John Henning Schumann is a writer and doctor in Tulsa, Oklahoma. He was recently named interim president of the University of Oklahoma, Tulsa. He also hosts Public Radio Tulsa’s Medical Matters.

Routinely, medical students ask him, “Why do I need to know this stuff?” His thoughts on this and more…..

Poor Old Dr. Krebs. His pain-staking Nobel-winning work on cellular metabolism, called the Krebs cycle, has made him the symbol for what’s ailing medical education.

For decades, first-year medical students have had to cram the details of the Krebs cycle into their heads. Now the biomedical model of educating doctors, based largely on a century-old document called the Flexnor Report, is coming under fire.

From our end, our long-standing medical education model is attacked as out of tune with the information age. By some estimates, our entire body of medical knowledge doubles every 3 or 4 years.

Critics say med students can’t possibly master so much information, which quickly becomes outdated anyway. Instead, the new theory goes, students should be taught and evaluated on their ability to find, assess and synthesize knowledge. And they should be educated in teams to help prepare them for what goes on in the real world.

From another angle, critics of the Flexnor model correctly point out that Flexner himself, an educational theorist with no medical training, was silent on issues such as poverty, housing, nutrition and other factors that we now call the social determinants of health.

We now know these factors collectively affect our overall health more than the $3 trillion health care industry.

Man times I’ve seen patients and found the tools I was trained to use aren’t nearly enough to provide help. No physical exam or X-ray can find a homeless person a bed. No lab test or medication can provide a laid-off worker with job training or education. It took more than a decade for me to learn to ask patients about hunger. I found out that many of the people I’ve cared for suffer from food insecurity – not knowing where their next meal will come from.

“But what can I do about those problems?” my students ask. “Isn’t that just social work?”

The answer may surprise you.

In my role as a medical educator, I attended the Beyond Flexner conference in Albuquerque in early April. The main theme of the meeting, sponsored by the W.K. Kelloff Foundation and others, was this question: “What is the social mission of medical education?”

Nearly 400 medical educators, activists, policymakers and students turned up to share ideas, hash out strategy and plan a road map for changing medical education.

To me, the most surprising aspect of the meeting was just how many medical schools are now getting serious about the importance of social determinants.

Many of the sessions at the conference explored obstacles that stand in the way of a culture change in medical education. At the top of the list: How to deal with a payment system that still prioritizes the quantity of medical care over quality? A decision by Medicare earlier this year to base a large proportion of future payments on quality and value has convinced many of us that the health system is on the path of change.

I left the conference with new ideas and fresh energy. I also left wondering what will replace the Krebs cycle in the medical education pantheon.

My bet? It will be a team of students finding ways to break the vicious cycle of poverty that contributes to so much suffering, illness and early loss of life.
April 26, 2015

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