Curriculum 2.0 -- a new medical school curriculum

For the last 80 years or so, medicine as we know it today has been delivered to patients in the same fashion. You become sick or have abnormal health condition(s), you get treated, you get well (hopefully). Why? Look no further than the training itself. Why do you fold your shirts into thirds or wash your veggies before you consume them? Why that's how you were taught, so of course that's how you do it. And the same goes for physicians.

The old approach: For the last ~80 years, "traditional" medicine has been practiced in the same manner-- year 1 of core prereq's (bio, chem, anatomy), followed by year 2 of foundations, and a disease focus, namely pharmacology, immunology, microbiology. You want more bazaar? Some schools teach one subject at a time! Everyday, the same subject for 8-week blocks. It's your standard turn and churn routine. But how does that make any sense, given that all of the systems and functions of the human body are inter-related in every aspect possible? At the end of year 2, students take the USMLE to test medical competency. In years 3 and 4, students begin rotations in various units and specialties, with year 4 seeing greater responsibility. Toward the end of year 4, each student must choose a focus area for their residency, which more or less means "hey choose what you want to channel all of your attention on". Subspecialties (e.g., anesthesiology) require additional years of training (called fellowships).

The new approach: Vanderbilt UMC and a few other med schools launched a new curriculum in the last 18 months, aimed at changing how students learn about medicine. Dubbed Curriculum 2.0, this new medical school model provides a deeper comprehension of the many scholarly fields essential to our understanding and practice of medicine. It more or less aims to instill a life-long learning model for all students, adapting to the every-changing shift in care practices and methods (based on research and outcomes data over time). After learning the core medical concepts (biochem, anatomy, etc), a personalized learning model shores up tailored course material as the student progresses. This aims to not only eliminate today's cookie cutter MD issue but also maximize the fit of clinician interest with both opportunity and curriculum. On top of it all, a longitudinal macro course ties is all together, helping to explicitly addresses the strengths and limitations of various diagnostic/therapeutic approaches and explain clinical reasoning as the student moves along on the journey called med school. This curriculum overlays onto the previous time span req't.

The gap: This new approach is eons better than the old approach. Doctors of old-- okay, let's be frank...all doctors in practice today-- learned on the archaic and ineffective legacy model or health care delivery, whereby students more or less are required to memorize the concepts and terminology in 40-50 2-inch text books, cram for exams/comps, followed up shortly thereafter with no recollection of what just happened. What did i just learn?! And if you are having a hard time relating to this, speak for 5 minutes in the foreign language you took in high school-- hell, even in college. Having issues? Yea, use it or lose it... that simple.

Although Curriculum 2.0 is a major advancement in the format of the curriculum, it's the curriculum itself that needs to be totally revisited. What do i mean? Today's medical field is littered with amazingly brilliant individuals, making immense strides in treatment and patient outcomes. But we have become so specialized in our care delivery that we have pigeon-holed ourselves when it comes to delivering a consistent and effective macro-patient care continuum. To address the pain in our chest, we now have to see 17 different specialists, of which 9 order separate MRIs with contrast. Brilliant. I'm not saying specialists aren't necessary; in fact, they are essential to our continued advancements in medicine. However, doctors are trained to focus on one specific area and no more. It reminds me of the days in school where we put up dividers during tests-- no cheating. Who am i fooling, cheating?! Every hospital/provider claims they provide the best care, but when is that ever possible without working together and/or sharing information? Bottom line-- no one provider has all the answers... impossible, in terms of both human retention AND time. But knowing who to turn to and what to look for/ask is within reach. That's more like it, eh?

Rankings schmankings

Every spring finds hospitals (along with many other organizations) scrambling in search of numbers. What numbers? Good question. Over the last month I've shadowed the 2 people at Vandy who are responsible for responding to the US News survey for ranking hospitals, on a myriad of factors. This was a huge learning experience because, while i haven't ever had much faith in rankings alone, it really shed light on just how arbitrary rankings actually are. In fact, majority of the survey questions, for US New and World Report at least, are subjective and interpretable in a number of ways.

So this begs the question-- for all the clout that rankings bring, not only for health care but any other industry/area, how valid are they? Political response-- it varies. I can say that after observing the hospital survey compilation, i hold VERY little faith in going to a top-10 hospital over a top-40 hospital. This is because majority of the hospital survey questions are quantitative but can be interpreted in a number of ways. For example, it may ask for a specific metric, which seems to be cut and dry. But there could be 4-5 different ways to capture that metric.

Also, how many rankings are there? Yes. And who pays for these? Exactly. Majority of the rankings available have some degree of political clout associated, donations, relationships, or otherwise. (same with research findings)

Additionally, a blanket ranking for an entire hospital/system can't possibly represent the quality of service delivery in each department/specialty. IOW, just because a hospital is #5 overall, doesn't mean that it is the best option for your open-heart surgery. In fact, they could have a heart institute that just launched in the last 2 years but people often associate the ranking with all services being golden.

My recommendations:

• ask the dept/unit/service how quality is measured in their area
• find out the readmissions rate and/or outcomes data; e.g., successful treatment of UTIs sans related complications as a result of the procedure/treatment; this is available at http://www.medicare.gov/hospitalcompare
• ask what service enhancements or changes have been implemented/incorporated over the last year; younger physicians and academic medical center clinicians (anywhere with a medical school) are usually the most "on top of the latest and greatest";
• seasoned clinicians (say a doctor with 20 years experience) often are averse to adoption of newer research findings into their practices; however, they're great for knowing about specific conditions and or treatments (in the age of "specialists"), so ask as many questions as your little heart desires!!!
• make the provider recommend several options of treatment (as necessary), with pros and cons of each; sometimes you find that a certain procedure is recommended b/c it's a higher bill code or will require 6 follow-up appointments; if the rec. procedure is done at a place where the provider receives financial benefit (owner or otherwise), that's... illegal (kickback statute).

If you only learn one thing from this post, don't go to a provider solely because the network has a high ranking!