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Med Ed in the 21st Century

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Daniel Lowenstein

on 25 January 2013

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Transcript of Med Ed in the 21st Century

. Dotty Pedi – The Kaleidoscope Eye - 1994 …increasing multi-institutional teams… 2012 The way forward Jude Rouslin - Grey Abstract - 1999 Connectivity Complex
Systems Deep
Mining Team
Systems Team
Science Going forward… TAKE-HOME MESSAGES: …increasing multi-institutional teams… THANK YOU! Deep
Mining We are living through an extraordinary revolution in the connectivity of humans and the access to information and knowledge. This revolution is leading us to a new era in learning, science and clinical medicine that has unimaginable promise for improving health. If we want to stay at the cutting edge, we need to reconceptualize the nature of medical training, from premed preparation to core requirements for M.D. to the necessary length of training. CAUGHT IN A REVOLUTION ! MEDICAL EDUCATION IN THE 21st CENTURY TO COVER 1. Setting the stage 3. The paths ahead 2. The four revolutions  JUST HOW MUCH HAS MEDICAL EDUCATION
CHANGED OVER THE LAST 150 YEARS OR SO? 1910 THE EVOLUTION OF MEDICAL EDUCATION OVER THE LAST 150 YEARS 1890 1860 2013 Medical training in 1869  "Many schools…are without redeeming features of any kind.
Their general squalor consorts well with their clinical poverty…
In wretched amphitheaters students wait in vain for ‘professors,
’ tardy or absent, amusing the interval with ribald jest and song.
The teaching is an uninstructive rehearsal of text-book or quiz-compend. One encounters surgery taught without patient,
instrument, model, or drawing; recitations in obstetrics without
a manikin in sight - often without one in the building." Abraham Flexner “The ignorance and general incompetency
of the average graduate of American Medical Schools, at the time when he receives his degree
which turns him loose upon the community,
is something horrible to contemplate.” 1945 1965 2013 THE EVOLUTION OF MEDICAL EDUCATION IN THE PAST 30 YEARS: A number of somewhat interesting advances… More small groups and PBL
Student well-being
On-line teaching tools
Simulation centers
Longitudinal clerkships
Earlier immersion into full-time clinical training
Work-hour limitations
Competency-based approaches
Flexible residencies CURRENT FORCES THAT WILL UNDOUBTEDLY LEAD TO MAJOR INNOVATION ... -------------------------------- -------------------------------------------- -------------------------------- --------------------------------------------- A Broken Health Care System Ongoing Advances in Translational Science Increased Specialization Rising Costs 4 True competency-based training
Team-based learning
On-line learning
Modify pre-med course requirements
Ban didactic lectures
Embrace transactive memory sources
Shift the nature of “core” learning
Promote broadening life experiences
Early practice-based learning/work
Individualized paths to MD and beyond BAN DIDACTIC LECTURES
(A) Adenine phosphoribosyltransferase deficiency
(B) Hypoxanthine-guanine phosphoribosyltransferase deficiency
(C) Increased cellular turnover of nucleic acids
(D) Increased conversion of hypoxanthine to inosine monophosphate
(E) Phosphoribosylpyrophosphate synthetase deficiency EMBRACE TRANSACTIVE MEMORY SOURCES EMBRACE EXTERNAL INFORMATION STORAGE Science 333, 776 (2011) A 4-year-old boy has delayed motor development and choreoathetosis. He had normal development at birth. He chews his fingers and lips, which has resulted in tissue loss. He has arthritis. Serum and urine uric acid concentrations are increased. Which of the following abnormalities is the most likely
cause of these findings? 21. From “Ferris Bueller’s Day Off”, 1986 “…conventional education, with its emphasis on rote memorization, artificially sequestered concepts, and one-size-fits-all curricula geared too narrowly toward testing, is clearly failing us.”

“Technology has the power to free us from these limitations, to make education more portable, flexible, and personal; to foster initiative and individual responsibility; to restore the treasure-hunt excitement to the process of learning.” Self-paced, asynchronous approaches for learning fundamentals
Use classrooms for active, team-based learning
Set a higher bar for demonstrating competency
Allow more time for learning in the real-world setting “These results suggest that processes of human memory are adapting to the advent of new computing and communication technology.” 1. People think of computers when they find they need knowledge.
2. People forget items they think will be available externally and remember items they think will not be available
3. People seem better able to remember where an item has been stored than the identity of the item itself. SHIFT THE NATURE OF "CORE" LEARNING Availability
Bias toward zero
Escalation of commitment
“…delivery system reform cannot be accomplished without simultaneously ensuring that the physicians and other health professionals we need have the skills necessary to integrate care across settings, improve quality, and use resources efficiently. Although the nation’s GME system produces superbly skilled clinicians and stunning advances in medical science, greater attention is needed to align its educational goals with the nation’s delivery system needs”
Advocacy Basic
Systems Patient Communication, Diagnosis, Therapy
Professionalism EDUCATING THE NEW HEALTH PROFESSIONAL Assigned to interprofessional teams and deployed to work on systems problems of institutional importance
-Situated and Authentic

Imbedded in clinical microsystems doing work that is developmentally appropriate
-Longitudinal and developmental

Science and practice of systems are taught throughout

Educational and clinical goals align: data driven, patient -centered, continuous quality improvement.
-Inquiry and Innovation DISTRUPTIVE STRATEGY:
“The system is the first patient” INDIVIDUALIZED PATHS TO MD AND BEYOND Systems
Skills Science Clinical Skills Three-Year Pathway to the MD Degree 2013 “Research, untrammeled by near reference to practical ends, will go on in every properly organized medical school; its critical method will dominate all teaching whatsoever.” * * New approaches to education, driven in part by technological breakthroughs, will enable our trainees to pursue efficient, individualized paths that are far more focused on the fundamentals of doctoring and the needs of society.
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