Creating the good doctor

Forty years ago, the quintessential doctor show featured Marcus Welby, M.D. — a primary care physician who made house calls, didn't charge patients who couldn't afford it, maybe even delivered a calf on the side of the road … all before performing difficult surgery on a young patient.

Fast-forward to 2011, and we are treated to non-stop House, the drug-addicted, narcissistic (but brilliant) 21st century physician.

How did we physicians go from saints to sinners so quickly in the public's eye? Solving that question has driven my research for the last 10 years. Why do physicians resist change rather than lead transformation? How would we need to change the way we select and educate physicians to turn us back from Dr. House to Dr. Welby?

The answer is simple, although the solution is somewhat more complex. In an article for the Physician Executive entitled "Biases Physicians Bring To the Table," I wrote that after four years of medical school, and three to seven years of graduate medical education, the young physician has joined a cult centered around four biases — competitive, autonomous, hierarchical and non-creative. A young medical student often begins his or her studies as an idealistic, optimistic overachiever, but by the end of the process, often loses those endearing qualities.

Think about this. In 2011, we still accept medical students in this country based on their science GPA, ability to memorize organic chemistry formulas and scores on the MCAT (a high-pressure national multiple choice test). Yet somehow we are amazed that doctors are not more empathetic, communicative and creative.

We have traditionally emphasized individualism and competition. It's a "One of you will get into the best residency, one of you will be the best in your group" mentality. Compare that to my MBA experience: On the first day we were told that the most important decision we would make was choosing a study group, as every grade we received would be a study group grade. There would be no individual grades because "teams are what matter."

Believe it or not, that medical selection process has not changed much in the last 50 years. And while it's being questioned, very few medical schools are changing their criteria. In fact, the MCAT is going through its first revision in 25 years. The problem is that these tests and criteria may be totally unsuccessful in choosing physicians who will increasingly need to look beyond the science and biology of their patients.

When I graduated from medical school, being able to memorize arcane material was of paramount importance, because if a patient came in with a headache, I needed to know all 20 potential causes of that headache. Now the 20 possible diagnoses are all on my iPhone 4, and the ability to communicate with my patient and see subtle changes in color take on increasing importance.

While medical school courses have changed over the past 30 years, graduating students still feel insecure about the future of medicine. Most relate that they had little or no management and leadership training in medical school.

In a survey that we recently completed, 60 percent of physicians practicing three years or less were "frustrated" that they did not learn what they most needed in practice. They learned microbiology and anatomy, cardiology and internal medicine. But they did not learn how to creatively embrace change, effectively communicate or collaboratively negotiate.

They learned to "become a doctor" but not how to make a patient happy, be a leader (or a good follower), be an individual who contributes positively to an organization or run an effective meeting.

Just about the time that Marcus Welby was airing his final episode, almost 40 years ago, the USF College of Medicine was born. Some of the founding leaders of the college spoke of a more "holistic" approach to medical education. I am proud to say that today in 2011, USF Health is leading the charge for training 21st century leaders through a program we call SELECT (Scholarly Excellence, Leadership Experiences, Collaborative Training.)

This program embraces the challenges of the Josiah Macy Jr. Foundation Report, which states that: "Medical education has not kept pace with the growing demands of an increasingly complex health-care system. Medical students too often graduate without the knowledge and skills that 21st century physicians need and without fully appreciating the role that professional values, leadership competencies and attitudes play."

Medical students from around the country are looking at the USF College of Medicine as a model for training for the future. In order to choose the students most likely to succeed in this environment, we have supplemented our SELECT admissions criteria and are working with the Telios Leadership Institute, founded by two Wharton professors, to actively search for characteristics of students — such as self-awareness, empathy and the ability to be a change catalyst — that make it most likely for them to be successful in a leadership role.

Letters of recommendation will be replaced by one-on-one interviews probing for emotional intelligence traits and flaws, and we are utilizing a behavioral experience interview, commonly used in choosing business leaders and aviation pilots, looking for potential leadership experiences and traits. The end result is less reliance on science GPA and MCATs and more on parameters that will create physicians less prone to the "biases" of the past.

Since more than 3,000 students apply to our program, choosing these future health-care leaders is a great responsibility. We want to make sure that we have a futuristic curriculum that emphasizes leadership education, values and ethics, and health systems and policy, so our students can become leaders as opposed to followers of health-care reform.

Another unique aspect of our program is mentoring and coaching. There will be a summer internship between Years One and Two in which students will be expected to follow and interact with a leader of their choosing. This may be a physician entrepreneur, the state's surgeon general or a health network medical officer. Each student will be given an opportunity to take a "minor" in business and entrepreneurship, health disparities, engineering, international medicine, law, medical humanities, public health or even medical writing or music.

Oh, and in the medical school of the future (which we've begun today) geography doesn't matter, so we have partnered with some of the best organizations in the country, including a hospital system 1,100 miles away. The new Center for Advanced Medical Learning and Simulation, to be completed next year in downtown Tampa, will encourage and simulate teamwork training in partnership with best practices from the military and other high-powered teams. And USF Health's new partnership with The Villages will afford these students the opportunity to interact with an entire community.

As a medical school dean, I don't have much time to watch TV these days. But as one of those baby boomers who will eventually slow down and most likely become a consumer of health-care services, I am hopeful that my future physicians will be empathetic, holistic, creative and caring. That while they may not be able to memorize the Krebs cycle, they have enough intelligence to know when to consult their iPhone 8. And yes … I hope that the personality of Dr. House as a model of physician behavior becomes as dated as Marcus Welby might seem to us today.

Stephen Klasko, MD, MBA, is dean of the USF College of Medicine and CEO of USF Health.

Creating the good doctor 05/21/11 [Last modified: Monday, May 23, 2011 7:24pm]

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