“I was not taught this in medical school myself,” says McKean. “We haven’t taught people how to be specific about working in teams, how to communicate with peers and colleagues and how to communicate to the general public about what’s going on in health care and medicine.”
It’s just one of many such changes, and it’s dramatically different from the traditional way medicine has been taught. Flexner’s model is known as “two plus two.” Students spend their first two years in the classroom memorizing facts. In their last two years, med students shadow doctors in hospitals and clinics. Mangrulkar says Flexner’s approach represented a huge change from the way doctors were taught in the 19th century.
“Literacy was optional, and you didn’t always learn in the clinical setting,” he says. Shortly after Flexner published his landmark review of the state of medical education, dozens of the nation’s medical schools closed or merged.
But today, says Mangrulkar, the two-plus-two model doesn’t work. For one thing, there’s too much medical science for anyone to learn in two years. And the practice of medicine is constantly in flux.
What Michigan and many other schools are trying to do now is prepare future doctors for the inevitable changes they’ll face throughout a long career.
“We shouldn’t even try to predict what that system’s going to be like,” he says. “Which means we need to give students the tools to be adaptable, to be resilient, to problem-solve — push through some things, accept some things, but change other things.”
One big shift at many schools is a focus on how the entire health system works — rather than just training doctors how to treat patients.
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