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Changes in the Medical Education Landscape


Published on

2017 Annual Meeting

Published in: Education

Changes in the Medical Education Landscape

  1. 1. |||© 2017 MCC | CMC #MCCam #aaCMC© 2017 MCC | CMC Jay Rosenfield MD, MEd, FRCPC Vice Dean, Medical Education Schulich School of Medicine and Dentistry Professor of Paediatrics Western University Adjunct Clinical Professor of Paediatrics University of Toronto Changes in the Medical Education Landscape
  2. 2. |||© 2017 MCC | CMC #MCCam #aaCMC Learning Objectives Appreciate the global context of the landscape of medical education reform Understand common reform themes and recommendations Consider what the future of medical education may/should look like in response to the landscape Consider transformative visions for future medical schools
  3. 3. |||© 2017 MCC | CMC #MCCam #aaCMC Healthcare Environment • Increased burden and complexity of chronic illness • Demographic shifts • Impact of technological advances both in treatment and health management by patients • Focus on safety, quality, outcomes and efficiency of health care
  4. 4. |||© 2017 MCC | CMC #MCCam #aaCMC Healthcare Environment • Genomics-personalized medicine • Big Data—impact on health care and on education (learning analytics) • Ongoing challenge of serving rural and remote populations • Increasing socioeconomic disparity • Health impacts of climate change
  5. 5. |||© 2017 MCC | CMC #MCCam #aaCMC AMA Innovations in Medical Education Webinar Series Changes in Healthcare Delivery
  6. 6. |||© 2017 MCC | CMC #MCCam #aaCMC Implications for Education • Medical Education will need to respond to a world that is increasingly globalized, complex, diverse and uncertain, requiring an educational system that is flexible and responsive to change. • Solutions to problems will need to be sought through transformation rather than incremental growth • Changes will be required at the level of curriculum, delivery and the system of education
  7. 7. |||© 2017 MCC | CMC #MCCam #aaCMC Recent Examples of Significant Pressures for Change in Education  Carnegie Report  Lancet Commission  FMEC  Medical Council of Canada  CanMEDS, CBME  Technology 7
  8. 8. |||© 2017 MCC | CMC #MCCam #aaCMC International Trends in Medical Education 2010 Carnegie Report Cooke, M., Irby, D.M., O’Brien, B.C. (2010). Educating Physicians: A Call for Reform of Medical School and Residency. Carnegie Foundation for the Advancement of Teaching. San Francisco: Jossey-Bass. 2010 Lancet Commission Report Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., … Zurayk, H. (2010). Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. Lancet, 376, 1923-1958.
  9. 9. |||© 2017 MCC | CMC #MCCam #aaCMC Lancet Report – Vision “All peoples and countries are tied together in an increasingly interdependent global health space, and the challenges in professional education reflect this interdependence.” “Our vision calls for a new era of professional education that advances transformative learning and harnesses the power of interdependence in education.”
  10. 10. |||© 2017 MCC | CMC #MCCam #aaCMC Lancet Report – Transformative Learning Lancet Commission Report, page 53 “Transformative learning is about developing leadership attributes; its purpose is to produce enlightened change agents.”
  11. 11. |||© 2017 MCC | CMC #MCCam #aaCMC Lancet Report – Interdependence “Interdependence … underscores the ways in which various components interact with each other, without presupposing that they are equal.” Involves three shifts: Isolation Stand-alone institutions Self-generated and self- controlled institutional assets Harmonized education and health systems Global networks, alliances, and consortia Harnessing global flows of educational content, pedagogical resources, and innovations
  12. 12. |||© 2017 MCC | CMC #MCCam #aaCMC Lancet Report – Proposed Reforms Lancet Commission Report, page 57
  13. 13. |||© 2017 MCC | CMC #MCCam #aaCMC Carnegie Report – Findings/Challenges o Inflexible curriculum o Not learner centered o Poor connections between formal knowledge and experiential learning o Clinical education overly focused on inpatient clinical experience o Inadequate longitudinal clinical experiences o Inadequate attention to patient populations and health care delivery systems o Limited understanding of non-clinical physician roles o Limited focus on professionalism
