CAMPUS CORRESPONDENT : Radical Treatment Needed for U.S. Med Schools
American doctors in the next century may not be as competent as today’s physicians.
The medical Establishment’s resistance to progress in education, coupled with sweeping changes in health care, threaten to diminish the skills of the next generation of practitioners and the quality of care their patients receive. Shrinking funds and an overload of scientific discovery are bringing matters to the breaking point.
The benchmark study of the reform movement, conducted by the American Assn. of Medical Colleges (AAMC), found that “most medical schools have done little to correct . . . major shortcomings.” Even more discouraging is that these schools have long neglected the prob-lems: The 1992 findings are remarkably similar to those previously published--in 1932.
But medical schools cannot afford to bury their heads in the sand for one more day, let alone 60 more years. Medicare reimbursements to teaching hospitals and affiliated medical schools for treating patients, which totaled some $1.64 billion in 1992 according to the General Accounting Office, are threatened. Without these funds, it will become even more expensive for schools to train students.
In addition, because of cutbacks in insurance, hospitals are no longer the laboratories of learning they once were. To save money, hospital patients are increasingly treated on an outpatient basis. Those admitted are often far too sick for students to learn from effectively.
The volume of new medical information, while valuable, also is worrisome. In the current teaching style of lectures and endless quizzes, the information explosion has placed more pressure on students to memorize it all, which makes them even more competitive for grades. This attitude runs counter to the approach needed to successfully treat patients: Cooperation saves lives.
Exacerbating these conditions is the lure of tenure for younger instructors. “. . . Faculty members are hesitant and insecure about meeting their education responsibilities in a new way and about becoming facilitators of the learning process rather than only transmitters of information to students . . . “ the ’92 study found. Indeed, lectures are the quickest and easiest way for faculty to deal with students--and to move on to “greater” matters such as research, which leads to promotion.
Even those with tenure have clung to the status quo. The association’s report cited such obstacles as “faculty members’ inertia; lack of leadership; lack of oversight for the educational program . . .,” all of which have contributed to an atmosphere of stagnation.
One solution to the lack of hospital patients and funding is to connect medical students with private-sector doctors who do not have to worry about institutional constraints. As a premed student, I have found “shadowing” a family physician as educational as years of lectures.
Getting new blood into decision-making positions is another way of bringing about change. All the participating schools told the AAMC that “the involvement and support of the dean is viewed as a critical component to the success of their efforts,” for reform.
Some medical schools, to be sure, are paying attention to the need for reform. One program, in place at more than 20 of the nation’s 126 medical schools, is problem-based learning. Students are thrown into a lion’s den of new material and forced to work together to understand it. They are learning by doing and, at the same time, practicing to become members of a medical community. Growing in popularity, because it requires less instructor time, is computer-assisted instruction. Among many applications, computers allow students to work on simulated case scenarios.
The challenge facing the 21st-Century physician will be learning how to learn. Without enough help from instructors and with less money available for teaching, future doctors will have no one to rely on in medical school but their computer, their peers and themselves--until major reform is implemented.
