The origins of medical education in North America
were best described and practiced by one of the most esteemed pioneers in
medical education Sir William Osler: “The practice of medicine is an art,
not a trade; a calling, not a business; a calling in which your heart will be
exercised equally with your head1.” This quote resonated with
medical education moving from developing solely medical experts to developing
medical generalist with expertice and associated competencies by the end of the
MD program. In the present day, medical education is trying to capture
the essence of the “art” of medicine as follows: “Medical education is at a
crossroads, with increasing calls to address societal needs, capture advances
in medical education and produce graduates with the required competencies2.”
D. Tannenbaum et. Al. The triple C
competency-based curriculum: A new direction for Family Medicine residency
education in Canada.
In my opinion, the medical expert is still one of
the top priorities of medical education. Over 96% of the objectives and
assessments in medical education in the present system develop the medical
expert aspect of the budding physician. The emphasis on medical expertise is
appropriate; however, is there a way of continuing to keep the emphasis on
medical expert and still incorporate the competencies that enhance the
functioning of the physician? This I believe is the tension between and
education system that trains medical experts versus a system that trains a
medical expert with medical competencies. The imbalance in the education system
is that the expectations of the newly emerging physician is not only to be a
medical expert but also to be able to function
at a high caliber as communicator, collaborator, manager, health
advocate, scholar and professional. So shouldn’t the medical education system
prepare the students accordingly? The overall encompassing motto of medical
education is to train patient-centered generalists by the end of the MD
program. If students are primed with these competencies by scaffolding these
competencies over the 4 years in a medical program, is the immediate end goal
of succeeding in a residency program more likely? And thus the evenual taining
of a competent physician more complete? Residency programs are measuring
residents in accordance to these competencies2. In reading the
article further is was almost disheartening to find that the competencies
expected of residents differ from one residency program to the other but
‘professionalism’ seems to be a common overriding competency across the various
residency programs. However, the residency program expectations seem to be a
bone of contention, out of my realm of practice as a medical educator.
The students' reflective write-up in week 6 during
ITM should give us an insight on where and how some of the competencies are
being realized by the students.
As a medical educator and anatomist how can I
bridge the gap?
The medical expert competency is well appreciated
in the objectives, teaching and assessments in anatomy. The terminologies
associated in initiated during anatomy and embryology classes and interactions.
The understanding of structure is a key component of objectives, teaching and
assessment in the lectures and labs.The competency of communication is not
really mapped as an objective but is taught in the lab as we ask student to
discuss the clinical cases and present them to the rest of the class. We need
to incorporate this as part of our objectives.
Collaboration is an emphasised competency that is
enriched in the anatomy lab sessions; where student explore, discover,
integrate and infer as a team. Interactions with allied health professionals
are encouraged in the lab sessions. Clinicians, physiotherapists and nurses
have been and are part of the teaching team in the labs.
Manager is probably one of the competencies that is
student driven rather than curriculum driven in the anatomy program. The reason
being student do manage a few clubs such as surgery club and suturing club that
operate out the anatomy lab. In these situations the faculty that assist are
invited by the students and the whole event is managed by the students. Sadly
there is no scope in the assessments to reward these activities. Scholarly
activities are encouraged via active learning, student-centered lively
discussions, but not to the extent of it amounting to mapped objective or
assessments.
Professionalism within the premises of the
classroom and lab are a common practice that is appreciated and practiced by
the faculty and students. During the induction to the Gross Anatomy lab,
professionalism is outlined and highlighted as the expected norm. Students
learn very quickly to appreciate of the gift of the donor and the
confidentiality that is associated with the gift of learning. The learning in
the lab is experiential and real. Students here have an opportunity to be
reflective as well.
Thus, competencies other than medical expert even
though are practiced in the anatomy learning experiences are not included as
objectives nor assessed to measure these affective domains.
11. Sir
William Osler; The Principles and Practice of Medicine: Designed for the Use
of Practitioners and Students of Medicine. [(6), p. 44].
2. College
of Physicians and Surgeons of Canada, R. (2011). International Conference on
Residency Education 2011: Transitions in residency education. Open Medicine,
5(3). http://www.openmedicine.ca/article/view/504/425
Hi Anna,
ReplyDeleteAs I understood your post, communication, collaboration and manager are all part of the skills students are exposed to within medical school, in varying degrees, although perhaps not formally assessed. I wonder a couple of things. First, if these are skills that you believe should be competencies that are included in the student’s education and measured, are there ways to incorporate them into the curriculum through deep learning activities to ensure at a minimum, students are exposed to these skills. Second, I wonder if these are all aspects of professionalism, the common competency you noted from the various residency programs. Finally, in terms of your comments re:professionalism, I wondered if you found any information to give you an idea of the outcomes for the different residency programs, for example, were there differences in student outcomes/competencies within programs that focused just on experts and those whose focus included competencies?
Beth
Anna,
ReplyDeleteIt is interesting to read many similarities among our classmates posts. You mention professionalism and explain how this is model and imparted to students. But what exactly is professionalism - how do you define it? I was on a committee that was looking at program outcomes and similarly, people in health promotion wanted students to graduate and be professional. So we had to consider how we would put this into the curriculum and how we would evaluate it.
Another thought I had was the concept of ongoing education (again, we considered this with the program outcomes). Is it the job of your program to cover all the expertise and competencies required to be successful? Are they expected to leave university as a 'finished product' and if not, what are the minimum expectations?
Anna, you do an excellent job of identifying the contributions you can make as a medical educator to resolving this tension between expertise and competence. Indeed, I certainly hope that students graduate with more than just some expertise in anatomy -- competence in using that knowledge to practice effectively seems important!
ReplyDeleteAs in many of your colleagues' posts this week, the idea of "professionalism" comes up here. Like Jules, I still don't know what this means - -either generally or in your particular context. You indicate that it contains aspects of respect and gratitude. But what else? What is packed into this idea and why is it important? This may become important to address as we move forward (especially when we get into ethics).
(Very minor point: Given the argument you make in this post, I would say that you really don't believe that the emphasis on medical expertise is "appropriate" or should be kept. It seems to me more accurate to say that you wish to balance it with greater attention to developing competence, because you see both as important.)
Now that you've taken this step, let's see how you can relate it to your previous posts in order to determine the path forward. Are there new questions you need to ask? New answers you need to seek?
I see one way forward for you (amongst many other possibilities, no doubt). At one point you ask a question that isn't really a question -- you seem to mean it as a statement. And as a statement it would read, "If students are primed with these competencies by scaffolding these competencies over the four years of a medical program, they would be likelier to succeed in a residence program". Treat that as a conclusion and argue for it. Own it. Draw out its implications, relate it back to your previous posts, and use it to charge ahead.
:)
Interesting thoughts here Anna. I believe your strive here is common among many disciplines. In our case, with engineering we try to spit what would lie under competencies and professionalism as learning outcomes in senior year courses, and perhaps Capstone graduation project- if we have LOs for them.
ReplyDeleteHowever, I am thinking perhaps if you go one more step and analyze further those competencies in terms of the three different pillars of knowledge and education. I believe competencies would be more geared towards practical knowledge (performative) and values/virtues (affective)- like the definition you started with conveying that somehow. So is this the case? And, if yes, do you see expertise lying more in the realm of declarative and perhaps skills as well (not as much as with competency)?
Let me know what you think? Thanks.