Education Evolution: Changes in Medical Learning

Alexa M. Mieses

Disclosures

July 20, 2015

Randolph Steinhagen, MD, chief of colon and rectal surgery at Mount Sinai, earned his medical doctorate from Wayne State University in the 1970s. That university started what was then a progressive curriculum. It included a system-based approach to learning in the first 2 years of medical school. He recalls, "They didn't have biochemistry or anatomy as individual courses. They had unit systems which were based on the body systems. So there was a GI course, a cardiovascular course. There was a neurology course, and within the course there were anatomy lectures, physiology lectures, and histology lectures—all of the normal stuff but it was all integrated. It made a lot of sense! There was one exam at the end of each year that covered all of the material, and you either passed or failed it. We did this 20 years ago; it made so much sense then and still makes sense." Perhaps the first year would have been more enjoyable for me had we learned in this way.

Luckily, practicing medicine is nothing like the first year of medical school. In the second year, we moved to a system-based approach to learning pathophysiology. Like Dr Steinhagen described, instead of discrete courses, we would cover all of the information related to the endocrine system at once, then all of the information related to the gastrointestinal system at once, and so forth. We also took our pharmacology course, and for the first time I was learning about the causes and presentation of disease and how to treat it. I finally felt like a medical student!

When I asked Dr Calman what should be changed in our current medical education system, he said, "Stress humanism. Teach about social determinants of health as the root cause of health disparities and what roles doctors could play in working for social change. Teach doctors how to reason, not memorize. Recognize that facts once committed to memory are now retrieved instantly from pocket devices. Stress shared decision-making with patients. Teach communication skills."

Irwin Dannis, MD, is a retired geriatrician and former chair of the admissions committee at the Albert Einstein College of Medicine (AECOM). He was a member of AECOM's first graduating class in the 1960s and echoes Dr Calman's sentiment: "Too much medical school training focuses on memorization. All of the vital info can be easily accessed on a computer. Compassion, patient communication, and interaction are expected to be acquired by the students themselves. No emphasis is placed on this important aspect of medicine."

Third year was even better than second year. I learned about managing illness through hands-on experiences. I felt more motivated than ever before to study, as I knew that what I was reading would affect the patients for whom I was caring. I was finally working on a medical team and with patients! Despite the need to conform more than ever before, I felt that my individuality was valued most by the patients I treated. For example, I related well to one elderly female patient who was a writer, and to another patient who was a dancer. All of the communication skills I have accumulated throughout life allowed me to establish rapport with my patients and earn their trust.

A physician combines scientific knowledge with the art of communication to care for others. A good physician is a person, a whole person, and not just a study machine. The third year of medical school reaffirmed that medicine is my calling.

On the basis of my experiences and of the experiences of those who came before me, one thing is clear: Medicine should be taught in a way that is logical and cohesive. The 40-year-old curriculum at Wayne State has since spread to medical schools everywhere, as most use a systems-based, pass/fail approach. In addition to logic and reason over memorization, our training should emphasize humanism. As Drs Calman and Dannis both agree, we need a greater emphasis on communication and humanism. This is what differentiates a scientist from a physician. The human condition is central to medicine.

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