Collaboration in the Medical Field: What kind? How? Who?

The requirements and prerequisites for admission into medical are pretty straightforward. One year of biology, chemistry, biochemistry (optional at some schools), mathematics, physics, and English. A good MCAT score and GPA. A display of interest in the medical field and serving one’s community and examples of community involvement including, but not limited to, volunteering and research. Another requirement that seems to be a recurring theme in requirements across multiple schools is Teamwork skills.

 

“Teamwork skills. Medicine is a strongly collaborative endeavor. The applicant must demonstrate the ability to work successfully with others toward a common goal. A significant experience requiring teamwork is therefore expected in the course of the applicant’s academic and/or extracurricular activities and should be documented in the application” (excerpt from the requirements page of John’s Hopkins)

 

The field of medicine is inherently collaborative. Health care involves the interactions and proper communication between different kinds of health professionals across different specialties to find workable solutions to various problems. Medicals schools have been pushing for a curriculum that prepares medical students for the extent of collaboration that is required. First-year students at Penn State College of Medicine work as “patient navigators,” which involves helping families of the ill and injured understand the medical system and work through it.  Students at New York University School of medicine required to take a course that investigates the drastic differences in cost-of –care across the country and what causes these problems. At Hofstra North Shore-LIJ School of Medicine, medical students spend their first eight weeks becoming emergency medical technicians and learning lifesaving skills that are useful tools to have as a medical professional. Some funding has been allocation to support interpersonal education which combines studies across the five health schools: medicine, nursing, pharmacy, dentistry, and allied health professions. At Virginia Commonwealth University, interpersonal education involves students from different health disciplines in a unified course working together in small teams.

These progressions show that medical schools are actively interested in preparing students for the true “turbulence” of the world and its unpredictability, much like Michael Maniates was advocating for in Teaching for Turbulence.

 

 

However, collaboration within the medical field is generally one-sided and the requirements reflect the nature in which collaboration is kept between peers/other medical professionals.

 

Samie Johna and Simi Rahman write of the damaging effect that Flexer’s report in 1910 had on the future of medical education. Flexner definied the goal of medicine to “fight the battle against the disease.” Flexner’s model of medical education shaped  the field to address the underlying biological alteration (disease) while actively neglecting the psychological and social impacts of the disease on an individual (illness) and resistance to this model occurred in the 1970s. However, this model still seems to prevail, because medical schools are not using collaboration in the wholesome manner.

 

 

 

With all of the hype about collaboration, the collaboration that medical schools push for seems to be only one-sided at times: a focus on the collaboration of the health professionals results to find the best solutions.  While ability to work in teams is necessary, the ability to recognize patients is a necessary part of a team and utilizing them is just as important. The field of narrative medicine emphasizes the importance of physicians understanding their patients’ diseases, treating their medical problems and accompanying them through their illnesses. Narrative medicine can be described as the attack on structures the Flexner model created through rehumanizing medicine and using stories of illness to aid in the process of healing. Narrative medicine also  urges the narration of physicians’ own experiences with illness in order to allow for them to express empathy and to also forgo the erroneous idea that an individual can not simultaneously be a patient and physician.

 

In order to observe real, effective changes that will propel the medical field away from the Flexner model, changes have to begin at the root. The root, in my opinion, is health institutions that create health professionals that have the power to influence the way that care is given.

 

Key Changes in Medical School Operations and Trainings

(The changes that I propose are only aimed towards medical schools, but I think the changes are translatable over various health institutions.).

 

 

1. Mandatory and Unified Curriculum Additions
   1.  Integration of Narrative Medicine principles 
   2. Expansion of teaching settings
   3. A Change in Admission Requirements and the Selection Process

 

 

Mandatory and Unified Curriculum Additions

 

Since the first two years of medical school are meant to equip medical students with fundamental skills and knowledge, all medical schools must begin to include a course to be taken by third-year medical students to prepare themselves for methods of approaching “collaborative” thought before they enter the active clinical rotations.

 

This course would be taken by all third-year medical students during the first four weeks of their third year, for two hours a week. The course, tentatively titled Narrative Medicine and Introspective Explorations, would be a course dedicated to instilling narrative medical principles and ecological, collaborative thought.

 

Working (Rough,Vague) Syllabus:

 Goals: Exploring themes of ecological collaboration and the applicability of narrative medicine in making up for shortcoming of the medical system model in place.

 Each Two Week Session will be br

WEEK 1: Shortcomings in the Current Healthcare Model System (in terms of healthcare and quality of services and treatments)

Part I: Group Explorations of Case Studies that show effects of lack of collaboration/poor communication/barriers between medical professionals and patients. 8-10 Case Studies.

a. Class splits into group of 3s. 8-10 case studies passed around. 30 minutes per group of. 30 min.

        b. Rotation of members  into other groups and discussing findings. 15 min.

        c. Class Discussion of findings. 15 min.

 

Part II: Understanding the structures in place that allow these shortcomings to happen

            a. History of the development of the medical field as an industry. Lecture. 1 hour

 

Homework: Read Introduction of Timothy Morton’s The Ecological Thought & Humanity before Science: Narrative Medicine, Clinical Practice, and Medical Education by Samir Johna and Simi Rahman

 

WEEK 2: Introduction to Narrative Medicine.

