Culinary Course Offerings in Medical Schools Grow

Last April, when Yale Medical School, in partnership with the Yale New Haven Health System, opened the doors to the new Digestive Health Center in North Haven, it included the Irving and Alice Brown Teaching Kitchen. This kitchen has become the home for one of the medical school’s newest courses: Defining “Healthy”: Culinary Medicine for Chronic Disease Prevention. 

The course, co-taught by Nate Wood, MD, and Max Goldstein, the lead dietitian chef, integrates instruction in nutrition, cooking, and evidence-based science. Wood and Goldstein work with students to identify the health-promoting components of evidence-based diets and gain an understanding of how diet impacts disease. And students do all the cooking. 

Wood said that the motivation for the course stemmed from the knowledge gaps he saw between dietetics, medicine, and cooking. Dieticians know how to plan for a healthy diet but not necessarily how to cook. Chefs have the skills to make a meal but typically don’t receive training in nutrition. And physicians, who combat diseases brought on by a poor diet, often serve as a first point of contact for people interested in making better choices. 

“Food is a problem, but it can also be a solution, especially if we can bridge the gap among physicians, dietitians, chefs, and patients. Culinary medicine is not only vital to patient care, but it can also provide necessary nutrition education for students, medical trainees, and health care professionals,” Wood said.

Yale is not the only school to provide instruction in culinary medicine. The first training kitchen, the Goldring Center for Culinary Medicine at Tulane University’s School of Medicine, opened in 2012 and the number of programs offering such courses continues to grow. The Health Meets Food culinary medicine curriculum has now been integrated into 33 medical schools, as well as some residency and nursing programs. 

Medical Schools Incorporate More LGBTQ-Focused Programs into their Curriculums

Studies show that individuals who identify as LGBTQ report worse health care experiences and poorer health outcomes. But in following the lead of the AAMC, medical schools are working to remedy these health inequities by incorporating more LGBTQ-focused initiatives into their curriculums. 

Below, we highlight a few medical schools with notable LGBTQ-focused programs. 

• The University of Louisville School of Medicine serves as the nation’s pilot site for the eQuality medical curriculum, which trains future physicians on the health care concerns and issues encountered by individuals identifying as LGBT, gender nonconforming, or those who are born with differences of sex development. 

• The Icahn School of Medicine in New York City, the University of Wisconsin School of Medicine and Public Health, the Vanderbilt University Medical Center, and Harvard Medical School have each received AMA Foundation National LGBTQ+ Fellowship Program grants. The fellowship program is designed “to provide enhanced physician training, education, and cultural sensitivity while bringing awareness of the health care and institutional barriers faced by LGBTQ+ patients and intersecting communities.” 

• Brown University’s Warren Alpert Medical School offers a scholarly concentration in LGBTQ Healthcare and Advocacy. The concentration prepares medical students to serve gender and sexual minority populations as clinicians, with an understanding of and sensitivity to, the unique social, cultural, and political context of the health issues faced by these communities.

• The Stanford University School of Medicine offers the Lesbian, Gay, Bisexual, and Transgender Medical Education Research Group. This group aims to contribute to the field of LGBT health through innovative research, influencing health and educational policies, and advocating for LGBT patients and providers.

• The University of Washington School of Medicine Health Pathways Program provides educational opportunities and experiences to medical students, which will prepare them to provide culturally responsive care for the LGBTQ population. 

For prospective medical students interested in pursuing an education that includes rigorous preparation in LGBTQ care, U.S. News recently published useful tips from medical school administrators and professors that will assist you in gauging the strength of a program’s curriculum. 

• Inquire about how LGBTQ+ topics are integrated into the required coursework. "Offering it as a requirement really does put the teeth behind it in the curriculum, saying this is something for all students," Dr. Steven Rougas, Director of the Doctoring Program at Brown University's Warren Alpert Medical School, said.

• Look for LGBTQ+ clinics and/or institutes for study and research. "Looking for centers is how I would go about doing it," Dane Whicker, Clinical Psychologist and Director of Gender and Sexual Diversity initiatives in the Office of Equity, Diversity, and Inclusion at Duke University School of Medicine, said. He also noted that a particularly good sign is a center that conducts research and provides comprehensive treatment programs. 

• Ask about how LGBTQ+ courses are developed and updated. "One key question is how the institution plans for change," Dr. John A. Davis, the University of California-San Francisco School of Medicine's Associate Dean for Curriculum, wrote to the U.S. News in an email. "Areas particularly involving gender identity and expression and sexuality are rapidly changing, and curriculum must keep up with that. How an institution plans for that type of rapid change says a lot,” he wrote.

