April 16, 2013
Diana Wieser has listened supportively to melanoma patients who are visibly upset. She has asked about symptoms that could be a sign that the cancer has returned, about family history of cancer.
She hasn’t even finished her first year of medical school.
The old way of training doctors was to hit them hard with science in the first two years and focus on clinical skills in the second half of med school.
But educators are rethinking this books-before-people approach. They’re emphasizing that good doctors must be able to listen to patients (and hear what they say), to work with them to build a healthier life plan and to help them cut through increasingly complex medical options.
At Ohio State University, where Wieser is midway through her second semester, a new curriculum started with this year’s 185 first-year students. The program — called “Lead. Serve. Inspire.” — has transformed how doctors are trained and focuses more on early clinical exposure, individualized learning and integrating science and hands-on skills. The last redesign of the curriculum was in 1996 but was not as complete an overhaul as this.
Dr. Daniel Clinchot, vice dean for education, said that as medicine has evolved, so must the way it is taught. In today’s hospitals and medical practices, more emphasis is being placed on collaborative health-care teams, on individualizing patient care and on prevention. Scientific advances are emerging at a faster pace than ever before, sometimes making what doctors knew last year obsolete.
Grading students on clinical competency through interactions with actors who portray patients and through their long-term work in clinical practices is a big departure from relying mostly on exams, he said.
Students still are expected to understand the science, but far more emphasis is being placed on human relations, and these young people will be better doctors for it, Clinchot said.
Wieser, who is 22 and from Lima, said she adores working in a clinic with patients. She said she has been surprised to discover how little some patients understand their conditions and has admired how the surgeon she works with is able to educate them and ease their fears.
“The first time that we interacted with patients, it was very nerve-wracking, and it’s all you can do to literally ask somebody, ‘What brought you in today?’??” said Alex DiBartola, 23, who is from Worthington and also in his first year.
“Over a few weeks, you develop more skills, and having earlier exposure to that is just going to make third year and fourth year much more easy and manageable.”
He said some of the things he enjoys about the curriculum are the virtual lectures that can be watched at any time and the podcasts that are available after live lectures.Wieser and DiBartola said they both like that basic anatomy is integrated with lessons about what can go wrong with the various body systems.
“I go into anatomy lab and I see one of the chambers of the heart, and the next day I’m learning about how it moves and contracts, and the next day we’re talking about the problems in that chamber of the heart,” DiBartola said.
Medical schools have been looking at these types of approaches for some time, but it has taken a while for curriculums to begin to reflect newer ideas about learning, said Dr. Carol Aschenbrener, chief medical-education officer for the Association of American Medical Colleges.
“The science is important, but we all know that science alone can’t make a good doctor,” said Aschenbrener, who commended Ohio State’s changes.
Dr. John Davis, associate dean for medical education at Ohio State, said that good tools for measuring competency — including empathy, communication skills and professionalism — have made it possible to make the change.
For instance, he and other instructors know to look for things such as questions framed in an open-ended way rather than those that invite a yes-or-no response, Davis said.
He said the new format helps to identify students earlier who excel at academics but whose interpersonal skills need work and also allows for earlier identification of those who shine at the bedside but sometimes struggle with the books.
Dr. Cynthia Ledford, associate professor of clinical medicine and pediatrics, said she has marveled at the changes she has seen in students as they interact with actors who portray patients.
“This is helping us all better understand what it means to be a really good physician,” she said.