Writing for NPR's "Shots" blog, John Henning Schumann, a physician and interim president of the University of Oklahoma, argues that medical education should be revamped to put more emphasis on the social determinants of health and less on the rote memorization of biomedical knowledge.
Currently, first-year medical students are required to memorize biomedical basics—like the Krebs Cycle, a process for cellular metabolism. According to Schumann, the biomedical model's popularity can largely be traced to the publication of The Flexner Report, which was written a century ago.
Yet, Schumann notes that Abraham Flexner, the publication's author, was not a doctor and that medicine has radically changed since his report was first published. It is time for medical schools to move on, he argues.
Instead of memorization, which is increasingly difficult given that the volume of medical knowledge is estimated to double every four years, aspiring doctors should be taught to think critically, Schumann says. "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," he writes.
Medical education should also emphasize the social determinants of health, Schumann says. That means educating doctors on the role "poverty, housing, nutrition, and other factors" play in a person's overall health. Schumann says it took him years in the field to understand how integral such factors can be to treating a patient.
For example, "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," Schumann writes.
Emphasizing social factors may confuse some who see medicine as a strictly science-based discipline, Schumann acknowledges. However, he points to a budding movement in the medical community to elevate such factors as evidence that progress is indeed possible.
Schumann this month attended a conference called Beyond Flexner, which was inspired by the question: "What is the social mission of medical education?" He writes, "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."
Schumann says he left the conference confident that medical education was on the cusp of a more socially conscious era. Now, Schumann's biggest question is: "What will replace the Krebs Cycle in the medical education pantheon?" (Schumann, "Shots," NPR, 4/26).
The takeaway: One doctor say the biomedical model of medical education is out of date and should be replaced with a focus on critical thinking and socially conscious health care.
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