AMA continues quest to accelerate change in physician training
A little more than a year ago, the American Medical Association announced $11 million in grants to 11 academic medical centers to fundamentally change the way physicians are educated and trained.
“There has been a universal call to transform the teaching of medicine to shift the focus of education toward real-world practice and competency assessment, which is why the AMA launched the Accelerating Change in Medical Education initiative,” AMA President Robert M. Wah said in a statement. “Over the last year, we have made significant progress in transforming curriculum at these medical schools that can and will help close the gaps that currently exist between how medical students are trained and the way healthcare is delivered in this country now and in the future.”
In late September, a consortium of thought leaders from the 11 academic centers convened on the campus of Vanderbilt University School of Medicine in Nashville to discuss progress and barriers in implementing individual projects, offer insights and innovations, give and receive feedback on the conceptual model for the master adaptive learner, and share other lessons learned in the first year. Much of the meeting’s focus was centered on the master adaptive learner (MAL), which is the AMA consortium’s term for an expert, self-directed, self-regulated, lifelong workplace learner. Developing this type of skill is considered critical to prepare physicians for careers in a healthcare environment that is constantly changing and evolving.
During the two-day event, Susan Skochelak, MD, MPH, group vice president of Medical Education for the AMA, and Bonnie Miller, MD, senior associate dean for Health Sciences Education and associate vice chancellor for Health Affairs at Vanderbilt, hosted a media roundtable to discuss the transformative initiative.
Skochelak said it makes sense for the AMA to be at the forefront of such an ambitious project. Upon being founded in 1847, the physician’s organization undertook two major tasks — to write the first code of professional ethics and to set the standards for medical education.
She added the AMA again took a lead role 100 years ago when there was a major movement to change medical education. Skochelak said the AMA published the standards of what medical education should look like and that became the basis for the Flexner Report.
“The Flexner Report really changed medical education to say it has to be science-based, and it has to be connected with knowledge generation,” she explained. “It made a great leap forward in the quality of medical education. But here we are a century later, and our format for training physicians remains almost identical to the structure that we described a hundred years ago.”
Skochelak added, “It’s not that the training is broken, it’s just that it hasn’t kept up with what’s going on in healthcare delivery today.”
She said the work being done as part of the Accelerating Change in Medical Education initiative is built on recommendations for change that have been well accepted for more than a decade by the medical education community. “We’re working in a great sense of consensus,” Skochelak noted. However, the fact that there has been broad agreement but little change points to impediments that must be addressed. “If it was easy, it would have already been done.”
To address the barriers and make it possible to move forward, Skochelak said, “The AMA wanted to provide resources and leadership to schools that are really ready to make the change.” That decision led to the grant program now in place for the 11 lead schools in the initiative.
In choosing the academic medical centers, Skochelak said the AMA was looked for programs that concentrated on key areas, including:
Getting students into the real world environment early on so they understand healthcare systems in a way that isn’t currently happening;
Emphasizing important core concepts in medical school education like team-based care, patient safety and outcomes, patient-centered approaches to care, and population management; and
Changing the way students progress through the educational system to provide more flexibility and individualized learning.
Miller, a general surgeon by training, has been involved in shaping medical education at Vanderbilt for more than 15 years in an official capacity and even longer as a faculty member. She noted Vanderbilt had already undergone a major transformation to their traditional curriculum from 2004-2007. Yet, she added, it became clear that even more needed to be done to support continuous learning throughout a career.
“We came to the conclusion that in order to do that you really did have to start at the beginning … that we couldn’t put our learners through our programs as usual and then expect magically at the end of their training they would be expert lifelong learners if we didn’t start to build those habits from the start,” Miller said of the decision to rework Vanderbilt’s programming for a second time.
“Curriculum revision is hard work,” she continued. “It’s not just a matter of developing new lesson plans. It really is a lot about culture change. We really felt that it was important to go back to the drawing board and start something new right away.”
Miller continued, “One of the things we thought a lot about was the context of learning. We felt that all learners need to work so that you’re really rapidly applying what you’re learning in the workplace … and that all workers need to learn.”
