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Precision education: Tailoring medical training to support future doctors

Since she was a little girl, Cyrena Gawuga, PhD, wanted to be a doctor. But struggles with lupus and bipolar disorder forced her to drop out of medical school. These same conditions, however, didn't stop her from going on to earn a PhD, due in large part to the program's flexibility and the administrators' willingness to work with her to ensure she succeeded. Her advisor even visited her in the hospital, Gawuga told a Medicine X | ED audience Sunday morning. In contrast, her medical school experience had been rigid and impersonal.

As currently configured, medical school has some improvements to make, speakers in the precision education panel agreed. "We're still sort of stuck in the old stodgy textbook era," said Joshua Landy, MD, chief medical officer at Figure 1, a mobile health education company.

It begins with admissions and the fact that the traditional process of screening potential medical students likely excludes people who could make very good, capable physicians, said David Lenihan, PhD, president of Ponce Health Sciences University in Puerto Rico. By tweaking the criteria used to evaluate these students, Lenihan said he was able to boost the number of underrepresented minority students, finding students who weren't accepted at other medical schools but who were nonetheless committed to becoming a doctor and capable of passing the board exams.

Once in school, many students shun the traditional way of teaching -- lectures -- and choose instead to master material using mobile study aids and videos, the speakers said. In addition, lectures might not correspond with topics students need to know to pass board exams or to excel in the clinic, according to Rishi Desai, MD, a clinical instructor at Stanford and chief medical officer of Osmosis, a digital medical learning company.

Digital tools can be designed to quiz students on topics they need to know, when they need to know them, Landy said. And instead of dry, isolated facts being delivered to students, information can be conveyed in the form of patient stories. "This is my model for medical education: Take cases and dump them in people’s brains," Landy said.

But does a brain packed full of cases and information make a good doctor? Not necessarily, Gawuga said. "I think the most important skill students need to learn is engaging with patients in a clinical environment."

Some students come into medical school with a natural gift for empathy, but for others, it can be taught, Landy and Desai said. Or, at least, students can learn the right things to say in particular situations and how to listen.

The need to rework medical training is urgent, the speakers said: Potential clinical stars like Gawuga are being missed, and millions of dollars are being funneled into methods that aren't efficient, burdening future doctors with debt. And the U.S. -- and the world -- is facing a dire shortage of medical professionals, Lenihan reminded the audience.

"You are seeing that ball move. But it has to move at a much faster pace," he said.

Previously: On learning, the patient's voice and the power of stories: Stanford's Medicine X | ED begins and Working together in health care: Why it's hard and what works and Medicine X | ED founder Larry Chu on the need to rethink health-care education
Photo courtesy of Stanford Medicine X

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