1. Robert Boorstein, MD, PhD

2. History of American MedicalEducation Grounding in BasicScience Analytical Reasoning Clinical training inacademic centers Research A moral dimension 3. A Schizophrenic Self Portrait: NEW YORK The United States standing in the world ebbs and flows, but one thing remains strong: the reputation of its medical schools and the physicians they produce. Whatever the international criticisms of its financial regulatory system or past foreign policy, the United States has long been perceived as the go-to place for state-of-the-art medical care. http://www.nytimes.com/2009/04/29/education/29iht-riedmedus.html?_r=1&ref=education 4. American Medical Education 100 Yearsafter the Flexner ReportThe need for a fundamental redesignof the content of medical training isclear.Our approach to education is inadequate to meet the needs of medicine.Ossified curricular structures, a persistent focus on the factual minutiaeof todays knowledge base, distracted and overcommitted teachingfaculty, archaic assessment practices, and regulatory constraints abound.These challenges threaten the integrated acquisition of technicalknowledge and contextual understanding, the appropriately supervisedmastery of practical skills, and the internalization of essential values thattogether make for an informed, curious, compassionate, proficient, andmoral physician. http://content.nejm.org/cgi/content/full/355/13/133 5. Multiple cycles of curriculum reform, based onpremise that there are major systemic failings ineducation, with direct but remediable consequencesto health care. 6. Medical Education is characterizedby ongoing change Patient centered education Small Group Teaching Problem Based Learning Horizontal Integration Vertical Integration Recognition of diversity Social Context Life-long learning Mastering information technology Just in time teaching Team based learning 7. Is change per se a desirable thing?Change Simply for the Sake of Change Is an Abdicationof Leadership John Luke Jr, chairman and CEO, MeadWestvaco. 8. Ongoing change is integral tosuccess Innovation: Innovation is the heart of our school. We are open to new ideas from faculty, students, staff and others. We seek out new ideas and will evaluate them with open minds in order to continue to improve the efficacy of health care and the health system.http://www.thecommonwealthmedical.com/oth/Page.asp?PageID=OTH000267 9. Pathology Education at NYUSOM Second year experience Spans the entire second year Integration with historic units in microbiology, pharmacology, medicine, and parasitolology. 10. The transition Pathology, the study and Pathology, the understanding of disease acquisition and use ofdiagnostic information 11. The Bottom Line Most of what students learn about diagnostic laboratory medicine is learned from point of view of internal medicine. 12. When to teach Clinical Pathology: After 3rdyear? Students have been exposed to many clinical settings. Developing a sense of natural history of disease Have some understanding of how much they dontknow. Looking for practical information Looking for intellectual underpinnings to unifyconcepts and facts 13. Utilization of Clinical Laboratories inMedical Practice. 2 week course Meets daily for two hours 24-40 students in two to three sections. Case based teaching, cases prepared and edited byfaculty and course director. Students read primary literature and lead discussionspresentations 14. Specific clinical pathology issues Handling of large amounts of clinical information Comfort with quantitative results and with resultsexpressed as risks Understanding the rapid pace of change in laboratorymedicine 15. Standards for success in medicaleducation For most exams, 75-85% on tests. In contrast, for medical practice, systems are moving toward 100% performance standards on defined task. 16. Evaluation of students Evaluation of the class as a whole, rather than ofindividuals. In class exam using audience response system, beforeand after. 17. Issues documented by pretest Small minority cannot accurately demonstrateknowledge of clear clinically relevant activity . Large minority, or majority, has learned somethingcontrary to what we teach. Large minority, or majority, has misunderstood majorprinciple, especially involving, statistics or time. Broad variations in understandings without intent,including unsupported consensus or unsupportedvariation. 18. Microbiology 19. Hematology 20. Cytology 21. IsHPV DNA Testing Positive with Normal there a correct answer? CytologyThe use of HPV DNA testing as an adjunct to cervical cytology for women aged 30 years and older increases the sensitivity of cervical cancer Repeat HPV DNA testing combined with cervical cytology in 12 months appears to be reasonable for patients in this group. http://www.guideline.gov/summary/summary.aspx?doc_id=13311&nbr=6755&ss=6&xl=99 9 22. Cancer 23. Frozen Sections 24. Algorithms 25. Monitoring 26. Screening 27. Conclusions Students entering their senior year have measurablegaps in knowledge, including knowledge of specificbehaviors with implications specifically related toprocesses, cost, and utilization, A course given at the begining of the senior year ofmedical school can be used to identify such gaps. The success of the medical system is based on theaggregate performance of all physicians.A standard of 100% in some areas is appropriate.