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All About the Education Evolution Revolutionby Ron Gilmore
Still hum tunes by Tommy James & the Shondells? Did you lust after your pal's GTO but drove to high school in a beige Gremlin? Were Banlon® shirts once a significant part of your wardrobe? Besides the fact that you are well, well into middle age denial, you may also be living with the misconception that surgeries and medical procedures are mostly done at hospitals. Hold onto your 45s, oh ye of aging and expanding waistline. Those days have gone the way of paisley...the first time! Most folks who have had virtually any kind of routine medical procedures in recent years are already aware that in this era of microfibers, blockbuster movies about computer-generated ogres, and water that costs as much as soda pop, outpatient care has replaced inpatient care in many instances. Although hospitalizations remain necessary for some surgeries and therapies that require round-the-clock care, the truth is that even inpatient-based treatment has seen a dramatic decline in the length of time patients spend in a hospital. With more and more patients receiving care at outpatient clinics and at doctors' offices, one fundamental question, especially important to centers of medical academia, remains - Why are we still training medical students and residents chiefly in hospital settings? "Today most hospital-based training focuses on specific procedures or acutely ill patients," said Dr. Major Bradshaw, senior vice president and dean of medical education at Baylor College of Medicine. "But the irony is that most of these physicians-in-training will go on to careers that are most likely outpatient focused." Dr. Donald Donovan, senior associate dean of student affairs at Baylor, explained that 15 to 20 years ago, patients were often admitted the night before surgery, and then remained in the hospital for as long as two weeks. Such extended patient stays provided plenty of patient exposure for medical trainees at various stages of the patient's recovery. "Today, even serious heart patients may only be admitted for five days," said Donovan. "Students today are not even aware that they are missing out. Other medical schools have been grappling with this changing scenario as well." While BCM students receive excellent educational experiences at affiliated hospitals including Ben Taub General Hospital, the Michael E. DeBakey Veterans Affairs Medical Center, St. Luke's Episcopal Hospital, Texas Children's Hospital, The Menninger Clinic, The Institute for Research & Rehabiliation and The Methodist Hospital, students have little involvement with the initial patient consultation, evaluation or subsequent follow up. Bradshaw believes that there exists a "disconnect" between how medical students and residents are educated and how they will eventually practice medicine. This incongruity is more prevalent in certain medical areas, including surgery and medicine, where performing major procedures is more routine. "The most exciting element about the Baylor Clinic is that students may well have the opportunity to follow a patient from their first encounter, through the treatment phase, and during follow-up." Enter Baylor Clinic, the new adult ambulatory care center set to open in early summer 2005. Baylor College of Medicine's new facility will not only provide patients a streamlined and more user-friendly environment, it will also offer much for medical trainees. The trainees will be at the forefront of a leading national movement to learn their craft in both inpatient and outpatient settings - a combination sure to provide a more comprehensive and real-life exposure to the patient care experience. "There are many teaching techniques useful in the faster paced outpatient setting when time with the patient is limited. For example, priming the learner for the patient encounter, the one-minute preceptor, techniques for observing the learner in a two-minute observation, steps for teaching clinical skills, and providing feedback to the learner," said Dr. Rebecca Kirkland, senior associate dean of medical education. "Taking advantage of the ‘teachable moment' is one of the skills of faculty who focus the outpatient teaching encounter around students' needs." From the moment students or residents enter the clinic, they are welcomed as important members of the health care team and are shown how to perform in the clinic environment, said Kirkland. Faculty development is ongoing to respond to the challenges and opportunities around teaching the learner while ensuring that the patient is cared for in a timely manner. "Establishing Baylor Clinic gives us an incredible opportunity to develop and perfect an effective teaching model for the outpatient setting," she said. Add to this such novel resources as readily available electronic medical records, MD Consultant, and nearby education rooms for discussing patient cases, and you have the makings of what Bradshaw says is tantamount to an "on-site" outpatient classroom. "The most exciting element about Baylor Clinic is that students may have the opportunity to follow a patient from their first encounter, through the treatment phase, and during follow-up, he said. "While the trainees receive