Although long since retired from the practice of medicine, I have remained interested in how new physicians are trained. This has been more in the foreground in the last half-dozen years since the conception and now functioning Virginia Tech Carilion School of Medicine and Research Institute.
For the last four years I have been among a large group of interviewers screening hundreds of applicants to VTEC. The number of those applying has been in excess of 10,000; about a 1000 have been invited for an interview and slightly over 200 have actually come here to begin the arduous journey to obtain the Doctor of Medicine degree. Periodically, I have reported on their progress and the first graduates were successfully launched into their residences the first of July, beginning at least three more years of study and in some cases, as much as seven additional years.
This past week I had an opportunity to observe a class of second-year students for a morning of study. The curriculum is vastly different from the traditional lecture/laboratory format that most medical schools still follow. It is a problem-based learning system. The class of 42 students is divided into six groups of seven students each and for a six week period they study under the tutelage of a facilitator, a physician who will guide their activities.
Dr. Bert Spetzler, the facilitator of the group I observed, invited me to attend a morning session. Widely known in the community, anyone privileged to spend three hours with him would instantly recognize what a gift he delivers just by his presence. It was obvious that his students held him in immense respect, as he did them.
At the beginning of the week a patient case was distributed . . . the crux of the problem-based learning. The basic data took 24 pages to present. The students then were assigned a topic based on the problem for which they would prepare a lecture for their colleagues. This case in point was extremely complex and the topics which were presented dealt with the highly difficult field of immunology, the role that viruses might play, and how the test results available might guide them toward a proper diagnosis and treatment.
PowerPoint and white board illustrations were used and the data from the presenter are posted on a website for all of the groups to review. I was dumbstruck with the depth and professionalism these students passed on the information to their colleagues; they had only two days from the assignment of their topics till the presentation.
They went at it for three hours but there was no flagging of attention so common in the traditional lecture room. On one or two occasions the group seemed to be drifting afield but Dr. Spetzler, in his gentle way, redirected their attention to the problem at hand.
At the conclusion of the class Dr. Spetzler had an individual evaluation with a student. He told me afterwards that he discussed the strengths he had seen and any areas in which he felt there was a need for improvement or additional work.
Much more could be said but I left with a feeling quite different from any of the hundreds of classes I had conducted as a medical lecturer. The students were at ease, obviously interested in each other’s welfare, and clearly had learned a great deal in the preceding 48 hours before class.
The system of problem-based learning conducted by the students themselves is clearly a success. The national testing has ranked VTEC students well above the national average and 100% of this year’s graduates secured a residency. Twelve of them will continue in a Carilion Clinic residency program.
For the school with its innovative teaching program to have achieved so much is truly an extraordinary feat of which the entire community can be justifiably proud.
– J. Hayden Hollingsworth, MD, FACC
