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Big data, Events, Medical Education, Medical Schools, Medicine and Society, Stanford News

Stanford Medicine’s Lloyd Minor on re-conceiving medical education

Stanford Medicine's Lloyd Minor on re-conceiving medical education

Stanford Dean of Medicine, Dr. Lloyd Minor.Stanford Medicine is no stranger to pioneering changes in medical education, so a panel on re-inventing health provider education at the Association of Healthcare Journalism 2015 conference this past weekend was the perfect fit for Lloyd Minor, MD, dean of Stanford’s School of Medicine. During his talk, Minor highlighted three topics that the school is pursuing in order to “re-conceive education so it better meets” today’s needs: team work, data sciences, and value-based health-care delivery.

Eschewing the old model of the omnipotent and self-sufficient doctor, Minor called for schools to “embrace from the very earliest stages that the delivery of health care is a team endeavor.” (The days of “see one, do one, teach one” are hopefully over, he said.) As paper records become a thing of the past and genome sequencing becomes even less expensive, we also need doctors who are very comfortable analyzing “big data.” “We have available to us a huge amount of data from which we are not extracting enough information,” he said before noting that many Stanford med students take classes in computer programming and data science. And, after highlighting the work of Stanford’s Clinical Excellence Research Center, Minor described how the new cohort of medical professionals has to have expertise in analyzing innovations based on value, defined as “outcomes divided by cost” – simply improving outcomes is not enough.

According to Minor, the basic goal of innovation should be to embed within the medical school curriculum as much flexibility as possible, since the workforce of the future needs to be diverse in terms of its talents and abilities. After discussing how many medical schools are exploring the “flipped classroom,” he noted that “Rote memorization is not the learning technique that’s going to address the problems that society has every right to expect health-care professionals to address. One project, one intervention at a time will achieve that transformative impact.”

Fellow panelist Henry Sondheimer, MD, senior director of medical education at the Association of American Medical Colleges, also discussed “seismic shifts” in medical education that require “a different culture, a different kind of student, and a different kind of physician.” This move from being hierarchical, autonomous, and competitive to being collaborative, service-oriented, and patient-centered is facilitated and reflected by changes such as the new MCAT, which assess not what students know but how well they can use what they know, and includes a new section addressing the psychological, social, and behavioral determinants of health. He stated that in a world where 32 percent of 2nd-year medical students attend lectures rarely or never, 14 percent regularly attend lectures at other medical schools, 40 percent source medical information from YouTube, and 87 percent from Wikipedia, education is not about memorization, but about connectivity. And this is not just in the U.S.: Speaking about a recent trip he took, Sondheimer reported that “Every single medical student at the University of Zimbabwe has a tablet.”

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Events, Health Disparities, Medical Education, Medicine and Society, Public Health

An ounce of action is worth a ton of theory: Med student encourages community engagement

An ounce of action is worth a ton of theory: Med student encourages community engagement

IMG_0775Right after graduating from Stanford, Steve (Suk) Ko moved to East Palo Alto with some friends who were also recent graduates. They put all their effort into becoming engaged in their new community, starting and running a tutoring program out of their apartment – which could get really crowded, judging by the pictures he showed last week while speaking to undergraduates interested in public health.

Soon after making East Palo Alto his new home, Ko started medical school at Stanford and continued his service work throughout. “We at Stanford are good at thinking and debating, but less good at action,” Ko said during this talk. “I felt some guilt about indulging in socioeconomic affluence when there was this community right next door.”

Ko’s talk was part of the Primary Care, Public Health, and Health Disparities Lecture Series sponsored by Stanford’s Center of Excellence in Diversity in Medical Education, which aims to produce leaders who can eliminate national-health inequities. Ko shared his personal experience and offered three points of advice:

1). Never lose what makes you special. 

If you’re thinking about how to improve public or global health, “don’t fake it – do what you’re passionate about.” This will lead you in the right direction. As for medical school applications, there are all kinds of ways to have a “research background,” he said.

For Ko, a Korean ethic of hard work and his Christian faith enabled his interest, experiences, and goals in public health. During an undergraduate service learning trip to Oaxaca, Mexico, he shadowed an OB/GYN at a public hospital and was moved both by the beauty of birth and the limited opportunities these newborns faced. Born resource poor and in a society with high gender inequality, “this baby girl had not made a single choice, but 99 percent of her life was already decided,” Ko said. He wanted to think about health in a broader context.

