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Volume 27 | Number 3
It's Time for Change in Medical Education: It's TIME for ITME
Fred Donini-Lenhoff, M.A.
Barbara Barzansky, Ph.D
Paul H. Rockey, M.D., M.P.H.
The Initiative to Transform Medical Education (ITME) was launched by the AMA in 2005 to address needed concerns in a medical education system that has remained largely unchanged in the past 100 years. Its goal is to promote excellence in patient care by reforming medical education from the pre-medical years through continuing education for practicing physicians.
Strengths of the current system were identified as knowledge and technical proficiency, physician concern for individual patients, and patient respect for physicians. Gaps and areas needing improvement were more extensive. Physicians are not prepared to adjust or improve the health care system, and are ill equipped to act as patient advocates on social issues or to participate in ethical and political discussion about resource allocation. They often lose their altruism through their training years, and have difficulty dealing with uncertainty. Managing information and effectively using technology also presents a challenge. Physicians typically expect to be autonomous in treating patients, yet are often uncomfortable discussing delicate issues with those patients.
The ITME identified ten ways to improve medical education. These include: assessing interpersonal skills in the admissions process; creating alternative pathways to medical education; introducing core competencies with accompanying methods of evaluation; assisting current faculty in shifting to the new paradigm; rewarding participants for their buy-in; modeling appropriate behaviors in the educational process; enhancing coordination among licensing, certifying, and accrediting bodies; funding medical education research and development; and evaluating effectiveness based on outcomes.
Change in admissions requirements is one way to change the system. The ITME suggests that greater breadth of coursework in pre-medical years as well as significant commitment to service would be good starting points. They also recommended that humanism, ethics, and professionalism be built into the curriculum at all points.
Entering the Continuum: Undergraduate Preparation for Medical School
Carol L. Elam, Ed.D.
Although the continuum of education for physicians is well defined, it is often not well integrated. The author has collected a series of articles describing courses typically taken in the first two years of medical school, the skills necessary for success in these courses, and recommendations for appropriate undergraduate preparation. The common thread is a general sense of what it takes to be successful in the first years of medical school.
Getting Started: A Primer on Comprehension
R. J. Jacob, Ph.D.
Successful medical and dental students are self-directed, life long learners. Jacob describes four levels of learning, each with progressively better comprehension and retention. The higher the level, the greater the chances are for success in a medical curriculum.
Human Gross Anatomy
Bruce E. Maley, Ph.D.
Maley asserts that the primary purpose of most anatomy courses is to teach the language of the profession to allow for communication in the discipline. A challenge for most students is working with a dead body and this creates considerable stress. The other major challenge is coping with the sheer volume of information. Suggestions for preparation include taking comparative anatomy, taking an anatomy/physiology course that includes dissection, and taking a medical terminology class. Even with such a background, medical students must be able to use the information, not just memorize the facts. Maley suggests study groups as a way of learning to use the information just learned, to find reasons for learning the extensive amount of information, and becoming comfortable with making mistakes. He also encourages students to seek faculty assistance to maximize efficiency in studying.
Cell and Tissue Biology
Brian R. MacPherson, Ph.D.
This area involves the study of cells, their organization into tissue, and ultimately into organs. It introduces the student to the appearance and organization of normal human tissue and organs. Although molecular biology has crept into some courses, MacPherson feels strongly that “what we can see” is a critical aspect of the course. Assessment is typically multiple choice and focuses on facts, not comparisons. Digital microscopy is becoming common as a way of more efficiently staffing labs. Group study is encouraged.
Dexter F. Speck, Ph.D.
Physiology is the study of the normal function of the body, and typically integrates many disciplines to describe health and disease. The study balances mathematical principles of predictability with biological principles of variability. It involves extensive use of charts and graphs, a skill often lacking from undergraduate studies. Comfort level in reading and interpreting graphs predicts success in this course. Once again, students are encouraged to study in small groups.
Thomas N. Oeltmann, Ph.D.
Neil Osheroff, Ph.D.
Biochemistry studies the structure, function, and interaction of bio-molecules, their synthesis and degradation, and the mechanisms by which their activities are coordinated and regulated. It also includes the pathways by which they are converted to usable energy and the process by which genetic information is transmitted. Medical school courses focus on mammalian systems. Students with a good background in organic chemistry, molecular biology, and biochemistry generally fare well in these courses.
Medical Behavioral Science
H. Jean Wiese, Ph.D.
John F. Wilson, Ph.D.
