Issue link: https://beckershealthcare.uberflip.com/i/1047089
65 PRACTICE MANAGEMENT THOUGHT LEADERSHIP Redesigning medical education to create the physician of the future By Robert C. Garrett, co-CEO of Hackensack Meridian Health M edical edu- cation must undergo a major transformation if we expect to succeed in moving the needle toward patient-cen- tered, value-based care throughout our nation's health system. e physician work- force of the future will face enormous changes including dramatically different patient demo- graphics, a tsunami of chronic illness, care mi- gration to the community and rapid technical advances that will render some of the knowl- edge learned in medical school obsolete upon graduation. So where are we in meeting these challenges? e good news is we're witnessing — and many of us are creating — new approaches to medi- cal education, driven by the urgent demand to address a new state of healthcare and the belief that medicine needs to be less transactional and more human. New approaches are taking root across the country thankfully as medical school enroll- ment has grown. In fact, we're on target to achieve a goal of 30 percent growth the Associ- ation of American Medical Colleges set in 2006 during the upcoming school year. Many schools are connecting students with pa- tients much earlier in their training. ey are doing away the "sage on the stage" approach, replacing the sometimes tedious lecture with highly interactive learning. Some are phasing out the traditional two years of basic science followed by two years of clini- cal work. Duke University School of Medicine in Durham, N.C. and Boston-based Harvard Medical School, to name a few, have moved to an accelerated curriculum with only one year of core basic science followed by core clinical work beginning in year two. Innovations in medical education also include interprofessional learning so that future physi- cians will thrive in practicing team-based care. We know through compelling research that this approach results in improved outcomes and more cost-effective care. A survey by the Liaison Committee on Med- ical Education found that the number of schools requiring interprofessional education doubled in less than 10 years — from 44 per- cent in the 2007-08 school year to 88 percent in the 2014-15 school year. We launched Hackensack Meridian School of Medicine at South Orange, N.J.-based Seton Hall University in 2018 to change the prac- tice of medicine from the ground up. Given the overwhelming evidence of the importance of the social determinants of health in both health outcomes and ultimately lower costs of healthcare, we are emphasizing the importance of community and behavior in healthcare out- comes and delivery. Our students are connect- ed to families and community organizations throughout their medical school years. We in- cluded many of these new strategies in our ap- proach. Our classes are highly interactive and our partner Seton Hall relocated its nursing and allied health programs to our campus to fully support interprofessional education. Our innovative curriculum connects stu- dents with patients in their first year. Stu- dents can also graduate in three years to help reduce debt — which is essential since med- ical school graduates launch their careers on average $180,000 in the red. Our mission is clear: Our students will play a major role in paving a new path forward, one in which all people in our state, and eventually our country, can realize the same high expec- tations of health and well-being regardless of race, wealth, zip code or degree of education. Here's why this is so important: we all know that 5 percent of the population consumes 50 percent of the healthcare dollar. But this is before the nation's 76 million baby boomers completely retire. is is before our popula- tion health strategies fully bloom to blunt the impact of 100 million U.S. adults living with diabetes or pre-diabetes. So whether we address this for moral reasons or financial ones, it's imperative that we take a new approach. e heart of our curriculum is our profound commitment to connecting students with fam- ilies in underserved communities whom they will follow throughout their entire education. We will graduate "physician detectives," so to speak. ey will be expert clinicians who com- pile facts from all spheres of patients' lives — includin their financial issues, transportation or legal matters, genetics, diet and work life — so they are mindful that someone can't afford a prescription or the bus stop doesn't connect with their clinic or a single mother with two children is the perfect candidate for a virtual visit because she doesn't have a babysitter. Atul Gawande, MD, a surgeon, writer, and now CEO of the nonprofit healthcare venture formed by Amazon, Berkshire Hathaway and J.P. Morgan Chase, notes that physicians must open themselves to their patient's lives and per- spectives to achieve the best outcomes. "Regarding people as having lives of equal worth means recognizing each as having a com- mon core of humanity," Dr. Gawande said in a commencement address at Los Angeles-based UCLA Medical School in 2018. "Without being open to their humanity, it is impossible to pro- vide good care for people." Our class of 60 students will pair up and work in 30 teams assigned to dozens of families. e families have been selected by non-profits who are already working with them and know they are eager for this support Each team will follow their families closely. In addition to connecting with families, students are required to attend meetings in the towns where their families reside to better understand the culture of the community. Actually, the school's motto puts it best: e community is our classroom, the patient is our teacher. Already, in just a few weeks into their first year of medical school, our students have inspired me with their insights. A young woman who is paired with an elderly patient who has mobility issues put it this way: "What surprised me most about meeting my pa- tient was that I found myself genuinely curious and caring for him as a person. It was amazing to get a picture of this man to see how different aspects of his life had impacted his health.'" At one immersion event in Asbury Park, N.J., students paired up with members of Habitat for Humanity to aid an elderly woman. ey mowed her lawn, removed old furniture and trimmed her shrubs. She thanked them profuse- ly and talked a bit about her life, working years as it turns out in one of our network hospitals. "It made me realize there's so much more to a patient than what you see in a doctor's office," a student said. Indeed. ese human-centered programs, combined with traditional rigorous science, will no doubt create a physician workforce up to the challenge of a new state of medicine. n