Biden Administration Works to Improve Nutrition and Health Education in Medical School Curriculums

Despite the prevalence of obesity and related diseases, including type 2 diabetes, hypertension, heart disease, cancer, and stroke in the US, there is little training on nutrition in American medical schools. 

Dr. Stephen Devries, a cardiologist and co-lead of the Nutrition Education Working Group at the Harvard School of Public Health, spoke about this gap in the medical curriculum on a recent AMA podcast. “Nutrition just hasn't been recognized as a priority in medical education, despite the fact that dietary changes are well recognized to be the leading risk factor for premature death and disability in the United States. On average, medical students spend about 19 hours over the course of four years in medical school on nutrition. But much of that is related to biochemistry and topics that are important but not directly clinically relevant for patients. So in the absence of meaningful nutrition education, what are medical students to think when they graduate, other than the fact that nutrition must not be very important in their training because they only learned about drugs and procedures?” he said. 

Due to the public health concern and the costs related to poor nutrition, government representatives are starting to speak up. From the House of Representatives to the White House, there are calls for action to improve education and outreach on nutrition and diet-related disease from medical schools to elementary schools. Earlier this year, following a congressional briefing with the Nutrition Education Working Group at the Harvard School of Public Health, Congressman McGovern (D, MA) and Congressman Burgess (R, TX) passed a bipartisan resolution in the House calling for “medical schools, residency, and fellowship programs to provide nutrition education that demonstrates the connection between diet and disease.” The resolution will encourage federal agencies to prioritize funding for medical “programs that incorporate substantive training in nutrition and diet sufficient for physicians and health professionals to meaningfully incorporate nutrition interventions and dietary referrals into medical practice.” 

In late September, the White House hosted its first Conference on Hunger, Nutrition, and Health in over 50 years where they unveiled a formal strategy to promote better nutrition and improve food security. The administration announced $8 billion in commitments, underneath five pillars, involving stakeholders from non-profits to universities to tech start-ups. The second pillar, “Integrate Nutrition and Health,” is most heavily geared towards medical students and physicians. Some of the named actions include:

• A commitment by the American College of Lifestyle Medicine (ACLM) to make an in-kind donation of $24.1 million to improve nutrition training for medical professionals

• A first-ever Medical Education Summit on Nutrition in Practice organized by the AAMC and ACGME to convene 150 medical education leaders

• A signed pledge by many leading health organizations (including the National Medical Association and National Hispanic Medical Association) to take action on strengthening health professionals’ nutrition education

• A commitment by The University of South Carolina School of Medicine Greenville to make a $4.8 million in-kind donation to assist in the implementation of its Lifestyle Medicine curriculum for interested medical schools and to provide content guidance to the National Board of Medical Examiners

Implicit Bias Training Could Be a Starting Point for Improving Health Equity

In 2020 Maryland’s state legislature passed a law requiring all health care providers in perinatal units to receive implicit bias training once every two years. Delegate Joseline Peña-Melnyk, the law’s sponsor, cited the striking disparity in maternal mortality rates (four times as high for black women than white women in Maryland) as the initial reasoning. However, in 2021, after seeing the pandemic’s devastation concentrated in minority zip codes, she introduced and the legislature passed an expanded bill. Implicit bias training was mandated as a licensing requirement for all healthcare professionals. 

Implicit bias training is predicated on the belief that most people hold unconscious biases related to race, gender, socioeconomic status, or weight. For many, the hidden biases directly contradict their conscious or stated views. And these latent stereotypes can take hold in times of multi-tasking, stress, or fatigue, which, in a healthcare environment, can impact care. “Health care providers, like everyone else … have an active way of processing information that is very conscious, but then we have these unconscious or implicit ways of processing information,” said Dr. Lisa Cooper, a researcher on racial health disparities at Johns Hopkins University. “There are things we’ve been exposed to throughout our lives that lead us to think and behave in certain ways. We think certain things but aren’t aware that we are thinking them.” The training seeks to bring awareness and acknowledgement of those hidden stereotypes so that a provider can notice when they’re occurring and proactively work against biases. 

Since 2019, five states—including Maryland—have adopted policies requiring implicit bias training for at least some segment of health care workers. And, more recently, eight additional states have had lawmakers introduce bills. It doesn’t stop there. Medical schools, including leading programs like Harvard, Icahn School of Medicine at Mt. Sinai, and Ohio State, have incorporated the training into their curriculum.