excellent educational experiences at all of our affiliated hospitals, what has been missing is this chance to see the patient in totality." Follow-through with patients, also known as "continuity of care," is an increasingly important element when it comes to residency reaccreditation. Continuity experiences are one of the most often cited areas of deficiency in the training accreditation process, according to Dr. Linda Andrews, BCM associate dean of graduate medical education. "Accrediting agencies are requiring more patient care continuity during training," said Andrews. "It is especially critical in certain surgical subspecialties." As a project sponsor for Baylor Clinic, Bradshaw asked Dr. Michael Fordis, associate dean of continuing medical education, to chair an education subgroup. The group visited Baylor's Family Practice Center, a model outpatient facility that has been using electronic medical records since 1999. The group also toured M.D. Anderson's new outpatient center to look at effective use of space for education. Bradshaw also toured similar facilities at the University of California-Los Angeles and Massachusetts General Hospital. "We are entering a new phase for medical education," said Bradshaw. "The 1970s and 1980s represented a period in which medical schools focused heavily on strengthening their research activities. But in the 1990s, an evolution began in education, particularly here at Baylor. The advent of an integrated and centralized medical school curriculum was a vital component." In 1991, then-BCM President Dr. William T. Butler convened a retreat of department chairs and center directors. One result was the formulation of a curriculum committee that has allowed Baylor to reform education. Bradshaw includes such innovations as problem-based learning, small group discussions versus large lecture hall education, early patient encounters, and exploration of societal and ethical issues, as some important results of this reform. Since then, Baylor has had a strong commitment to the principle of "teaching teachers to teach" - a process that, according to Bradshaw, has enhanced faculty development and recognition. Such programs as the educator development programs, the Educational Resource Center, and the master's of education in teaching program with the University of Houston are examples. Educator recognition awards such as the Barbara and Corbin J. Robertson, Jr. Presidential Award for Excellence in Education, the Fulbright & Jaworski L.L.P. Faculty Excellence Award, the John P. McGovern Outstanding Teacher Award, and the Resident Teaching Awards selected by medical students, are all examples of programs that reward educators for their efforts. This "educational evolution" has been one reason that Baylor College of Medicine has long been recognized as a leader in education. The addition of Baylor Clinic will not only allow students and residents to have more exposure to outpatient medicine, but it will also provide a sense of a centralized "home" for residents during this phase of their training, according to Andrews. "Residents are usually spread out in private clinics throughout the medical center, often using a preceptorship-based model in private clinics to complete this aspect of their training," said Andrews. "Having the opportunity to be in a central outpatient location and be exposed to other disciplines will help residents to see their colleagues in new ways. I also hope that it will allow residents to feel more like BCM residents first who happen to work at BCM affiliated hospitals." Donovan echoed Andrews, saying that medical students will benefit through spending time at Baylor Clinic. "Medical students complete a longitudinal ambulatory care experience during their third year, but, in general, do not get the multi-year exposure to patients that residents do," he said. "But at Baylor Clinic, it is likely that they will be able to see several different disciplines working together. For example, if a pregnant patient also has diabetes, they will have the chance to see how obstetricians, endocrinologists, and diabetes nurse specialists work together toward a common solution." Although there remain many issues to be resolved to incorporate educational training into the new Baylor Clinic, what is clear is that the College is headed in a new and promising direction. "There is amazingly little literature out there on outpatient-based education," said Bradshaw. "Training of residents and medical students is dramatically different from what it was just two decades ago. It is an exciting new era of education that we are exploring."
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Patient CareBaylor Clinic from the Inside Out Oil and Medicine: Profile on Dan Duncan ResearchEpilepsy: Seeking the Cause of a Lonely Disease Epilepsy: A history of stigma and superstition In for a Checkup? Check Out the Research Too EducationAll About the Education Evolution Revolution Community ServiceIntroducing the Problem Solvers College NewsRededication of a Monument to Medicine New BCM Logo Takes Center Stage The Perfect Fit: Putting the Pieces Together
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Volume 1, Issue 1, Spring 2005 |
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