May 14, 2010

Medical education must evolve: speaker

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Following his recent Dean’s Lecture, George Thibault, M.D., left, talks with, from left, Bonnie Miller, M.D., and School of Medicine students Dustin Hipp and Sabrina Poon. (Anne Rayner)

Medical education must evolve: speaker

Speaking at a recent Vanderbilt University School of Medicine Dean's Lecture, George Thibault, M.D., president of the Josiah Macy Jr. Foundation, said the revolutionary changes put into place by Abraham Flexner at the turn of the last century are overdue for an overhaul.

Flexner's review of the nation's medical schools in 1910 led to the closing of 70 schools at a time when teaching physicians was largely a for-profit endeavor.

The tough standards Flexner developed to raise the bar for medical training have remained largely unchanged over the years. Thibault said that Flexner himself was a kind of intellectual innovator who might reject his own system today in light of the current issues facing health care.

“I think he would be aghast that we, 100 years later, are still using his model,” Thibault said. “We need to seize this moment, as health care reform creates a demand for providers, to innovate. We cannot increase the number of schools and providers we train in medicine unless we change the environment in which we train them.”

Among his list of major changes needed to meet the needs of the public were full integration of science into the teaching of medicine and finding a new model for clinical education that seamlessly allows learning in a variety of competencies and uses computer technology to allow learning at different speeds. One major idea emphasized by Thibault was the need to teach and model teamwork.

“Health care is provided by teams, and teams provide better health care. Every individual will be part of the team, and so we should train in this format. This should be true of all the health professions,” Thibault said.
Many of Thibault's proposals echo plans at Vanderbilt to bring students from the different health disciplines together more often for clinical training.

Also among his suggestions were an emphasis on innovation in teaching programs and a reduction of the rigorous testing and admission criteria that discourages diversity.

“A lot of people who would be great medical doctors are late bloomers or people who are discouraged right from the start from even trying to go to medical school because of the rigid cutoffs in required scores from standardized testing.

“It is probably true that testing and accreditation standards and controls hold us back from incorporating truly innovative ways of teaching and learning. We need to speak in a much more holistic way about the continuum of education,” Thibault said.

The Macy Foundation supports programs designed to improve the education of health professionals in the interest of the health of the public. For more information, visit