2). An ounce of action is worth a ton of theory.

Last summer, Ko implemented a 5-week summer meal program in East Palo Alto that served kids and their families. The suggestion to focus on food insecurity came from Stanford pediatrician Lisa Chamberlain, MD, Ko’s mentor. The YMCA, Stanford Medicine, and Revolution Foods supported the project, which served 270-370 kids and 4-30 adults every day, and provided a total of 2,525 take-home meals. Ko said it’s “like pulling teeth” to get kids to eat healthy food, but shaping tastes early is key to forming long-term habits. The team ran both quantitative and qualitative analyses of the program, gathering insights like that families are hungrier in bad weather because those who work outdoors or in construction cannot earn money, and that libraries could be great food distribution points.

One of Ko’s most rewarding recent memories was when several of the high-school students he works with made a documentary film about East Palo Alto. They wanted to challenge its unfair portrayal in the news media – although it had the highest homicide rate in the country in 1992, gentrification is now starting to be a bigger problem than crime. “The 90’s were a long time ago,” the students pointed out.

3). Community engagement is difficult, and therefore a privilege.

It was very hard for Ko to gain the trust of his adult neighbors (he says kids are easy: just smile at them). After living there for years, he felt gratified last week when he was ill and a neighbor brought him soup. Trust comes slowly; you have to prove you’re there for the long haul. Even so, circumstances are just hard – what do you do when a student tells you a family member just died from gang violence? Ko coped with the emotional and physical difficulty through his faith and by finding joy in the process, not the outcomes.

One of the audience members asked a question about “white knight syndrome” – the problematic idea that someone from a different community is able (and welcome) to storm in and fix everything. Ko agreed that good intentions can hurt vulnerable people. Temporary involvement doesn’t require accountability and invites the community to be jaded and skeptical, focusing on the impact of the last person/organization. For this reason, it can be much better to join an existing project than to start a new one, he said. But above all, Ko favors humility and a sense of wonder, not just going in and”fixing it”.

Previously: A quiz on the social determinants of health, Stanford researchers use yoga to help underserved youth manage stress and gain focus, Med students awarded Schweitzer Fellowships lead health-care programs for underserved youth, Nutrition and fitness programs help East Palo Alto turn the tide on childhood obesity and Doctors tackling child hunger during the summer
Photo, of Steve Ko (right) and Marcella Anthony of Stanford Medicine’s Community Outreach, by Andrea Ford

 

Medical Education, SMS Unplugged

“Us” and “them”: Losing the patient perspective

“Us” and “them”: Losing the patient perspective

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

holding hands - smallThis past Saturday, I received a call from a close friend from college that went something like this:

Friend: “Hey… so I’m in the ER right now, and I didn’t know who else to call.”
Me: “WHAT?! OH MY GOD WHAT HAPPENED?!”
Friend: “They think I have appendicitis.”
Me: “Ohhhhh – oh my gosh, thank goodness. I thought it was something really bad.” (nervous, relieved laugh)
Friend: “Wait, why are you laughing? I’m freaking out right now. What if my appendix explodes inside me? I’m so scared.”

A flush instantly spread across my face. I felt terrible.

In my head, appendicitis was relatively low on the list of all the possible horrible things that could have happened to my friend. I knew it was a common condition, that an appendectomy was a straightforward procedure, with minimal risk, and that of all the body parts to lose, the appendix wasn’t the worst by far.

When my friend mentioned that he might have appendicitis, my mental reaction was to think of all the factors that go into that diagnosis, and I was bursting to ask if he had guarding or rebound tenderness, and if the doctor’s said anything about McBurney point. (Side note – I’m currently studying for Step 1 – not that that excuses my impulse to run through a mental illness script). When that flush washed over my face, it was because I was shocked at myself: Why did I not – first and foremost – put myself in his shoes and try to feel the same pain and panic he was feeling?

I immediately apologized – again and again and again. Over the next few minutes, he asked me questions about appendicitis, how likely it was that his appendix would rupture, and more. At the end of the phone call, we had made plans to meet the next day, after his surgery, and my friend was calm. I, however, felt unsettled, and so guilty.

