What Doctors Aren’t Learning In Medical School And Why It Matters

  • What doctors aren't learning in medical school and why it matters

What Doctors Aren’t Learning In Medical School And Why It Matters

Originally posted July 27, 2015

Source: http://www.forbes.com/sites/athenahealth/2015/07/27/what-doctors-arent-learning-in-medical-school-and-why-it-matters/#5994e331d23a

By: Stephen Klasko, MD, MBA (athenahealth Contributor)

In the 1960s, America’s doctor was Marcus Welby, a family physician who made house calls, didn’t charge patients who couldn’t afford it, and maybe even delivered a calf on the side of the road—all before performing difficult neurosurgery on a child before the end of the show.

This generation’s favorite doctor is Gregory House: drug addicted, narcissistic and, of course, analytically brilliant.

Physicians have gone from saints to sinners in the public’s eye, which is why the results of athenahealth’s ninth “Epocrates Future Physicians Of America Survey” don’t surprise me. If you didn’t see it, this survey asked 1,462 medical students to share their opinions about topics impacting the medical profession.

  • Although nearly all of them felt well prepared in terms of medical knowledge, only ten percent of them would seek solo or partnership practice.
  • An impressive 96 percent of students believe that to deliver high quality care, it is important to collaborate effectively with extended care teams, including registered nurses, physician assistants, specialists, and medical staff (a stance not often shared by the medical societies they may soon be joining).
  • However, nearly 60 percent consider lack of communication between care teams the biggest obstacle to effective care coordination. In fact, concerns about inadequate cross-team communication was acknowledged by seventy-five percent of students surveyed.

In other words, most students, residents and graduating physicians felt unprepared in the important people skills of building a business, running a practice and communicating with their colleagues—never mind relating to actual patients. Our future physicians are more House, less Welby.

How did this happen?

After seven to twelve years of medical education, today’s young physician has joined a cult centered around four biases: competitive, autonomous, hierarchical and noncreative.

This happens because medical schools in the US still accept medical students based on their science GPA, ability to memorize organic chemistry formulas, and MCAT scores. Yet, we are amazed that doctors are not more empathetic, communicative or creative. We still believe that a student with a 3.9 GPA will be a better doctor than one with a 3.5 GPA, even though the former may have had no social life. We still do not recognize (or account for) the difference between just seeing and observing.

The athenahealth survey meshes nicely with a study I completed in 2013 in which 70 percent of physicians practicing three years or less did not feel they learned what they needed to be successful and felt insecure about their future.  As one of the young physicians put it, “I have $250,000 worth of debt … and you taught me half of what I need to know.”

Yes—they learn microbiology, biochemistry, cardiology and orthopedics, but they didn’t learn how to effectively and empathetically communicate, be an individual in an organization, be a leader (or a follower, for that matter), make patients happy, run an effective meeting, market themselves or their practice, or even how to manage change (which is not in short supply in healthcare!).

Changing the DNA of our future physicians, as I said, is complicated, but I believe we are fostering that change at Thomas Jefferson University. I am proud to be leading an organization that, while almost two hundred years old, is beginning a revolution in selecting and educating physicians.

Being the change you seek

While TJU is home to the largest longitudinal database on physician attitudes (Jefferson Scale of Empathy) and a nationally recognized inter-professional education curriculum, we are leading the charge for training twenty-first century leaders through a combination of holistic admission criteria, curricular change and creative partnerships.

The Sidney Kimmel Medical College actively searches for emotional intelligence characteristics of students—such as self-awareness, empathy and the ability to be a change catalyst—that make it most likely for them to be successful in a leadership role. Letters of recommendation have been replaced by one-on-one interviews probing for emotional intelligence traits and flaws; and we are utilizing a behavioral experience interview, commonly used in choosing business leaders and aviation pilots, looking for potential leadership experiences and abilities.

The end result is less reliance on science GPA and MCAT scores and more on parameters that will create physicians less prone to the “biases” of the past. Recently announced partnerships with Princeton University and St. George’s University in London allow us access to a pool of non-traditional medical school candidates from the Princeton design program and for cross-cultural learning opportunities across the pond.

Further, we are embarking on the institution’s boldest curricular change in two hundred years, replacing some traditional courses with longitudinal education on health systems competencies, patient-centered care and cultural competencies, population health, and leadership, innovation and professionalism.

As a university president and health system CEO, I don’t have much time to watch TV these days. But as one of those baby boomers who will eventually slow down and most likely become a consumer of healthcare services, I am hopeful that my future physicians will be empathetic, holistic, creative and caring; that while they may not be able to recite the Krebs cycle by memory, they have enough intelligence to know when to consult their iPhone.  If we succeed, the personality of Dr. House as a model of physician behavior will become as dated as Marcus Welby might seem to us today.

Stephen Klasko, MD, MBA, is President and CEO of Thomas Jefferson University and Jefferson Health in Philadelphia.