PHILADELPHIA -- Medical students have a little secret: many of them don't think very highly of the training they're getting, said a professor at the soon-to-open .
"A major contributor to [medical student] burnout -- but also a subtler contributor -- is that students are much more aware that what they're being trained to do is not particularly helpful," said Paul Chung, MD, speaking here at the sponsored by Thomas Jefferson University.
"They are finding less and less obvious intrinsic justification for becoming a doctor, because when they look out at the health of the population they don't see it getting better," said Chung, who is professor and chair of Health Systems Science at Kaiser's new medical school in Pasadena, California. "So part of [our effort] is to help students recapture a sense of purpose and lead a purpose-driven life."
Three Unusual Schools
Chung spoke during a panel discussion featuring officials from three unique medical schools. At Kaiser -- slated to open in August 2020 -- the curriculum is based on "flipped" classrooms featuring case-based small group and team-based learning; the emphasis will be on preparing students for careers in primary care and specialty medicine in diverse settings. There will also be longitudinal experiences with patients -- and those don't involve just shadowing physicians -- starting from the first year at the school, which will begin with 48 students in each class.
Those aren't the only unusual features of the school, according to Chung: one entire floor of the building will be dedicated to student wellness, and patient data will be incorporated into classwork routinely. "There will be opportunities for population-level exercises ... so we have a good sense that students will be swimming in this stuff, which I think is actually wonderful. It's one of the things that excites me most about the school." One other thing: the first five cohorts at the school will be able to attend tuition-free.
And, just in case anyone was wondering, the school "is not a training ground for Kaiser Permanente," Chung said. "Kaiser Permanente has 22,000 physicians, and 48 students means nothing to them ... What's the point of keeping it all internal? There are so many other kinds of health systems our students need exposure to; the diversity of U.S. healthcare is amazing and impressive -- and troubling, all at the same time."
Another school still in the works is the University of Houston College of Medicine, where the goal is to have 50% of the students coming from underrepresented minorities, and also to have 50% enter primary care or much-needed specialties such as general surgery and psychiatry, explained Stephen Spann, MD, MBA, the school's founding dean and vice president for medical affairs. Students will provide care to the Houston community through interprofessional teams. "There is a big focus on interprofessional care ... and finding ways to engage with and partner with communities, particularly those with major health disparities."
As part of their experience, "students will spend half a day every week for the entire 4 years of medical school as part of a primary care team, either in a federally qualified health center or a practice providing value-based care," Spann said. "They will also spend one half-day a month as part of an interprofessional student team who will each be assigned a family with complex medical and social problems to follow that family monthly over 4 years." Like Kaiser, the school is scheduled to start its first class in the summer of 2020.
"We hope that our graduates will have a deep understanding of the social determinants of health, and of health disparities," said Spann. "Our four departments are medical sciences, clinical sciences, behavioral and social sciences, and health systems and population health sciences: there is a lot of emphasis on population and health sciences."
Improving Care in the Community
Steve Scheinman, MD, president and dean of the Geisinger Commonwealth School of Medicine, in Scranton, Pennsylvania, said one of the unusual things about his 10-year-old institution is that "we were founded by the community, not by a university or a medical system ... The community wanted to improve care in the community and replenish the [healthcare] workforce. We were the first school to implement a longitudinal integrated clerkship for the entire class."
Scheinman said his school, along with Kaiser's and Houston's, "are all moving away from the model where somebody stands at a podium and talks at you." He said his schools weaves together clinical and basic science across the 4 years, with emphasis on subjects such as population health, genomics, social determinants, value-based care, wellness, health economics, and health policy.
The type of student the three schools are recruiting is different from more traditional schools, the speakers said. "We're not looking for a class full of people from 'The Big Bang Theory,'" Scheinman said, referring to the geek-centric TV show. "We want people who can make good eye contact and have a demonstrated commitment to service that goes back more than just a couple of years before they applied to medical school. We require 100 hours of community service and over half of our students do well more than that. I think we've gotten good at telling applicants who have what we're looking for."
At Kaiser, "we're placing a premium on a commitment to social justice," Chung said. "We want students who are humble and curious [so they want to] acknowledge [the] system we're in and work to change it ... Those are the students that we're looking for. [We want] an intentionally diverse community of students representative of the community that medical students are going to have to practice in."
Houston's ideal student is similar, said Spann. "We're looking for students that have done something between college and medical school, who have evidence of grit and resilience," he said, noting that the standard grade point averages and medical school entrance exam "will set a floor but not be the ultimate factor" in admissions decisions.
Changing the Admissions Process
Session moderator Billy Oglesby, PhD, associate dean for academic and student affairs at the Jefferson College of Population Health, noted that "some schools, like ours, are threatening to eliminate the Medical College Admission Test as a requirement for admission. We are experimenting with a new initiative where intentionally seeking undergraduate students with no experience in the sciences ... who would come to us a few months ahead of time to get the science pieces."
Scheinman said Geisinger actually addresses that issue in its materials, although students do have to demonstrate that they're capable of doing well in the sciences. "Students know we're looking for somebody committed to service, and academics are a small part of what we're looking for," he said.
Scheinman added that Mount Sinai's medical school in New York City is a model in this area because it actually reserves 25 seats in each medical school class for humanities majors. In spite of these efforts, however, "premed students are gun-shy of majoring in anything but biology or chemistry because they're afraid they won't get in."
As for getting faculty to teach at these types of schools, that doesn't appear to be a problem. "We put out a call for applicants for clinical faculty leadership positions," said Chung. "That was a mistake because hundreds and hundreds of people were applying. [But] it's incredibly gratifying to know there are people who want to help and who believe in this mission."