February 27, 2004

VUSM retreat focuses on reforming medical education

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Dr. Steven Gabbe

VUSM retreat focuses on reforming medical education

More than 80 years after the first modern medical school curriculum was established, and 40 years since the last major change took place at Vanderbilt University School of Medicine, more than 100 key representatives of the Vanderbilt University School of Medicine met last week for a two day retreat to reform the way Vanderbilt educates medical students, house staff, and supports life-long learning of its graduates.

The retreat, held at the Center for Better Health, and proposed changes in the medical school curriculum were designed “not to throw the baby out with the bath water, but to build on a great heritage of teaching and training medical students at Vanderbilt,” said Dr. Steven G. Gabbe, dean of VUSM. The leaders, who included faculty members from both the Schools of Medicine and Nursing, Medical Center administration, department chairs, medical students and external experts, affirmed what they believe the medical school already does well, and created a substantial list of ideas and improvements for successfully preparing clinicians and physician scientists for the future. “The retreat was designed to stimulate participants to look into the future and then work backwards,” Gabbe said, challenging those attending the retreat to scrutinize both what should be included in the curriculum and how the content should be taught.

Participants prepared for the retreat by reviewing reports on key national initiatives in medical education, such as the Institute of Medicine’s recent publication, “Health Professions Education: A Bridge to Quality.” This report recommended five core competencies that are needed for health care professionals: providing patient-centered care in a professional manner, working in interdisciplinary teams, employing evidence-based practice, applying quality improvement strategies and utilizing informatics.

Dr. Harry R. Jacobson, vice chancellor for Health Affairs, told the group that change, especially practicing evidence-based medicine, is necessary to improve health outcomes.

“There are reportedly thousands of deaths due to prescription errors in this country and drastic differences in some cases in how patients are treated from one community to another. Improving these situations must be related to the way we train our medical students and residents. Vanderbilt and other major academic health centers must consider how our educational programs can impact health care in this country.”

Jacobson said that as part of the curriculum reform process it will also be necessary to re-educate the faculty. “There’s no question if we do anything at Vanderbilt to achieve what we’re going to achieve, we’re all going to have to learn together.”

Gabbe told participants that many changes are already underway that will positively impact current and future medical students. In 2002, the school named seven faculty members as Master Clinical Teachers. This program is currently focusing on students’ experiences during their clinical rotations in the third and fourth years. In addition, the program provides “protected” time for these faculty members to focus specifically on teaching, which often competes with research and patient care demands, and offers them the opportunity to improve their teaching skills through monthly seminars. Also, beginning with the entering class of 2004, the medical school will offer the new Emphasis Program, offering two years of self-directed study. Students will develop and pursue a project in one of eight areas related to medicine in order to gain skills and knowledge that will enhance their medical careers.

Ideas generated from the retreat include:

•Creation of an Office of Medical Education that will include a new Learning Center for medical education.

•Integration of five core competencies throughout the entire curriculum — practicing evidence-based medicine (aided by Vanderbilt’s strong informatics program and the new Center for Evidence-based Medicine), patient-centered care, excellent communication skills, professionalism and lifelong learning.

•Incorporation of a “spiraling” of basic science and clinical learning, whereby clinical training will be brought into the curriculum earlier, during the first year, along with the current basic sciences, and the two will be again integrated during the fourth year allowing the medical student to focus on the basic science related to the medical specialty he or she has chosen for residency.

•Utilization of small teams of students, residents, and alumni who will work together throughout medical school and beyond to create a model early in medical school for life-long learning.

•Continuing the medical school’s focus on increasing diversity, both in attracting a more diverse group of students and faculty and offering a curriculum with more opportunities for students, residents and fellows to gain cultural competence.

Gabbe said that work groups will be developed to follow up on proposals from the retreat and create a timetable for implementation.