Sunday, July 29, 2012

A Season of Renewal

It’s the season of renewal at the University of South Dakota Sanford School of Medicine.   Our former senior medical students have moved on to residencies to complete their transformation from student to colleague.  Men and women who were college students a few short months ago are now medical students.   They bring with them their enthusiasm, aspirations and hope for the future.  

Our new students will find a medical school that is undergoing its own process of renewal and transformation.   In 2012, USD SSOM was rated in the top ten schools in the nation in rural medicine and in family medicine and was named one of the top ten most popular medical schools in the country by US News and World Report.    Our graduates have enviably high rates of passing national boards and high median board scores, and the school recently passed accreditation with flying colors.  Despite this great foundation, changes are afoot because we recognize that the curriculum of the past will not adequately train physicians of the future.   .   

Soon, students will notice fewer lectures and more interactive small group sessions.  Basic science courses will be coordinated with each other to provide a more vivid and memorable picture of the function of the human body.   Clinical work will be more clinic-centered, because the outpatient setting is where most diagnoses are made and where 75% of visits in the U.S. occur.  More time will be set aside for electives and this will occur earlier in the curriculum to allow students to gain more experience in an area of interest before they have to choose a specialty.   Our new Frontier and Rural Medicine (F.A.R.M.) program will allow a select group of students to spend significant time in a rural community of less than 10,000 people.

This is a lot of change and we are not alone.   Virtually every medical school in the country is overhauling its curriculum right now.   In part this is in response to the recent Carnegie report that pointed out that the structure of medical education had not changed in more than a century.   Medical education has simply not kept up with educational theory.   Long-term memory is created when learning is interactive, uses multiple modalities, is repetitive, and is directly related to patient care.  Clearly, it is time for us to change.  But how do we know that we are creating a better system?   The answer is that USD SSOM is uniquely positioned because the Carnegie report cited the Avera Sacred Heart Yankton campus of USD SSOM as a national model for educational reform.   This means that the school has experience in delivering the modern clinical curriculum and has the outcome data to show that students who go through this curriculum are highly successful as measured in many ways including performance and test scores.   Only a small handful of schools in the country have this experience.   Another major asset in this process is the high quality of the teaching faculty in the school.   It is difficult to ask basic scientists and clinicians to change the way they teach, yet they are not only willing to do so but they are also highly engaged in creating the new model.   The best systems (and the best people) are those that are flexible and responsive to changing needs.   The communities and health systems are strong supporters of medical education, and we will continue to rely on these important partners.   Our final important asset is the students themselves, who provide critical input and advice to us at every stage of the process.  

The new curriculum must be responsive to the medical needs of South Dakota and the nation.   It is always important for physicians to provide excellent care in a face to face environment.   However, there is an increasing need for physicians to step back and consider the health of populations.   The modern physician should insist that the quality of care be measured and improved, leading the effort rather than resisting it.  Medical school needs to provide the tools for young physicians to do this.   Many diseases now are related to behaviors and social factors that are not going to be influenced by medications or tests.   Modern physicians need the tools to motivate behavioral change.  Physicians also need to be competent to practice in an increasingly multi-cultural world.   Finally, and perhaps most importantly, physicians need to adhere to the highest standards of professionalism.   These are tall orders, but they can be accomplished.

One of the things I like best about academic medicine is the variety and change that is inherent in it. We have the privilege of working closely with some of the best minds and some of the nicest people in the country.   Building on this foundation, we share our new students’ sense of optimism and look forward to the future.

--Mary Nettleman, MD, MS, MACP is Vice President for Health Affairs and Dean of the University of South Dakota Sanford School of Medicine