At our “Transition to Clerkships” retreat this past Friday, we sat in small groups and reflected on our individual hopes and fears for clinics. One of my fears was that I might become jaded or desensitized to patients’ conditions and not react with the empathy my classmates and I have cultivated and practiced so carefully. This incident with my friend brought that fear to the forefront of my mind.

I think that in many ways, it is a blessing for a physician to be somewhat desensitized to human suffering (after all, I can’t be fainting all over the place, can I?). But I also think there’s value in reflecting on how we can work to retain and prioritize that element of emotion that makes us human and that makes a doctor someone who is kind and trustworthy. As I move into clerkships this June, I sincerely hope I’m able to find that balance.

Hamsika Chandrasekar is a second-year student at Stanford’s medical school. She has an interest in medical education and pediatrics.

Photo by george ruiz

Medical Education, Patient Care, SMS Unplugged

The first time I cried in a patient’s room

The first time I cried in a patient’s room

SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

Moises bedside sketchThis blog entry marks my last contribution to SMS Unplugged. I am two months from graduating from Stanford Medical School and starting my adventures as an intern. My fiancé and I happily matched at Baylor for our residencies and look forward to contributing to patient care in Houston. Having finished my clinical duties and finding myself spending less time in the hospital, I didn’t anticipate the powerful experience I would have at a patient’s bedside this past week.

In my clerkships I have encountered various situations in patient care that are difficult to deal with: the weight of sharing a negative prognosis, the death of a patient, disappointments in personal performance. Through these encounters I took pride in remaining professional and controlling my emotions, finding a balance between showing empathy and connecting with my patients but not allowing my personal feelings to take over. More specifically, I have never cried in front of a patient. This changed last week, and it happened in the most unexpected of moments.

As a teaching assistant for the second-year class my responsibilities include recruiting patients for students to interview and examine. For the most part, it’s a tedious thing to do and can be a task to dread. But every now and then I meet a patient that reminds me how amazing patient – and human – contact can be. During my last recruitment session, I met a patient that made me cry. I cried not for her, but because she cried for me.

In the process of introducing myself I could tell that she was a warm and caring person. This made it easier to open up to her when she asked about me, where I was heading next, and what life plans my fiancé and I have. It’s not usually a conversation I would have with a patient that I’ve only known for two minutes, but something about her genuine interest was welcoming. Wrapping up our conversation, I began to thank her and make my exit when she reached for my hand and asked if I could give her just two more minutes. Instead of continuing with generic conversation, she closed her eyes and began to pray while holding my hand tight.

Praying with a patient wasn’t new; several patients in the past have asked for me to share moments of prayer with them, and they were beautiful moments. But this time it was about me. She prayed that I have a good residency experience and that I emerge from my training well prepared. Then she opened her eyes and revealed the tears that she would bless me with. She asked that I never forget the dynamic that I will share with my patients. She asked that I always remember to look my patients in the eye, check my position of power and recognize the intelligence of my patients, and more than anything “kick the heck out of life.”

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Events, Medical Education, Medical Schools, Pediatrics, SMS Unplugged

A Match made at Stanford: From medical student to resident

A Match made at Stanford: From medical student to resident

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

IMG_1127On March 20, in synchrony with thousands of senior medical students across the country, I received an envelope that determined where I would be spending the next three years of my life for residency training.

My academic advisor, Oscar Salvatierra, MD, had come out of retirement to share this day with his students. He had supported us over the years, from studying for our first-year exams to choosing a specialty and applying to residency. He supported my husband and me in the additional challenges of tackling medical school as a married couple, guided us through my husband’s decision to pursue a combined MD/PhD degree, and even weighed in on our decision to have a child during medical school. Now, on Match Day, I was so grateful that he was the one to call my name and hand me my letter.

“Open. Open. Open,” my daughter demanded, grasping for the bright red envelope with the same steady persistence that she normally uses to ask for raisins. My husband took her from my arms so that my shaking fingers were free to open the envelope and unfold the letter. It was real, right there in black and white: I’ll be staying at Stanford for a pediatrics residency.

I grinned, then I cried, then I started soaking in the hugs and congratulations of my family, friends, and mentors who all knew how desperately I had hoped for this outcome. But the fun part about Match Day is that there is more than just your own news to celebrate. Within minutes, I was fighting through the crowds to track down my friends and classmates to find out where they had matched. I was incredibly impressed, but not at all surprised, to hear about the excellent programs they will be attending across the country.

