Insights on Residency Training

This past week, I attended the annual AAMC meeting where the question, “What will medical education look like in 2033?” was asked in a session called “Lightyears Beyond Flexner.” This session included a contest that Eastern Virginia Medical School won by producing a breath-taking and accurate portrayal of 2033. I encourage you to view the excellent video above that captures the essence of where academic medicine is headed.

After this thought-provoking session, I too pondered academic medicine’s fate. I would like to share my reflections in this forum.

Without question, technology stood out as a major theme in this conference. And for good reason: clearly it is already permeating every corner of our academic medical lives. But as technology outpaces our clinical and educational methods, how exactly will it affect our practices in providing care and in training physicians?

Our educational systems will evolve in ways we cannot predict. But in reality, the future is already here as transformations are already afoot. MOOCs — massive open online course for the uninitiated — like Coursera are already providing higher education to the masses and undoubtedly will supplant lectures in med schools and residencies. In a “flipped classroom” era, MOOCs will empower world renowned faculty to teach large audiences. Meanwhile, local faculty can mentor trainees and model behaviors and skills for learners. Dr. Shannon Martin, a junior faculty at my institution, has proposed the notion of a “flipped rounds” in the clinical training environment, too. In this model, rounds include clinical work and informed discussions; reading articles as a group or having a “chalk talk” are left out of the mix. In addition, medical education will entail sophisticated computer animations, interactive computer games for the basic sciences, and highly intelligent simulations. Finally, the undergraduate and graduate curricula will have more intense training in the social sciences and human interaction. In a globalized and technologized world, these skills will be at a premium.

But why stop at flipped classrooms or even flipped rounds? Flipped clinical experiences are coming soon too.

Yes, technology will revolutionize the clinical experience as well. Nowadays, we are using computers mainly to document clinical encounters and to retrieve electronic resources. In the future, patients will enter the exam room with a highly individualized health plan generated by a computer. A computer algorithm will review the patient’s major history, habits, risk factors, family history, biometrics, previous lab data, genomics, and pharmacogenomic data and will synthesize a prioritized agenda of health needs and recommended interventions. Providers will feel liberated from automated alerts and checklists and will have more time to simply talk to their patients. After the patient leaves the clinic, physicians will then stay connected with patients through social networking and e-visits. Physicians will even receive feedback on their patient’s lives through algorithms that will process each patient’s data trail: how often they are picking up prescriptions, how frequently they are taking a walk, how many times they buy cigarettes in a month. And of course, computers will probably even make diagnoses some day, as IBM’s Watson or the Isabel app aspire to do.

Yet even if Watson or Isabel succeeds in skilled clinical diagnosis, these technologies will not render physicians obsolete. No matter how much we digitize our clinical and educational experiences, humans will still crave the contact of other humans. We might someday completely trust a computer to diagnose breast cancer for us, but would anyone want a computer to break the bad news to our families? Surgical robots might someday drive themselves, but will experienced surgeons and patients accede ultimate surgical authority to a machine? A computer program might automatically track our caloric intake and physical activities, but nothing will replace a motivating human coach.

With all of these changes, faculty will presumably find time for our oft-neglected values. Bedside teaching will experience a renaissance and will focus on skilled communication. Because the Google Generation of residents and students will hold all of the world’s knowledge in the palm of their hands, they will look to faculty to be expert role models. Our medical educators will be able to create a truly streamlined, ultra-efficient learning experience that allows more face-to-face experiences with patients and trainees alike.

So where is academic medicine headed beyond Flexner? Academic physicians will remain master artists, compassionate advisers, and a human face for the increasingly digitized medical experience.