UT Medical School Houston:

Friday, 01 January 2010 00:00

EDUCATION AND HEALTHCARE:

Advancing State of medical Education

BY Giuseppe N. Colasurdo, M.D., Dean and H. Wayne Hightower Professor in the Medical Sciences of The University of Texas Medical School at Houston

When I decided to advance my medical training more than 20 years ago, I knew I wanted to be challenged by the best academic medical centers the world had to offer. So, in 1988, I made the move from Italy to the United States, where the opportunities for medical students and trainees are unparallel.

Today, as dean of The University of Texas Medical School at Houston, I find our bright students are drawn to learn in our vibrant Texas Medical Center, where they not only have access to the latest knowledge and technology but also are able to serve an incredibly broad patient population.

When our medical school opened in 1970 to help meet the health care needs of Texans, 19 students comprised that founding class. Today, we accept 230 students per class to accommodate the increasing demands brought about by an aging and growing population faced with complex medical requirements. Despite our evolution, our mission remains steadfast – to educate the next generation of physicians for the state of Texas.

Because we are a state school, 90 percent of our students must be state residents. Our aim is to educate a student body that is most reflective of our state population. We have been making great strides when it comes to recruiting diverse medical students. In 2008, 20 percent of our medical students were members of an underrepresented minority. Our increases in ethnic minority students are remarkable, especially with the nationwide decline in the number of underrepresented minorities who are biology majors applying to medical school. We will continue to ensure that we not only recruit the best, brightest, and most diverse student population – but also that our students succeed and excel with the best learning tools to facilitate a top-tier medical education.

We are fortunate to be able to offer outstanding learning facilities, which are best exemplified by our Surgical and Clinical Skills Center. This facility, unique in the country, is home to the latest tools in medical training. Outfitted with a fullsized operating room with task simulators and virtual reality simulators, students of all levels learn in a controlled environment without repercussions of patient error. High-fidelity simulators resemble patients and “respond” to treatments and mistakes, offering a “real-world” feeling and experience. The state-of-the-art center also offers standardized patient learning, with actors portraying patients. Despite this very powerful and sophisticated environment, we still value an old-fashioned approach of basic medicine – being able to take a patient history and performing a physical exam. Bedside teaching is irreplaceable.

In addition to our comprehensive curriculum, we are implementing careerfocused paths to help our students become better prepared for their chosen specialties. With mentored, hands-on opportunities in areas such as women’s health, geriatrics, and surgery during the four years of medical school, students will excel when presented challenges during their training programs. Their patients will be the beneficiaries.

We offer a robust and highly competitive graduate medical education program, with more than 8,000 applicants a year vying for about 200 residency positions. This makes us one of the most comprehensive residency programs in the country. These training programs are where students become prepared for clinical practice. In order to retain physicians in Texas and alleviate shortages in rural areas, more residency positions will be needed.

Attending the largest school of a six-school health science center, our students have unlimited opportunities for collaboration. Our students become active members of the health care team early in their careers.

Just as our physicians are teachers, so are our residents and students. Our students are evaluated on their ability to teach in different settings and give feedback to the patient, the family, and the whole health care team. This is key to collaboration and the delivery of modern health care.

The idea of collaboration fosters excellent research, which is important for our young minds to be exposed to and experience. Academic medical centers like ours must maintain the flexibility to promote risktakers and encourage innovation, which is sometimes not blessed by consensus.

While predicting the future is a risky business, we must prepare our students to work in an unknown future of health care. In this climate of uncertainty, academic medical centers are best poised to lead organizational change that delivers quality and excellence. We must do our part to train more primary care physicians and also to educate the physicians of tomorrow to always prioritize their patients, keeping quality and cost at the forefront.

The advancing nature of health care delivery requires new educational objectives and goals. The electronic medical record is being used to improve quality and safety, and it is incumbent upon us not only to learn, but to teach, this tool. For us as educators, we must accept that a cause of health care delivery problems is cost. We must emphasize preventative care and deliver medicine with greater value. We then must teach our students how to deliver more efficient care. The status quo is unsustainable.

Professionalism is the keystone of our curriculum and vocation. We promote ethical practice and effective interactions, instilling a commitment to medicine and its values. It is our responsibility to practice evidence-based medicine and to create an evidence-based culture for our students and residents – one that is shown to be effective, cost-effective and driven by clinical studies that have become standard of care. We have national leaders on our faculty who, in partnership with our primary teaching hospital, Memorial Hermann – Texas Medical Center, are redefining clinical effectiveness and advancing patient care through our Academy for Clinical Safety and Effectiveness.

The words I heard from the senior class president last year on his graduation day convinced me that we are fulfilling our mission. “I dare say that UT-Houston students are some of the luckiest students in the country,” he said.

As physicians, it is incumbent upon us to do everything to earn our patients' trust and maintain it. As educators of the next generation of physicians, we must ensure that this bond between patient and physician is never broken. The message we hope to impart to our students comes from one of our most beloved faculty members, Dr. James “Red” Duke, Jr.: “It is always my intention to attempt to treat others, be they patients, colleagues, or strangers, with the dignity and respect that I can best determine would be their desire. I have never considered this some special behavior, just the manner in which any individual would relate to another human being.”