Dr. Erica Sutton, M.D., a surgeon with University of Louisville Physicians, and Dr. Amy Holthouser, M.D., an associate dean for medical education at the University of Louisville School of Medicine, discuss best practices for training new doctors.
“Back when I was in medical school,” says host Dr. Wayne Tuckson, “the concept was “Learn everything you can, and then after you finish medical school, that’s when you learn to be a doctor.’”
Such a neat, orderly transition from acquiring knowledge to developing clinical skills and a bedside manner is beyond passé in the medical community these days, and those ambitious and dedicated enough to pursue careers in medicine are well aware that the learning path begins early and immediately, and is truly a never-ending one.
In this week’s Kentucky Health, Dr. Tuckson talks with two University of Louisville doctors about the most effective ways to train budding physicians and surgeons as they prepare for their professional careers.
Measuring success in a demanding discipline
Dr. Erica Sutton, MD, is a general surgeon with U of L Physicians, and Dr. Amy Holthouser, MD, is an associate professor of internal medicine and pediatrics at U of L. Both are also assistant deans of medical education at U of L.
According to Holthouser, the general public is familiar with the basics of medical practice from popular television shows such as “ER” and “House.” But they may be unaware of just how detailed and drawn-out medical training is, and how many sacrifices residents must make in order to obtain a medical degree.
“I think we have a lot of work to do to meet the interest and fascination the public has [about doctors] with substantial information that is both reassuring and informative, and helps them see that medical education and medical training is actually extremely elaborate, and extremely intensive, and that before a person gets to a point where they’re practicing independently on a patient, there’s a lot of checks and balances in place to make sure that the public is safe.”
The University of Louisville Medical School requires that female enrollment among its student population does not fall below 40 percent. Moreover, around 30 percent of medical students at U of L qualify as non-traditional. According to Holthouser, these metrics enhance the training programs at U of L by creating a more diverse group of students that have varied life experiences and a willingness to collaborate.
The medical school’s success in creating such a dynamic student population was recently recognized when U of L was named the pilot site for a training program tailored to assist LGBT patients established by the Association of American Medical Colleges.
Even if students work in teams, much of the medical training at U of L is ultimately tailored to an individual student’s proposed area of expertise. And instead of tallying cases or hours worked, Sutton says that she assesses successful training by how well each student masters both core hands-on medical training and the valuable communication skills necessary to interact with patients. These must be acquired gradually and under close supervision and guidance.
A “lifelong process” of learning
Sutton says that she emphasizes to her students early on that medical education is a lifelong process. The initial demands for students in the field of general surgery are daunting, and only get more rigorous, but there are many new technologies and techniques that help along the way.
“There’s always going to be a cognitive assessment of your competency – that usually begins most of our training,” she says. “What we’ve added to surgical training is a practice field. These exist in virtual reality or a simulation lab that residents are required to participate in before the will be certified. … Now, after you have demonstrated competency in the practice field, then with close supervision you will have the privilege of operating on another person.”
Sutton says that the use of models in training has increased in recent years, and that one “human simulator model” costs $250,000. Students train on these three-dimensional, responsive models, and then apply their skills assist in operating on an actual patient. Patients who agree to undergo such operations are assured beforehand that Sutton will maintain total control of the procedure.
For students aspiring to become internists (doctors specializing in long-term care of patients with particular diseases), Holthouser says that the training is different. In addition to learning about disease pathology, students must master the sort of procedural skills akin to detective work, in order to come up with a plan for treatment that may last for a patient’s entire life and could require many changes along the way. Just as important, students must also master interpersonal skills, in order to both manage other doctors and to partner with each patient in treating the specific disease.
Communication Is Key
“We all know brilliant surgeons, or brilliant subspecialists, or brilliant primary care doctors who do a great job medically but cannot communicate, can’t form that therapeutic relationship [with the patient],” Holthouser says, “so medical education has to address all of those things.”
During residency, students are required to develop and test these interpersonal skills with what Holthouser calls “standardized patients.” These are actors trained in a particular medical discipline who will ask the resident relevant questions and display behavior applicable to their condition. For example, residents first relay bad news about a prognosis to standardized patients, and then receive feedback later to improve their bedside manner.
Sutton says that U of L is also committed to giving students instruction in “cross-cultural competency,” which will enable them to identify unconscious biases they may have about certain patient populations that can inhibit care. Holthouser says that many students arrive to medical school with altruistic worldview and consider themselves to be compassionate and fair, and are often shocked to find out how many preconceived biases they harbor about people from different backgrounds once they begin training.
Overall, both Sutton and Holthouser say that medical training has improved by leaps and bounds over the past 20 years and that the emphasis on teaching communication skills is a big reason why. Students who are taught to interact with patients in medical school are set on a path where they can continue to refine those skills throughout their professional career. This guarantees better individual patient outcomes and improved public health in the long run.