  14. 14. |||© 2017 MCC | CMC #MCCam #aaCMC Carnegie Report – Goals of Reform o Standardization of learning outcomes and individualization of the learning process o Integration of formal knowledge and clinical experience o Development of habits of inquiry and innovation o Professional identity formation
  15. 15. |||© 2017 MCC | CMC #MCCam #aaCMC Future of Medical Education in Canada (FMEC) FMEC-MD Report Association of Faculties of Medicine of Canada. (2010). The Future of Medical Education in Canada: A Collective Vision for MD Education. Ottawa, ON: FMEC-PG Report Association of Faculties of Medicine of Canada. (2012). The Future of Medical Education in Canada: A Collective Vision of Postgraduate Medical Education in Canada. Ottawa, ON:
  16. 16. |||© 2017 MCC | CMC #MCCam #aaCMC The physician of the 21st century (FMEC) • Skilled clinician • Able to adapt to new knowledge & changing patterns of illness as well as new interventions, personalized therapeutics and rapidly changing medical science and health care systems. • Physicians will need to: - Be independent and critical thinkers, capable of appraising evidence free from - personal bias and inappropriate influence. - Manage uncertainty, tolerate ambiguity, non-algorithmic work
  17. 17. |||© 2017 MCC | CMC #MCCam #aaCMC Physician of the future (FMEC cont..) • Highest level of professionalism • Medical expertise, a deep understanding of the patient, family and population, excellent communication skills, compassionate care and productive interactions with medical colleagues, co-workers, and the public • Work with other health professionals as team members and as partners in leadership for health-system management and change. • ‘Civic professionalism’ -physicians feel an individual obligation to their patients but also collective obligation to local and global communities • Life long learning skills, capacity to practice for 30 to 40 years in a constantly shifting environment
  18. 18. |||© 2017 MCC | CMC #MCCam #aaCMC FMEC-MD Recommendations I. Address Individual and Community Needs II. Enhance Admissions Processes III. Build on the Scientific Basis of Medicine IV.Promote Prevention and Public Health V. Address the Hidden Curriculum VI.Diversify Learning Contexts VII. Value Generalism VIII. Advance Inter- and Intra- Professional Practice IX. Adopt a Competency- Based and Flexible Approach X. Foster Medical Leadership Enabling Recommendations A: Realign Accreditation Standards B: Build Capacity for Change C: Increase National Collaboration D: Improve the Use of Technology E: Enhance Faculty Development
  19. 19. |||© 2017 MCC | CMC #MCCam #aaCMC FMEC-PG Recommendations 1. Ensure the Right Mix, Distribution, and Number of Physicians to Meet Societal Needs 2. Cultivate Social Accountability through Experience in Diverse Learning and Work Environments 3. Create Positive and Supportive Learning and Work Environments 4. Integrate Competency- Based Curricula in Postgraduate Programs 5. Ensure Effective Integration and Transitions along the Educational Continuum 6. Implement Effective Assessment Systems 7. Develop, Support, and Recognize Clinical Teachers 8. Foster Leadership Development 9. Establish Effective Collaborative Governance in PGME 10. Align Accreditation Standards
  20. 20. |||© 2017 MCC | CMC #MCCam #aaCMC Medical Council of Canada Blueprint Project o Purpose was to evaluate how well the MCC’s exams reflect the reality of medical practice and the health-care needs of society today o MCC Blueprint Project involved a substantial review of the content covered on MCC examinations o New Blueprint is a matrix of foundational core competencies to assess the readiness of medical graduates to enter residency and independent practice
  21. 21. |||© 2017 MCC | CMC #MCCam #aaCMC Medical Council of Canada Blueprint Project
  22. 22. |||© 2017 MCC | CMC #MCCam #aaCMC Competency-based Medical Education
  23. 23. |||© 2017 MCC | CMC #MCCam #aaCMC Common Learner Portfolio
  24. 24. |||© 2017 MCC | CMC #MCCam #aaCMC So, what should be the contemporary priorities in medical education?  Competency-based approach- public schools doing too! “A New Kind of Classroom: No Grades, No Failing, No Hurry” (Aug 2017 New York Times)  Flexibility in learning pathways (incl. options for combined degrees)  Integration of basic and clinical sciences, with early clinical experiences  Active learning model, fewer if any, passive lectures  Effective use of eLearning  Interprofessional with community exposure 24
