based on the old lecture-based, static course design. Students are talked-at instead of to. There is relatively little interactivity in the lesson plan and no chance for experiential learning. With the decreasing attention span of the average human, perhaps the traditional school is simply an outdated tool of the past.
Non-traditional Educational Materials- Luckily, students are no longer limited to only the resources provided to them by their instructors and textbooks. As one that doesn’t do well with textbooks, I was often limited to instructor presentations and the rare resource online that was sufficiently deep and organized to be useful. Today, students have several experienced YouTube education channels for videos, such as AnatomyZone, Armando Hasudungan, Osmosis, FreeMedEd, Picmonic, and many others. Of course, there’s also the ever-popular OnlineMedEd for Step 2 material as well.
Some students opt to take free MOOCs to supplement their class time, including Coursera, EdX, and dozens of others that can all be searched via Class Central. Some of these courses are much more informative and have better resources than student classes may: begging the question why a more predominant stance for online medical school has not been pushed for (oh ya, $$$).
Not only can these resources cover much of what consists of the basic science course work for medical students, but other useful topics such as developing critical-thinking skills, physician/personal finance, leadership skills, and many other potential electives that most schools do not have the resources or ability to offer their student populations. They also cover healthcare policy, HIPAA, and numerous medically relevant topics that many students don’t have the ability to become familiar with until late in their academic progress or even wait until residency.
Podcasts are becoming more popular every year in the general public. Luckily, this trend is also being seen in education with an ever-increasing catalog of medically relevant podcasts for students to listen to. If you want to learn how to learn during or in preparation for medical school, you might find my show, The Medical Mnemonist Podcast, very informative. With expert interviews on learning, cognitive psychology, and memory techniques there is something there for everyone interested in learning and remembering better. Within the InsideTheBoards network, we have a growing number of physician and student-run educational podcasts directed at students in all levels of education.
Students can utilize these materials to supplement their current curriculum, which is a great benefit. However, this is still only a small step in the right direction. In order to effectively reshape medical education so that it later has a positive influence on healthcare, a more direct and systematic approach may be needed.
Adoption and Adaptation within Medical Education
The reasons for the slow adoption of new medical education paradigms are likely multi-faceted, but greater efficiency within the system should not be feared. The privacy of students, quality of learning materials, and countless other excuses have been used in the past to halt education progress. Many of these arguments can be likened to the contemporary lack of progress in the medical system. However, with so many seemingly intelligent people involved in medicine, shouldn’t these concerns be easily mitigated with rational discussion?
Accreditation boards, such as the Liaison Committee on Medical Education for US medical schools and Caribbean Accreditation Authority for Education in Medicine and other Health Professions (CAAM-HP) for many Caribbean schools, have the ability to allow for new and experimental pilot projects within the academic environment. They also have the responsibility to integrate their mission and purpose with current educational research. They should be aware of the contemporary cognitive psychology of learning within all of graduate education, not only medicine, to become aware of how educational applications in other fields may be translated into medicine in the future.
The Administration of each school must also be aware of the vast resources available to them when it comes to educational advancement. They should not fear to try a new pilot project, reaching out to their counterparts in other schools, and deliberating with their instructors on how to best manage the constant flow of updated science. Forming collaborations and coalitions with others in the field will also provide a much-needed support structure between institutions and physicians. Some do this very well, but others struggle to find the appropriate mix for their students and educators.
Finally, instructors themselves, if they wish to remain relevant while also providing a necessary service to their students, must consider the success and limitations of their current curriculum and teaching style. Far too often are tales of students lost in the complexity, or dismayed by the simplicity, of a lecture. Finding that Goldilocks zone in the classroom will provide the most benefit to their students. Alternatively, realizing that you may not possess the skill to reach this ideal zone may hint that looking into another profession would benefit both parties.
Thanks to a recent podcast from our friends at InsideTheBoards, I would like to share with you The Philosophy of Medicine Reborn. In it, Patrick C. Beeman MD discusses the moral and bioethical issues considered by Dr. Edmund Pellegrino and how they relate to modern hospital and classroom settings. The aspect of medicine as a strictly biomedical concern has been long shunned as paternalism and has made way for patient autonomy. However, most medical schools still teach in a manner that is focused mostly, if not completely, on the biomedical achievement. His argument is powerful and points that Pellegrino sought “incontestable moral truths” in medicine, as we should consider in academia as well. I do recommend you check out the complete article.
The Future of Medical Education Design
The most logic pathway moving forward is likely that of a highly technological and gamified education system. There is no rational reason to continue to force instructors to recite the same lectures every year or semester. There is no salient point that denotes a need for an attendance policy for students. For the majority of medical education, and arguably for the entire program, there is also no need to mandate brick-and-mortar buildings for an educational environment.
Though I do not advocate elimination of all of these traditional practices and structures, for a significant percentage of students these facilities do not provide any benefit and only help to increase tuition costs. For those students that do prefer the more traditional type of learning environment, the basic foundation of a system that has been in place for decades is not going to change overnight. Expanding the current system simply makes it more affordable and personalized to those that would be more productive in an alternative environment.
Ideally, these programs would also be self-paced and open-education where anyone with an interest in medicine may join and learn at their leisure. This also helps to limit the financial burden placed on medical students or the restrictions that may prevent potentially competent future physicians from ever enrolling. Students will not need to be concerned with arbitrary graduation deadlines, something that many modern students ignore in order to take time for research, entrepreneurship, or gain much needed personal time.
The need for the quantity of instructors would also decrease due to the added reach of an online system or systems, and the quality of those that remain would be well above average. This would free many physicians from the burden of constant lecturing, allowing them to focus more one-on-one or in group tutoring sessions for which they may prefer. This is not dissimilar to how modern MOOCs work: with options for open education (audit the course) for free or adding a small fee for those that are degree-seeking students.
It would also be heavily interactive, gamified, and have a strong educational support system in place. Peer-tutors and physician-mentors would be available to all struggling students. The cut-throat system currently in place would be diminished if not altogether eliminated. As a wider audience is reached, and affordability and education support is increased, we just may begin to see a drop in current issues of student loan debt, student and physician burnout, and physician shortages.
The best part is that nothing new need be created for this to become a reality. All of the technology currently exists. The only change needed is that of the medical education paradigm currently in charge. Will changes be needed to protect the legitimacy of the medical education system? Of course. Should these bumps in the road prevent us from revamping the system and making it more widely available to others? I do not believe so. It’s time the accreditation boards open up the doors to modern education. It’s also time for physicians, administrators, and students to fight for the future of the healthcare system. It’s time to start MedEd 2.0
If you have an interest in advancing education, send us an email. You can also preview this simple concept video for ideas about the future goals of FreeMedEd’s course content design.