Medical behavioral science includes multiple social science disciplines. The authors note the Institute of Medicine ’s recommendations for teaching basic behavioral principles. They recommend that undergraduates take courses in social sciences to broaden their knowledge, but also to become familiar with a multi-disciplinary approach to problem solving. Service and service learning are valuable preparation as well.
Introduction to Clinical Medicine
David W. Rudy, M.D.
Traditionally composed of learning how to take a history and how to perform a physical exam, this course has broadened in recent years to include the doctor-patient relationship and general communication skills. It may also include learning to present a case, write up a medical case, and write progress notes for a patient chart. Suggestions for undergraduates include taking a broad range of courses outside of the sciences, learning to reflect on experiences, and developing good communication skills. Seminar classes and experiential learning are also encouraged.
Jeffrey N. Davidson, Ph.D.
Medical genetics, the study of the interaction of genetic mutations and environment, has become an integral part of all medical specialties. The focus is on disease and abnormality, and undergraduate preparation in molecular biology may be more useful than a standard genetics course. The author recommends also taking courses in ethics, religion, and psychology. Comprehension is more effective than memorization.
Donna R. Weber, Ph.D.
Pharmacology studies the mechanism of drug action on the body, the kinetics of drug absorption, metabolism and elimination, and the use of drugs in disease prevention and treatment. Weber suggests that undergraduates prepare by taking biochemistry, anatomy and physiology. She also recommends that students learn about drugs as consumers by reading labels and package inserts. Success is predicted by learning at the highest levels as defined by Bloom’s Taxonomy, staying current with coursework, understanding one’s personal learning style, and actively engaging in class.
Demystifying Careers in Medicine: The Physician-Student Mentoring Program at Butler University
Johnny D. Pryor, J.D.
Michael J. Samide, Ph.D.
The authors describe a physician mentoring program established in 2006 at Butler U. Sophomore pre-medical students are matched with a physician mentor for a 2 year commitment. Students and mentors complete a participation form and meet at least once each semester. In addition to shadowing opportunities, the pairs share a meal, attend a performance, or engage in a volunteer activity. Mentors may be alumni or local physicians and are matched with students by medical interests, general interests, and gender.
The program is too new to have assessment data, but appears to be successful. Students are enjoying the experience and are learning from their mentor. Some have learned that a medical career is not appropriate for them to pursue.
Health Professions Advisors and AHECs: A Partnership That Benefits All
Jason C. Baker, Ph.D.
Paula Overfelt, M.Ed.
Authors Baker and Overfelt describe an effective partnership between the Northwest Missouri Area Health Education Center (AHEC) and the health professions advising services at Missouri Western State University. By collaborating on programs, they conserve time and resources, as well as providing good attendance for their various activities. The AHEC office has extensive contacts with health professionals, and staff to organize events. The pre-medical students become familiar with AHEC, and, presumably, are more apt to work with them when they get into practice. Working with the AHEC also makes it easier to work with other institutions creating a larger audience for speakers and recruiters. Some examples of collaborative efforts include mock exams, mock interviews, personal statement writing sessions, and day long workshops on specific medical topics.
Not So Elementary, Dr. Watson: Points to Ponder When Gang Involvement is Detected in an Applicant's Background
Wafeeq Sabir, Ph.D.
Karen de Olivares, Ph.D.
The use of criminal background checks has created a new concern in medical school admissions: how to deal with gang activity and affiliation. “Gangs” are defined specifically by state penal codes as groups regularly engaging in criminal activity. Further definition includes the common use of identification (name or symbol) and the atmosphere of fear and intimidation created by the criminal activity. Some of the issues of concern are the level of perceived threat, the types of criminal activity (petty theft vs murder), and the misidentification of individuals as gang members. Especially troubling is the disproportionate assignment of gang membership to minority members. Although there are criteria by which individuals are labeled as gang members, these vary, are used inconsistently, and may be applied by law enforcement agents with little or no training about gangs. The authors present an interesting and convincing case of misidentification.
The authors in no way condone true gang activity or the violence associated with it. Rather, they suggest caution in making assumptions about individuals and offer two major suggestions. First, that gang membership and related criminal activity be carefully researched, and that assistance should be sought of someone with specialized training in gangs. The second suggestion is to keep an open mind. Some gang members do get out, go back to school, and set a positive course for themselves. The applicant should be considered as an individual with potential positive attributes as well as some negatives in their past.