Medical Education Needs Major Surgery
(ED NOTE: It seems that some schools are already taking advantage of changes of technology, adopting an iPad based curriculum, such as UC Irvine, Cornell, Dartmouth)
With costs rising, does it make sense to pay 170 anatomy professors to design 170 courses?
- JONATHAN DAVID
Medical-school costs have risen at double the rate of inflation in recent decades, with average annual tuition and fees now about $50,000. Since most medical students must borrow to pay for their education, physician debt has grown sharply. The median for 2012 graduates was $170,000, and more than a tenth of private-school graduates owe more than $300,000, according to the Association of American Medical Colleges. Meanwhile, physician income is widely expected to decline under ObamaCare.
Rising educational debt and the prospect of declining income threaten to reduce the number of young men and women who choose medicine as a career. Managing the cost of medical education is also important in controlling rising health costs in general, because a deeply indebted doctor is more likely to be one who practices to pay off his loans rather than for his patients’ best interests.
The U.S. medical education system is the finest in the world, yet it is very expensive and inefficient. Although each medical school prides itself on the quality and delivery of its curriculum, all medical schools teach basically the same material.
For the first two “preclinical” years, students immerse themselves in the study of normal and then abnormal human bodily structure and function: anatomy, histology, physiology, pathophysiology and related disciplines. The curriculum is largely standardized by national accrediting bodies, and also by common sense (no school could eliminate the study of anatomy), although many schools will add such “extras” as “creative writing in medicine” or “medical drawing.”Historically, each school has operated in isolation from others nearby, viewing their “brands” as valuable intellectual property to be guarded. For this reason, each of the 170 or so U.S. medical schools invests a huge amount of time and money to develop and implement its course of study. But students generally skip the live lectures to watch videos of those lectures and read the books on their own.
The uncomfortable truth is that medical schools today provide a preclinical education that their students neither want nor need. Students hate live classroom lectures, especially for basic content, and they know they learn better on their own time at their own pace. Yet schools still rely on these educational relics.
A more individualized system of self-study using the latest in digital technology, along with small study groups to integrate knowledge, would provide more effective learning. It seems wasteful to pay 170 anatomy professors to design 170 separate courses and then bill students for this privilege.
The cost structure of medical education is also opaque. Tuition has no relation to the cost of educating medical students. Few schools even measure what it costs to provide medical education and instead lump tuition income into their general budgets. Since there are a limited number of accredited schools providing M.D. degrees, and a vast oversupply of would-be doctors vying for spots, students resist questioning the status quo. They also feel grateful to be among the elite who are accepted for admission.
To make the medical education system more responsive to the academic and financial needs of its students, medical schools should measure the resources they devote to preclinical students. Each school should document all tuition they collect, as well as all government support and charitable contributions raised for student education, and report annually to the public how that money is spent. A more transparent cost structure might prompt schools to temper tuition increases.
The second step is to remove barriers to educational innovation. The Liaison Committee on Medical Education, which is the accrediting agency that establishes standards for medical schools, enacted strict guidelines on staffing for medical schools long before the Internet and YouTube. They should update their guidelines to accommodate innovation and collaboration for preclinical study.
Ultimately, students and young physicians need to make their opinions and needs known. Antiquated and expensive preclinical medical education does not serve the next generation of physicians, or all of us who will depend on them for medical care.
Dr. David, a board-certified gastroenterologist, practices in Westchester County, N.Y., and is a clinical assistant professor of medicine at the Albert Einstein College of Medicine.