Flipping the script to prepare tomorrow’s doctors
By Mark Donahue
The next time you’re on YouTube, cue up a medical school lecture — any one will do — set it to double speed, then click play. See if you can follow along.
“That’s the life of a first- or second-year medical student,” says Michael Herring, now a third-year student at Rush Medical College. “The first time you listen to it, it's very, very strange, but it's amazing how quickly your brain will adapt."
Herring recently was part of a pilot program at Rush Medical College to test out a renewed approach to training future doctors, which will go into effect for the 2017-18 school year. One aspect of this pilot allowed students to view pre-recorded instructional content at their own schedule and pace.
And though they weren’t encouraged to speed-listen, Herring attests that medical students put their own spin on things, showing creativity in effective time management.
"This recognizes the reality of how our students learn,” says Robert Leven, PhD, assistant dean for basic sciences education. “The majority of students don’t often go to lectures. They use other resources already, so we're really just embracing what they've already been doing."
With lecture removed from in-class time, students instead focus on tackling case studies in groups. Through this, Leven and other medical college faculty stress the renewed MD program curriculum makes meaningful connections between the classroom and the clinic sooner, better preparing students to enter a residency after graduation and make an immediate impact on patients.
There’s no doubt the way doctors are trained today is changing — from emphasizing team-based care to navigating the many roles they must play.
You could say it’s moving at double speed.
New approach to an old foundation
Rush Medical College’s renewed approach is a collaboration of faculty, staff and students — Herring, for example, is part of a work group helping to develop the curriculum — and it reflects a blend of recent trends and proven concepts.
For more than a century, the curriculum in most American medical schools has stood on the “two plus two” model: two years of education in basic and clinical science (a “pre-clerkship” that focuses on the human body’s major systems and the diseases that affect them), followed by two years of patient interaction in clinical settings (rotations through core and elective “clerkships”).
This arrangement works, says Elizabeth Baker, MD, associate dean for education, but it can delay the clinical significance of the material presented. In revamping its MD program curriculum for the pre-clerkship period, Rush Medical College looked at ways to build on the solid two plus two foundation while helping students make clinical connections sooner.
Set to roll out in fall 2017, first-year students will take courses based on organ systems, looking at both normal and diseased states, with an emphasis on clinical application of basic science. Students will begin to develop a range of critical skills early on, from examining and communicating with patients to identifying social determinants of health, to name just a few.
Learning in the renewed curriculum will be case-based to demonstrate real-life applications of conditions, Baker says. Students also will have opportunities to work on state-of-the-art simulators in the Rush Center for Clinical Skills and Simulation.
"They're going to complete an activity where they're working on a case or working in a team,” Baker says. “I think for a lot of students that's much more appealing than what I did in medical school, which is sit in a lecture room for eight hours a day while people talked at me."
Flipping the classroom
The framework for this change is a concept called the “flipped classroom.” Though not new to medical education, Rush Medical College is in the vanguard of institutions in the U.S. and abroad pursuing this approach wholesale for its classes.
In the flipped classroom, students receive the “lecture” part of a class on their own, at their own pace. This content can take the form of online animated videos, audio recordings, or selected readings and exercises. Students then spend their class time working in small groups to apply what they’ve learned to those cases, with faculty as facilitators.
Select second-year Rush medical students got to experience the flipped classroom in the genitourinary (genital and urinary organs) class block during the 2015-16 academic year. Leven says the students’ evaluations ranked this pilot the highest rated class of that year.
For faculty members experienced in more traditional teaching approaches, some adjustment time will be needed to adapt to the flipped classroom. Rush Medical College has already begun holding faculty development sessions on the model.
“Rush is now embarking on an effort to train faculty to move from being a ‘sage on the stage’ to a ‘guide on the side,’” said Ranga Krishnan, MB, ChB, dean of Rush Medical College.
Roles for tomorrow
The goal, say medical college faculty, is to train doctors who are more ready to step into a clinical setting during residency and beyond and to understand the roles asked of a physician today.
These roles are spelled out explicitly in the renewed curriculum as areas of competency: practitioner, scholar, educator, communicator, advocate, leader, professional and collaborator.
Collaboration is key, and first-year Rush Medical College students have also begun participating this fall in a new course focused on interprofessionalism, as part of a federal Health Resources and Services Administration grant awarded to Rush. They will be grouped into teams that include students of at least three different health professions (such as nursing and allied health) to work closely together through a series of exercises.
"Students come to Rush for this reason,” says Jan Odiaga, DNP, CPNP, assistant professor in the College of Nursing and one of the directors of the interprofessional effort. “They want to be a part of a team. They want to be one of the best teams around."
These new developments keep medical students busy. In Herring’s estimation, he can get through a 30- to 40-minute video lecture in around 15 to 20 minutes. There is, after all, a lot to learn, but he’s not daunted.
"There are a finite number of things that can go wrong in the human body,” he says. “Finite, of course is a large number, but finite nonetheless. The key here is efficiency.”