How can medical students in 2019 learn all there is to know in medicine in four (or even five) years of school?
When I was in medical school and residency training more than 30 years ago, there were 400 to 450 FDA-approved medications (including OTC products). Only about 150 of those were applicable to my patients. I learned them all, their possible side effects and contraindications. Since then, the number of FDA-approved drugs has tripled, making it impossible to keep up. Now I have to rely on my subspecialty consultants to know the medications specific to their limited scope of practice, which I am exposed to less often.
Similarly, technology has led to more treatments and procedures -- microsurgeries, laser surgeries, robot-assisted surgeries and more -- that may benefit patients. Again, recently I have found consultants recommending therapies with which I am not familiar.
Simply put, the explosion of knowledge in medicine has made staying current challenging. Throw in the evolution of electronic health records, and medical students have more cognitive knowledge to master to become physicians than I or my peers ever did.
But many of us older folks benefited from an excellent education in the doctor-patient relationship and other arts that are crucial in all fields of medical care, not just in primary care. Although even long ago, medical school was no walk in the park, there was time between scientific knowledge acquisition activities to learn this art: how to cultivate an effective and caring doctor-patient relationship and how to use other modalities along with that medical knowledge base to serve patients.
It's no wonder that a current medical student might be drawn to a limited-scope specialty rather than the broad, comprehensive, evolving field that is family medicine. But as family doctors, we know how important it is for every doctor to practice the art as well as the science of our work to be successful in our healing field.
Despite recent advances in the curriculum by some medical schools, students spend much of their first two years focused on core science classes before starting clinical rotations in their third year. By the start of year four, most have made important decisions about their career path, yet many still have their family medicine/primary care rotation ahead of them. It leaves me wondering how -- and when -- students will learn the art of building relationships with patients. And if they don't have adequate exposure to this vital skill, which is at the heart of primary care, what are the odds that they will choose a broad-spectrum specialty like family medicine?
Medical schools should be actively resisting medical practice becoming a lost art. We must know how to care, listen and give our time. Relying on evidence-based medicine alone is no substitute for these skills. Students need to see the power of connecting with patients so that they can see what a rewarding and meaningful specialty family medicine can be for them.
The AAFP and seven other family medicine organizations have undertaken the 25 by 2030 project that aims to achieve 25% of U.S. medical students matching into family medicine by 2030. This is a big reach -- one that is vital to strive toward not just for our specialty, but for our country's health care.
Key to success in this goal is having high school and premed students exposed to the joy of a career in medicine, and medical students exposed early to what we do in our clinics that augments the scientific knowledge they are acquiring and transforms an excellent scientific physician into an excellent clinical doctor.
I wrote in this blog a few years ago that I had started precepting first- and second-year medical students again in my clinic after taking a break from it. What I rediscovered is that working with students is rewarding, and they do not slow me down or present an obstacle to an effective patient visit. More significantly, students are eager to acquire the noncognitive patient-physician relationship-building techniques that I model and teach them in my office. I've had students drive more than an hour to spend time with me in my clinic.
Students have told me that, even on busy days when there isn't much time for answering questions, they can learn a lot just by observing. Although there is so much to learn in medicine, they see the connection I make with patients. After more than 30 years in practice, I can read the expressions on my patient's faces and gauge how they react to my words.
The students I teach, as well as those I am exposed to in my AAFP travels, are eager to learn this aspect of doctoring. I recently gave up some of my clinic teaching to take on co-teaching small group sessions at the medical school. I am struck by the extensive check-off lists of competencies that each student must demonstrate. I empathize with my full-time faculty colleagues who have so much cognitive knowledge to teach (and check off on lists of achievements), and it has helped me understand how they struggle to include relationship-building education.
This early exposure requires schools to carve out time in the first year, and even the first semester, for students to learn the art of doctoring. It also requires us veteran physicians to accept students into our offices to watch us deliver health care and to practice that art as time allows.
If you aren't already connected to students, contact a medical school department of family medicine in your area, and embrace the role of mentor.
Alan Schwartzstein, M.D., is the speaker of the AAFP Congress of Delegates.