How Would You Do in 21st Century Med School?

There is a lot of talk these days about empowering patients to observe their own treatments and be their own advocates. This is supposed to give us a safety net and and reality check in a health care system that is increasingly stressed and error prone.

Somehow I doubt that Joe Doe Patient feels so empowered yet.

Since long before Drs. Kildare and Welby, there has been a mystical veil around matters medical. Doctors belonged to a rarefied order with its own language and rituals that only the most robust of minds could enter. It all left a lasting impression in the minds of many observers that mere mortals should not aspire to become physicians.

 

So what would you think here in 2008 if I told you that I was going to take a group of high school frosh and sophs with no prior training in science, and run them through a first year med school course in the pathology of disease?

What would you predict? Would you expect them all to flunk, or perhaps a few to at least earn a C, or maybe an eager beaver or two to earn an A or B? 

Keep on reading to see.

The Phoenix Experiment
This little experiment really took place last summer at the Phoenix branch of the medical school of the U. of Arizona. And almost all of these high school participants (typical age, 16) earned As and Bs using the same books and course materials you see in a modern med school.

Ron Weinstein MD, head of the UA telemedicine program which connects rural patients with urban specialists, is not too surprised. His team conducted this experiment and the results seem to confirm one of his hypotheses -- that success in physician training today is less about stuffing heads with pre-med courses in bio and chem than it is about open minds and keen interest.

 

Neil Kochenour MD, former Medical Director of the hospital and clinics at the University of Utah, agrees. Dr. K started med school 30+ years ago as a rare bird himself, an engineer becoming a doctor at a time when most students came in through the door marked "Pre-Med."

 

Both Dr. K. and Dr. W. told me that they took these results to suggest that medical schools need to do more to encourage students with a wide range of background and interests. I would agree, but then I'd add a parallel theme that hits even closer to home.

 

What this UA experiment also suggests to me is that a motivated patient can learn enough to be an informed observer and advocate.

A sea change in science and medicine

I remember when pre-med friends of mine were buried in books and sweating grades and expecting to burn every candle at both ends if they made it into med school in the 70s. I don't know if they would have believed it if someone like Dr. W. had told them what he tells budding young hopefuls today. He advises the 21st century students of tomorrow that if they enjoy reading science and health in places like Scientific American, the New York Times, or Newsweek, then med school will not be too difficult.

Hard work, yes, but fascinating, not a frustrating grind full of sleepless nights.

 

I had never heard med school described so pleasantly before Dr. W. told this story, but at another level, it made total sense to me. If I step back and look at the last few decades, it seems to me there has been a sea change in science as a whole, both in ease of access and breadth of understanding.

 

I have been reading things written by doctors and writing reports for non-scientists since my first job out of college, most recently as a sci-tech journalist. I had already seen that it was taking less and less time to distill the gist of complex issues, and I knew this increasing speed was not only about my own expanding experience. From my perch in the peanut gallery over the years, it also seemed clear we were making long strides in both the form and the substance of science and medicine.

 

In short, we learned a whole lot more about how things work and we got a whole lot better at telling the story.

 

Box tops for puzzles

Between the 1970s and the end of the century, science acquired a wider, deeper, clearer lens on how brains and bodies operate. Our understanding of subsystems and sub-specialties grew large enough to see the overlaps and dependencies too. Specialists began to look at problems less as technicians skilled in tight, tiny niches and more like strategists assessing aspects of large dynamic systems.

 

At about the same time in a parallel track, we also had huge changes in how we communicate, both to access information and to share it, whether with words or with pictures. This parallel shift was aided first by desktop computing and later by the Internet. Thus, when our next generation of doctors and scientists began to convey their new wider, deeper levels of insight, they had also become much more adept in the simple expression of complex concepts.

 

The total impact on learning in science and medicine now versus then is like the difference between assembling an enormous jigsaw with and without the box top.

Not easy, but simple

Once you see the big picture clearly, details have a place to rest and a reason to be. But without this "higher order" grasp of the general patterns in things, any odd piece might forever be a puzzlement.

As a result of these larger insights and the wider connecting of dots, topics that might have seemed cryptic to anyone but a specialist years ago can be conveyed much faster and more clearly, even to non-scientists. As a physicist friend of mine joked just yesterday while talking to high school students, "it is simple -- not easy, but simple."

 

What my friend was trying to tell the kids in this case is that increasing the ease of understanding does not erase all effort. You still have to put in the time to absorb, retain, compare and connect what you read. But the concepts themselves are not always so difficult.

 

It seems to me that this added simplicity borne of greater clarity is what makes substantive writing in science and health more common today in everyday places like Newsweek and Time, and this, in turn, is what might make a med school course accessible to an eager young teen given good coaching.

 

I find this all encouraging on several levels. It lets us hope for increasing accuracy in the treatments we are given. It also lets us hope for increasing skill from the health pros who help us, whether doctor, nurse or lab technician. And last, but far from least, we can certainly hope to learn what we need to know when it comes time to be helping ourselves.

 

That "helping ourselves" aspect is what we will be exploring again in more depth as my "e-patient" theme in this blog unfolds.

The next time this topic leads, we'll be learning more about what the term "e-patient" means to some of the people who use it most.

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