That mantra became a foundational principle of Vanderbilt’s Curriculum 2.0. Miller added other tenets of the programming was that it should be team-based, interprofessional, modular to allow for different entry and exit points, and include new content areas to help students understand the context of healthcare delivery, as well as what is happening on a molecular and genetic basis. The new curriculum rolled out last year with the incoming class of 2013.
During the recent consortium meeting, Vanderbilt and other participants shared their progress and discussed barriers to change. Skochelak said that unlike a research grant, where a recipient is given money and works on an individual project, the AMA initiative was designed to pool information and work in collaboration.
“We told the schools if you receive grant monies, you will be part of a consortium of schools. Right from the beginning we’ll work together, and we’re going to share ideas because we want your projects to benefit from each other … and our ultimate goal is to share this with all of the schools,” Skochelak said.
Over the next four years, the AMA will continue to track, gather data and report on the progress of the 11 medical schools and their collective work in order to identify and broadly disseminate best practices to retool medical educational models across the country. Skochelak added the lessons learned would be shared with institutions educating other health professionals, as well.
Snapshot of Grant Projects
Indiana University School of Medicine is working to create a virtual health care system (vHS) and a teaching electronic medical record (tEMR) to teach clinical decision-making and ensure competencies in system, team, and population-based healthcare skills.
Mayo Medical School is creating an innovative educational model based on the science of healthcare delivery to prepare students to practice within patient-centered, community-oriented, science-driven collaborative care teams to deliver high-value care. The curriculum’s experiential learning program focuses on how interprofessional teams, patients, communities, public health resources and healthcare delivery systems impact care, outcomes and cost.
NYU School of Medicine is launching the NYU by the Numbers Curriculum, which is a flexible three-year, individualized, technology-enabled blended curriculum to improve care coordination and quality improvement.
Oregon Health & Science University School of Medicine is implementing a learner-centered, competency-based curriculum that enables medical students to advance through individualized learning plans as they meet pre-determined milestones. A portfolio-based system will track milestone achievement and clinical experiences, allowing some students to complete medical school in less than four years.
Penn State College of Medicine has collaborated with Penn State Hershey Health System leaders to design educational experiences that align medical education with health system needs. The Systems Navigation Curriculum (SyNC) prepares students to work throughout the continuum of care. During school, students are embedded in clinical sites across central Pennsylvania as patient navigators to help them better understand patient and health system issues.
The Brody School of Medicine at East Carolina University is implementing a new core curriculum in patient safety for all medical students that features integration with other health-related disciplines to foster interprofessional skills to prepare students to lead healthcare teams for a systems-based approach.
The Warren Alpert Medical School of Brown University is establishing a dual MD/MS degree program to create a new type of physician leader with expertise in population health. The master’s degree program, which includes nine courses, emphasizes teamwork and leadership, population science and behavioral and social medicine and includes two courses being introduced to all students on health disparities and epidemiology/biostatistics.
University of California, Davis School of Medicine is working in partnership with Kaiser Permanente and UC Davis’ residency program to create a three-year medical school pathway called the Accelerated Competency-based Education in Primary Care (ACE-PC). Those enrolled in ACE-PC will simultaneously be considered for acceptance into local primary care residencies.
University of California, San Francisco School of Medicine is crafting the three-phase UCSF Bridges Curriculum, which seeks to create physicians who learn to work expertly in interprofessional teams to continuously improve the safety, quality and value of healthcare.
University of Michigan Medical School’s innovative curriculum includes a two-year foundational “trunk” consisting of integrated scientific and clinical experiences followed by flexible professional development “branches,” which are development tracks to cultivate advanced skill sets within clinical domains at a student’s own pace.
Vanderbilt University School of Medicine has launched Curriculum 2.0 to create master adaptive learners who are embedded in the healthcare workplace during their undergraduate medical education. Students will also use their own competency-based performance data to complete self-assessments and devise individualized objectives to hone self-directed learning skills.
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