As I stepped back into my apartment later that morning, clutching my residency Match letter, it felt a lot like bringing a newborn baby home from the hospital: it was odd and unsettling to walk back through familiar doors into my familiar home when our family’s life was all at once so deeply changed. In residency (like becoming a parent), I am going to have to work harder than I’ve ever worked before, and be challenged in ways I haven’t even imagined. But at the same time, I have no doubt that it will be worth it, and that this was exactly what I want for my life.

I hope that my classmates are feeling the same excitement to start the next phase of the journey. Congratulations to the Stanford Medicine Class of 2015 on an incredible Match!

Jennifer DeCoste-Lopez is a final-year Stanford medical student who will soon start a residency in pediatrics at Stanford. She was born and raised in Kentucky and went to college at Harvard. She currently splits her time between clinical rotations, developing a new curriculum in end-of-life care, and caring for her young daughter.

Photo courtesy of Jennifer DeCoste-Lopez

Global Health, In the News, Medical Education, Pregnancy, Women's Health

Project aims to improve maternal and newborn health in sub-Saharan Africa

Project aims to improve maternal and newborn health in sub-Saharan Africa

5567854013_6bd1e2b76b_zIn sub-Saharan Africa, maternal and neonatal outcomes are some of the worst in the world. What would happen to those numbers if 1,000 new obstetrician/gynecologists were trained with state-of-the-art educational materials in the region over the next ten years? The 1000+OBGYN Project, a collaborative training effort between American and African universities, aims to do just that.

The University of Michigan’s Open.Michigan initiative, in partnership with the UM Medical School’s Department of Obstetrics and Gynecology and Department of Learning Health Sciences, just released four new collections into the 1000+OBGYN Project’s open-access database, thanks to a grant from the World Bank.

A UM press release published today describes the new contributions, which cover a diverse range of subjects, including abnormal uterine bleeding, pregnancy complications, vaginal surgeries, pelvic masses, newborn care, postpartum care and family planning. The materials are all free, publicly available, and licensed for students, teachers and practitioners to modify according to their own curricular context.

Frank Anderson, MD, MPH, associate professor in the UM Department of Obstetrics and Gynecology and director of the 1000+OBYGN Project, comments in the release:

There is an urgent need to train Obgyns [sic] in sub-Saharan Africa, but their institutions don’t always have access to the same body of educational materials as doctors in developed countries have… Many newborn and maternal deaths are preventable. We want to ensure that future Obgyns in low resource countries have access to the same high-quality learning materials available here so they are equipped to provide the best care possible for mothers and babies.

The project hopes to overcome local barriers to good education, such as availability of training materials, licensing costs, and unreliable internet access. To make the materials available offline, the initiative partnered with the Global Library of Women’s Medicine, which compresses research onto USB flash drives and distributes them globally, particularly to women’s health professionals in Africa.

Previously: Countdown to Childx: Global health expert Gary Darmstadt on improving newborn survival, Gates Foundation makes bold moves toward open access publication of grantee research, Improving maternal mortality rate in Africa through good design and Using family planning counseling to reduce number of HIV-positive children in Africa
Photo by DFID – UK Department for International Development

Events, Medical Education, Medical Schools, Medicine X, Stanford News, Technology

Registration now open for the inaugural Stanford Medicine X|ED conference

Registration now open for the inaugural Stanford Medicine X|ED conference

15168705662_f658f6aa3a_zSome exciting news for those who have followed our Medicine X coverage in the past or who have attended the popular event in person: The first-ever Stanford Medicine X|ED conference will be held on campus this fall. The two-day event, scheduled for Sept. 23-24, will bring together innovative thinkers to explore the role of technology and networked intelligence in shaping the future of medical education.

Lawrence Chu, MD, associate professor of anesthesia at the School of Medicine and executive director of Medicine X, explained in a release that he launched the conference because “changing the culture of health care starts with redefining medical education.” He hopes the gathering will “address gaps in medical education to drive innovation and make health care more participatory, patient centered and responsive.”

