Most readers are familiar with the use of flight simulators for pilot training. But did you know that when Boeing or Airbus comes out with a new aircraft, the pilot trains and is certified in a flight simulator and is qualified to fly the plane and carry passengers only after 25 hours of actual flight time? The use of simulators guarantees that each pilot has been exposed to a standard set of experiences that she might encounter in real life. In fact, the simulator allows the pilot to be put in situations that would otherwise be too costly, too risky (even life-threatening) to do in an actual aircraft.
Harvard Business School is famous for scenario-based training using their case study method. Can this be done in medical education? Certainly. It might not be simple, but one can imagine a variety of techniques used to develop and refine clinical skills using multimedia, actors posing as patients, automatonic simulation and the like. Important issues not receiving enough attention in the current training system, such as medical ethics, can be introduced and explored in depth in this manner.
Scenario-based training would not only reduce training time and assure a standard level of clinical skills, it could also readily be employed for continuing medical education and recertification, potentially bringing a much more efficient use of faculty time and thereby reducing the overall costs of medical education.
Ultimately, it is not just the teaching technique that must be changed, but the focus of medical education as well. We need to train doctors to work in teams—with other physicians, with nurses and physician’s assistants, with pharmacists, social workers and so forth. Underpinning this new approach must be a laserlike focus on evidence-based medicine. Future physicians should develop and practice their art based on protocols and performance standards. These skills are vitally important for improving quality and reducing the costs of health care, yet currently, they are mostly absent from medical school curricula.
My mentor in cardiac surgery, in reference to the long training periods for cardiac surgical residencies, used to quip, “The hardest part of surgery is getting to operate.” With scenario-based training, one could get to the operating table much earlier and at the same time be better prepared and more competent. Rather than requiring medical students and resident physicians to spend years acquiring enough experience through on-the-job training, I believe we should be taking this different approach—one utilized successfully in many different highly skilled professions. Our current model is essentially an apprenticeship; I hope we can create a structured learning environment that ensures each student is exposed to all elements of a discipline before certification of competence.
Readers expecting a third column on reducing the costs of medical education are to be disappointed—all the important means of slashing costs are contained in this and the prior column. It all comes down to reducing training periods by making the acquisition of skills more efficient. Do this, and we will dramatically reduce costs for the student and, at the same time, reduce the burden of clinical education on our faculty. It may, however, throw a monkey wrench into the machinery of how we staff our teaching hospitals, but that’s another idea for a another column.
Training for 21st Century Medicine
Most readers are familiar with the use of flight simulators for pilot training. But did you know that when Boeing or Airbus comes out with a new aircraft, the pilot trains and is certified in a flight simulator and is qualified to fly the plane and carry passengers only after 25 hours of actual flight time? The use of simulators guarantees that each pilot has been exposed to a standard set of experiences that she might encounter in real life. In fact, the simulator allows the pilot to be put in situations that would otherwise be too costly, too risky (even life-threatening) to do in an actual aircraft.
Harvard Business School is famous for scenario-based training using their case study method. Can this be done in medical education? Certainly. It might not be simple, but one can imagine a variety of techniques used to develop and refine clinical skills using multimedia, actors posing as patients, automatonic simulation and the like. Important issues not receiving enough attention in the current training system, such as medical ethics, can be introduced and explored in depth in this manner.
Scenario-based training would not only reduce training time and assure a standard level of clinical skills, it could also readily be employed for continuing medical education and recertification, potentially bringing a much more efficient use of faculty time and thereby reducing the overall costs of medical education.
Ultimately, it is not just the teaching technique that must be changed, but the focus of medical education as well. We need to train doctors to work in teams—with other physicians, with nurses and physician’s assistants, with pharmacists, social workers and so forth. Underpinning this new approach must be a laserlike focus on evidence-based medicine. Future physicians should develop and practice their art based on protocols and performance standards. These skills are vitally important for improving quality and reducing the costs of health care, yet currently, they are mostly absent from medical school curricula.
My mentor in cardiac surgery, in reference to the long training periods for cardiac surgical residencies, used to quip, “The hardest part of surgery is getting to operate.” With scenario-based training, one could get to the operating table much earlier and at the same time be better prepared and more competent. Rather than requiring medical students and resident physicians to spend years acquiring enough experience through on-the-job training, I believe we should be taking this different approach—one utilized successfully in many different highly skilled professions. Our current model is essentially an apprenticeship; I hope we can create a structured learning environment that ensures each student is exposed to all elements of a discipline before certification of competence.
Readers expecting a third column on reducing the costs of medical education are to be disappointed—all the important means of slashing costs are contained in this and the prior column. It all comes down to reducing training periods by making the acquisition of skills more efficient. Do this, and we will dramatically reduce costs for the student and, at the same time, reduce the burden of clinical education on our faculty. It may, however, throw a monkey wrench into the machinery of how we staff our teaching hospitals, but that’s another idea for a another column.