 

Part I: Introduction of Narrative medicine: history, conception, reception. 30 minutes

 

Part II: Discussion on the reading: student feedback. Will it work? Is this a pausible solution What is the Ecological thought and how does it apply to the medical field? How can it be incorporated.

1. 15 minute individual writing activity of what narrative medicine means and how ecological thought applies in this context.
2. 45 minute Group discussion on reflections

 

 

WEEK 3: Practicing Narrative Medicine

 

Part I: Revisiting Case Studies from Week 1 and making adjustments as a collaborative thinker and coming from a narrative perspective.

 

 

Part II: As a group, explore a change that you think could bring positive change to the health field and present it to the group. 10 minute presentations explaining the value of this change, its practicality, its necessity, and its value. The group should also

 

 

WEEK 4: Group Presentations

 

Follow Ups throughout 3^rd and 4^th years.

 Frequency: Once a week for an hour during clinical rotations.

Purpose: Look through cases and explore any teaching, learning moments. Valuable lessons that show the improvement of the health field and its treatment of the patient as a whole individual.

Who: The groups of 3s that were formed during

 

Expansion of Teaching Settings

 

In the traditional model, the first two years of medical school are based on setting the foundations upon which medical students will be pulling from including: biochemistry, anatomy, topics in clinical medicine, etc. The third and fourth years are when students are introduced to hands-on aspects of the teaching environment through clinical rotations in various specialties of health care including family medicine, pediatrics, ambulatory care, etc. These clinical rotations are usually done within teaching hospitals or medical care facilities approved and sponsored by the medical school. The teaching facilities are important in providing students exposure to first-hand treatment in a controlled environment, and are often places where many people who may not have private insurance can find care. These teaching hospitals are also breeding grounds for new technologies and treatments as a place that encourages learning, research and collaboration. 

 

But, are teaching hospitals/clinics the only places of legitimate and valuable learning? Medical schools should include a rotation that focuses on using the acquired skills from the 3^rd and 4^th years, to aid local, underserved areas that may be lacking of quality care. I’m thinking of Teach for America, but with continued guidance from the medical professionals that have been supervising the students throughout each rotation.  These underserved areas would include local regions that are suffering from a lack of access to quality medical care such as primary and secondary schools with low-funding, local clinics that may be understaffed, or even prisons with inmates that are not provided adequate care.

 

Although some teaching hospitals are placed in “urban” area and are considered to be “safety net” hospitals that will admit patients who can not afford private insurance, a different type of learning is acquired when placed in a setting that may not be as advanced or clean-cut as these academic institutions. Working with marginalized groups, within the constraints of the facilities that they have access to, pushes students to a new level of understanding and learning to overcome the “turbulence” that may arise.

 

 

Change in the Selection Process

Reading this request of teamwork ability in juxtaposition to the academic requirements leaves me in wonder about how an applicant is to convey these ”teamwork skills.” Aside from the occasional group project and working with lab partners, the academic requirements requested appear to leave no true space for genuine collaboration. College, itself, can be seen as one huge individual endeavor. The grades earned are assigned to a single individual. The work is often done individually, admittedly with the aid of professors, tutors and TAs. MCAT scores and GPAs are all individually assigned. Often times, teamwork ability has to be shown outside of an academic setting.

 

Therefore, I think that the selection process should include a group interview in which participants work on case studies and discuss the tactics that they would undergo to find a solution. This is very remiscent of the process in which the Posse Foundation screens for Posse Scholars: the Dynamic Assessment Process. The case studies would not necessarily be based on knowledge medicine, but based in ethics and real life situations. I would like some of the case studies to be in the perspective of the patient/patients’ caregivers.

 

An example scenario would have students discussing issues of life support and a conflict that one family may have with deciding whether or not to keep a family member on life support. The group interview would have interviewees split into further groups of 6 members and a medical school admissions officer/worker would sit in on the conversations and listen and observe what the applicants have to say. Taking notes. The applicants will then have an opportunity to write about this experience and what they thought about it. Questions on the debriefing form would include:

 

How did you feel about this process?

Did you feel that your group was able to come to a conclusion?

Did you feel that your group take into consideration all of the possibilities and their effect? Why or why not?

If so, was your conclusion different from the others?

What did you gain from this experience?

What would you change about this experience?

 

These questions would give an insight into the thought processes of the applicant and their views on making collaborative effort.

 

Academics and recommendation letters can’t give the clearest sign of a perfect medical school applicant and neither can this additional screening process. However, this addition would allow medical schools to actively search for teamwork ability rather than just asking for explanations written on paper. Even if this group interview wasn’t plausible, similar scenarios could be given in 1:1 interviews and still indicate some of those same qualities. However it would be done, the teamwork requirement could not simply be one that is written on the website and hoped to be true. This only allows for the perpetuation of the idea that collaboration only happens when it is “forced” or “required” rather than it being a natural part of the process which is what the medical field is hoping to move towards.

 

 

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