Digital media pioneer Howard Rheingold will kick off the conference with a keynote address, with the rest of the first day of the conference focusing on five core themes, including engaging millennial learners, opportunities and challenges for innovation in medical education, interdisciplinary learning, and how digital media and massive open online courses are redefining the educational landscape. Abraham Verghese, MD, vice chair for the theory and practice of medicine for Stanford’s Department of Medicine, will deliver the closing keynote.

Day two of the program will include a range of interactive and educational opportunities, as I describe in our release:

The conference will offer tutorial-style classes called “learning labs” on topics such as incorporating instructional technologies into curricula, and using social media to promote patient safety. Additionally, attendees can participate in 90-minute workshops on using 3D printing in medical education, interprofessional care models and methods for bringing real patients’ stories into medical education.

Conference-goers can also enroll in master classes where experts in specific disciplines will conduct small-venue seminars. Confirmed master-class speakers include [Lloyd B. Minor, MD, dean of the School of Medicine]; Bryan Vartabedian, MD, assistant professor of pediatrics and director of digital literacy at the Baylor College of Medicine; Bertalan Meskó, MD, founder of Webicina; and Kirsten Ostherr, PhD, professor of English at Rice University and director of the Medical Futures Lab.

“Health care has changed dramatically in recent years, but the way we teach the next generation of doctors has largely remained the same,” Minor commented. “Stanford Medicine X|ED brings together some of the most innovative minds in medicine, technology and education to re-imagine medical education for the new millennium.”

Registration details can be found on the conference website. Medicine X, Stanford’s premier conference on emerging health-care technology and patient-centered medicine, will kick off the day after Medicine X|ED.

More news about Stanford Medicine X is available in the Medicine X category.

Previously: Stanford Medicine X: From an “annual meeting to a global movement” and Medicine X aims to “fill the gaps” in medical education
Photo of Chu by Stanford Medicine X

Aging, Global Health, Medical Education, Patient Care, SMS Unplugged

After the rain: Experiencing illness as a medical student and granddaughter

After the rain: Experiencing illness as a medical student and granddaughter

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

rainy groundIn India, when the first heavy droplets of rain meet dry earth it releases a particular kind of smell: a dampness arising from sizzling soil that in Bengal we call shnoda gondho. It is raining on the second day we go to visit my grandfather in the hospital.

He has been readmitted to the hospital, after spending a week recovering at home from a hospitalization for rib fractures and bleeding into his lungs. The irony of his hospitalization is not lost on his family: that a renowned doctor, one of the first cancer surgeons in the city of Kolkata and one who spearheaded oncological care in this region, is now gowned and sitting in a hospital bed. This happens frequently, of course, for doctors are not immune to being patients, even if we would like to think so. The problem is that we are little prepared for the unstructured, unscripted nature of experiencing illness rather than treating it.

Certainly for my grandfather, a man who even recently traveled to multiple hospitals each day to supervise surgeries and see patients in clinic, being confined to bed for respiratory treatments and being unable to walk without support feels equivalent to being bound up, tied down, and chained to the hospital. This is the way illness imprisons. For his family, used to seeking his wise medical advice on various things from pesky coughs to unremitting cancers, we are unprepared to now help make decisions for him.

We never stop being medical students, and later we never stop being doctors, whether in relationships with family members, friends, acquaintances, or strangers in emergency situations

Perhaps this reflection is too personal for a forum created for sharing medical school experiences. But I suppose my realization is that medical school is not a place but rather a privilege we hold. We never stop being medical students, and later we never stop being doctors, whether in relationships with family members, friends, acquaintances while traveling, or strangers in emergency situations.

But, as I spend these three weeks with my grandfather and my family in Kolkata, I find that it is important to play both roles: that of medical student, the one who can help translate the staccato of medical jargon into fluid lines, and that of loved one, the one who listens not via an earpiece through the taut drum of a stethoscope but through bare ears and naked eyes, the one who listens for and is moved by the cries of pain, or suffering, or confusion, or desperation, of the ones they love.

In many ways the loved one is the harder role to play, for it is the role with no lines. No chest x-rays to evaluate in the morning. No medications to re-dose for a rising creatinine. No growing charts of oxygen saturation, or heart rate, or urine output. As someone who has recently grown used to doing these things on the medicine wards of Stanford Hospital, I now acculturate to a more improvisational kind of care. Placing a soothing hand on an aching back. Sitting at someone’s bedside while he nods in and out of sleep. Holding down an arm so that it doesn’t tremble like the string on a harp. In Indian hospitals, the family must often arrange to bring the medications that the doctors have prescribed and may often visit the hospital multiple times a day to bring food. We mix rice with soft, curried vegetables or boiled eggs and offer them to our loved ones, hoping to find through these labors some connection, some solace.

