1. Medical Education for the Future We Haven’t Invented Yet (or flying the plane while building it) Wisconsin Association of Osteopathic Physicians and Surgeons May 29,2015 Lisa Grill Dodson, MD Campus Dean, MCW Central Wisconsin ldodson@mcw.edu

2. Disclosure I certify that I have no material personal or professional conflict of interest to disclose

3. Objectives 3

4. What do we want? Doctors In the right numbers (supply) In the right places (maldistribution) In the right specialties (overspecialization) Safer care More effective care More patient centered care (“nothing about me without me”) More teamwork 4

5. Pop Quiz: How do we get the doctors we need? A.True or False: Educate the smartest students (MCAT and grades) and they will have all the skills needed B.True of False: Educate students in the best universities and they will become the doctors we need. C.True or False: Medical schools routinely follow best practices in adult education techniques, with “no hidden curriculum” D.True or False: Allowing market forces to determine specialty choice ensures the right specialty mix E.True or False: Current payment policies favor a correct mix of physician specialties 5

6. Results “Good doctors, trained and rewarded for doing too many of the wrong things in the wrong places in the wrong system, unsafely” Anonymous Keep the good doctors Change the healthcare system and it’s reward system Address payment system Triple aim (better quality, better experience, lower cost) Build an education system for the future 6

7. Start with the end in mind (a few examples) What would a perfect medical education system look like? All students have clear motivation for becoming a physician All interested students have a shot at becoming a physician Students (doctors) are representative of all aspects of society The admissions process rewards character as well as intellect and test taking Students would not be subjected to a “hidden curriculum” re: career choice Curriculum would match what is needed for practice Medical specialty mix would match societal need Patients would not be disadvantaged by income or geography 7

8. What now? The “new Flexner report” Cooke et al. Educating Physicians: A call for reform of medical school and residency 2010 GoalsChallengesRecommendations Standardization and Individualization Medical education is: Not outcomes based Inflexible Excessively long Not learner centered Standardize through competency based assessment Individualize learning Support development of skills for inquiry and self improvement Integration Poor connections between formal knowledge and experiential learning understanding of patient experience understanding of nonclinical and civic role of MD Early clinical experience Time for reflection and study Integrate basic, clinical, social sci Comprehensive focus on patient experience(incl longitudinal connection) Experience broader MD roles Interprofessional and teamwork exper Habits of Inquiry and improvement Focused on todays skills/knowledge, not long term excellence Inadequate attention to populations, practice based learning/improvement Insufficient participation in improvement activities Prepare for routine and adaptive expertise Engage learners authentically Population health, QI and pt safety exp Locate in many settings of quality care delivery not only Univ teaching hosp Professional formation Failure to assess, and advance professional behaviors Inadequate expectations for progressive involvement Erosion of professional values due to pace and commercialization Formal ethics instruction Address hidden curriculum Longitudinal mentoring/advising Promote relationships with faculty Collaborative learning environments 8

9. What now? The “new Flexner report” Cooke et al. Educating Physicians: A call for reform of medical school and residency 2010 GoalsChallengesRecommendations Standardization and Individualization Medical education is: Not outcomes based Inflexible Excessively long Not learner centered Standardize through competency based assessment Individualize learning Support development of skills for inquiry and self improvement 9

10. What now? The “new Flexner report” Cooke et al. Educating Physicians: A call for reform of medical school and residency 2010 GoalsChallengesRecommendations Integration Poor connections between formal knowledge and experiential learning understanding of patient experience understanding of nonclinical and civic role of MD Early clinical experience Time for reflection and study Integrate basic, clinical, social sci Comprehensive focus on patient experience(incl longitudinal connection) Experience broader MD roles Interprofessional and teamwork exper 10

11. What now? The “new Flexner report” Cooke et al. Educating Physicians: A call for reform of medical school and residency 2010 GoalsChallengesRecommendations Habits of Inquiry and improvement Focused on todays skills/knowledge, not long term excellence Inadequate attention to populations, practice based learning/improvement Insufficient participation in improvement activities Prepare for routine and adaptive expertise Engage learners authentically Population health, QI and pt safety exp Locate in many settings of quality care delivery not only Univ teaching hosp 11

12. What now? The “new Flexner report” Cooke et al. Educating Physicians: A call for reform of medical school and residency 2010 GoalsChallengesRecommendations Professional formationFailure to assess, and advance professional behaviors Inadequate expectations for progressive involvement Erosion of professional values due to pace and commercialization Formal ethics instruction Address hidden curriculum Longitudinal mentoring/advising Promote relationships with faculty Collaborative learning environments 12

13. MCW-CW Mission: Address the shortage of primary care and psychiatry in northern and central Wisconsin. Barriers:  Geography  Social/cultural  Educational (K-premed)  Financial  Curricular 13

14. MCW- Central Wisconsin features Regional campus of Medical College Wisconsin Bi-directional digital classrooms, basic sciences Regional clinical classrooms, clerkships Mission: meet workforce needs of central and northern WI Primary care (FM, IM, Peds), Psychiatry, General Surgery Different mission, different students, different delivery model 25 students per year 134 week curriculum (154 week in Milwaukee): accomplish in 3 yr Longitudinal integrated clerkship model for clinical Scholarly Pathway: “Physician in the Community” Community partners, regional clinical exposure

15. Triple threat Regional campus 3 year curriculum Longitudinal integrated curriculum 15

16. Facilities update Aspirus Wausau Hospital: Administrative, classrooms Under construction, anticipated occupancy October 1, 2015 Northcentral Technical College: Anatomy labs, simulation Demo Summer 2015, construction Winter 2015-16 16

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18. Faculty : M1 and M2 year MCW faculty: basic science lectures Local/regional faculty opportunities: Clinical integration sessions (classroom, weekly) Mentoring Anatomy/procedure tutors Foundations of Clinical Medicine ( M1 July/August) Clinical apprenticeship: ½ day/wk primary care office ( with specialty exposures) Scholarly pathway project mentors 18

19. Faculty Development Begin Fall/Winter 2015 General information sessions Faculty 101 Targeted Faculty development based on role and interest Monthly sessions: in person with video archive 19

20. Faculty: M3 (clinical year) Longitudinal Integrated Clerkship Competency based, NOT time based PT faculty navigator for each health system Core primary care faculty over 9-12 months Specialty and hospital experience to achieve competencies Student driven, flexible MCW-CW staff do the tracking and monitoring 20

21. M2 summer and M3: What’s a Longitudinal Integrated Clerkship? Students: Participate in comprehensive care of patients over time Develop longitudinal, continuity relationships with faculty Address core clinical curriculum competencies across multiple disciplines simultaneously Source: Cooke, Irby and O’Brien. Educating Physicians: a call for reform of medical school and residency. 2010 and Consortium of Longitudinal Integrated Clerkships (CLIC) 21

22. Clerkship Models Traditional Block Longitudinal Ambulatory Track Hybrid Block & LIC Longitudinal Integrated Source: Janet Lindemann, University of South Dakota Sanford School of Medicine

23. DRAFT sample LIC schedule 23

24. Longitudinal Integrated Clerkship Data on LIC: [equivalent or better on most measures] Equivalent test scores, better retention, better patient interaction, less burnout, more enter primary care residencies, better residency director ratings SAVE THE DATE: LIC Consultation visit Friday October 16, 2015 (afternoon) Janet Lindemann, MD Dean of Medical Student Education University of South Dakota Sanford School of Medicine, 24

25. Questions? Lisa Grill Dodson, MD Campus Dean, MCW-CW ldodson@mcw.edu 715.847.0414 ldodson@mcw.edu