Research substantiates that implicit bias plays a role in provider care and patient interactions, and research will likely continue. Michelle van Ryn, a researcher on implicit bias in health care and owner of a company providing diversity and inclusion consulting services, wants to know more about how implicit biases impact health disparities and the efficacy of training. “Lots of people are doing interventions,” she said, “but there’s not a huge body of evidence of what works.” 

Student Bloggers Urge Medical Schools to Incorporate Gun Safety Training

Can medical schools play a role in preventing gun violence? David Velasquez, a fourth-year student at Harvard Medical School, and Jesper Ke, a third-year student at the University of Michigan School of Medicine think so. Their blog, published in StatNews, urges medical schools to take on gun violence by educating their students on the risks and empowering them to proactively speak with patients about gun safety and violence prevention. Just 15 percent of medical schools currently have gun-related material as a component in the curriculum.

The authors suggest the following curriculum updates:

• Teach the basics of responsible gun ownership and safety in class. The article notes that first-year medical students at the University of California, San Francisco used a small group discussion-based curriculum, which included a patient counseling role-play exercise.  

• Invite patients impacted by gun violence to tell their stories and discuss how guns have impacted them physically, mentally, and emotionally (similar to how patients battling disease are invited to share their clinical journey). 

• Incorporate relevant gun-related content into clinical rotations. The authors note that the Warren Alpert Medical School of Brown University updated their curriculum to embed firearm safety throughout the four-year program, and incorporate skills exercises into clinical rotations.

Trends in Medicine: Shortening the Preclinical Timeline

American medical schools have traditionally followed a similar structure: two years of preclinical work followed by two years of clinical rotations. But there is an emerging trend within medical education, which accelerates preclinical studies in order to allow students more time to gain clinical experiences. According to the Liaison Committee on Medical Education, during the 2019-2020 academic year, six percent of medical schools ended pre-clinicals after one year, 29 percent ended them after 1.5 years, and 56 percent retained the traditional two year structure. 

Kim Lomis, MD, and Vice President for Undergraduate Medical Education Innovations at the American Medical Association, explains that the reasoning for the curriculum update is so that students are better able to contextualize learning within patient care. “Proponents argue that learners are able to better anchor their learning of foundational sciences in a meaningful context, fostering professional identity formation as well as knowledge base,” she said. Early adopters include the elite medical schools at Harvard, Duke, Vanderbilt, and NYU Grossman. Each of these schools now condense preclinical learning into the first year, with students beginning clinical clerkships at the start of their second year. 

Rutgers Robert Wood Johnson Medical School recently launched its updated curriculum, which starts the clerkship after 18 months. Carol A. Terregino, MD, and Senior Associate Dean for Education and Academic Affairs at Rutgers, notes that the curriculum change is beneficial because it puts an emphasis on “knowledge for practice.” 

“Anything that is going to increase students’ clinical knowledge and ability to apply that knowledge to clinical practice is going to make students stronger as future physicians,” she said. She also noted the presence of unknowns related to the recent pass-fail update of the USMLE Step One exam, which could potentially increase the importance of the Step Two exam. “To make sure my students are able to do well and prepare for the licensing exam, I want a longer launching pad to get them there,” she said.

Others say that looking just at “preclinical” and “clinical” years oversimplifies medical education. Students at Ohio University Heritage College of Osteopathic Medicine, for example, follow the traditional two and two calendar, but are exposed to clinical experiences through observations and interactions during the first two preclinical years. “Distilling a college’s program to the length of time in preclinical or clinical curriculum misses all the nuances of what each college does to prepare its students. We emphasize patient-centered care from the first day of medical school, making our students well-rounded when they engage in their clinical rotations,” said Jody M. Gerome, DO, and Heritage College’s Senior Associate Dean for Medical Education.

Related Blog: U.S. Medical Licensing Examination’s (USMLE) Step One Moves to Pass-Fail Scoring

Medical Students Push for Climate-Related Health Courses

Emory Medical School, at the behest of its student population, has formally incorporated the health impacts of climate change into the medical school curriculum. The addition, which follows many public health programs throughout the country, makes Emory the latest elite medical school to incorporate climate-related health courses. 

Emory’s decision—and the student pressure behind it—falls in line with an article published last fall in The Journal of Climate Change and Health. In the article, survey results (including responses from 600 students from 12 medical schools) showed that most medical students want to include climate change in their studies. 83.9 percent of respondents believed that climate change and its health effects should be included within the core medical school curriculum. 13 percent believed that their school currently provided adequate education on the topic. And just 6.3 percent of students said that they felt “very prepared” to discuss how climate change can affect health with a patient. 

