Rare just a decade ago, high-tech simulation centers like the one at the Stanford University School of Medicine are part of a transformation taking place in medical education, fueled by calls from the Institute of Medicine and key bodies like the American Medical Association to bring medical training into the 21st century. Practicing on a medical mannequin capable of blinking, breathing and even bleeding has safety benefits. But simulations also let budding doctors and nurses practice working seamlessly as members of a team, getting a feel for what it will be like to care for patients alongside anesthesiologists, radiologists, pharmacists and allied health professionals. "Physicians know that the medical education of the past does not prepare us for the kinds of care we deliver," says Susan Skochelak, group vice president for medical education for the AMA, which is giving $10 million in grants to med schools to boldly shake up their teaching methods and lessons. It used to be that medical students trained with real patients acting as guinea pigs. Today's Wi-Fi enabled mannequins, operated by staffers in a control room, do just about anything a real patient does, including responding to the drugs medical students give them. Some 86 out of 90 medical schools and all 64 teaching hospitals that responded to a 2011 survey by the Association of American Medical Colleges reported that they now use simulation to train medical students. One of the newest facilities, the 90,000-square-foot Center for Advanced Medical Learning and Simulation at the University of South Florida Health Morsani College of Medicine, uses technology and actors to simulate everything from childbirth to combat medicine. The technology is a key tool in implementing a second innovation: training all sorts of medical professionals together. The explosion of knowledge over the last half century has led to a highly fragmented health care system, where specialization is increasingly narrow — cardiologists become electrophysiology cardiologists, arrhythmia cardiologists and transplant cardiologists. Consequently, medical students should increasingly expect to find themselves in "interprofessional" relationships, training and coordinating patient care with students in nursing, pharmacy, physical therapy and other departments. New York University School of Medicine, for example, pairs first-year med students and NYU nursing students to care for a virtual patient and in simulations. Students are assessed on their ability to work together. Experts expect the team approach to medicine to reap multiple benefits for patients, including fewer errors, shorter hospital stays and better care overall. With health reform putting a premium on patient-centered care, safety is itself much more widespread a medical school topic. Some 62 percent of schools now report teaching students about the urgency of precautions such as infection prevention strategies and using checklists. In one exercise, medical and nursing students at the University of Missouri School of Medicine partnered to assess patients' risk of falls — a major safety hazard in hospitals — and created customized fall prevention plans for them. How best to nurture the connection between physician and real patient? Traditionally, third-year students have spent monthlong rotations in a series of specialty areas. Instead of these "block rotations," students in the Harvard Medical School Cambridge Integrated Clerkship follow a panel of patients over a six-month period, from diagnosis through hospitalization to discharge and even home visits. The goal: to see the patient not as a disease but as a person. Bedside manner is getting more emphasis, too. In a course at Stanford, one exercise has students helping horses overcome their fear in scary situations like walking past shiny balloons. That theoretically hones students' ability to pick up on signs of fear in their human patients and show patience and compassion, says Beverley Kane, who runs the course. "Unlike our patients, horses will 'tell' us when we have touched them too roughly." The imperative to change medical training is becoming ever more urgent as the pace of medical discoveries proceeds at an astonishing rate. Perhaps no breakthrough to date promises to impact medicine's future so profoundly as the sequencing of the human genome completed in 2003. Doctors have already begun practicing medicine differently in some instances, using this tool to personalize care by screening patients for select mutations that put them at greater risk for disease and make them more likely to respond to drugs for cancer and other conditions. The latest on genomics is taught, of course — at Mount Sinai and Stanford, students actually analyze aspects of their own genome. But the point is the need for schools to address the reality that what future physicians learn about cutting-edge medicine is apt to be outdated by the time they finish their residencies. "One thing that will be critical for people coming out of med school in the future is the ability to meaningfully understand 'what don't I know and how can I learn it,'" says Lindsey Henson, vice dean for medical education and student affairs at Florida Atlantic University's medical school. The school uses "problem-based learning," in which small groups of students grapple with difficult patient cases in their first two years, with a faculty member standing by to help them understand that "you have to figure out what you need to know," she says. Despite the pockets of innovation, medical schools as a whole still have a way to go to be in step with the trends and technology transforming medicine, argue observers like Eric Topol, chief academic officer of the Scripps Health hospital and clinic system in San Diego and author of "The Creative Destruction of Medicine." But change is clearly coming, he says. "It's inevitable." Source
