Medical Education

 This week our LWV-PA Healthcare Committee put on a session focused on the new medical school in Pasadena, the Kaiser Permanente Bernard J. Tyson School of Medicine. Margan, as the Chair of our committee, worked extremely hard to bring this to fruition. It had to be delayed several times, not least because of the covid pandemic, but it finally occurred this past Thursday. It sparked conversations between M and me because of how the concept of undergraduate medical education has changed since we went to med school.

The paradigm that Temple and Maryland, as well as all other medical schools in the 60s and 70s operated under, was a result of the Flexner Report in 1910. Medical education in America at the turn of the 20th century was a hodge-podge. There were a few excellent schools (Johns Hopkins) and many plain lousy diploma mills. Flexner helped reform medical education so that the Hopkins model (and its German roots) became the norm. This resulted in a standardized curriculum that definitely improved medicine because it was based on science. Requirements for entry to medical school became more rigorous; completion of a baccalaureate degree with science courses prior to matriculation to med school, followed by a period of post-medical school education in a hospital that provided clinical training before a physician could be licensed. This model has persisted to this day.

However, there is today an ongoing reassessment of the model. As Thomas Duffy noted in a paper from Yale, the emphasis on the hyper-rational system of German science created an imbalance in the art and science of medicine. As KPSOM and other medical schools today are doing, the curriculum is being revised to better integrate the realities of medicine today: working in teams; focusing on diversity, equity, and inclusion in medical education; and fostering the fact that physicians really deal with people and not just their diseases, syndromes, and symptoms.

The panel from KPSOM included faculty members who discussed how this was being done. It also included a first-year student who very nicely presented his typical week in medical school. I found this fascinating to say the least.

Gone are gross anatomy lab with its formalin-preserved cadavers, replaced with plasticine predissected cadavers and holographic devices that show in three dimensions and from all angles what organs look like. Labs use simulations for chemistry and physiology rather than benches with reagents and dogs. The benefits of technology bring much to the old days of analog searches through the medical literature (remember Index Medicus?) and a whole variety of simulations. History taking is sharpened by the use of skilled actors who play a patient while the student learns the intricacies of ferreting out what a problem is.

So, do I regret my time at med school at Temple in the early 1970s? No, I do not. I have many fond memories of the classes in Kresge Auditorium with tons of information that I may not completely remember but that sharpened a work ethic for learning that I had already built in the public school and university days before arrival. I remember the smell of the gross anatomy lab with mixed feelings (especially when formaldehyde was found to be carcinogenic). Physiology lab with dogs was always intense and I felt a pang every time we euthanized the dog at the end. And the clinical years were hard, intense, and so rewarding that they still resonate in my memory. 

Memory is, of course, not something fixed but something that transforms for each of us over time. We tend to submerge the memories that are bad or painful and promote the memories that we find good. That is simply human neuroscience at work. After listening to the presentations from the KPSOM panelists, Margan and I talked and agreed we did not regret the model in which we became physicians. As Duffy alludes in his paper, perhaps the one thing that the KPSOM model does better is foster a clearer path to humanism in medical education. Medical schools today emphasize that preparation in the humanities is as important as preparation in the sciences for prospective students. I sensed that the new model is an improvement in carrying that forth into the medical school experience. The science of understanding disease must be firmly linked to an understanding that the patient is a human being and understanding the human being is a skill that must be sharpened throughout one’s practice of medicine. Thanks, Temple, for preparing me for my profession; you gave me an excellent start. Medical education moves on and we saw that on Thursday. I hope that in 50 years hence a KPSOM graduate will feel the same.