In the final session of last International Conference of Residency Education (ICRE) conference – “Medical education at a strategic inflection point”, Dr. Catherine Lucey, Vice Dean for Education and Executive Vice Dean for the School of Medicine at the University of California San Francisco, addressed the need to transform medical education and reviewed her ideas in response to the pandemic and going forward.
Fault lines of medical education
Throughout the pandemic, the efforts of medical professionals demonstrated the effectiveness of medical education; it prepared physicians with the scientific knowledge to solve problems, epidemiologic principles to predict the pandemic, and the creativity to design new strategies when essential resources weren’t available.
However, Dr. Lucey points out, the pandemic also uncovered fault lines. Long-term care and chronic diseases like diabetes, heart disease, substance abuse and severe mental illness continue to threaten the health of communities. Rural areas and Indigenous communities also didn’t have enough physicians to combat the pandemic. This led to dramatically different levels of morbidity and mortality across communities.
The pandemic also demonstrated the power of urgency to transcend resistance to change. “It was this sense of urgency, our house-is-on-fire moment that catalyzed all stakeholders in the ecosystem to change,” she says, as leaders and stakeholders adopted strategies previously identified as too hard to implement.
Does medical education need to change?
Dr. Lucey feels it must, but she feels just preparing physicians for the next pandemic will be insufficient. “The stress test is how reliably we can deliver high-quality, equitable, patient-centred care every day, in every community to every patient regardless of their power or privilege. If we design a system that accomplishes that, we will be ready for a crisis that appears in the coming generations.” To realize this vision, Dr. Lucey proposed ten goals to re-engineer the medical ecosystem and redesign the medical education.
10 goals to transform medical education
(1) Establish a national vision for the physician workforce
Dr. Lucey explains that physician workforces need to understand how national and global health crises result from a complex interplay of biology, behaviour, social systems and environmental conditions. She advocates that the national workforce must be diverse and skilled at approaching people different than themselves with cultural humility.
(2) Achieve equality in medical education and healthcare
“The medical profession has a responsibility to address the structural and interpersonal racism which threatens the health and healthcare of marginalized communities We have to engineer all processes and education to achieve equity and diversity — from school admission strategies to the selection and ranking of residency candidates.” It’s a responsibility she feels must be approached with the same commitment as patient safety and quality.
(3) Design physician education to address endemic causes of suffering
Accountability, basic sciences and clinical skills must be redefined in the coming decades. “The pandemic illustrated that all physicians must be able to understand complex mechanisms of diseases that extend beyond traditional medical sciences.” She believes schools and programs must include a broader set of disciplines, including public health strategies, systems engineering, population science, sociology, psychology, organizational change, and policy.
(4) Prioritize curricular exemplars to focus on local communities
With every medical school and residency program having latitude regarding the types of diseases they use to teach about core concepts, she recommends curricula be relevant to the specific healthcare challenges of the local communities.
(5) Promote equity by adopting programmatic assessments
A student’s opportunity to be recognized should be based on the achievements that predict their future success in medicine — rather than test scores at the early part of their schooling. “Without equity in assessment,” explained Dr. Lucey, “we have no opportunity to establish equal opportunities and lifelong impact in medicine.” Instead, she suggests a move to programmatic assessment, which helps minimize unconscious bias, decreases learner stress and improves team and faculty relationships.
(6) Adopt competency-based training to help students advance
“Learners should have the ability to advance to another educational opportunity as soon as — but only when — they have successfully demonstrated the breadth of competencies needed to succeed in their next endeavour,” said Dr. Lucey. However, she recognizes that institutional systems rely on a certain number of residents to manage a clinical workload and adopting this approach would require an overhaul of these systems as well.
(7) Redesign education systems to increase equity and equality
Dr. Lucey identifies that the move to virtual medical school during the pandemic allowed learners to continue their education, reducing some inequities in medical education which have consistently favoured the wealthy. She also points to the need for new admissions strategies, such as using AI strategies to assess learner skills.
(8) Prioritize workforce well-being
Dr. Lucey believes aspiring and practicing physicians should be able to work and learn in environments allowing them to thrive in both their personal and professional lives. “Stories in the media during the pandemic showcased the extraordinary burden on healthcare providers shouldered.” New strategies to help address the social, emotional and physical burden are essential and leaders should be held accountable for workforce well-being.
(9) Address underserved communities through innovative partnerships
All patients deserve ready access to preventive and therapeutic care, yet the pandemic highlighted how the unequal distribution of physicians and healthcare systems across nations affected under-resourced communities. Dr. Lucey suggested medical schools to develop well-resourced and sustainable pipeline programs to build a clearer path to under-served communities and build regional campuses/programs to influence community support.
(10) Match the support of the workforce to the expectations
Many health professionals provide care without adequate support because of inadequate investments in public health. “The social contract on which the medical profession is based implicitly expects physicians to respond to a call of duty to care for the sick and injured, regardless of the risk to self,” Dr. Lucey explained. However, she points out that “A redesign of the social contract — with clarity about mutual expectations and responsibilities — is overdue.”
Dr. Lucey believes medical leaders and educators have the capacity to educate a workforce that will make the diverse world better. “Our eyes should be open to the challenges … but also to the possibilities,” she said. “We have no option but to transform if we hope to accomplish the goals of improving the health of all our communities.”
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Diane Amato is a Toronto-based freelance writer who loves to talk about finances, healthcare, travel and technology.
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