Medical Students Aren't Showing Up To Class. What Does That Mean For Future Docs?

Oleh Admin 01 Jun, 2023 Posting Komentar

During my first two years of medical school, I never went to class. Even my classmates. In fact, I would estimate that not even a quarter of the medical students in my class ever learn in person. According to one of my professors, Dr. Philip Grupuzzo, in 40 years of teaching, conference attendance is the lowest he has ever seen it. Even before the Covid-19 pandemic, first- and second-year medical students routinely missed classes. Instead, they decided to watch the tapes at home in their spare time. The pandemic accelerated these changes. This absence from the classroom has led many in the medical education system to question how it will affect future physicians and has sparked much debate within the medical establishment. Medical education is changing rapidly and students are leading this change. So how are schools adapting to the reality of virtual learning while teaching the greater responsibility of patient care?

"Change" the room in the first two years.

The first half of medical school (typically the first two years, also sometimes called the pre-clinician years) prepares students for success in the second half of medical school, where they work directly with patient care teams. Pre-medical education is when students learn the technical aspects of a doctor's job before seeing patients. Includes Medical Sciences - Anatomy, Embryology, Physiology, Pathology and Pharmacology - and Medical Sciences - Ethics, Professionalism and Public Health. And passed the conference. This includes dissecting the human body in the anatomy lab, practicing patient interviews and fitness tests (usually with patient actors), and interspersing several small group discussions with lectures.

During these first two important years, virtual learning had several significant drawbacks. I could not ask the pre-recorded speaker any questions. One of the parts of medical school that I looked forward to the most was the student-teacher relationship that was so difficult to develop. Sometimes it was isolated.

Dr. Grupus and I started a conversation and have some ideas about how to change the medical education system to reduce these harms by supporting students' decisions to learn on their own time.

Our proposal is to use the flipped classroom model more widely for pediatric medical school classes. In this model, the face-to-face course practically disappears and students study most of the course material on their own before the face-to-face course, hence the twist. We suggest starting with a series of virtual modules to develop individual case studies in small groups. Activities such as the anatomy lab, patient interviews, physical examinations and specialty rooms will remain closed. Essentially, it includes a virtual classroom orientation, but requires actual attendance for hands-on learning in small groups.

A medical student's perspective - Alexander Phillips

To begin with, I used a virtual conference. Pausing, stepping back, reviewing, and pacing the conversation was a great way to focus on my pain points and save time, and given the amount of information to learn, time was my most valuable asset as a medical student. Virtual learning has made it much easier for me to incorporate extracurricular resources such as flashcards, web-based tutorials, or third-party courses into my curriculum.

In a flipped classroom, my typical day might include a morning review. I then had small group discussions with my professors and classmates for an hour or two where we discussed hypothetical patient cases focusing on the clinical application of this medical science. Additional days are spent practicing clinical skills in the anatomy lab with standardized patients (patient actors) under direct faculty supervision, in-hospital supervision, and unstructured time engaged in other activities such as research, advocacy, and community service.

Besides being able to talk and get to know my teachers and classmates, it brings some regularity to my schedule. With the current system, with the convenience of recording lessons, I was taking the course alone and it was easy to fall behind.

Professor's view - Dr. Philip Grupuzzo

I have taught medical students for nearly 40 years in a variety of settings: walking the hospital, meeting patients, leading small group discussions, and teaching large classes. I have lectured on topics ranging from biochemical pathways and lifestyle diseases (related to things like lack of exercise) to nutritional science and the biology of aging.

The most rewarding part of the training is the less tangible aspects of being a doctor: showing respect for all patients and how to be a true caregiver. I do this by talking about my clinical experiences in the classroom, and the result for me is the connection with the students. The pandemic and accompanying changes have changed everything in the way students learn.

A completely virtual education for the first two years of school may be necessary during the pandemic, but if it continues, young people will be ill-prepared for the medical profession.

