Medical Education’s Seismic Shift (and What It Means for Leadership)

Medical education is undergoing a significant and much-needed transformation. For over 100 years the standard medical school curriculum has comprised two years of lecture-based science classes followed by two years of clinical rotations. Even relatively recent innovations—such as the adoption of problem-based learning, where students master fundamental knowledge by solving problems rather than by ingesting facts and memorizing material, and the integration of the clinical experience throughout all four years of medical school—have been a part of the medical curriculum for over three decades.

Now, however, change is coming quickly as medical education undergoes a seismic shift in how classes are taught, what subjects are included in the four-year curriculum, who has the expertise and skills to teach and, finally, how schools can navigate these necessary changes to educate the physicians of tomorrow.

Expanding Challenges

Innovative teaching approaches are found throughout higher, secondary and even elementary education. The recognition of how we learn, what motivates learning, and the neurobiology of learning has spawned innovative teaching methods that span on-line, blended/hybrid, peer teaching and the novel use of technology. Although some medical schools are innovators, many of these major teaching innovations have been slow to find their way into medical education, in part because of the reliance on research professionals rather than educators/professors to support the classroom lectures that make up the bulk of the first years of medical education.

Adding to the challenge is that medical information is being generated and disseminated exponentially—doubling as fast as every nine years by some estimates. It is no longer possible to attempt to include a high-level survey of the relevant advances in drug treatments, pathobiology and scientific discoveries that will impact clinical care in the short term as well as the future in the standard curriculum.

Medical school professors have been challenged with expanding content for many years but, recently, attention to adding relevant content has gained importance. Understanding and implementing the Affordable Care Act, use of evidence-based practice to inform clinical care, the role of inter-professional teams and systems-based practice in caring for patients, the science and measurement of health care delivery, and continuous quality improvement are just some of the topics that will prove vital to newly-minted practitioners.

In addition, there are many obstacles to adopting new and creative innovations in teaching and learning in medical curriculum. These include budget limitations, time constraints of medical school and clinical faculty, lack of leaders who appreciate or understand opportunities for educational change and struggle with other immediate challenges, and the inherent difficulties in implementing large-scale curriculum change.

Faculty: From Researchers to Educators

The reliance on research faculty to teach the bulk of the initial medical school curriculum has undergone a revision. This is in part due to decreases in research funding, but also because of the early introduction of clinical experiences into the curriculum, and the need to address new and relevant topics outside the realm of the research lab. An additional emphasis on integrated learning has caused medical schools to shift teaching away from a single department or faculty and instead use groups of faculty from across multiple disciplines.

An emerging model that is gaining momentum is the establishment of medical education departments with full-time professors as teachers. These professors shift their focus away from research and spend the majority of their time teaching. It has been recognized for many years that the rote memorization of facts and lists of drugs does not equate to learning or better performance as a physician. These new medical education teachers are utilizing novel ways to integrate learning with case studies, group learning, and the utilization of technology and distance learning.

Further, this new model recognizes that most medical school faculty to date have had little or no training in education or methods of teaching. Creating a group of faculty focused on educating allows for skill development and training in new methods for teaching and learning.

Impact on Leadership

From department chairs to associate deans and deans of medical schools, maintaining the status quo and just “making sure the trains are running on time” are no longer options for overseeing medical education. There is increasing scrutiny from governing boards to ensure that medical school leaders are accountable for the educational mission, as well as from external accrediting bodies such as the LCME (Liaison for the Committee of Medical Education) that oversees the quality of content, delivery and expertise of those providing the education.

Those medical schools that are adopting innovations in medical education delivery and content are seen as trailblazers. This is important in terms of national reputation. If an institution’s reputation declines for any reason, it may impact its ability to secure federal and private research funds, as well as the opportunity to procure philanthropic gifts to offset budget increases and decreasing indirect cost recoveries. The LCME provides significant oversight of medical education, and their assignment of probationary status, even if temporary, can significantly damage an institution’s reputation.  This can greatly impact the quality of a school’s prospective students and its ability to attract outstanding faculty and researchers.

Where will future medical school leadership come from? The usual step-wise progression from resident or post-doctoral fellow to junior faculty as an assistant professor, and then promotion through the ranks until a leadership role is obtained may not yield the type of innovator required in these demanding times. In the past, leaders were often chosen to be department chairs or deans based on their successful research career not on their contributions as an instructor.

Managing a research laboratory or having a successful clinical practice does not ensure or even predict success in a leadership role, especially a role that oversees the educational mission. Leadership in medical education now requires an understanding of the science of learning, a grasp of technology utilization for multiple forms and deliveries of learning, and a willingness to change and adapt to the constantly changing world of medicine.