The Need for Medical School Curriculum Overhaul

Overhauling the pervasive academic medical curriculum at any institution is an audacious task, yet a tremendous need to revamp undergraduate and graduate medical education so tomorrow’s caregivers can meet the needs of future patients is all too real. Longitudinal patient safety and quality curricula are just two glaring omissions from today’s offerings. Team-based care, understanding and appreciating the roles of other health science professionals in the care-team, effective communication skills, high reliability and risk reduction methodologies, information technology, outcomes-based care, transparency, population health and wellness are all areas where current medical education and experiences are being short-changed or left out altogether–and this void continues to affect the delivery of care, as well as the overall well-being of healthcare itself.

Older health science schools hold on to traditional curricula in place for many years…curricula deeply embedded in their school’s history. “It worked twenty years ago so it must be working today,” is what many academic deans hear from their curricular committees when change is proposed. “We cannot add anything new to the curriculum – the schedule is already jammed-packed,” is another change-halting response. Tenured professors do not like to give up long-standing lecture spots for forward thinking but less understood educational needs. As a result, educational progress is shut down.

However, with 18 new medical schools in various stages of accreditation, fresh starts are emerging across the US. The question remains, however, how will their curricula address the areas of opportunity mentioned above? These schools have the benefit of starting anew, and creating programs that meet the needs of the 21st century caregiver. And if the Florida International University (FIU) Herbert Wertheim College of Medicine is any indication, perhaps there is hope. There is a creativity at FIU, and other new academic programs, not commonly seen in medical colleges of old. For example, FIU’s Medicine & Society curriculum takes a new and different approach to medical education by claiming to:

…prepare physicians to not only treat the disease, but also to assess and address the non-medical causes that affect health outcomes. Students will learn to approach the treatment of disease from a “cell to society” perspective, incorporating both molecular and societal factors. The curriculum integrates ethics, public health principles, the social determinants of health, cultural competency, interdisciplinary experiences, and household community visits.

…prepare physicians to identify the personal skills and systems-level processes that support continuous quality improvement and patient safety, and use standard precautions in the healthcare setting.

…send medical students along with their counterparts in social work, nursing and public health, into the community from the onset of their academic programs (through a program called NeighborhoodHELP).

Concepts such as community health and interdisciplinary teams are being taught in real-time at FIU, as soon as students step onto campus — a glaring difference to the experiences at the medical schools where many of this year’s Telluride student scholars attend. A number of Telluride senior level students voiced not knowing whom their nursing counterparts were, how those colleagues were trained and what their role was in patient care.  As physicians and educators, we swore to “recognize the limits of (our) knowledge and pursue lifelong learning to better care for the sick and to prevent illness”. We owe it to our patients and our students to find the courage to recognize our personal educational biases and limits, and continue redesigning curriculum that fits the changing needs of society and healthcare.

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