Medical Education at Albert Einstein College of Medicine

I'm Gordon Earll associate dean at Albert Einstein College of Medicine I'm here at the Ruth L got a spoon clinical skill centered Einstein I'm talking with dr. Marty Grayson who has the education programs at the College of Medicine welcome dr. Grayson thank you the education program that Einstein with the cover story in our recent magazine and we talk about all the changes that are going on with the education programs for students or the medical school students I'd like to ask you about some of the changes that are going on in technology particularly a new online education system you had called eMED so tell me about that so we're actually very excited about eMED which stands for the Einstein Medical Education database it's a new initiative that we started this this past academic year and it really brings our education into the digital age we shopped around looking at a number of learning management systems but the exciting thing about this one is that it's custom-made for medical students for medical students and the faculty that teach them it was developed by Tufts University School of Medicine and it allows our students to see everything that they need to see for their education online they can see it on their computers in the classroom they can see it in at home in their apartments or if they're visiting family or friends in California they can see it all are you finding that for that kind of system that students are either required at this level or they demand it of the medical school because they've had this there's technological sophistication undergraduate so they're really looking for this kind of system the students want that and as you said a lot of them have had that of their undergraduate institutions they're used to it they're of the millennial generation they're used to doing everything in a digital way our faculty who did not grow up with this kind of technology including myself there's more of a learning curve and our office of educational informatics is working very hard with the faculty and once they get the hang of it they're actually loving it as well you know one thing that surprised me is I know that helps when they're here at Einstein but I think in previous conversations you told me if this kind of system helps them when they graduate and become doctors with electronic management systems and that kind of thing is that correct right one of the things we're trying to do is to train our students to function in the future as physicians and the world of medicine has totally changed now we're a few years ago many of us including myself we're still writing patient notes on paper charts and looking up information in textbooks and or pulling a journal article now now everything is electronic now when I see a patient I write a note in electronic medical record if I need information we utilize electronic books that are constantly being updated and all the journals although I still get the hard copy we now everything is sent online and we look it up that way in addition to the new technology I know that you're reviewing a new curriculum at Einstein and it goes away from just required courses to new competencies which doctors have to learn and I've seen is very very exciting so tell me and I know the review isn't complete yet but tell me about the competencies you're looking at a hundred years ago there was a report called a Flexner report that really laid the foundation for what medical education currently is today and then just in 2010 there was an update to this report by the Carnegie Foundation that talked about students developing specific competencies that we would assess over time so we put together a task force of talented faculty within our Austin community and we generated a listing of competencies that have as the anchor the two things that we see is most important the physician is healer and the physician of scientists but then we looked at other competencies that we felt were really key to our vision of the future physician a physician as a colleague a role model an educator a lifelong learner and very important and unique to Einstein I believe is physician as advocate we know that all students have to know the science and the medicine but it seemed like a lot of incompetencies focus on the humanism in medicine the patient interaction so they become doctors not the good scientists but they become good doctors with their patients is that fair to say that a lot of the competencies are in these areas absolutely again at Einstein what we did is we looked at what are the baseline knowledge and skills that students have to have that is expected of all medical students before they enter any type of residency from family medicine to neurosurgery but then we went beyond that and we really fell looked at what we felt as faculty that we would want our own Stein students to know and there is a focus on humanism communication skills advocating for patients forming relationships serving as educators all of these things are very important that's something that patients have been asking for – if you just read the news report – saying I want a doctor who I can talk to and who can communicate with me right right if I go to any party or anything outside my medical world and someone here some of the doctor the first thing they want to talk about is either they have this fantastic doctor who really listens to them or they were disappointed in someone who did not I think those kind of skills we really emphasize here at Einstein everything from getting the basic information to practicing difficult conversations such as telling a patient about a difficult diagnosis there was I also understand you're looking at some of the social sciences so for instance healthcare policy which is revolutionising your field there are some courses that have to do with policy oriented questions that the doctor has to know for for the future it's interesting that every year the Association of American Medical Colleges sends out a survey to all graduating medical students to ask them what did you learn well and what did you wish that you had more information about and across the country they talked about students said I need more health policy I need more in economics I need more medical law our students are the same as those students so I had a great group of students who came to me and said they wanted a pilot health policy and economics course they found a faculty advisor we piloted it last year even though it was at night and after a whole day of educational activities and totally voluntary the auditorium was packed and I asked the students to have evaluations which they did and they were outstanding evaluations so that's now going into our regular curriculum let's focus a little bit more on how we're making doctors better with their patients and it's appropriate because we're in the clinical skills facility at Einstein where it happens so tell me more about how you're making doctors be better doctors for their patients this clinical skill center is very important to the education of our medical students here at Einstein because this is where students get to practice in a safe environment and they are supervised and observed and given feedback so we actually bring in standardized patients which are actors who come in and say doc I have a stomachache I have a headache I feel tired all the time and our students actually interview the patients they do a physical exam they talk with the patient about what they're going to do and they even write the note in an electronic medical record and and then that's videotaped our faculty members give feedback to the students giving them ideas about ways to improve it's a very crucial part of medical education today and more and more schools across the country are utilizing standardized patients as well as the national boards one of the national boards uses standardized patients as well another mantra that you have is active learning for your students this is part of active learning or is that something else this is also part of active learning because the students are actively practicing what they need to go and solidifying their skills and getting feedback on it but the other thing that we love that utilizes active learning is back in the old-fashioned lecture hall in in the old days when someone gave a