Vice dean to med schools: Get with the times

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While medical school curriculum has evolved along with the healthcare system over the past two decades, one educator says schools need to continue to refine training and prepare future physicians to function in teams, manage their patient populations differently and capitalize on available IT in order provide quality healthcare.

“There have been tremendous advances in our understanding of how doctors learn, but the doctors we’re producing may not be keeping up with the times,” Catherine Lucey, MD, told Cardiovascular Business. Lucey, a vice dean for education at the University of California, San Francisco (UCSF) School of Medicine, published an article discussing her viewpoints online July 15 in JAMA Internal Medicine.

Today’s doctors, Lucey argued, are members of highly skilled healthcare teams that include nurses, pharmacists, social workers and others. However, medical training still emphasizes the role of the physician as a sole, independent provider, a notion popular about a century ago.

“What we have assumed is if you create individuals to be individual experts, we will have teams of experts, but we’ve learned that we actually have to train people to work effectively in teams,” she said. “We haven’t made team competencies as explicit and measurable and required as we have individual competencies.”

The consequence of such an approach in the modern healthcare system is that patients get lost navigating through a team of specialists who are often not aware of the other members of the team and how to work with them.

Future doctors also must learn the tools they need to function as part of a larger microsystem. This training includes basic clinical knowledge, but also quality improvement, economics and financing, leadership and systems engineering.

Medical students should learn to approach patient care management from a chronic condition perspective rather than emphasize treatment of acute diseases, transitioning from the acute focus is embracing available technology.

“The other big area that we are challenging people to consider is using data and information systems to proactively manage patients and not focus on reactive patient visits,” Lucey explained.

This means, for example, using the power of EMRs to reach out to patients with a condition such as hypertension who may not be taking their medication instead of waiting for the patients to come to the office after noticing their blood pressure starts running high.

Medical schools should encourage students to use the vast amount of available information to help patients interact with the healthcare team and participate in their own care.

“Clinical knowledge is increasing dramatically, so we should teach people to use point-of-care decision-making tools,” Lucey said.

Another key element to improving quality of care is utilizing evidence-based practices, which “should be considered as important as embracing new treatments for heart disease or new techniques for surgical procedures,” she wrote.

And it’s not only medical schools that can contribute to this new model of learning. Insurance companies and other entities that determine reimbursement strategies need to reconsider what it takes to make a good modern-day physician.

The changes Lucey suggested may take some time to implement, but she said they are underway. UCSF recently received a grant from the American Medical Association to revamp its curriculum and implement it, which she hopes will happen by 2016.

“The challenge is for us to build on our success and turn our attention outward to look critically at the type of physician that will be most successful in achieving the Institute of Medicine goal of quality healthcare.”