Preparing doctors for a future in medicine

In the second part of this Spotlight on Health podcast episode, Ontario doctors and physicians in training discuss how medical schools are adapting and innovating curriculum to meet the demands and challenges of the health-care system, while preparing the next generation of doctors for the future. Training, they agree, must prioritize a community-focused, team-based approach to health care that supports physicians through their careers and holistically cares for patients. 

Transcript

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Georgia Balogiannis: In this podcast the Ontario Medical Association looks at current issues of interest in health care. Spotlight on Health gives you all the straight talk. We're Ontario's doctors and your health matters to us. I'm Georgia Balogiannis for the Ontario Medical Association. 

Ontario's healthcare system is facing unprecedented challenges, and the province’s medical schools may be part of the solution. In part two of a two-part episode, physicians discuss what the future may hold for medical schools in the province.

Dr. Cathy Mastrogiacomo is a comprehensive family physician practicing in Scarborough and the chair of the Ontario Medical Association’s Section on General and Family Practice.

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Dr. Cathy Mastrogiacomo: I think the idea that medical schools or government or higher-up bodies would actually subsidize the training and actually the setting up of a practice, that would be a great incentive for people to start a practice and to go into comprehensive family medicine. Because that's a big deterrent — they come out with huge loans, and then they get burnt out in the first five years of practice. If they had that assistance, where the infrastructure to run the practice would be subsidized by government or by whoever, that would keep people in practice. That would help. 

Medical students and family medicine residents need to be taught the ins and outs of starting a practice and how to keep running the practice. I think running a practice where we would have sessions on how to do your bookkeeping, how to do your billing, which EMR should you be investing in, team-based care. All of that stuff, I think would be helpful to medical students, so not just for the clinical, but also for the practical part of practicing medicine.

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Dr. Mastrogiacomo: The training and the support that medical students need in terms of going out into family medicine afterwards, or any kind of practice actually, does need to change. Things in medicine have changed, so I think the training has to be different.

What we need is assistance in place for when they finish medical school. I think if we had the infrastructure for the roundabout care that a patient needs, that would help the practicing doctors. Spending more time on geriatric care would be important in medical schools and in family medicine training programs, because you're starting off, in general, you’re a young doctor, but as you age, your patients get older with you. Their complexity goes up, the amount of time you spend per patient increases. 

So, training our medical students a bit more on the aging population, and the differences in terms of how to care for them and the resources that they need. I think if medical schools could recruit special populations of students and trainees to go into family medicine, various communities, all of that would be a big help.

But I think when it comes to the system issue. How do we keep you in that community? What are the supports that you need in practice to succeed and to be fulfilled and to have that work/life balance?

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Balogiannis: Dr. Jane Philpott is dean of the Faculty of Health Sciences and director of the School of Medicine at Queen's University and co-chair of the Council of Ontario Faculties of Medicine.

Dr. Jane Philpott: At Queen's, we're very excited about our new satellite project in partnership with Lakeridge Health in Durham Region, to be able to actually do some really innovative work around building what will be a seamless program from medical school right through to residency for young people who make a commitment at the onset that they want to be family doctors, that they want to be on the frontlines of comprehensive primary care. And so, we are actually doing some pretty significant rethinking of what an admissions program looks like for something like that, as well as the curriculum reform that might be necessary. This is just one of the kinds of innovations that are happening across the province.

We are looking to work with communities even at the stage of our admissions processes, having some of the small, mid, and large communities across eastern Ontario working with us, helping us to figure out how we will identify students who, from the outset, have a commitment to working in their communities. And then, through the curriculum, embedding them in those communities right from the first year onward.

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Dr. Philpott: I would say that Queen’s, like every other medical school in the province and even in the country, is constantly looking at changing demands and how we can make sure education is constantly adapting to meet those demands. It's a big question as to how medical schools can deal with the challenge of the shortage of family doctors as well as decreasing numbers of students choosing to go into family medicine.

So, we didn't get here for one single reason, and so we're not going to fix it with one single solution, and we need a complex response to this. It has to do with how we change the way we do medical education, how we actually change health systems, so that we make it be a more attractive way to practice with much more emphasis on team-based interdisciplinary care that will help, and we have to address the context that people are going into.

So, that's where the work of Ontario health teams, for example, is really important so that there will be places for people to practice family medicine, where they will feel that they've got the resources, including the rest of the allied health team to be able to let them use their skills to their best possibility. 