lecture you sat there for the 60 minutes while somebody a very knowledgeable faculty member talks about a particular area or a topic the literature on education shows it doesn't matter how good the lecturer is after 10 or 15 minutes you your mind drifts it's it's it's just been shown over and over again so we've instituted a number of measures and a lot of our faculty are now using them one of them is called the audience response system which uses clickers so after 10 or 15 minutes the faculty member might suddenly ask a question to the class and the class all on their clickers gives the answer everybody gets to see what the class is a whole answered and more importantly the faculty member gets to see if the students actually understood what he or she were talking about it keeps the students engaged and it's actually a lot of fun it's a lot of fun to do I've participated in lectures like that we also have something called team-based learning which more and more of our faculty are being trained in and what that is is you take a big lecture hall and you divide up students into groups of let's say roughly ten students they all work on the same problems and then they actually have debates with the different groups and they discuss it a very lively discussion that really allows you to use your critical thinking skills and learn the materials in a very active way what it's all about is the interactivity improving the interactivity between the the faculty member and the student and getting that that energy going is that correct yes yes and really analyzing and thinking instead of just sitting there while the information is is swirling here okay let me ask you down another program which I believe in the pilot stage and that's the scholarly concentrations program tell us a little bit about that because that brings in the research for the clinical side which is a lot about what Einstein is all about we are going to pilot a scholarly concentration program this year the name for Einsteins program is swords student opportunities in the academic research and it's very exciting because what it does it allows the students starting from year 1 through year 4 to work on an area of interest for them an area of scholarship that they can really gain some mastery of and really become an expert and the concentrations that we're choosing are not specialty specific they are geared to students no matter what kind of residency they're going into some of the concentrations that we'll be offering this year are relate to integrative medicine global health health public health biomedical ethics just to name a few and students will work on either a research project or what's called a capstone project for instance a student in our urban health track which is another one might interview a group of and work with a group of adolescents and decide what they need to decrease health risks and then they may come up with a video that would be shown to the ad and that might be their final project or someone else may have a hypothesis based research study in a lab so we're going to be looking at all these different ways for our students to gain expertise and to have a scholarly project this is one other mantra which I've heard is making our physicians lifetime learners so tell me a little bit about that you've just mentioned it but there's something else about this lifelong learning we're trying to instill it here actually one of our competencies that we will have as physician as lifelong learner and that's a main theme of our education and Einstein the information that's available to doctors now is not the information that I had when I went to medical school it's constantly changing there's a scientific explosion so what we have to do is make sure that our students know how to access the latest and greatest information that's available to know how to appropriately analyze it to make sure that it's valid and makes sense and then can take that information and apply it to the care of the patient who's sitting in front of them or the population that they take care of so we're next year we're starting with a brand new course that's going to be a two year course called FM epidemiology Public Health and evidence-based medicine and that course will teach our students everything from biostatistics population health and then more importantly how to take the evidence that's out there and to utilize it appropriately in patient care now you were a student at Einstein you graduated a few years ago so how is what you're offering everything that you sum up different than the experience you had at Einstein well first of all I have to say I had a wonderful education at Einstein and I jumped at the opportunity to come back here to to make a difference because I am so grateful for the education that I had but times have changed and everything from going from paper to electronics to classroom to active learning there was no such thing as standardized patients and having those opportunities we're about to get a simulation center here where students can actually practice on mannequins and various simulators certain techniques and the other thing is because of all the electronic resources we have we're offering our students multiple ways to learn the same material that wasn't available back then and now it is and that makes it very exciting for us as faculty because our students can learn in a number of ways and tailor what they do to their own learning style let's blue sky Medical Education and what the future looks like you know what it was like when you were a medical school you know what it's like now so if we think 15 years down the road what are we gonna see in terms of medical education so that's an interesting question I actually think a lot of what we're going to see we're already building the foundation for now so there's going to be a lot of customization there's going to be a lot of operative we're going to have students who come in with even more diverse backgrounds that they do now some will have expertise in the social sciences some in the basic medical sciences some will already be healthcare professionals and we're then going to be able to say you can go through our program utilizing the various resources that we have whether they be electronic or whether they be simulators or whether they be standardized patients and you can learn what you need to learn and then we're going to have a method to assess and make sure that you've reached the level of competency that we're looking for I believe what that will lead to is that the length of medical school may vary if a student came in and they were already in another healthcare profession they may be able to go through those steps you know more rapidly than four years but other students are going to want to master some related area for instance biomedical ethics or public health or an area within the sciences and perhaps that will lengthen their training so that they can get everything that they want I think what's exciting for us as faculty is having all these different methods allows us to really free up our time to more closely mentor our students and to assess their judgment and to work with them and hopefully serve as role models and that will lead to a wonderful even more wonderful relationship with our students it sounds like like most things in life you have to strike the balance so there'll be more technology more online tools for students on the other hand you have to have the personalized human aspect of medicine that's reflected in the cover of our magazine we have we have a doctor and students in this facility but they're on top of a tablet to underscore the high technology but it sounds like that's the balance we're going to have to reach right and I think the technology helps free us up so that the faculty and students can work closer together so some of the fundamentals will be covered by baseline things that you can learn online with interaction and then the faculty can really be there for the nuances and the subtleties and the role modeling and and that's what it's all about I see our faculty being very engaged with their students and being from it freed up from some of the things that can be handled electronically or in another manner dr. Grayson thanks for joining us that sounds all very very exciting Thank You Gordon

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