A joke: At the swearing-in of America’s first Jewish President, the President’s mother fell into conversation with an official beside her. Their conversation went like this:
The Official: “Mrs Cohen, you must be very proud of your son?”
Mrs Cohen: “Sure, sure I am proud, but did you know, my two other sons are doctors.”
Doctors are held in high regard by the public, as well as by Jewish mothers and as a result receive many privileges: We earn a good wage, we do good work; compared to many professions we are well paid and autonomous when it comes to defining and regulating our scope of practice and of course the greatest privilege is our access to the mysteries and delights of human behavior.
That position is hard earned. Entry criteria for medical school has become incredibly difficult, even for the brightest students, with academic super-excellence as the single constant factor most likely to predict entry. Once accepted postgraduate studies are long and socially, potentially crippling.
The demand for places into medical school far outweighs the places available and every year thousands of young people receive the thin envelope carrying a rejection notice – those unsuccessful in Auckland receive the bad news just before Xmas!
However, despite the high status of doctors in society, we are recognised as a difficult group, firmly wedded to a fixed set of beliefs and in some cases unwilling to change what we do and how we do it. Some simple examples of that might include our appallingly slow adoption of clinical guidelines and evidence, and a woeful performance when it comes to hand washing.
Our medical graduates are a product of the system that produces them, therefore we should not be surprised by what they believe and do. If we want to change those behaviors, we need to continue to rethink how we select and train the doctors of the future. While there have been many changes in medical education over time, and accepting that there is precious little evidence in how best to select candidates for medical school, these extraordinary and obstinate behaviors persist.
Recognising that, the relatively new Hofstra Medical School affiliated to the enormous Long Island Jewish Health System in New York, has taken a very different approach to medical education. They began by defining a core set of values and describing as best they could what the ideal medical graduate in 2020 should be like. They then designed a programme to deliver on that. In essence they have created an environment to encourage and support adult learning as opposed to one that supports the way old teachers teach.
Their 4 year graduate course takes students through a fully integrated learning experience following groups of patients over a long period of time. Their initial exposure is to gain an Emergency Medical Technician (EMT) qualification and experience the full gamut of history taking and physical examination by week nine, by following real patients, with the help of sophisticated simulation technology. Key to its success and the many other skills they acquire, is how they are reinforced and enhanced by meaningful interactions with patients and their families, individual and group learning, and a close 1:1 long term relationship with individual members of the Long Island Jewish teaching faculty.
There is no department of anatomy, or physiology, or biochemistry, and no basic science chairs! There are only two departments: one devoted to research and publishing and one devoted to education. All the disciplines are in the same space and aligned around the learning objectives for the students, who after all, are a smart group of people: generally graduates; many with diverse and interesting life experiences. They are adults, who when treated as such, respond in kind.
Although in its early days – year 4 intake is just about to begin- early results, both objective and subjective are impressive.
Maybe, well before we have the first Jewish President of the United States of America, that old Jewish joke will have a new meaning.