The individualized nature of medicine or the dissection of the human body taught in clinical skills programs cannot be captured by an inherently impersonal teaching format. Childhood education is not everything; Other ways to promote general medical education, such as research, special studies, and volunteerism, are virtually impossible with virtual education.

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Finally, the reforming role of the teaching physician poses a real threat to the organization of medical education. Physicians are uncommon in the profession, so they teach regardless of where or what specialty they practice. If we take away the joy of face-to-face teaching, we lose the commitment of teachers, many of whom are completely volunteer.

Medical education is our common vision at the starting point

In discussing what post-pandemic medical education might look like, some have called for preschool to be entirely virtual. Promotion in the office is based on ability (i.e. whether you manage your courses), not time. However, based on this flipped classroom, we recommend incorporating much less virtual learning.

Brown University's Warren Alpert School of Medicine, among other schools, is using this approach. The benefits of interacting with peers, asking questions, and building relationships with teachers are greatest and most effective when students have a solid understanding of the basic structures and key concepts of basic science. This framework can often be most effectively built into an appropriate virtual environment where students can actually work on their pain points, allowing educators to focus on helping students apply this knowledge to patient care. Educators can add to these discussions by sharing experiences of how medical students have diagnosed and treated specific patients working in the organizations and communities where they work during internships. Moving away from large face-to-face medical science conferences and focusing on developing or researching high-quality virtual content builds on the strengths of virtual learning; Redirecting time and resources to facilitate regular one-on-one and small group sessions with teachers and other students based on case studies can reduce the disadvantages of virtual learning.

Medical education is at a crossroads. For health scientists, the traditional flipped classroom is just one of many solutions we face as we think about how to teach the next generation of physicians. For example, the following questions are closely related to the role of virtual education in medical education and are being discussed simultaneously in schools across the country.

What is the role of medical science courses in medical education? The USMLE Level 1 exam is a major medical licensing exam that primarily tests concepts in the medical sciences. The transition to a shorter visitor's course will only be accelerated by the recent change to the pass/fail test. Encouraging students to think about medicine from a clinical perspective early in their education is good, but the lack of time to develop a deeper understanding of disease mechanisms and treatment can undermine the foundation of learning.

To what extent can premedical education integrate external resources for effective learning? For years, medical students have turned to external resources as part of self-directed study programs to supplement or replace regular medical school courses. This usually happens regardless of faculty or administrative input.

If education costs are standardized in schools with virtual content that can be reused or easily updated, the resulting efficiencies have the potential to reduce education costs. If this can be achieved, should it reflect a reduction in the cost of medical education? If so, access to better medical education, reduced student loan burdens, and careers in low-income specialties, including primary care, may become barriers. Conversely, the time and intensity of small group sessions can increase costs for schools.

Are the benefits of these educational reforms shared by all? For less affluent students entering medical school, including students with neurological differences or from underrepresented groups in medicine (URiM), online courses may result in lower academic outcomes. Conversely, neurodivergent students may benefit from personalized learning modules. URIM students and those who normally have less access to tutors may find more time for face-to-face learning. As education becomes virtual, it is important to assess its impact on all students.

These questions are more difficult to answer than whether flipped classrooms deserve a greater role in pre-service medical education. But these options are not all or nothing. Changes must be made by understanding changes and expecting to minimize the negative effects of those changes.

Medical colleges must provide proper medical education before becoming a registrar. A solid foundation from the first two years of medical school (Alexander Phillips) helped me diagnose, admit, treat and discharge my first patient a few weeks ago as a third-year medical student in my first internship. We believe that the next fastest step to medical education is becoming an employee. The flipped classroom, and the growing role of virtual learning in the early years of medical school, is a promising model. Can we meet the overall goals of pre-college medical education by supporting medical students' decisions to study on their own time? We think so.

Alexander P. Phillips is a third-year student at Brown University and tweets @AlexPPhilps. Dr. Philip Grupuso is a former associate dean of medical education and currently teaches at Brown University. This article represents only the views of two authors who would like to thank Dr. B. Starr Hampton and Dr. Sarita Warrier of Brown University for their contributions .