Momentum around educating students on climate change is growing within the medical community. Emory joins Johns Hopkins University, Harvard, Yale, and the University of Washington among others. Johns Hopkins created its Environmental Health Institute in 2007, and in 2017 Columbia University unveiled its Global Consortium on Climate and Health Education. Columbia’s Consortium, which develops best practices for teaching climate health, has now grown to include 47 U.S. medical schools as members, as well as more than 240 schools of medicine, nursing, public health, dentistry, and veterinary medicine globally. 

Additionally, the American Medical Association has endorsed teaching medical students about the impacts of the climate on health. “All physicians, whether in training or in practice for many years, have to be able to assess for, manage, and effectively treat the health effects of climate change,” Lisa Howley, PhD and AAMC Senior Director of Strategic Initiatives and Partnerships said. 

The AAMC understands that there will be some resistance to climate health’s inclusion in already packed curriculums, and have highlighted a few ways climate change has been meaningfully integrated into current medical curriculums:

• At the University of Illinois College of Medicine (Urbana-Champaign), climate-related health risks have been incorporated into case scenarios to promote a physician’s consideration of the environment along with other contextual factors. The physician also learns to incorporate and consider not just medical treatment, but also environmental mitigation factors (masks, HVAC filters, etc.).

• At the Icahn School of Medicine at Mount Sinai (New York City), climate information has been integrated into existing medical content for first- and second-year students. For example, slides that cover Lyme disease also include information on how climate change impacts tick habitats. The information is designed to complement existing content.

• At the University of Colorado School of Medicine, an elective course for fourth-year students titled “Climate Medicine,” incorporates op-ed writing in addition to climate and health content.

• At the University of California San Francisco Medical School, medical students partner with nursing and dentistry students to create the Human Health and Climate Change group to facilitate educational forums and on-campus sustainability initiatives.

Medical Schools Train Students to Combat Medical Misinformation

Earlier this month, the University of Pennsylvania announced the Penn Medical Communication Research Institute (PMCRI), a collaboration between the Annenberg School for Communication and the Perelman School of Medicine, which will focus on reducing medical misinformation. The Institute will research methods for patients, particularly within vulnerable groups, to access reliable, useful medical information and develop strategies to increase the trust of healthcare providers and the scientific community.

The Institute is reflective of a growing momentum within medical education focused on combating medical and scientific misinformation. Schools are exploring a variety of methods to achieve this.

Brian G. Southwell, PhD, and Jamie L. Wood, PhD, Co-Directors of the Duke Program on Medical Misinformation, and Ann Marie Navar, MD, PhD, wrote in the American Journal of Public Health that, “Encountering patient-held misinformation offers an opportunity for clinicians to learn about patient values, preferences, comprehension, and information diets. Systematically training health care professionals to address patient-held misinformation with empathy and curiosity, acknowledging time and resource constraints, will be a crucial contribution toward future mitigation of medical misinformation.” In turn, Duke’s program, a part of the Duke Center for Community and Population Health Improvement, shares provider guidelines that promote developing “psychologically safe” relationships with patients. In other words, the patients should feel comfortable sharing the information and sources that they use to make medical decisions with their physicians and caregivers without fear of judgment or ridicule. Once physicians and the care team understand where the patient is coming from, they can provide support and guidance to correct misinformation and provide alternative, credible sources.

Other schools are incorporating communication techniques into the medical curriculum so that students can acquire the skills they need to reach broader audiences.

Last Spring at University of Chicago’s Prtizker Medical School, Vineet Arora, MD, MAPP and Sara Serritella, the Director of Communications at the Institute for Translational Medicine, developed and co-taught an elective course for first-year medical students titled, “Improving Scientific Communication and Addressing Misinformation.” Serritella, speaking to the critical nature of the course, cited a 2016 study by the National Science Foundation in which less than one-third of respondents said that they had a “clear understanding” of the meaning of “scientific study.” Medical students, she continued, need awareness of the gap between their understanding and that of the general public so that they can effectively bridge it. The course focused on teaching students the principles of scientific communication, how to identify misinformation, and how to debunk misinformation using infographics. But, more than that, it asked students to consider various audiences and ways to share information that were relatable, understandable, and relevant to those groups. Arora noted that students are well-positioned to play a key role in combating misinformation. “Addressing medical misinformation using evidence-based strategies is one way that medical students can add value and also learn a lifelong skill they will need to improve communication and trust in medical care for their patients,” he said.

