By Jacob Scott MD, Sandeep Kishore PhD, Ali Ansary,
At the turn of the 20th century, we built a healthcare system on responding to acute, curative, episodic issues. This system saw the eradication of many diseases and the advent of vaccinations and new treatments. The model was truly developed to be a "sickcare system," which was what we needed at the time, and saw huge successes.
Fast forward 100 years and Americans are sicker than ever -- but with different illnesses. What's more, there is finally a national consensus that our healthcare system is broken. With increasingly tragic consequences, the reactionary medical paradigm has not provided the preventive care or chronic illness management that our culture needs. Healthcare spending currently consumes 17 percent of our GDP and without a radical shift in thinking, this number may grow even higher.
Sadly, patients are not the only ones suffering. The status quo is breeding a morale crisis among our nation's doctors. If you asked one of the many thousands of medical students who are just beginning their fall semester why they chose medicine, many of them would give you confused, anxious responses about the field they are entering. This does not bode well for the health of future generations.
Last Spring, we met at TEDMED, an annual "grand gathering" in Washington, DC where forward thinkers from all sectors explore the promise of technology and the potential of human achievement as it pertains to health and medicine. Here, we presented our respective positions. One of us, Ali, argued that new technologies will actively change our health behavior. Another, Sunny, argued that we needed systems thinking in public health, focusing on the causes of the causes. Yet another, Jacob, argued for stopping the "imaginectomies" and fostering creativity in medical training by rethinking selection criteria and curricula for entrance to medical school.
This led to conversations across the country -- with trainees and senior leaders -- with all trying to imagine (and reimagine) what would be different for this generation, the generation of millennials (and beyond). What are the expectations that we, and our patients, have about how we practice medicine in the 21st century?
The short answer is we don't know yet -- but the conversation has begun.
On Sept. 10, an intimate discussion was co-sponsored by the Institute for Healthcare Improvement (IHI) and the Young Professionals Chronic Disease Network in Boston on medical education in the 21st century. Here we began to define four questions:
1. What should be the image of the 21st century physician?
There is no doubt that health and medicine attract the most dynamic thinkers in the world, many of whom come with a love of science and art, a yearning to improve health and well-being and an appreciation for thinking differently. To us, the creative enterprise of imagining what could be is a central competency of the 21st century physician. It provides a new platform, value and principle that allows us to unlock gains in technology, in public health, in discovery and in mapping new connections to the full gamut of knowledge that can help help our species not just to survive, but to thrive. We think it should be someone who is, above all, creative, imaginative and compassionate.
2. What should be the new quality standards for training?
We think they should be the ability to work on a team (to put collective rather than individual interests first) and to always focus on the needs of the patient. We believe that protected time for exploring creative endeavours in medical school, graduate medical education and in practice, is essential for transforming our health. Taking a cue from Google's successful policy, we recommend that medical schools create the space for students to spend at least 20 percent of their time exploring. And for those who doubt that we can spare 20 percent of the time during the medical school curriculum, we suggest that at least this much of the curriculum is now no longer worth committing to memory, in our new world defined by information at our finger tips.
3. What are the models?
The traditional classroom model where one professor lectures to a room of over 100 students is changing. We think that providing didactic lectures online would allow students to maintain focus on their core medical education while freeing up time to discuss relevant topics not always covered in their textbooks. Take, for example, longitudinal 'concentrations' such as the Yale System where there are no required exams, no mandatory courses, a pass-fail curriculum and a requirement for a thesis. At Duke, the second year of medical school focuses on core clinical competencies while the third and fourth years allow students to explore clinical investigations and complete elective rotations. We think these models begin to provide the requisite space for creativity.
4. What does the disruptive innovation look like?
With viral movements via Youtube, the ability for students to create their own content and mentor each other online, and new platforms like TEDMED, which challenge medical standards, we have a new way of sharing information -- of creating a vision and executing it together. Students themselves could create curricular content -- they could become each others' teachers in partnership with physician educators.
Conversations like this must continue -- not only at places like TEDMED or the IHI, but inside classrooms and teaching hospitals, between mentors and students, and between patients and physicians.
As we adopt a 21st century vision of where we are headed, we must adapt and adjust our training so that it meets the challenges facing the patients of tomorrow. Creativity -- the spark behind imagining the structure of DNA, in vitro fertilization, the pacemaker -- must be valued to unlock major health gains. It will be these new innovations and new models of healthcare and delivery that will continue to push medicine forward.
Even as physicians reimagine the practice of medicine, we must adhere to the same principles that we swore an oath to -- to practice medicine ethically and honestly, and to serve humanity. And unless we, as healthcare professionals, take the time to do this reimagining, it will be done by those who have not taken the same oath, and whose approach to reimagining medicine is driven by other motivating factors.
We submit that the best source to imagine the new mental model is from within medical education and it must be accompanied by forward thinking changes in practice and delivery. We need to stop the "imaginectomies" and help, collectively, step by step, to make creativity, imagination and compassion the 21st century standards of medical education.
This century, your future and your health may just depend on it.
Share with us your vision of a 21st century doctor at
www.tomorrowsdoctor.org.
Dr. Jacob Scott is a research fellow at the H. Lee Moffitt Cancer Center and Oxford University Centre for Mathematical Biology. Sandeep Kishore is an MD/PhD student at Weill Cornell Medical College/Rockefeller University/Sloan Kettering Institute. Ali Ansary is a medical student at Rocky Vista University.