Grading Medical Schools
The following interview is part of a Roundtable series highlighting how philanthropy can improve America’s health-care system by investing in medical education to achieve transformational results.
Sociologist Regina Russell studies how future M.D.s are taught. She sees real improvement.
Regina Russell is an assistant professor of medical education and administration at Vanderbilt University’s School of Medicine. She has a Ph.D. but is not, she hastens to add, a medical doctor. She is a sociologist who studies the effectiveness of medical education. She spoke about the Flexner Report, avoidable deaths in hospitals, and how to get more people into medicine. This interview has been edited for length and clarity.
Jeremy Lott: What is the focus of your scholarship?
Dr. Regina Russell: I studied sociology of education and moved to Nashville. I found a position at the Vanderbilt School of Medicine. My focus in medical education is thinking about, "What are we doing? What might we be doing better? What other disciplines might have something to share with us about that?"
Lott: Where is medical school working for our future health-care professionals, and where is it failing?
Russell: In 1910, there was a report called the Flexner Report. One hundred years later there was deep introspection in the whole community about, "Is medicine going in the direction that we need it to?" A number of books and articles came out about things we should be trying to focus more on. Interprofessionalism is one of them.
Lott: Why is interprofessionalism important?
Russell: If you have ever been in the hospital, I imagine you have met many other types of people who work in medicine besides doctors: nurses, pharmacy folks, technicians that work in all different levels of hospitals and clinical settings, front desk people—everybody who has some kind of an impact on how the patient experience is in medicine. If we don't think about medicine as an interprofessional experience, with a lot of people coming from different backgrounds needing to coordinate their ideas, their actions, plans, policies, then we have a lopsided picture of what happens in providing health care.
We need to do a good job of taking interprofessionalism back into medical education and having our students learn with nurses, learn with pharmacists, try to understand what are social workers getting at when they talk to patients.
Lott: What are medical schools getting better at?
Russell: Having more individualized education. We get people that come into medical school with Ph.Ds. already in something, or they've got a lot of experience working in an ambulance. They already know a lot about emergency care, and they want to become an emergency physician.
We've started to do a much better job at looking at that individual person when they come in and helping design a plan for them that's not the same for every single person. It used to be a medical degree was exactly four years and everybody did it the same way.
That goes hand in hand with competency-based education, the idea that we can still monitor that people are getting to the required level, even if they're going different routes.
Lott: A lot of people die in American hospitals because of medical errors. Do you see improvement on that front in the medical-school level?
Russell: Yes. One of the things that came out of that big introspective, "What are we doing?" Flexner thing was looking at a report about the hospital errors and how many people die or are injured from things that happen in the health-care system.
Schools put in place a Health Systems Science curriculum to get people thinking about quality improvement from the start. Our students start looking at safety and quality improvement in their first year, and they do a quality improvement project while they're in medical school.
Lott: How do we improve Clinical Learning Environments for future health-care professionals?
Russell: The first thing is just to recognize that hospitals and clinics are learning spaces as well as clinical care spaces. That's how we get the next generation of doctors and nurses. We put them into those spaces and allow them to watch the role models, listen to how care is delivered, answer patient questions, try to figure things out. Trying to figure out how to make clinical learning environments safe and comfortable for everybody is one of the biggest challenges that we have.
Lott: What can we do to get more people who are economically, regionally, and demographically diverse into medicine?
Russell: There has been a lot of work on pipeline programs. Those are really important to get people, really early on, interested in sciences and interested in medicine and providing supports for them. That means summer programs where kids from all different backgrounds can come and learn what a career in medicine might be.
They don't have role models. I'm a first-generation college student from Arkansas. I'm currently the faculty advisor for 1GMD—First Generation M.D. students. They feel very much like they're coming into this world that doesn't understand them and their backgrounds.
We have to recognize that the people that we serve are incredibly diverse. The patients represent everybody—age, income, education, race—all those things. And if we don't have doctors that look like those people or come from those kinds of backgrounds, we're going to continue to mismatch what we think they need and what they actually want and need.
Lott: What do you do for would-be medical professionals who don’t have a strong science background?
Russell: If you've got somebody who doesn’t have enough science, you can't put them in the science classrooms with the folks who've done nothing but science their whole lives and expect them to swim on their own. You’ve got to give those people opportunities to catch up in summer programs. This goes with what I was saying about individualizing programs.
Lott: If a philanthropist came to you and said, “I’d like to give money to improve the quality of medical education in this country and thereby improve health care. What’s my best shot to do that?” what would you advise that person?
Russell: I would ask somebody to invest in expanding the humanities and social science—the knowledge that's coming from fields outside of what we traditionally think of as medical intervention fields—and to have more of those voices in the discussion about what medicine will be.
Jeremy Lott is a writer who lives in Lynden, Washington. He conducted this interview on behalf of The Philanthropy Roundtable. To read the rest of this series, click below.