What medical schools will look like in 10 years? I think we'll see a lot more innovation from the technological space. But, in some ways, we need to do that totally lined up with much more social and community focus at the same time as this much more highly technical biomedical focus.

I think we will see a much broader range of representation. And that means not just diversity in terms of people's ethnic or cultural background or racial background, but also people coming from a whole range of socio-economic backgrounds, for example, which I think is really important. I do think that we are going to continue to see innovations around making sure that comprehensive general practice or family medicine is emphasized and valued in a stronger way throughout the curriculum.

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Balogiannis: Dr. Sarita Verma is president, vice chancellor, dean and CEO of Northern Ontario School of Medicine, or NOSM, University.

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Dr. Sarita Verma: Where do I see medical schools going in the next 10 years? And where do I see a university like NOSM University going in the next 10 years? I think we should be reducing the length of training and really trying to agree on what the core competencies are, and get people out into practice. And use practice and continuing professional development as the way to enhance people's confidence and competence to stay in practice. 

Thinking about what will the future university look like. At NOSM University, to become a truly what we call an ecological university and ecological university that lays the platform for the future and is driven by the community within which it serves. 

So, an ecological university is connected to all of the ecosystems within its region — the government, the other health care providers, like hospitals, clinics, pharmacists, it's connected to all of the industry in the community. So, if you don't link with transportation, and all the various places where you buy foods, like supermarkets, and you're not linking to good food security, addressing poverty, homelessness, and transportation to your hospital to your health care provider — we believe that we are one part of the ecological system that provides health care to everybody. Right now, it is a fractionated system. So, we're going to lead in that space. We're going to lead to talk about models that work within communities that create healthy communities and healthy cities.

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Dr. Verma: We will lead in curricular reform for all our programs to go from just-in-case learning to just-in-time learning. What that means is, learning will never stop. Our emphasis will be on continuing professional development. 

We also want to recognize the changing needs of a post-pandemic, stay-at-home, technology-driven world. That means virtual medicine and new micro-credentials will be a direction for NOSM University.

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Balogiannis: Angela Salomon is a fourth-year medical student at Queen's University and the president of the Ontario Medical Students Association. 

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Angela Salomon: I think medical students today do have different expectations of what they want to learn through their degree and the kind of provider that they want to become once they graduate. It's no longer enough to be just a medical expert to understand the biology in and out, to memorize the textbook in that way.

I think med students want to know how to handle complex ethical situations and how to work in an interdisciplinary nature with their colleagues and with other allied health professionals. We're expecting to know how to deal with trauma in our patients and how their social situation and the social determinants of health impact their wellbeing. We want to be competent with different cultures, even if it means we haven't lived that culture. How do we provide care that is safe and doesn't perpetuate harm for those who have experienced it already? We really care more about who the patient is as a person, I think rather than just understanding the malady within them.

I think the next step from that will be what we can do as med students and as physicians on a systemic level to impact change. We've seen it through the COVID pandemic; doctors are turned to as voices of authority to answer questions about health policy. And if we don't understand that landscape, first of all, we don't understand who has the power to enact change, who is deciding X, Y, and Z policies that actually do have implications on health.

We don't know who to advocate to, we don't know who to talk to, we don't understand who the decision makers are. So, health policies, systems design, gaps within the healthcare system — if we see them, which we will, what do we do about them? Really just how the healthcare system intersects with the political landscape and how to get actively engaged with that. I think that's, that's the next step that we need to take.

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Salomon: Other people have told me that they would like to see a little bit more clinical integration from day one. So, imagining this curriculum in which each day of classroom learning is then followed by one day of hospital or clinical exposure, or X number of hours, to put into action and to see in real life what you just learned about. 

This idea of getting familiar with the inner workings of the clinical setting early on would be really nice. And I find that sometimes the biggest hurdles to jump are the technical ones, logistical ones. What form am I supposed to fill out for this? There's so much administration and bureaucracy in healthcare 

I think a lot of the change has to come from past med school and I know that improving administrative support, increased pay is just a small piece of it, but better allied health support, ability to work in teams, and rely on people trying to connect people better. Just being more comfortable in the learning environment, in the clinical environments, would be a huge step. It gives students a little bit more competence. It helps them to feel a little bit more prepared.

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Balogiannis: This podcast is brought to you by the Ontario Medical Association and is edited and produced by Jodi Crawford Productions. To learn more about the Ontario Medical Association, please visit oma.org.

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