The Path to Personalized Learning
On Bonnie Miller’s to do list: dismantle the 100-year-old medical education system.
“We can’t change the way we provide care without also changing the way we educate providers. It simply won’t work,” said Miller, M.D., senior associate dean for Health Sciences Education. “In the world of personalized medicine, there will be no way that one provider can know everything needed for every patient encounter every time, but medical education is still built on this assumption of the omniscient doctor.”
Miller and colleagues plan to introduce a new pilot program this fall that will build a culture of inter-professional teams while introducing students to the fundamental principles of professionalism and health care systems. The pilot program reflects a shift from autonomous, individual practitioner-based care to care delivered by very large teams of individuals.
“When a patient gets admitted to Vanderbilt, even for a brief hospitalization, there will probably be upward of 50 people who are working together to do the right thing at the right time, to deliver what he needs in terms of diagnosis and therapy, to monitor, feed and take care of him. A very small number of them are physicians. The care team has a minority of physicians involved. And everyone needs to be on the same page and executing as a team,” said Dan Masys, M.D., professor and chair of the Department of Biomedical Informatics.
The pilot program will include first-year nursing, medical, social work and pharmacy students. Six students from each discipline will arrive on campus a month before their classmates to participate in an immersion course that focuses on understanding the U.S. health care system and the context in which all health care providers work, including local health care systems and community resources. At the same time, they will learn fundamental teamwork skills and basic patient care skills.
“By working and learning in teams from the beginning, the students will gain an understanding of how the different professions evolved, what their foundational ethics and philosophies are and how each contributes to patient care,” Miller said.
Upon completion of the immersion course, students will be assigned to a clinic either at Vanderbilt or in the community where they will work in supervised teams two half-days a week.
“This program will focus on community and population-based health so that our graduates will be able to care for individuals and populations at the same time. This is a key skill in improving practice outcomes,” Miller said.
The students will continue to take core sciences classes, and their clinic days will be built into their elective time. The success of Vanderbilt’s medical student-run community clinic, the Shade Tree Clinic in East Nashville, is a springboard for this portion of the pilot program.
“We know students are capable of delivering high quality care in teams as long as they are well supervised,” Miller said.
“Personalized medicine is not the only reason we need a different way of educating providers. We have a tremendously complex health care system and we can’t simply hope that individual physicians will figure out on their own how to make systems work,” Miller said.
“Our students must learn about systems in order to constantly improve them, so that consistently outstanding, up-to-date care is given to every patient every time.
“We have to change education to support a new way of practicing.”