Rebooting Medical Education

reprinted from Issue 18, Spring 2014 of Frontiers of Medicine (PDF)

Anna Chang, MD, (left) is developing a com- prehensive geriatrics curriculum, and Louise C. Walter, MD, is chief of the Division of Geriatrics.

The UCSF Division of Geriatrics has cultivated many leaders in the care of older adults, including more than 115 fellows in geriatrics and other health professions. For the last three years, it has also hosted the Bechtel Geriatrics Scholarship Award Summit – a national competition for residents to discuss their aging research with colleagues and mentors.

While UCSF is known for its excellence in training geriatricians, the need for expertise in caring for older adults goes far beyond this specialty. "There is less than one geriatrician for every 6,000 people over 65 in the United States," says Louise C. Walter, MD, chief of the Division of Geriatrics. UCSF geriatricians are helping lead the way in training the next generation of providers.

Although teamwork is the heart of providing optimal care to older adults, traditional frameworks of medical education have left learners ill-equipped to practice in this model. Trainees are often taught in silos – physicians teaching medical students, with little longitudinal contact with learners and clinicians from other professions – and many programs still reward individual achievement rather than competence in working with colleagues as a team member.

"A myth in education is the idea if you are around someone from a different profession, then somehow you must be learning to work as a team – but it's so much more than that," says Anna Chang, MD. She leads a School of Medicine initiative funded by the Donald W. Reynolds Foundation to develop a comprehensive geriatrics curriculum that will prepare physicians to work effectively within interprofessional teams."

For example, first-year medical students could partner with pharmacy students to review the safety of lengthy medication lists in older adults admitted to hospitals and nursing homes. Second-year students would learn to develop care plans for older patients, integrating input from physical thera- pists and social workers. "We're hoping to create high-functioning teams composed of learners from different professions, and have them learn by struggling through real clinical problems together," says Chang.

She also helps lead the UCSF School of Medicine Bridges Curriculum, which recently received one of only 11 grants nationally from the American Medical Association to create 21st century physicians with skills to work collaboratively. Part of this ambitious reboot effort seeks to create opportunities for students to contribute authentically to patient care, challenging the traditional perspective that learning in the first two years of medical school is best done in classrooms.

"What if students could be prepared from day one to enter the clinic, hospital, nursing home or patients' homes to help the clinical team improve patient outcomes?" says Chang. She recalls a medical student who learned health coaching skills, then used them to discuss strategies for weight loss with a clinic patient. "Months later, the patient came back and said, 'Because of what that student discussed with me, I have made real progress towards my weight loss goals. Will you thank that student for me?'

"At UCSF, we are saying, let's leverage all the creativity and passion that our students bring, and give them tools to learn as they help solve some of the most important questions in health care," says Chang. "Geriatricians are well-poised to lead this kind of change. We have a philosophy and practice of working effectively in teams to take care of older adults facing complex problems that don't have a single solution. We are bringing all that we've learned to problems that face both the health care system and medical education."

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