  25. 25. |||© 2017 MCC | CMC #MCCam #aaCMC … contemporary priorities (cont.)  Explicit teaching of cognitive sciences  Support professional identity formation  Learning about illness prevention and public health  Learning about health care system, patient safety, QI  Multiple types/points of assessment to enhance learning and allow early identification of gaps (programmatic assessment)  Comprehensive faculty development-critical 25
  26. 26. |||© 2017 MCC | CMC #MCCam #aaCMC Typical attendance of traditional lectures Integrative Summary and Application Lecture
  27. 27. |||© 2017 MCC | CMC #MCCam #aaCMC Example of a (now not so new)concept- Longitudinal Integrated Clerkship (LInC) A LInC is characterized by being the central element of clinical education whereby medical students: 1) Participate in the comprehensive care of patients over time; 2) Participate in continuing learning relationships with these patients’ clinicians; and 3) Meet the majority of the year’s core clinical competencies, across multiple disciplines simultaneously through these experiences. -The International Consortium of Longitudinal Integrated Clerkships 27
  28. 28. |||© 2017 MCC | CMC #MCCam #aaCMC Longitudinal Relationships “Turns out, it’s not WHERE, but WHO you’re with that really matters.” -Dave Matthews 28
  29. 29. |||© 2017 MCC | CMC #MCCam #aaCMC A SUBLIME Vision of the Future o Can lessons learned from and potentialities of LInCs be applied to medical education as a whole? o Can we be student-centered and patient- centered? o Can’t ignore the democratization of knowledge and role of teacher in medical education o Importance of meaningful contact for learning and professional identity formation
  30. 30. |||© 2017 MCC | CMC #MCCam #aaCMC The medical school of the future? • longitudinal integrated clerkships evolve to a full longitudinal integrated model of medical education, commencing at the beginning of training, and not restricted to traditional clerkships. • Supervisor Based Longitudinal Integrated Medical Education (SUBLIME), based entirely in the clinical workplace(s) of the supervisor. • Is this the next evolution of a fully integrated CBME system across the continuum of medical education? 30
  31. 31. |||© 2017 MCC | CMC #MCCam #aaCMC Coaching 31
  32. 32. |||© 2017 MCC | CMC #MCCam #aaCMC The medical school of the future? • Distributed internet enabled loose network of supervisor-based longitudinal medical education across each country (even crossing borders where helpful) • Supported and funded by communities and their health services (and students where relevant), who negotiate with educational institutions of their choice to assess and accredit the learning outcomes and award the requisite qualifications when the student has attained the required competencies. 32
  33. 33. |||© 2017 MCC | CMC #MCCam #aaCMC The medical school of the future? • Provides opportunity for students to sit accredited assessments, based around entrustable professional activities (EPAs), that would not be time dependent, but based on supervisor recommendations of readiness, irrespective of the length of the study. 33
  34. 34. |||© 2017 MCC | CMC #MCCam #aaCMC The medical school of the future- Role of University? • provide guides to the teaching and learning materials already available on the Internet • provide high quality faculty development to teachers, mentors and coaches • provide programs of ‘assessment for learning’ that can be used by the students and teachers to guide their progress • provide or support accreditation processes 34
  35. 35. |||© 2017 MCC | CMC #MCCam #aaCMC The medical school of the future- Role of University? • manage complaints by learners • provide pre-requisite assessments in the basic biomedical and social health sciences • provide guidelines for professional conduct 35
  36. 36. |||© 2017 MCC | CMC #MCCam #aaCMC A SUBLIME Vision of the Future o Evolutionary or revolutionary, transformative or incremental? o Supervisor Based Longitudinal Integrated Medical Education = SUBMLIME o Workplace-based assessment of readiness by those closest to students o Maintain relationships with educational institutions, who would help support “micro-schools” o Not a return to the past of apprenticeship, but a transformative response to the future Ref: Worley, P., Rosenfield, J, A Vision for Longitudinal Integrated Clerkships (LICs) in Nations with National Health Systems in Longitudinal Integrated Clerkships (LICs): Principles, outcomes, practical tools and future directions, Eds. Poncelet, A., Hirsh, D., Alliance for Clinical Education, 2016
  37. 37. |||© 2017 MCC | CMC #MCCam #aaCMC© 2017 MCC | CMC THANK YOU! @RosenfieldJay