As medicine rapidly evolves, many healthcare leaders worry that medical schools are falling behind, or moving in the wrong direction altogether.
From the decline of hands-on training and business acumen to the implications of AI, 10 physician leaders joined Becker’s to discuss the medical trends most concerning them.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What developments in medical school education do you find most concerning at the moment?
Deborah August, MD. Physician at Nuvance Health (Norwalk, Conn.): The development in med school education that is most concerning now is the elimination of [diversity, equity and inclusion] in admissions, without which we will be unable to educate a diverse physician workforce.
Ed Corbett, MD. Internal Medicine Physician and Former Deputy CMO Health Catalyst (Highland, Utah): My biggest concern about medical education is that it does not adequately prepare future physicians to practice in the emerging era of technology-augmented care. The current combination of academic tradition and accreditation inertia limits innovation by mandating outdated curricular frameworks and standardized testing paradigms. Instead, medical institutions should lead educational reform by pioneering innovative teaching methods and integrating AI-based learning technologies. Foundational data and AI literacy will be crucial for future doctors to critically evaluate and effectively use the tools and models necessary for practicing evidence-based, data-driven medicine. New teaching models must become more student-centered, interactive and personalized — moving away from traditional didactic lectures toward multimodal, AI-driven tutoring and active group-learning experiences. Emphasizing problem-based and simulation-based learning will further strengthen critical thinking and clinical reasoning skills. Medical education is ripe for disruption, but remains locked in a system resistant to change and slow to adopt innovation.
Connie DiMari, MD. Ophthalmologist in New York City: How do you teach a medical student to handle the conflicts of interest inherent in value-based payment models where a physician — or their organization — can receive a monetary penalty for spending more in caring for a patient?
Harry Haus, MD. Medical Director of Dr. Haus & Associates (Erie, Pa.): Some medical schools are having a three-year option but there are major problems with this:
1. Normally a person must go all year round to a three-year program. If the student does poorly in one class, there is no summer school available to make the class up. You will now wait a year to make up that one class.
2. The match is a problem for three-year programs. After second year, before third year, you must apply to the match. You have not taken electives so you must apply without any experience in the specialty you selected in most cases. Worse, some specialties require one or two references from doctors outside of your medical school. You cannot even try to match without those references that you do not have, since you do not have any away rotations completed at that time. Some three-year program medical schools allow you to select for residency at the end of first year or the beginning of second year at your school, but this means you select a specialty without any experience in the specialty.
3. Finally, some medical schools allow a person to do most or all learning over a computer and not attend class. I have taught these students and they often have no social skills needed to take care of patients.
Alexander Levit, MD. Medical Director of Hospital at Home at Lee Health (Fort Myers, Fla.): I am most concerned about a general de-emphasis on objective measurements of competency. This is substantiated by the transitioning of [United States Medical Licensing Examination] Step 1 into a pass/fail examination. Ironically, it seems clear that the consequence of this change is a new emphasis on [USMLE] Step 2 CK scores in terms of residency selection. A survey of internet forums among medical students tells the reader that Step 2 CK now inhabits the same “make or break” place in the medical students’ consciousness that Step 1 did in the past. Furthermore, when Step 1 had a quantitative score, Step 2 CK did represent a “second chance” opportunity. I do recognize that the reasonable desire to truncate medical school into a three- to 3.5-year process may render two quantitative examinations impractical. However, the mentality behind the current changes has an air of strong de-emphasis on knowledge. While AI and the internet have leveled the playing field in terms of knowledge, I do, as a physician, have concerns that a decline in the fund of knowledge of prospective physicians will narrow the gap between them and advanced-practice providers — particularly in nonprocedural fields.
Po Raval, DPM. Podiatry Specialist in Waldwick, N.J.: The lack of business education continues to be the most concerning issue not being addressed by medical schools today.
Sheldon Taub, MD. Gastroenterologist at Jupiter (Fla.) Medical Center: Medical training has changed drastically over the last 50 years. Knowing what I know now, I certainly think it would’ve been helpful to have business courses taught, as well as instructing how to communicate effectively with insurance companies. When I trained, computers were not part of the system. Today it’s critically important to have good basic knowledge and computer skills. Analyzing scientific information was never taught, and, I think, the ability to discern fact from fiction is critically important. The physician-centered care model has disappeared, so it’s important that training now includes working in interprofessional teams. Shared decision making with the patient is now of utmost importance,and this was never taught previously. Physicians’ mental and physical health was never taken into consideration, and I feel now there is stronger emphasis on these aspects of medical training.
Marla Tobin, MD. Former Family Medicine Physician and First Woman Resident Chair at National Conference of Family Medicine Residents and Medical Students: It seems COVID-10 changed medical education and many things became more virtual — labs, interviewing for residency, lectures, telemedicine, online courses. I have concerns regarding the hands-on “real” experiences for medical students and what they get to learn. Students I speak with seem to have lower volumes of procedures, less actual experience and less ongoing patient relationships than we did. I know the scope and depth of knowledge in medicine has vastly increased in 45 years but real experience is still very important. AI also poses a very real change to medicine that I do not think we all really understand yet and will be impactful to medical education.
Tom Shaffrey, MD. Hospitalist in Bound Brook, N.J.: Being a primary care physician/hospitalist I still find that the fundamentals of anatomy, physiology and pharmaceuticals are critical to understanding disease processes and any thought of reducing these requirements should be strongly discouraged.