As family members we grasp for metaphors. In India, these metaphors of illness are often built around ideas of hot or cold, of water or wind. Perhaps that is why I find it so poignant that it rained today, the dense, gray clouds releasing their water just as the water from the pleural effusion in my dadu’s lungs was drained.

I hope that one day soon, when this rain had cleared, my grandfather will write his own words as he has planned to do. And then he can tell you his story, not I.

Amrapali Maitra is a fifth-year MD/PhD student working towards a PhD in Anthropology. She is interested in the illness experience, the cultural and social basis of health, and practices of care.   Amrapali grew up in New Zealand and Texas, and she studied history and literature as an undergraduate at Harvard. She is a 2013 Paul and Daisy Soros Fellow.  

Photo by Jason Devaun

Medical Education, Medical Schools, Stanford News, Surgery

After work, a Stanford surgeon brings stones to life

After work, a Stanford surgeon brings stones to life

MA15_Profs_Greco_480pxClassrooms, research, grant writing, faculty meetings… It can be easy to forget that professors have a life outside of the classroom, perhaps with surprising hobbies and talents. The new issue of Stanford Magazine highlights the extra-professional lives of some of the university’s extraordinary professors, including Ralph Greco, MD.

Greco is a sculptor of stone as well as a surgeon. His work decorates his home and has sold for as much as $8,500. Perhaps his most notable sculpture is the abstract “S” that graces the Department of Surgery. He created the work of art from a 400-pound marble boulder that was gifted to him at a graduation dinner when he was the director of the general surgery residency program.

It’s perhaps not surprising that the multi-faceted Greco is an advocate for work-life balance among surgeons. He established a support program after the suicide of a surgical resident, and because he says sculpting can be “too self centered,” he pursues other interests as well. Check out the article to learn more.

Previously: Program for residents reflects “massive change” in surgeon mentality and New surgeons take time out for mental health
Photo by Nicolo Sertorio

In the News, Medical Education, Medical Schools, Research, SMS Unplugged

Research in medical school: The need to align incentives with value

Research in medical school: The need to align incentives with value

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

7336836234_05b7e59045_zIt is a truism of American medical education that students should do research. Stanford medical school’s website espouses a “strong commitment to student research,” because it makes us “valued members of any medical field.” A similar message can be found at almost any other institution. It’s not just medical school either. Many undergraduate programs tout their research offerings for pre-medstudents, while residencies and fellowships often encourage their trainees to pursue investigatory projects.

There are several reasons for the emphasis on research in medical training. One obvious explanation is that schools want to prepare students for a career in academic medicine, through which physicians can combine scientific discovery with clinical insight to drive medicine forward. More broadly speaking, research is a way to develop analytic and critical thinking skills. These abilities not only help students better understand disease – they teach us how to read and interpret scientific literature to keep up to date with the latest advances in the field.

I believe in the value of engaging in research, but I recently came across the work of two prominent academic physicians who question whether it accomplishes these goals. The first is Ezekiel Emanuel. While he may be best known for his work on the Affordable Care Act as a special advisor to the White House, Emanuel’s background is in academics. After completing an MD/PhD at Harvard, he stayed on as an associate professor; he’s now a vice provost and professor at the University of Pennsylvania.

In his book, Reinventing American Health Care, Emanuel discusses how to make medical education more effective, and he specifically targets the research paradigm as an inefficiency. Whether or not it is explicitly stated, many top-tier programs require their students to do research in addition to their clinical training. To Emanuel, this constitutes “exploitation of trainees for no improvement in clinical skills.” He argues that eliminating such requirements can streamline medical education and boost the physician workforce. The physician shortage is one of the most discussed problems in health care. Trimming the length and cost of training can help address it. Reducing research requirements would allow students to prioritize their clinical work or other relevant interests.

“Exploitation” is perhaps an overstatement, but Emanuel addresses a legitimate concern about whether students’ time is best spent on research. And findings from researchers like Stanford’s John Ioannidis, MD, amplify the concern.

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