“Why do I need to know this stuff?” medical students ask me.
“How many times have you used the Krebs Cycle lately?” senior doctors jokingly reminisce.
For decades, first-year medical students have had to cram the details of the Krebs cycle into their heads. Now the biomedical model of educating doctors, based largely on a century-old document called The Flexner Report, is coming under fire.
From one end, our long-standing medical education model is attacked as out of tune with the information age. By some estimates, our entire body of medical knowledge doubles every three or four years.
Critics say med students can’t possibly master so much information, which quickly becomes outdated anyway. Instead, the new theory goes, students should be taught and evaluated on their ability to find, assess and synthesize knowledge. And they should be educated in teams to help prepare them for what goes on in the real world.
From another angle, critics of the Flexner model correctly point out that Flexner himself, an educational theorist with no medical training, was silent on issues such as poverty, housing, nutrition and other factors that we now call the social determinants of health.
We now know these factors collectively affect our overall health more than even the $3 trillion health care industry.
Many times I’ve seen patients and found the tools I was trained to use aren’t nearly enough to provide help. No physical exam or X-ray can find a homeless person a bed. No lab test or medication can provide a laid-off worker with job training or education.
It took more than a decade for me to learn to ask patients about hunger. I found out that many of the people I’ve cared for suffer from food insecurity – not knowing where their next meal will come from.
“But what can I do about those problems?” my students ask. “Isn’t that just social work?”
The answer may surprise you.
In my role as a medical educator, I attended the Beyond Flexner conference in Albuquerque, N.M., in early April. The main theme of the meeting, sponsored by the W.K. Kellogg Foundation and others, was this question: “What is the social mission of medical education?”
The conference came about as an outgrowth of a 2010 paper that ranked medical schools by their social commitment rather than their research dollars or U.S. News and World Report scores. It began as something of a shot across the bow to organized medicine, challenging orthodoxy, such as making students memorize the Krebs cycle.
Over the years since then, more research has shed light on the economic and health impact of social determinants. The media has caught on to this as well.
Nearly 400 medical educators, activists, policymakers and students turned up to share ideas, hash out strategy and plan a road map for changing medical education.
Our hosts from the University of New Mexico demonstrated that medical schools that are serious about community engagement build strong partnerships that take social determinants into account. We heard how community health workers and a re-imagination of the agricultural extension model for health education are improving the health of New Mexicans.
To me, the most surprising aspect of the meeting was just how many medical schools are now getting serious about the importance of social determinants.
Many of the sessions at the conference explored obstacles that stand in the way of a culture change in medical education. At the top of the list: How to deal with a payment system that still prioritizes the quantity of medical care over quality? A decision by Medicare earlier this year to base a large proportion of future payments on quality and value has convinced many of us that the health system is on the path of change.
I left the conference with new ideas and fresh energy. I also was left wondering what will replace the Krebs cycle in the medical education pantheon.
My bet? It will be a team of students finding ways to break the vicious cycle of poverty that contributes to so much suffering, illness and early loss of life.