In a national health care environment shaped by changing priorities and shifting policies, Senior Associate Dean Andrew Filak, MD, discussed how the UC College of Medicine is preparing to better educate medical students and adapt for the future of healthcare in his senior associate dean presentation Monday Feb. 18.
Filak gave his talk on medical education at UC in a presentation titled, "We’ve Only Just Begun,” to an audience in Kresge Auditorium.
In recognition of the Presidents Day holiday, he first quoted President Abraham Lincoln’s 1862 comment to Congress: "The dogmas of the quiet past are inadequate to the stormy present. The occasion is piled high with difficulty, and we must rise to the occasion.”
"There’s no doubt that we live in a rather stormy present with regards to health care,” said Filak, "but I have no doubt that we, both here in Cincinnati and as a nation, can rise to the occasion to create a health care system that works—and a key function of the health care enterprise is our system of medical education.”
Filak highlighted several medical education endeavors at UC already showing signs of success. The curriculum redesign is "off to a great start,” he said. Organizers are in the final stages of a new design for the third-year curriculum, beginning this summer, while also revising and improving the first year offering.
In medical school admissions, Filak said the number of applicants to the MD program has continued to rise, particularly from out-of-state students. In 2013, more than 5,000 students applied to the program, up from just under 4,000 in 2010.
Within the student body, the college is also reaching its goals for increasing diversity. In 2012, the College of Medicine achieved gender balance in its entering class and saw 10 percent of those students coming from an underrepresented minority (URM) population. Compared to this time last year, the college has seen a 14.3 percent increase in URM applications and a 27.6 percent jump in URM acceptances.
"We’re optimistic that these gains will lead to an increased number of matriculating students from underrepresented minorities,” said Filak.
He went on to address an issue important to many of those students—the large amount of debt that graduating physicians face. The average medical school debt for a UC student is $164,625, with 80 percent of students graduating with more than $100,000 of debt, just over the national average.
"But what really worries us is the percentage of students graduating with significant debt,” said Filak. "Ten percent of our classes are graduating with more than $250,000 of debt.”
Filak further discussed the difficult environment these students graduate into as growth in residency training programs is not keeping up with growth in medical school enrollment. The result is that medical students may find it more and more difficult to obtain a residency training position upon graduation.a
"So to summarize,” he told the audience, "we’re graduating more students, with a large debt load, with a relative static number of core residency positions, while facing GME (graduate medical education) and other funding cuts and we’re also anticipating a physician shortage.”
But despite that stormy present, Filak highlighted ways in which the college is working to expand its offerings in medical education—specifically with a new venture in undergraduate education.
Professor of molecular genetics Anil Menon, PhD, is leading the effort to develop an undergraduate minor in medical sciences taught by College of Medicine faculty on the medical campus. The program is on track to begin this fall, offering up to 50 students a total of 18 credit hours of education in the health sciences.
The ultimate plan, said Filak, is for the minor to eventually lead to a 4 year Bachelor’s in Medical Science program, with a proposed start date of fall 2015.
Filak also discussed the opportunities for intra-university collaboration in launching new dual-degree programs or certificates, including a joint MD-MPH degree, business certificate in conjunction with the Linder College of Business and partnership programs with the colleges of nursing, pharmacy and allied health sciences.
On the high-level view of medical education, he said there will be pressure on educators to look at the length of education at all levels of the continuum.
"This will be driven both by the anticipated physician shortage and by finances,” he said. "Can individuals afford 11 to 18 years of training from college through residency? Can we as a society afford both in terms of dollars and time?”
That may mean earlier specialization for students. There is also a movement toward a competency based education in which students may move at their own pace of learning, rather than following a set timeline. It is yet unclear as to whether this will lead to an overall shortening of or lengthening of the educational timeline.
Filak closed with a view into the future of medicine—with the broadening availability of advanced health care technology, increased patient control and a greater ability to communicate with providers and patients. He focused on a need to adapt the medical education program to how tomorrow’s physicians will practice. How can medical schools prepare their graduates for an uncertain future in a rapidly changing world?
"We have the opportunity to make this happen,” he said. "Following the dictum of President Lincoln, we must rise to the occasion in these turbulent times—that’s the exciting part. And yes, we’ve just begun.”