Traditional medical school training is too expensive, takes too long, and is not addressing the primary care needs of the country, a complex problem with many moving parts. Medical students burdened by mountains of debt and unable to begin earning until well into their late twenties or early thirties often gravitate to higher-paid specialties and practices in urban settings.
What might we do differently to solve the primary care shortage, particularly in rural areas? And what can we do to reduce the expensive supply side economics of healthcare – where, for example, having too many surgical specialists can drive up either the volume of elective surgeries or the cost of each procedure?
Both of us are passionate about medical education (MedEd) innovations that support the need to better engage students, rekindle their love for medicine, and move away from the traditional pedagogy to andragogy (utilizing principles of adult learning) where the doing trumps memorizing?
Here are four innovations we particularly like:
1. Democratize the opportunity to study medicine.
The US has a highly competitive pre-medical school admissions process that ensures, by and large, that only those with the best grades and MCAT scores have a real shot at being accepted. Will students skilled at rising to the top in this type of intense competition be happy practicing general medicine in a small town far from the intellectual excitement of academic medical centers? And, given the widespread availability of technology to put advanced medical knowledge at the fingertips of practitioners no matter where they work, we wonder whether “best grades, best MCAT scores” is a reasonable predictor of who will become an effective primary care doctor. Are there other factors that should be considered if we are to address the primary care shortage?
The National Health Service Corps offers scholarships if applicants commit to primary care in an underserved area (two years of service for the first year of financial support, and one year for each thereafter). Although financial incentive programs like NHSC can help students who might not otherwise have been able to attend medical school, there is no evidence to date (in part because there haven’t been that many published studies) that these types of programs lead to long-term commitments of healthcare workers to practice in these areas.
Enter Escuela Latinoamericana de Medicina (ELAM), a Havana-based medical school that is one of largest in the world with close to 20,000 medical students from 110 countries. The students come from Latin America, the Caribbean, Africa, and Asia. Currently, just 91 are from the US.
What really makes ELAM different is their focus on enrolling the students from the poorest communities who are committed to returning to practice in those areas. They want women, people of color, and people who speak the language of the poor communities. Tuition and room and board are free, and the students receive a small stipend.
There’s a concept: Train people from communities who are committed to returning to those communities to practice medicine. This differs from the standard US approach of parents paying for medical school or students incurring expensive loans. Basic economics, and experience, indicate that this approach graduates physicians who want largely urban, well-paid, specialist practices to give them a chance of paying back those loans before they retire.
2. Virtualize MedEd course work
NextGenU offers medical education via MOOCs (Massive Open Online Courses). By partnering with leading universities; professional societies; and government organizations like the Centers for Disease Control and Prevention (CDC), Grand Challenges Canada, and the World Health Organization, NextGenU gives students credit for their online coursework. According to the organization’s website, the courses are “competency-based, and include a global peer community of practice, and local skills-oriented mentorships…and, “initial data show that NextGenU’s training performs comparably to traditional American medical schooling.” All courses are free of cost and free of advertising.
Not only can NextGenU have profound impact by democratizing the US medical education process, it is also helping the developing world by training local people who otherwise might not have been able to go to medical school. For example, NGU has a partnership with Sudan to train 10,000 new family physicians in five years.
3. Use Simulation to Teach Diagnostic Skills
i-Human Patients teaches diagnostic skills via its i-Human case player that simulates a wide variety of cases using virtual patients. The program presents users with what are called undifferentiated cases, meaning the student does not already know the patient’s current diagnosis or medical history. That must be elicited by asking the right questions. Participants perform a virtual physical exam that includes listening to heart and lung (breath) sounds. They can order and interpret labs and construct a differential diagnosis, or a list of possible diagnoses. They do all of this without the need for in-person patients, whether standardized or not.
Thus far, the company has about 100 clinical cases in their toolkit. These are written by clinicians, many of them on staff at academic institutions. The cases can be customized to meet the teaching needs of the different training programs. In addition, medical educators can craft their own cases and share them on the site. This flexibility allows hundreds of cases, each with varying levels of difficulty and different learning objectives, to be available online. Students and practicing clinicians can access from anywhere in the world. Here is a link a recent video interview with i-Human Patients CEO Norman Wu.
4. Learn to Solve Complex Cases via Crowdsourcing
CrowdMed pairs “Medical Detectives” (retired physicians, medical students, other health professionals, and anyone with something to contribute) with patients with hard-to-diagnose conditions on a platform that incorporates a “patented prediction market system” that collects bets and develops a list of the most likely diagnoses and solutions.
Students learn to review the history, physical data, and lab data from cases that have been worked up by many different doctors over many years. This is similar to what medical students and residents do once they are treating real patients. The difference? They learn, in real time, from more experienced physicians also working the case on the same platform.
Here is a link a recent blog post and interview with CrowdMed’s CEO, Jared Heyman. (Full disclosure, Pat has been a CrowdMed Medical Detective since 4/2014.)
We are just at the beginning of the health tech revolution, so we expect many more innovations to be deployed into the Medical Education marketplace. Health technology innovators and others who see opportunities to transform medical education are creating and applying their creativity to make MedEd better, faster,and cheaper.
Do you have a MedEd innovation you’d like to share? Let us know. We’ll cover your suggestions in a future piece. Stay tuned for a future blog post on creative approaches in medical schools – from team learning (and grading) to choosing medical schools for their emotional intelligence and providing leadership training.
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