At the University of Minnesota, Dr. Kristina Krohn, MD, an assistant professor in the Department of Medicine, saw a social media-specific need that medical students were well-positioned to breach in the early days of the pandemic. In the Spring of 2020, she developed an elective course titled “COVID-19: Outbreaks and the Media” that is still available. The goal of the course is to enable students to leverage social media to relay health information to the public. While the course offered general communications information including defining an objective and creating infographics, it also included basics such as how to create social media accounts, fact-check data, translate scientific literature into layman terms, and relay accurate information in simple, compelling ways… all via social media. Dr. Kohn explains the reasoning behind the course for medical students: “If we share publicly our knowledge in formats that are open and available to the public, we help people make better choices sooner, but we don’t learn how to do that in medical school. I think it’s a huge skill that we’ve overlooked, and social media has made it so that a medical student can do this. We just need to help them do it well and give them the appropriate teaching and tools,” she said.  

Trends in Medical Education: Online Learning

During the Harvard Medical School Office for External Education’s 2021 IMPACT Symposium, Adrienne Torda, the Associate Dean of Education and Innovation at the University of New South Wales, stated that “Digital teaching and learning are here to stay,” And most attendees, leaders in medical education agreed. The covid-19 pandemic has accelerated a movement towards online learning and technology that they expect will only grow in significance. 

Suzanne Rose, MD, MSEd, and Senior Vice Dean for Medical Education at Penn Medicine, called out technology’s impact on the delivery of medical education and patient care as one of the top five trends in medical education, noting that it can provide more interactive experiences for students that will aid in content delivery and retention. One area she is exploring is the use of shortened lectures on key topics followed by team-based learning experiences and/or small group discussions. Medhub also describes a shift to a more proactive engagement between students and technology that is “... aimed at more effectively engaging students, assessing them against measurable outcomes, and responding to individual learner needs.” 

In addition to collaborative learning, the role of Virtual Reality (VR), as well as augmented reality (AR), mixed reality (MR), and artificial intelligence (AI) are expected to grow. These tools can enhance training experiences for students as they develop an array of necessary, but difficult skills. Medhub says, “Case studies with online simulations, designed to build skills as diverse as having difficult patient conversations to making complex diagnoses, are becoming increasingly sophisticated. They are effective tools in medical education and we can expect enhancements to keep learners engaged, offer real-time feedback, identify areas of weakness, and even foster some healthy competition with performance comparisons to colleagues and leaderboards.” 

Many schools are already implementing these measures. University of Miami’s Miller School of Medicine, for example, takes advantage of AR, VR, and MR to train students on treating trauma patients. At the Gordon Center for Simulation and Innovation, students get the experience of working with stroke, heart attack, or gunshot victims, in addition to practicing cardiac procedures on Harvey, a mannequin who can simulate nearly any cardiac event. Students can wear VR headsets to get a visual of Harvey’s underlying anatomy.

While there is no doubt that many aspects of medical education must still be experienced using in-person training and experiences, technology will only grow in importance within medical education. 

Report Recommends Comprehensive Reforms to Improve Medical Students’ Transition to Residency

Last week the Coalition for Physician Accountability released a report recommending comprehensive reforms to improve the transition between medical school and residency. The Coalition’s Undergraduate-Graduate Medical Education Review Committee (UGRC) included 34 recommendations spanning nine themes. The report’s authors strongly encourage related stakeholders to work together to implement the recommendations in full, as together they will “create better organizational alignment, likely decrease student costs, reduce work, enhance wellness, address inequities, better prepare new physicians, and enhance patient care.”

The Charge

The UGRC’s initial charge was to address the following documented problems occurring in the transition between medical school and residency, as well as to uncover other existing issues. The report noted that the impact of these problems has grown over time resulting in significant stress to the system. 

• Disproportionate attention towards finding and filling residency positions rather than on assuring learner competence and readiness for residency training

• Unacceptable levels of stress on learners and program directors throughout the entire process

• Inattention to optimizing congruence between the goals of the applicants and the mission of the programs to ensure the highest quality health care for patients and communities

• Mistrust between medical school officials and residency program personnel

• Over reliance on licensure examination scores in the absence of valid, trustworthy measures of students’ competence and clinical abilities

• Lack of transparency to students on how residency selection actually occurs

• Increasing financial costs to students as well as opportunity costs to programs associated with skyrocketing application numbers

• The presence of individual and systemic bias throughout the transition; and 

• Inequities related to specific types of applicants such as international medical graduates

A Common Framework to Assess Students’ Clinical Skills 

At its core, the report calls for changes that promote standardized ways to evaluate and assess medical students in a meaningful and equitable way. More specifically, the report suggests that less weight should be placed on the USMLE numerical scores and the emphasis should shift to a standardized and comparable assessment of students’ performance in a clinical setting. The report recommends that medical schools and residency programs work together to define a framework and set of competencies with which to measure students as they make the transition from medical school to residency. 

