June, 2012

Rethinking Medical Education: Creating innovative caregivers and teams

As we conclude the current academic year we have the opportunity to reflect on our academic mission. While Commencement is a ceremony steeped in tradition, our approach to medical education is anything but static. Since our founding Penn State College of Medicine has been at the forefront of innovations in medical education. More than four decades later, Penn State College of Medicine and Penn State Hershey Medical Center are continuing to lead innovative efforts to transform medical education in ways that respond to the needs of our patients and all those whom we serve.

While the image of the solo practitioner may still be common in media portrayals of doctors, the reality is that caring for patients in virtually any setting today is a team effort, involving not only physicians but also a vast array of health care professionals. Clearly we have a responsibility to prepare medical students to work effectively as part of a coordinated patient care team - which means teaching teamwork and communication, not just scientific knowledge and clinical skills. Penn State is a nationally recognized leader not only in medical education but also in interprofessional education, particularly for some of our programs that train medical and nursing students together to work as teams. The College of Medicine was one of seven medical schools selected to participate in the New Horizons program, sponsored by the Carnegie Foundation and the Josiah Macy Jr. Foundation, to develop interprofessional curricula and training for medical and nursing students. Teaching medical and nursing students to work together does more than prepare new health professionals to practice effectively - it also enhances the safety and quality of patient care by ensuring that members of the care team are communicating with one another and keeping the patient at the center of all they do.

Our Penn State Hershey Clinical Simulation Center plays a central role in training students and clinicians to work as teams. In addition to giving individual students an opportunity to practice procedural skills such as intubation or laparoscopic surgery on simulation equipment - before using those same skills on real patients - the Simulation Center also provides group training that emphasizes teamwork, as in a simulated trauma or operating room setting. Participants not only practice their clinical skills but also the necessary effective communication that is essential to ensuring that patients receive safe, high-quality care from the entire team. Individual communications skills are also honed in the Simulation Center, through the use of standardized patients who provide students with the opportunity to practice the all-important skills involved in communicating with patients. The value of the team-based approach to training emphasized in our Clinical Simulation Center is reflected in the high demand for this training, not just for our students and clinicians, but also for external groups from across the region and around the world.

Our emphasis on interprofessional education is also reflected in the integration of the patient-centered medical home model of care into the medical curriculum. By incorporating experience with the patient-centered medical home into how we train students, we are giving learners valuable experience in managing the health of individual patients over time by working as part of a coordinated health care team. This experience provides a multitude of learning opportunities and prepares our students to practice medicine in what is becoming a widely used model of care, particularly in primary care and in the management of patients with chronic disease.

Keeping medical education current involves much more than updating classes and curricula to reflect the latest scientific knowledge. Physicians must also be increasingly knowledgeable about health care systems and delivery, which is why one of the newest dual degree programs we have developed is the MD/MBA program. Offered in conjunction with Penn State's internationally recognized Smeal College of Business, this is the first dual degree program based at our regional medical campus at University Park. Other new dual degree programs at the regional campus are in development, including a new MD/PhD program with the College of Engineering.

As our commitment to interprofessional education suggests, meeting the health care needs of the future involves more than just educating physicians. Shortages of physicians and other health professionals have been widely predicted, particularly with an increased burden of chronic diseases and a growing and aging population increasing the demand for health care services. To respond to that need, we have not only increased the size of our medical student classes but also introduced new programs to train other types of clinicians. In collaboration with Penn State's School of Nursing, Penn State Hershey Medical Center now offers an expanded array of advanced training programs for nurses. We have also developed a new master's-level training program for physician assistants, which will begin enrolling students in 2014. Advanced practice nurses and physician assistants already play a vital role in meeting the demand for health care, and training more of these clinicians is an important way in which we can meet the health care workforce needs of our region and the commonwealth.

Continuous reevaluation and revision of our curriculum is essential to ensuring that we are preparing physicians who have mastered the knowledge and skills they will need to be successful in a changing health care landscape. A proposed new curriculum structure is currently being evaluated by our faculty; the new curriculum design would integrate clinical training into the curriculum even more fully than our current curriculum, reinforcing for students the connections between the scientific underpinnings of medicine and the practice of medicine in clinical settings. Revitalization of the curriculum is a constant process. Small group problem-based learning (PBL), now a common instructional approach here and at many other medical schools, was an innovative practice when first introduced at the College of Medicine more than two decades ago.

Some aspects of our original curriculum, such as our integration of medical humanities into medical education, also continue to characterize medical education at the College of Medicine and have become much more widespread among our peer institutions. Our founding dean George T. Harrell, who placed great importance on the value of humanities in medical education, also was a firm believer in requiring medical students to conduct original research, both so that they would understand clinical practice in the context of scientific endeavor, but also so that some would be inspired to pursue careers as investigators. The requirement that students complete a Medical Student Research project remains a part of our curriculum to this day. More recently, the College of Medicine introduced a Graduate Clinical Rotation as an option for students in the Graduate School interested in gaining experience in a clinical setting. This program is open to graduate students from across the University, and recognizes that just as future physicians will benefit from exposure to research, future researchers will benefit from exposure to patients.

The Penn State College of Medicine has been nationally recognized for decades as a leader and innovator in medical education. Innovation in medical education is at the heart of our institution. From our early emphasis on medical humanities, to our current leadership in areas like clinical simulation and interprofessional education, Penn State College of Medicine is at the forefront of national efforts to keep medical education vital and responsive to the needs of all those whom we serve.

 

Harold L. Paz, M.D.
Chief Executive Officer, Penn State Hershey Medical Center
Senior Vice President for Health Affairs, Penn State
Dean, Penn State College of Medicine