Becker's Hospital Review

47 Physician Affairs More and more, technology is shaping what med- ical schools teach, how professors teach it and how students learn. "There are not a lot of microscopes anymore," laughed Morgan Passiment, director of healthcare affairs for the Association of American Medical Colleges. Cadavers could soon be on their way out too, in favor of virtual anatomy. Instead, schools are beginning to incorporate EHRs, simulation, data analytics and new instructional approaches inspired by mHealth and telemedicine. Medical school students now need to learn more technology-based skills, which require new set- tings and strategies that break from the tradi- tional lecture hall environment. The challenge medical schools face is in preparing students for roles that continue to shift as care models and technologies change. "This is a new era for medical education and it parallels the changes that are happening in our healthcare delivery system," says Marc Triola, MD, associate dean of educational informatics and the director of the Institute for Innovations in Medi- cal Education at NYU School of Medicine. But curriculum evolves slowly, Ms. Passiment says. Changes are typically reviewed and formal- ized every eight to 10 years. "We knew there was a consensus out there for what had to change, but it wasn't happening," says Susan Skochelak, MD, AMA vice president of medical education and director of the AMA Cen- ter for Transforming Medical Education. That's why the AMA decided in 2013 to launch its Accelerating Change in Medical Education Pro- gram, which awarded $11 million in grant fund- ing to 11 medical schools. When the AMA put out a request for applications, nearly 85 percent of American medical schools responded, according to Dr. Skochelak. "People want to teach IT, but they don't have the resources or don't know how to teach it," she says. The 11 chosen schools were tasked to form a con- sortium and develop new curricula and learning strategies to share with other institutions around the country. Through 2018, the 11 selected uni- versities, including Indiana University School of Medicine, NYU School of Medicine and Vander- bilt University School of Medicine, will be in the implementation stages of their individual cur- riculum projects. The AMA's program isn't the only initiative fo- cused on updating medical school curriculum. The ONC sponsors a Curriculum Development Centers Program, for example, which has award- ed schools like Oregon Health and Science Uni- versity with $2.7 million to overhaul curriculum and include new emphases, like EHRs. While there is still not consistent integration of health IT across medical schools, pockets are div- ing into technology-based curricula, according to Ms. Passiment. "The challenge we have right now is helping our learners understand the role technology can play in healthcare, and focusing on care outcomes, not on technology. Technology is a tool," says Ms. Passiment. The disappearing paper trail Just as hospitals strive to integrate EHRs as a tool for improved patient care, many medical schools still grapple with how to best integrate EHRs into curriculum, Dr. Skochelak says. Some universities continue to teach old-school paper record-keep- ing first, while others debate the use of templates. Meanwhile, at the residency level, students are missing the opportunity to use EHRs due to lack of training or HIPAA restrictions, she says. "The challenge for educators at the beginning lev- el and at the medical school level is we don't know the methods or the pedagogy that work best," says Dr. Skochelak. IU School of Medicine, based in Indianapolis, is working to develop better methods and pedagogy to incorporate the EHR in a learning environment. It received a $1 million Accelerating Change in Medi- cal Education grant from the AMA for its proposal to develop a virtual health system and teaching EHR, which would let future physicians practice clinical decision making in a realistic environment. "I want our medical students to understand this. If I just put them in a lecture hall and talk at them, they won't get it," says Sara Jo Grethlein, MD, associate dean for undergraduate medical education and pro- fessor of clinical medicine in the division of hema- tology and oncology at IU School of Medicine. IU worked with the Indianapolis-based Regen- strief Insitute, an informatics research organiza- tion, and with the support of Eskenazi Hospital in Indianapolis it launched a fully functional teaching version of its EHR a year into the imple- mentation stages of the grant. The tEHR uses real, carefully de-identified patient data from roughly 10,000 patient charts, down to the written notes. The tEHR stands alone, unconnected to the hos- pital system, so students are free to write in orders and notes in a simulated environment where it can't hurt anybody, Dr. Grethlein says. Second-year students at IU will soon start using the tEHR. They will receive 12 sessions across the year learning about systems-based practice and big data, according to Dr. Grethlein. Now officials are developing activity-based as- signments for third-year students to incorporate into their rotation schedules. For example, stu- dents could be assigned a hypothetical patient in the tEHR with cholecystitis, or a "hot gallbladder", who received gallbladder surgery. The student will then be asked to go into the tEHR, look at the labs and imaging tests performed during the patient's stay and justify each of them, Dr. Grethlein says. If they cannot do so, she says, they must find out how much money was wasted on unnecessary tests. The ideas behind the tEHR are not entirely new — Dr. Grethlein says she used to have students write down tests that weren't justified on index cards — but, "it's just a slicker, higher-tech way of doing the same thing." The most important part is showing students how to use the EHR as a tool to better understand their role in providing care. "It's not just how you put in notes or orders, it's how you use it as a tool to answer clinical ques- tions and design intervention," says Dr. Skochelak. Getting a hold of big data To use EHRs as a tool, it is increasingly important for physicians to understand how to make data from EHRs and other sources actionable at the point of care. "The analytics piece, just like the EHR, becomes the tool and mechanism to provide care. Many schools are headed in this direction. However, I don't believe it is consistent across medical educa- tion," says Ms. Passiment with the AAMC. Clinical informatics became a certified subspecial- ty only a few years ago, in September 2011. It em- phasizes data management to help improve how The future of medical school is — almost — here. "The challenge we have right now is helping our learners understand the role technology can play in healthcare and focusing on care outcomes, not on technology. Technology is a tool." — Morgan Passiment, Director of Healthcare Affairs for the Association of American Medical Colleges

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