From the September 2016 Inside OME
From the President M
Stephen C. Shannon, DO, MPH
ost U.S. medical schools are operating under an educational model established in the early 1900s by Abraham Flexner. The Flexner model focuses the first half of undergraduate medical education on in-class lectures and in-classroom learning. Most hands-on learning—attending clinics and shadowing physicians—doesn’t occur until the second half. While the Flexner model originally helped to raise medical education and practice in the United States to its current internationally recognized level of excellence, this teaching model has changed very little over the past century, while the nation’s health care needs continue to evolve. It is clear to medical educators that new, innovative medical training models are needed that align the skills and competencies of physicians with the care today’s patients require, patient-centered, preventive, interprofessional, primary care.
Innovative Teaching Models
Innovation has always been a cornerstone of the osteopathic medical education system, with many of our colleges ensuring early hands-on clinical experience for students, and a consistent focus on community-based, primary care training with a focus on prevention. In many ways, AACOM and U.S. osteopathic medical schools are already changing the training models to incorporate additional competencies, including:
Flexible, competency-based pathways for students
- Interprofessional, team-based experiences
- Both clinical and health care delivery skills
- Community-based clinical learning settings
- Integrating technology into learning and assessment
- Leadership opportunities and training
- Advocacy and communications training into curricula
- Competencies to teach students resilience and adaptability
- Opportunities for early-immersion pathways for students to enable easy, and sometimes early, transition from medical school to residency training
- … and more
The “Osteopathic Core Competencies for Medical Students,” published in 2012, is one of several important guiding frameworks for health care education and training produced by AACOM. Used for assessment in both undergraduate and graduate medical education, the document outlines a set of performance indicators that should be common to all osteopathic medical schools, effectively setting a baseline for curriculum across the OME community.
Following the Core Competencies was the 2013 release of the Blue Ribbon Commission (BRC) on the Advancement of Osteopathic Medical Education (BRC)’s1 white paper report, “Building the Future: Educating the 21st Century Physician.” The report, a comprehensive summary of more than two years of collaborative work among commission members and affiliates, was published in conjunction with a study featured in the November 2013 edition of Health Affairs, which analyzed the concepts and recommendations presented by the BRC. The central outcome of the report suggested that osteopathic medical schools, which enroll one in four medical students in the United States, should develop programs in partnership with teaching hospitals and other training sites to provide more hands-on learning, and provide students with the opportunity to advance in their training based upon satisfying measures of competency instead of a prescribed number of months of study. The goal of this recommendation is to efficiently and effectively train primary care-focused physicians who can deliver team-based care and will be proficient in prevention, health care systems planning, leadership, and emerging health information technology.
Then, in 2014, the American Association of Medical Colleges (AAMC) published the “Core Entrustable Professional Activities (EPAs) for Entering Residency: Curriculum Developers’ Guide.” The guide was a framework for advancing competency-based medical education in order to enhance the quality of medical education and assessment. The overall goal of the guide was to ensure that medical schools are prepared to train graduates in the outlined competencies and ensure that they are competitive in the residency application process. Following the publication of this guide, AACOM established an EPA Steering Committee in the fall of 2015 with the goal of examining the relevance the 13 EPAs to OME and identifying a strategy for moving forward. As a result, the first version of “The Osteopathic Considerations for Core Entrustable Professional Activities (EPAs) for Entering Residency” was finalized in 2016. The document serves a guide to the implementation of EPAs in osteopathic medical education and is seen as a living document that will adapt to the evolving needs and best practices.
Another step toward further medical education innovation is the National Board of Osteopathic Medical Examiners (NBOME)’s “Fundamental Osteopathic Medical Competency Domains 2016” (FOMCD 2016). This document, released in July 2016, represents the expert consensus of a distinguished Blue Ribbon Panel—comprised of representatives from AACOM, the American Osteopathic Association (AOA), the Accreditation Council for Graduate Medical Education (ACGME), the Association of Osteopathic Directors and Medical Educators (AODME), the Organization of Program Director Associations (OPDA), the Federation of State Medical Boards (FSMB), and the American Association of Osteopathic Examiners (AAOE)—on the required elements and measurable outcomes for seven osteopathic medicine core competencies. This report is the result of years of research and expert input, and clearly outlines a vision for an expanded osteopathic competency framework that sets the stage for the development of future assessment approaches.
Innovation in Medical Education Technology and Tools
Along with supporting the development and implementation of innovative teaching and training models, the nation’s colleges of osteopathic medicine (COMs) are also committed to keeping their students in the forefront of medical education and care technology. Advancements in training tools, software programs, and learning materials are integral aspects of student life at the COMs.
Advanced simulation is one of the many cutting-edge innovations in medical education technology. Since hands-on experience is often a key element in effective learning, many of the nation’s COMs have prioritized both manikin and live simulation work in undergraduate training. Patient encounters using live simulated patient volunteers from the community help students practice taking patient history, performing physical exams, and using empathy to connect with patients. Manikin simulation work helps students get comfortable performing medical procedures in real-life scenarios, with team of health care professionals and under pressure. A manikin/human integrated version of simulation is cut-suit simulation, and is also used by many of the COMs. A “cut suit” is a human worn surgical simulator, and is one of the most realistic ways to simulate performing real surgical procedures on a human with severe traumatic injuries.
Other advancements in medical education include the implementation of digital learning tools, including training software, e-books, and digital test-taking programs. Although digital learning tools have been around for decades, they were not universally adapted for a number of reasons, including issues with reliability of new software, untested outcomes, and differing comfort levels with technology (for both students and professors).
Today’s patients have come to expect digital advancements in their care, whether through electronic medical records, online patient profiles, email access to their care provider, or interprofessional care via a care team portal. Fortunately, studies show that millennial medical students exhibit high comfort levels when using and learning new technology, and there are many more trustworthy and time-tested training programs available on the market today. While most schools have not moved over to an entirely digital learning model, many are using what is referred to as “blended learning.” This type of instruction involves the combination of traditional, in-person instruction with digital teaching techniques. These programs not only enhance the digital literacy of students and provide a more customizable learning experience, they also allow for instant and ongoing student assessment which helps educators more accurately measure the learning of each student.
Finding the Right Balance
As we move into the future, we are certain to encounter ongoing innovation. However, it is important that we continue to prioritize the teaching and practice of empathetic, preventative, patient-centered care while at the same time embracing technology and cutting-edge educational models. By striking this balance, the osteopathic medical education system will be poised to produce physicians capable of meeting the country’s health care needs—physicians with exemplary clinical skills who are adept at working in interprofessional settings, comfortable with the latest technology, involved in the legislative issues affecting health care, practiced in exercising patient empathy, and life-long students of medicine.
Read more news on innovations in medical education in the latest issue of Inside OME.
1 The Blue Ribbon Commission for the Advancement of Osteopathic Medical Education (BRC) was established in 2011 and set-up as an independent group by AACOM and the American Osteopathic Association (AOA).