Medical Education – Past and Future

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by Hayden Hollingsworth

Recently, a group of retired physicians were guests for lunch at The Virginia Tech Carilion Medical School and Research Institute. We were given a talk by Dr. Cynda Johnson, the President/Founding Dean, followed by a tour of the facilities.  All of us had practiced medicine in Roanoke for decades; Drs. Douglas Fear and Charles Bray were the most senior.  When they first arrived in town the institution was called Roanoke Memorial and Crippled Children’s Hospital because of the polio epidemics that occurred every summer.

The contrast of those days with the new medical complex is amazing.  The medical school building is flanked by the adjoining research facility and the Carilion Clinic building.  Across the river stands Carilion Roanoke Memorial, one of the largest hospitals in Virginia.

Although we didn’t discuss it, I am sure that we were all replaying in our minds our first year in medical school so long ago.  In just a few weeks the initial class at VTC will have navigated those potentially treacherous shoals but the curriculum they have experienced bears no relation to what we encountered.

This is not a piece about “the good old days;” they were anything but that. We were taught what we needed to know in order to become doctors of medicine in the mid-twentieth century.  It was a no nonsense, around-the-clock grind for four years followed by, in many cases, six additional years of training.   That first year would be remembered as one we would never want to repeat.  Endless labs and thousands of pages of laborious text had to be mastered before we ever encountered a patient.

Medical education had not changed since the Flexner report in 1910 which exposed the slipshod way doctors were being trained.  The study was sponsored by the Carnegie Foundation and in the aftermath many medical schools were closed as new regulations were imposed.  During the next one hundred years, there have been few changes.  Despite the astounding advances in technology, the medical school curriculum saw little alteration until the last few years.

Now VTC along with a handful of other medical schools are changing their teaching methods in a radical way.  Rather than didactic lectures and strictly controlled labs the new system is called problem-based learning.  Six groups of seven students each are assigned a clinical case and are guided by a series of mentors to work out a total approach to the patient.

The students themselves will be the teachers, each being assigned a particular aspect to present to their group.  Anatomy, physiology, biochemistry, pathology, pharmacology, histology, bacteriology and all the rest will be explored with close faculty supervision in relation to the case.  After eight weeks the groups will be rotated, a new case assigned, and the process repeated.  At the conclusion of the year there will be a week of individual study followed by exams.

Not in a dingy basement of an ancient building where most of us labored have these 42 students learned. The latest in electronic teaching devices in brightly lit and attractive classrooms bring to their hands all the tools they need.  Not a microscope to be found; all that is done by video display and capable of being connected to medical facilities around the world with a few taps of the keyboard.

The library was impressive:  There were virtually no books.  Any text, any medical journal, any needed printed resource can be downloaded to the students’ computers.  If studies are too wearing, there is an exercise facility to ramp up the energy needed to keep at it.

After the lecture and the tour, we asked a few question but I suspect most of the group was as awestruck as I.  The sense of vision to conceive such an effort, the monumental planning, the enormous financial resources brought to bear are staggering.  I thought back to the prospective students that I had been privileged to interview and felt a sense of excitement for them, for the institution, and for our community.

Dr. Ed Murphy of Carilion Clinic and Dr. Charles Steger, President of VPI have brought together these institutions in an unique joint venture.  We should all hope its grand beginnings can achieve equally impressive success.  They are off to a remarkable start.

Now I want to talk to the medical students and hear how it went for them in this inaugural year, but first . . . exams.  It surely must have been more fun than what my colleagues and I endured.  Stay tuned.