Med Ed Day Continues to Stir Curriculum

Photo by Steve Gilbert In his keynote speech at Medical Education Day, Ron Arky emphasized the need for faculty members to be activists in continually improving medical education. (He appears above among students at a recent White Coat Day.)

The fifth annual Medical Education day, held on Nov. 7, was the first to occur after the launch of the new integrated curriculum. In acknowledging this milestone, Academy director George Thibault said in his plenary session introduction, “This is a time to feel good about what we do, but not rest on our laurels. There is a lot more to be done.” Workshops throughout the day covered topics such as teaching nonnative English speakers to communicate with patients, avoiding presentation disasters, and giving an effective and engaging large lecture. The poster presentations and plenary session gave attendees a glimpse of how the HMS community is addressing the ever changing world of medical education. 

Three poster session participants presented their work in the plenary session. Mary Thorndike, HMS clinical fellow in medicine at Brigham and Women’s, and Graham McMahon, HMS instructor in medicine at BWH, presented their paper, “The Evidence-based Medicine Skills of Students Entering Their Clinical Clerkships.” The project was designed to identify the kind of skills students learned and retained in  evidence-based epidemiology workshops. Using a voluntary self-assessment, Thorndike and McMahon determined strengths and weaknesses in the students’ performances, and they are using this information to develop workshops in the BWH pilot clerkship program to try to reinforce the skills learned in class.

Jeremy Schmahmann’s presentation focused on assessing medical students, particularly in the clerkships. Schmahmann, an HMS associate professor of neurology at Massachusetts General Hospital, said that the current assessment strategy was not useful in predicting which students would succeed. He determined that using a performance-based assessment that he developed along with the subjective evaluation used in all clinical clerkships was the best way to get a complete picture of a student’s performance. To translate this composite score into a final grade, Schmahmann recommended a five-tier scale instead of the four-tier scale, placing an emphasis on clinical proficiency.

Richard Blum, HMS assistant professor of anesthesia at Children’s Hospital Boston, presented an abstract,  “Attending Physician Response to Challenge by a Subordinate.” He and colleagues performed a simulation-based study to test attendings’ responses to challenges by residents. They found that when challenged by a resident during a mock critical situation, only 22 percent of faculty members in the study responded in a way that acknowledged the disagreement and explained their actions. Blum said that this lack of response not only reduced the resident’s opportunity for learning, but also put the patient’s safety at risk. He is currently developing a more systematic study. 

The keynote speech was given by Ron Arky, the Charles S. Davidson distinguished professor of medicine. In his talk, titled “100 Years Is Not a Long Time,” Arky looked at the Quad Centennial from an education perspective, beginning with Abraham Flexner’s famous report, The American College, which lauded many of the ideas Charles Eliot put into place at HMS. He noted that HMS was one of the first medical schools in the country to focus as much on clinical training as on lectures, forging ties to area hospitals early on.

Arky said that while the School has been able to adapt to changes over the years, it has not been as innovative in medical education as in research and basic science.

“We really have never looked at medical education as a science,” said Arky, explaining that medical school graduates tend to focus on clinical practice, without much thought to teaching. “We’ve been casual in our attitude towards education … and I would contend that it is time for a change.”

He argued that medical education should be its own specialization. He suggested conducting “clinical trials” to compare medical education methodologies and training faculty to examine the outcomes and apply them to new teaching strategies.

Paraphrasing Francis Peabody’s famous “The Care of the Patient” lecture, Arky said, “We suffer from periods of stagnation … but it is us, the medical professionals, and certainly the teachers, who must stir up the pot, stir up the pool, and clean it of its sediment.”

—Emily Lieberman

top