Rethinking Medical School
Medical school isn’t what it used to be. Budding doctors have to learn more and study harder than they ever have. And changes in the health care system are prompting even more dramatic changes inside medical schools. Next in our series Future Docs, learn how Brown University has adapted, from the man who helped redesign the curriculum.
Dr. Phil Gruppuso started out as a pediatrician. He says that when he entered med school in the 1970s, his path looked really clear.
“It was pretty simple for me. I was able to complete medical school knowing that I would become a licensed physician and would practice medicine in a system that was not very different than the one I’d grown up in. And that was really true until about five to 10 years ago.”
Extra: A very brief timeline of medical education in the U.S.
Today, Gruppuso splits his time between research, seeing patients, and being associate dean of the Warren Alpert School of Medicine of Brown University. And what’s changed in the last five or 10 years is…everything. First, there’s a staggering amount of new scientific information physicians and students have to keep up with. Then there’s the unprecedented change in how we deliver health care, how much it costs, and how we pay for it.
“The whole system is in such a state of flux. And there are so many inherent and burgeoning problems with how we deliver health care that we need to prepare our students to provide patient care in the context of a system that will change in ways we can’t anticipate.”
That means med students need to know how to communicate and empathize, and how to think creatively, perhaps beyond the narrow scope of a particular specialty. But Gruppuso says that also means they have to be prepared to care for patients in new settings. So how do you squeeze more information and more preparation into the same four years of medical school?
“Well one of the ways you do it is you actually make the curriculum longer. So our students here, I’ve talked to a few students about my medical school experience, and they’re pretty surprised to hear that I had, basically I had summers off during medical school.”
Gruppuso has just helped redesign Brown’s curriculum, not only to pack more in but also to give students a broader, more liberal education. For instance: “The amount of content that we’re now delivering in areas related to population health and public health is markedly increased from what we were delivering only three to four years ago.”
Extra: Find out how other American medical schools are adapting in this snapshot of U.S. medical education, including reports from individual schools, in the journal of the American Association of Medical Colleges.
The redesign also took the emphasis off pure biochemistry and put the focus more on the body’s systems, so students can learn how they relate and interact in the whole person, “...relating the information they’re learning in, for example, their anatomy course to what they’re learning in their basic science course to what they’re learning in their doctoring course where they focus on basic clinical skills.”
Gruppuso says Brown’s experiences are unique, of course, but they’re part of a larger trend, one that involves rethinking the way we’ve been training doctors for the last hundred years.
“One of the challenges in medical education is balancing the humanistic parts of learning to be a physician with the hard core information with the sort of softer information that’s mostly in the areas of behavioral and social sciences and in some cases population health.”
Gruppuso says, like other schools, Brown is trying to meet that challenge in a variety of ways, like putting students with patients early on. He says students can also pick what they call a “scholarly concentration…”
“Our advocacy students can work with somebody from Roger Williams law school who is interested in medicine, law, and health disparities. We have a scholarly concentration in delivery of care to the underserved. It’s something that we sort of all know that we’re in the business of doing but we’re talking about students doing actually scholarly work in that area.”
In the past few years, organizations like the American Medical Association have called for a transformation in medical education, saying there’s a gap between how we train physicians and what they’re going to be expected to do in the shifting health care landscape.