The Journal Gazette
Sunday, December 23, 2018 1:00 am

Med school gets a makeover

AMA rethinking standards, and IU's in the mix

SHERRY SLATER | The Journal Gazette

The American Medical Association is working with medical schools nationwide to update what – and how – future doctors are taught.

Seemingly everything is on the table for reconsideration, including how long aspiring physicians must attend classes. The standard four-year requirement is passé, some say.

An experienced physical therapist or registered nurse might be able to finish medical school in less than three years, while some other students might need more than the typical four, said Dr. Susan Skochelak, the AMA's vice president for medical education.

“We had no mechanism to right-size training,” she said, adding that physician training “can be more flexible and individualized than it has been.”

The AMA's effort to revamp medical training expanded to 32 medical schools in October as it enters its sixth year. Indiana University's School of Medicine, one of 12 original participants, has embraced the project at each of its nine campuses, including the one in Fort Wayne.

IU's contribution to the education overhaul includes a significant piece of medical school curriculum designed to familiarize students with electronic health records.  

“They've developed a much-needed teaching platform,” Skochelak said, adding that more than a dozen other medical schools have adopted the curriculum. “They've definitely been a star among our schools on the innovation front.”

Getting technical

IU's medical school assembled more than 10,000 patients' symptoms and medical histories into a database. All that's missing from the electronic health records are patients' names and other identifying data.

Students use the information to offer a diagnosis, order tests or recommend consultation with a specialist – decisions that won't be carried out but reviewed and evaluated by instructors. Meanwhile, aspiring physicians gain experience using technology similar to what they'll be required to use on the job with real patients.

The curriculum is designed to teach students about quality, safety and cost of medical care, according to Dr. Jay Hess, dean of IU's medical school.

IU's medical school is the largest in the U.S., based on the number of campuses – nine – and number of students – more than 1,400, Hess said. Each year, the school graduates about 360 new doctors who have the same quality of education regardless of which campus they attended, he said. 

The majority of physicians practicing in the state earned medical degrees from IU, Hess said, citing data published last month in a report by the IU School of Medicine Bowen Center for Health Workforce Research and Policy.

Along with developing curriculum around electronic health records, IU's medical school has led the effort to train doctors to work in teams by creating the Interprofessional Education & Practice Center.

“There's a lot of different ways that we can make medicine better,” Hess said.

IU was one of more than 140 medical schools that applied for the dozen first-round places in the AMA's program. Each spot came with a $1 million grant.

“It was very competitive,” the AMA's Skochelak said of the selection process.

Expanded effort

The next phase for the AMA Accelerating Change in Medical Education Consortium includes efforts to improve medical students' well-being, improve quality of patient care, enhance patient safety, and address ways socioeconomic factors affect patient health.

The $15 million initiative builds on progress already made, Skochelak said.

Among experienced physicians' concerns about new medical school graduates are they:

• Don't know how to work in teams

• Don't know how to work in outpatient settings

• Don't understand the health care system, including the difference between Medicare and Medicaid.

Penn State's medical school was among the early participants that tackled finding ways for students to have more hands-on learning.

The State College, Pennsylvania-based program assigned medical students to act as patient navigators. They now help patients and families dealing with cancer, diabetes, Alzheimer's disease and other diagnoses learn what services are available.

Aspiring physicians who haven't dealt with serious health problems have an incomplete understanding of what challenges families face, Skochelak said.

“The students are now functioning differently than previous students,” she added.

Residency program faculty are excited about the changes in medical school training, Skochelak said. Graduates of those schools, she added, have an advantage when applying for residency placement.

Skochelak said it's important to expand the revised training to residency programs so new doctors don't dismiss updated approaches as unworkable.

Eye on aging

Each of IU's nine medical school campuses focuses on a specific topic, which allows interested students to research and publish papers in that “scholarly concentration.”

Numerous medical students are also pursuing master's degrees in public health, Dean Hess said.

Among the specialties offered are medical ethics and disparities in urban health. The Fort Wayne campus focuses on aging studies, including the progression of diseases such as Alzheimer's and Parkinson's.

“Aging study is a perfect focus for interdisciplinary medical education,” said Dr. Fen-Lei Chang, associate dean of IU's medical school and director of the local campus.

Professionals who address aging-related issues include nurses, pharmacists, dentists, physical therapists, social workers, architects and urban designers in addition to physicians, he said.

Chang, who moved to Fort Wayne 20 years ago to practice neurology, joined the school's administration in 2007. At that time, medical students could receive only two years of training locally before transferring to a bigger campus for the final two years.

Since then, local enrollment has more than doubled to about 80 students who can remain in Fort Wayne for all four years of medical training, Chang said.

The local medical school is on the Purdue University Fort Wayne campus, just north of the Gates Athletics Center. The two-story building, which also has a basement, shares a parking garage with the Rhinehart Music Center. It includes small lecture rooms for classes of about 10 students each, various laboratories and a cold room where students can dissect donated cadavers.

Local support

After establishing a foundation in science during the first two years, medical students go on to do clinical work at a Parkview Health or Lutheran Health Network-owned facility. The final phase is an elective internship that transitions into residency.

The Fort Wayne Medical Education Program, which is independent from the IU medical school, offers a residency in family medicine. Chang is grateful that more than 450 local health care professionals voluntarily share their expertise with IU's medical students as coaches and mentors.

Local students have collaborated on research projects with various area organizations, including the Manchester University College of Pharmacy, OrthoWorx in Warsaw, the Fort Wayne Neurological Center and the University of Saint Francis. 

Chang's priority is for graduates to leave the local medical school with more than scientific expertise. He stresses compassion for patients, effective teamwork and a desire for life-long self-improvement.

“Equally important” to academics, he said, “we want to make sure our graduates are good people.”

At a glance

The American Medical Association is one of two groups that accredit medical schools. The Chicago-based professional organization focuses on improving communities' health, helping physicians run their practices and improving medical education.

During its 2018 Interim Meeting, held in November in Maryland, the AMA adopted several new policies on public health issues including:

• Supporting stronger firearm permit background checks

• Advocating for food labeling transparency

• Opposing e-cigarette use by youth

• Encouraging medical students to seek training in rural areas

• Preventing medical student and physician suicide

Source: American Medical Association

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