The report’s recommendations also seek to increase efficiency in matching students with residency programs. The number of applications submitted per student continues to rise, as medical students fear that they will not find a placement so expand their reach. A recent AAMC article noted that the average number of residency applications per student in 2016 was 87.7 and in 2020 was 95. Among international medical student graduates, who often face a tougher time finding a spot, the average is 136. The process is a huge generator of stress for medical students, their advisors, as well as residency program directors. “This year, we received 5,800 applications for 24 positions. It’s just not possible to thoroughly review most of them,” explains Richard Alweis, MD, a UGRC committee member and associate chief medical officer for medical education at Rochester Regional Health in New York. Not surprisingly, the 2020 National Resident Matching Program Director Survey reported that just under half (49 percent) of applications receive an in-depth review. 

The UGRC’s recommendations seek to provide stakeholders involved in the application, selection, and placement processes with better information and support in an effort to reduce the number of submitted applications. Students, they contend, need access to better information to appropriately gauge their likelihood of acceptance while residency programs need better ways to cull their applicants by updating and improving technology to provide effective and equitable filters for applications. Additionally, the UGRC encourages the entire eco-system to innovate and implement pilot programs to reduce the friction associated with matching medical students to residency placements. 

Next Steps

While there is great optimism around the release of UGRC’s report, because of the comprehensive nature of the recommendations and the number of critical players involved, there is still considerable work to be done. Each of the 13 member organizations making up the Coalition is independently run; each organization will determine what recommendations they will enact and the timeline. And despite its support, the AAMC’s statement reacting to the final report emphasized a need to move with caution and carefully consider what, if any, unintended consequences may occur as a result of enacting recommendation(s). However, while the timing for change is unclear and the speed may be slow, there is unprecedented agreement within the member organizations around the need for change and improvement for students, residents, medical advisors, and resident program directors. “For the past 10 years or more, we've been stuck in the same place… The recommendations are a monumental step in breaking through that,” said Grant Lin, MD, PhD, a pediatric resident at Stanford Health Care in California and a member of the UGRC committee.

Covid Crisis Brings Attention to the Need for Humanities in Medical School Curriculum

Over the weekend, The New York Times published an opinion piece urging medical schools to more fully integrate humanities courses and themes into their curriculum. The op-ed, written by Dr. Molly Worthen, a historian at the University of North Carolina at Chapel Hill, notes that amidst the covid crisis and student transitions to distance learning, humanities classes proliferated. Worthen discusses the usefulness of these topics when addressing questions relevant to modern healthcare. “This is the moment for champions of the medical humanities to strike. To make sense of disproportionate Covid death rates in Black and Latino communities or white evangelicals’ vaccine resistance, researchers need to consider everything from the history of redlining to theologies of God’s judgment. They cannot afford to stay in highly specialized lanes or rely solely on the familiar quantitative methods of the medical sciences.”

Dr. Worthen’s piece is just the latest among recent efforts in the healthcare community to call attention to the benefits that humanities and the arts provide within the medical curriculum. Last year, the AAMC published a report titled, The Fundamental Role of the Arts and Humanities in Medical Education. The report identified four aspects of medical training that are improved by the integration of the arts and humanities: 1) Mastering skills – improving clinical care capabilities (e.g., case presentation, critical thinking); 2) Taking perspective – showcasing the sometimes contradictory perspectives of patients and others in clinical situations; 3) Personal insight – nurturing reflection and self-understanding to promote personal wellbeing and resilience; and 4) Social advocacy – urging students to assess and improve norms when identifying and rectifying potential inequities and injustices within health care.

While the report found that most medical schools have, to varying extents, incorporated arts and humanities into their curriculums, the potential benefits have yet to be fully realized because of inconsistencies. The report details “significant variation in the content, curricula integration, teaching methods, and evaluation methods” in MD programs, and recommends ways they could both improve and assess the benefits. A few of the recommendations direct medical schools to demonstrate the linkages between humanities coursework and core physician competencies, as well as increase the collaboration between faculty, students, patients, and partners in the arts and humanities to create and implement programs.

The report also details a few of the noteworthy humanities programs currently offered in medical schools.

