educating physicians: a call for reform of medical school and residency david m. irby, phd iamse...
TRANSCRIPT
![Page 1: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/1.jpg)
Educating Physicians: A Call for Reform of Medical School
and Residency
David M. Irby, PhD
IAMSE WebinarSeptember 1, 2011
![Page 2: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/2.jpg)
Reforming Medical Education -1910- -2010-
![Page 3: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/3.jpg)
Objectives
• Describe the key findings and recommendations of the 1910 Flexner Report
• List the four key recommendations of the 2010 Carnegie Report
![Page 4: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/4.jpg)
Precursor to 1910 Study
• Concern over variability in medical schools
• AMA /AAMC site visited schools in 1906 – Validated concerns but unable to sanction
their own
• Sought impartial third party – The newly created Carnegie Foundation for
the Advancement of Teaching• Abraham Flexner, an educator, hired for study
![Page 5: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/5.jpg)
1910: Flexner’s Observations
• Great variability• Lax admissions standards• Passive learning, anemic
curricula, poor facilities• Faculty of practitioners• No accreditation, certification
or residency training
Flexner. Medical Education in the United States and Canada (1910).
![Page 6: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/6.jpg)
Flexner’s Legacy
• High standards for admission – College degree with science
requirements
• Expanded science-based curriculum– Two years basic sciences with
laboratory experience– Two years clinical experience
• University/teaching hospitalUC Medical Department 1910
![Page 7: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/7.jpg)
19101910 20102010
Medical Education Then and Now
Dissecting Room, medical students and professor
Multi-disciplinary lab with media support
![Page 8: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/8.jpg)
Medical Education Then & Now
-1910- -2010-
![Page 9: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/9.jpg)
AAMC FSMB AHME ABMS CMSS AMA AHA
Medical Schools
State Boards
NBMESpecialty Boards
Specialty Societies
MCAT USMLECert
ExamsCME
Recert/ MOC
Subject Exams
In-Training Exams
PremedicalMedical School
Residency and Fellowships
LCME ACGME ACCME NCQA JCAHO
Practice
AAMC
![Page 10: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/10.jpg)
2010 Carnegie Research Team
![Page 11: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/11.jpg)
2010 Carnegie Study
• Part of 5 profession study– Clergy, law, engineering,
nursing, medicine
• Included 14 site visits– Interviews, focus groups,
observations
• Based on research in the learning sciences and medical education
![Page 12: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/12.jpg)
Recommendations for the Future
• Standardization and individualization– Set outcomes and allow flexibility in learning
• Integration– Connect knowledge and experience
• Habits of inquiry and improvement– Focus on excellence
• Identity formation– Develop professional values and dispositions
![Page 13: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/13.jpg)
Standardize on Outcomes
• Standardize on learning and practice outcomes
• Develop competencies and milestones
• Use multiple forms of assessment
![Page 14: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/14.jpg)
Competency Milestones -Patient Care
Competency Domain for Patient Care
Sub-Domain Mid First Year Milestones
Mid Second Year Milestones Early Third Year Milestones Late Third Year Milestones
Fourth Year Milestones Graduate will be able to ... (Competencies)
History Taking
• Gather, synthesize, and organize basic information from a patient into the standard format of the medical history
• Gather, synthesize, and organize information from a patient into the standard format of a medical history, including information related to sensitive topics and information relevant to specific populations
• Obtain a complete history in an organized fashion •Obtain a complete history in an organized fashion
• Gather complete and focused histories in an organized fashion, appropriate to the clinical situation and specific population
• Obtain a focused interval history (e.g., follow-up visit, pre-rounding interview)
•Obtain focused, pertinent history in urgent, emergent, and consultation settings
• Gather history relevant to specific populations or behaviors as outlined in the clerkship learning objectives (e.g., acute pain, geriatric, pediatric, preoperative)
• Gather history relevant to specific populations or behaviors as outlined in the clerkship learning objectives (e.g., acute pain, geriatric, pediatric, preoperative)
• Identify and begin to use alternate sources of information to obtain the history when a patient is unable to provide a clear history
• Identify and use alternate sources of information to obtain the history when a patient is unable to provide a clear history
• Identify and use alternate sources of information to obtain history when needed, including from primary care and other physicians and patient caregivers
• Begin to apply approaches of clinical reasoning to help define relevant information to gather in the history
• Apply approaches of clinical reasoning to focus the history and gather information relevant to the patient’s chief complaint
• Apply clinical reasoning to focus the history, and identify and resolve important missing information
• Demonstrate clinical reasoning and efficiency in gathering focused information relevant to a patient's care
![Page 15: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/15.jpg)
Individualization: Core & Depth
Medical School
Core & Depth
Medical School
IntegratedCore
Depth
Residency Training
Core & Depth ResidencyCore
Depth
Subspecialty Training
Core & DepthFellowship
Core
Depth
Practice
![Page 16: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/16.jpg)
Recommendations for the Future
• Standardization and individualization– Set outcomes and allow flexibility in learning
• Integration– Connect knowledge and experience
• Habits of inquiry and improvement– Focus on excellence
• Identity formation– Develop professional values and dispositions
![Page 17: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/17.jpg)
Integration
• Connect knowledge and experience
• Engage in multiple forms of reasoning– Analytical reasoning – Pattern recognition – Creative and adaptive
reasoning
![Page 18: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/18.jpg)
Examples of Integration
• Early clinical immersion
• Longitudinal integrated experience
![Page 19: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/19.jpg)
Recommendations for the Future
• Standardization and individualization– Set outcomes and allow flexibility in learning
• Integration– Connect knowledge and experience
• Habits of inquiry and improvement– Focus on excellence
• Identity formation– Develop professional values and dispositions
![Page 20: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/20.jpg)
Habits of Inquiry & Improvement
• Develop habits of learning and innovation– Develop routine and adaptive
expertise
• Advance expertise through deliberate practice & feedback– Experts vs experienced non-
experts
• Participate in communities of inquiry and practice
![Page 21: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/21.jpg)
Everyday Inquiry/Improvement
• Engage in real projects, with training and support
• Document and assess project-based learning
• Learn methods of inquiry and discovery
![Page 22: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/22.jpg)
Recommendations for the Future
• Standardization and individualization– Set outcomes and allow flexibility in learning
• Integration– Connect knowledge and experience
• Habits of inquiry and improvement– Focus on excellence
• Identity formation– Develop professional values and dispositions
![Page 23: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/23.jpg)
Professional Identity Formation
• Formation– Process of taking on identity – Commitment to values,
dispositions and aspirations
• Learned through – Participation in a community of
practice– Observation of role models,
interactions– Coaching, instruction,
assessment and feedback
![Page 24: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/24.jpg)
Strategies for Formation
• Courses, rituals, and codes of conduct
• Self-assessment, reflection, planning
• Appreciative inquiry
• Ratings of respect
Institutional Culture
![Page 25: Educating Physicians: A Call for Reform of Medical School and Residency David M. Irby, PhD IAMSE Webinar September 1, 2011](https://reader036.vdocuments.mx/reader036/viewer/2022062408/56649ee15503460f94bf1222/html5/thumbnails/25.jpg)
Summary
1. Individualize and standardize
2. Integrate
3. Inquire and improve
4. Identity formation