Transform medical education for a new world

At times struggling to find adequate personal protective equipment, working multiple shifts and even succumbing to COVID-19 themselves, physicians around the globe exhibit hard work, sacrifice, and compassion. Many are applauding them for it.  

At a time that has rapidly changed how physicians live and practice medicine, it is urgent to consider if current medical education is preparing new doctors for the changes ahead in the health care system. And to propose how to fill that preparation gap.

In this country, competition among the 50,000 medical school applicants is difficult for barely 22,000 spots to begin nearly a decade of grueling training and residency before graduation. Only 800,000 physicians care for a U.S. population of 328 million. 

But in this country, medical schools looks very different now than it did 10 or 15 years ago. Then students crowded lecture halls for hours each day during much of the first two years of a guided curriculum. 

Due to COVID-19 shutting down in-person learning, lectures and cases are readily available to students online, on-demand, anywhere. Most medical students have the freedom and flexibility to create personalized learning schedules that work for them, choosing when and where to study, listening to lectures in double time via podcast.  

While the paradigm of flexible, distance learning has allowed medical students to continue their studies while sheltering in place, on-demand, modular learning and curricula of today’s medical education creates an unreasonable expectation of flexibility and convenience for students.

But this method of learning fails to translate to the rigidity and rigor of actual medical practice. 

To be sure, the current state of medical education is in stark contrast to the medical school life these students imagined for themselves and the values that drew them to medicine in the first place. And the stress of isolation and the uncertainty ahead pose new challenges for students.  

This disconnect between today’s education and the reality of the disrupted profession possibly sets up new physicians early on for failure, creating unreasonable expectations and worsening professional dissonance. This tension can contribute to the rapid rise in resident and physician burnout. 

Now, more than ever, students and medical schools need to find ways of learning and instructing that better approximate the realities of medical practice. 

Certainly, the ability to reinvent methodology for learning speaks to a certain resilience that is required of physicians. But it is just one trait — and by itself often not enough for success. 

The recent news that the United States Medical Licensing Examination Step I licensing exam will transition to pass/fail grading in January 2022, further underscores the disconnect between the perception of medical school’s intensity and the rigor of actual practice. 

Dr. Susan Skochelak, a chief academic officer of the American Medical Association, recently explained, “Current residency selection is causing distress for our students.”  

As doctors, we understand daily distress. We are responsible for making decisions that affect, and perhaps determine our patients’ lives. The importance of this responsibility to society has never been as clear as it is right now as physicians and health care workers around the globe place patients’ wellbeing and care above their own. 

More than 320 physicians around the world so far have died from COVID 19. Many continued to work as physicians until their deaths. Physicians continue to separate themselves from their families over fears of spreading the disease to loved ones. Others are writing wills and making plans for who will raise their children in the event they cannot. 

Medical education administrators and policymakers needs to address the discrepancy between this newly disrupted medical education and medical practice.

Although learning can be done virtually, it is not the ideal choice to teach the nuances of a successful patient-physician relationship which is central to good patient outcomes.  

As medical school’s purpose is to prepare future doctors for practice, students need to adapt from a virtual practice to hands-on practice. Medicine is based on observation, examination, and the relentless critical assessment of patient presentation translated into facts, data, and relevant evidence.

Even before COVID-19 added new challenges to practicing medicine, physicians were leaving the field at alarming rates.  A mounting shortage of doctors threatens to further burden an already challenged system.  

The top three contributors to burnout for Millennial and Gen X doctors include a glut of bureaucratic tasks such as charting and paperwork; the number of hours spent at work; and lack of respect from administrators and staff. 

And yes, many medical schools have increased early intervention and access to mental health care, wellness resources, career planning, and mentorship for students. There has been a shift in helping students find ways to maintain physical health and wellbeing despite long hours.

These are positives. 

But with the sudden changes to how medical students learn, there must be a shift to accommodate what they experience and lessons they have lost in real life in order for them to be effective physicians.

With a likely second coronavirus surge in the fall, medical schools need to prepare for long term changes to medical education.

With adequate personal protective equipment and hands-on learning and mentorship from clinical instructors, medical students have a vital role to play in the clinical setting. They can learn how to take a history and the challenges of a physical exam via telemedicine. They can and should be included. 

Working alongside physicians during this pandemic offers invaluable education to prepare these medical students for an evolving future career.  

Dr. Inna Husain, M.D. is an otolaryngologist and assistant professor at Rush University Medical Center in Chicago where she also serves as Associate Residency Program Director and Director of the Voice, Airway, Swallowing Disorders Program.  

Dr. Rebecca Van Horn, M.D., M.A., is a psychiatrist and assistant professor at Rush University Medical Center in Chicago and the Medical Director of the Road Home Program: The National Center of Excellence for Veterans and Their Families at Rush.