-          Jazz and the Art of Medicine at Penn State: This four-week elective is offered to senior-level students. Students are asked to listen to jazz music, the give and take between the lead and accompanying musicians, then relate it to standard conversations facilitated by physicians with patients. At its core, the course is about how to listen and respond, rather than simply going through the motions. Students practice these improvisational techniques in clinical visits, which allows them to improve their listening and response skills while under real time constraints. The students are also encouraged to play to their strengths and thoughtfully and proactively build their communication style as care providers. A study that compared 30 of the students to a control group showed that they displayed statistically significant and meaningful gains in adaptability and listening.

-          My Life, My Story at VA Boston Healthcare System: This program is integrated into students’ clinical work, though it does require additional time outside of standard rounds. Students work with military veterans to help them compose a personal narrative which, with the patient’s permission, is entered into their electronic medical record. This promotes the idea of patient-centered care and demonstrates to the medical students the benefits of knowing and understanding a patient as a complex human being. In qualitative assessments, students described the power of the exercise as being the “best thing they’ve done in medical school,” with many stating that they wish they knew more of their patients so intimately.

-          Program in Bioethics and Film at Stanford: Events are integrated throughout the curriculum. Students watch documentaries and films about health issues and medical care. Faculty then lead small group discussions about how gaining additional insight into people’s lives and experiences may drive a physician’s thinking when working with patients, as well as in their role as care providers in a community. These small groups also delve into topics in medical ethics, culture and perspective, and communication. While the incorporation of the film events throughout the curriculum make it difficult to measure the program’s affect, faculty say that they can see the impact on students by the quality of the discussions and student conversations afterwards.

In 2019 Richard Ratzan, MD published a piece in JAMA, How to Fix the Premedical Curriculum – Another Try, in which he described the importance of taking humanities courses as a prerequisite for understanding the human condition, and thus medicine. He recommended that medical school admissions officers boldly look for students who majored in the humanities, with science classes as options on the side. He wrote, “... No premed majors need apply; the science training will come after acceptance.” While this provocative stance has not been wholly accepted by the medical community, the many proponents of the medical humanities are gaining attention. Admissions committees are looking for more well-rounded students who understand that there are many lenses through which a physician must look to see, hear, and heal a patient. Dr. Worthen’s editorial stated it potently, “… medicine is not a science but an art that uses science as one of many tools … The scale of the Covid crisis should force both scientists and humanists to ask new questions, to realize how much they don’t know — and perhaps to learn more from one another.”

Medical Schools Called to Increase Diversity as Pandemic Highlights Racial Disparities in Healthcare

Glaring disparities in health outcomes by race, of those individuals diagnosed with COVID-19, have prompted providers and administrators to look at how structural racism has taken root within health education, training, and practice.

Late last month, The Atlantic published an article, Five Ways the Health-Care System Can Stop Amplifying Racism. While the article describes a complex system, including the inner-workings of hospitals, government, and insurance companies, it directly advocates for medical schools, and other provider training programs, to increase diversity in their student bodies and create a curriculum that addresses existing bias and racism, common in medical practice.

Medical schools have long sought to increase diversity, as diversity in providers means significant improvement in patient outcomes—A study out of Oakland, CA showed black doctors’ involvement with black patients increased preventive care and reduced the cardiovascular mortality gap between black and white men by 19 percent. Another study of black newborns in Florida showed that the newborns treated by black physicians had a mortality rate that was half that of babies cared for by non-black physicians.

But the number of minorities in medical school has remained low. A congressional report released last month by Democrats on the Senate Committee on Health, Education, Labor, and Pensions, reported that as of 2019, only 5.8 percent of physicians identified as Hispanic, 5 percent as Black or African American, 0.3 percent as American Indian or Alaskan Native, and 0.1 percent as Native Hawaiian or Other Pacific Islander. Further, among 2019 medical school graduates, 5.3 percent were Hispanic or Latino, 6.2 percent were Black, 0.2 percent were American Indian or Alaskan Native, and 0.1 percent were Native Hawaiian or Other Pacific Islander.

Why? Perhaps it is because there are barriers to medical education: substantial costs, the time and attention required to prep for and take the MCAT, apply to medical schools, travel to interviews, as well as a hostile learning environment. A report released early this year found that underrepresented minorities, including Hispanic, Black, and Native American students, were more likely to experience bullying or harassment during medical training than white students at 38 percent and 24 percent respectively.

Providing medical students with a curriculum that exposes bias and the roots of structural racism is vital. The Atlantic article points out that, “To this day, medical textbooks still depict mostly white skin tones. Many medical students hold empirically false beliefs about race-based physiological differences—including the notion that black patients have a higher tolerance for pain than white patients. These beliefs affect the kind of decisions that doctors make.” 

