Medical Innovation and Accreditation: LCME Update Barbara Barzansky, PhD, MHPE, LCME Co-Secretary( Continued)
In the 1980s, there was a perception of a physician oversupply. Capitation disappeared and medical schools no longer received additional government funding which resulted in stifled growth. The number of US medical schools between 1980-2000 did not change, hovering around 125.
2010-20 has brought the perception of a physician undersupply, but there is nothing equivalent to capitation as a ready funding source. The federal government is not handing out a lot of money. Existing medical schools are tasked with finding additional resources to grow. New medical schools need to develop and demonstrate a stable financial foundation beginning with the accreditation process.
Dr. Barzansky shifted the discussion to describe how medical schools have diverged and what they have become. The 2 + 2 curriculum structure model is slowly disappearing; it is no longer the only model. More than one third of schools have ended preclerkships in the middle of Year 2. Clinical training is starting earlier; basic science education has been shortened in those schools to a year / year and a half duration. This is not a new concept.
In the 1950s-early 60s, Case Western Reserve introduced discipline-based curricula where organ systems subsumed the traditional disciplines. You had a GI course; a musculoskeletal course. It was thought of as a way to organize content thought to be more relevant to what students are going to be doing in clinical settings.
Some of the newer models were organized by topic areas. And there’ s one system that purports to be very patient centered, where you spend a week on sore throat and look at the presenting symptoms and what are the differential diagnoses that you might come up with. In other words, she noted, there’ s a lot ways to cut the cake in thinking about basic science content. And how you cut the cake may affect how student training relates to particular parts of the anatomy.
Back in the 1960s there was a school led by a dean named Andy Hunt who said no, the traditional basic sciences need to go beyond anatomy, physiology, and biochemistry. His school’ s curriculum tended to consider things like economics and sociology. It needs to think about how care is delivered and what students need to know about those issues. Although offering those subject areas wasn’ t widely espoused at that time, in the pre-clerkship period, in addition to the classic basic science, you’ re finding topics that will come from a number of different areas that Dean Hunt would say are his version of basic contenthealth disparities, cultural competence, and patient safety.
And one of the things that has stimulated this part of the conversation is that a number of these topic areas are a requirement of the LCME accreditation standards. How the subjects are taught, where they’ re taught, and if enough of the information taught allows the school to meet the objectives that the faculty has set for the medical education program. And the question is, how does the institution put the topic areas where students see that they make sense in the context of the foundational sciences?
Students will say,“ I have to study biochemistry. I don’ t know when I have time for domestic violence, public healthcare systems or healthcare financing. I don’ t see how it fits.” And the question is how you make students aware of the facts: all these elements contribute to a budding physician’ s ability to understand problems. To deal with the problem of presenting those issues to them is a difficult one.
There are a lot of different ways to organize content and the ability for students to learn content in a way that isn’ t strictly discipline-based. The LCME uses terms like active learning, or self-directed learning where students have the opportunity to ask their own questions related to a situation, then go find the answers that they think they need. Or engaged learning, where someone else gives them the questions and the students go out and find the answers.
Both approaches allow students to be much more involved in their learning than being lectured to and supports the retention of information. It is also a good approach to bring facts together in a way that is meaningful to them. Computer-assisted instruction has appeared and disappeared as a model. It’ s pretty hot today because of the COVID-19 pandemic. In essence, there’ s a lot of ways to put content together.
CDU College of Medicine | PG. 14