While people can change over time, schools must proactively work to diminish racism in future doctors. This summer, a team of professors at Yale Medical School published an article in the Journal of General Internal Medicine that proposed schools seek to filter out racist applicants and withhold admittance. While acknowledging the difficulty of evaluating racist attitudes, the professors suggest using additional essays, interview scenarios, and evaluative questionnaires to adequately provide admissions teams insight into where an applicant falls on a “continuum of racial attitudes.”

Doctors Seek Additional Training as Technology and Big Data Converge with Patient Care

Classes in data analytics, artificial intelligence, and technology may sound like the course load of an MBA student, but a recently released report shows the immense value of this subject matter for medical students as well. The Stanford Medicine Trends in Health 2020 report entitled “The Rise of the Data Driven Physician” describes a future for physicians where data and technology are increasingly intermingled with effective patient care.

The report, which includes a survey of physicians (n=523), residents (n=133), and current medical students (n=77), analyzes how trends in medicine impact those on the front lines of patient care.  The health care sector, the report claims, is undergoing “seismic shifts, fueled by a maturing digital health market, new health laws that accelerate data sharing, and regulatory traction for artificial intelligence in medicine.”  And the report’s findings show that while there is acceptance and even enthusiasm around the benefits of data and technology among providers, there is also a real gap that exists between the training that physicians, residents, and students receive, and the demands of the evolving profession. Lloyd Minor, MD and Dean of the Stanford University School of Medicine says, “We’ve found that current and future physicians are not only open to new technologies, but are actively seeking training in subjects such as data science to enhance care for their patients. We are encouraged by these findings and the opportunity they present to improve patient outcomes. At the same time, we must be clear-eyed about the challenges that may stymie progress.”

The respondents appear keenly aware of the changes occurring within medicine and both physicians and residents say that they expect about a quarter of their current duties to be automated using technology over the next 20 years. Students predict that, on average, 30 percent of their duties will be automated. Further, just under half of the physicians surveyed (47 percent) and about three-quarters of the students surveyed (73 percent) say that they are currently seeking out training to better prepare themselves for innovations in health care. Among physicians who said they are currently attending training, the most popular subjects are genetic counseling (38 percent), artificial intelligence (34 percent), and population health management (31 percent). Students seeking additional training courses are taking advanced statistics and data science (44 percent), population health management (36 percent), and genetic counseling (30 percent) at the highest rates.

When asked about which innovations have the most potential to transform health care in the next five years, physicians as well as students and residents (grouped) were both most likely to respond with personalized medicine, followed by telemedicine. Both groups also see potential in artificial intelligence, wearable health monitoring devices, and genetic screening.

When the groups were asked about how helpful their education has been in preparing them for new technologies in healthcare, just under 20 percent of both students and residents (18 percent) and physicians (19 percent) responded “very helpful.” Current students and residents were more positive overall, with 58 percent responding that their education was “somewhat helpful.” Only 23 percent responded negatively. Among physicians, 36 percent found their education somewhat helpful, and the remaining 44 percent replied negatively.

The most notable gap, perhaps, is the one highlighted below, which showcases the difference between the perceived benefits of medical innovation for patients and how prepared the provider is in implementing that innovation. The two charts, students and residents (grouped) and physicians, show the group that agreed an innovation will be “very beneficial to future patients” compared to the group that said they feel “very prepared to use the innovation in practice.” Some of the gaps are marked. For example, over half of students and residents (55 percent) and physicians (51 percent) believe that personalized medicine will be very beneficial to future patients, yet only five percent of students and residents and 11 percent of physicians feel prepared to deliver it. Personalized medicine showed the largest gap between perceived benefit and preparedness for both groups, while virtual reality showed the smallest. Both groups feel very prepared to work with electronic health records, but there were lower levels of perceived benefit to the patient.

Gap Between Perceived Benefits to Patients and Provider Preparedness

This report demonstrates the changing nature of the medical profession, its current and continuing intersection with technology and big data, as well as the need to provide opportunities and training to medical providers so that they can use these innovations to improve patient care. Prospective and current medical students will want to carefully consider how they are using their time prior to and during medical school. It may be beneficial for them to spend time speaking with physicians and residents to gauge what technologies and research are driving change. Taking classes prior to medical school, in statistics and data modeling, as well as technology and AI may have a positive impact on their ability to bridge the gap between present demands and the traditional medical school curriculum.