As modern medicine continues to advance, it’s important that medical education correlates. The traditional approach to medical school was institutional centered learning, but more schools are making the transition to patient-centered learning programs. There are currently many gaps in the healthcare system, for example treating transgender patients, patients with disabilities, and forming doctor-patient relationships. Could medical school curriculum be to blame?
Institutional-centered learning focuses on teaching med school students through lectures prepared by professors. The first two years of medical school typically takes place in the classroom, followed by clinical rotations and finally residency. In the first two years of med school, students take courses in basic sciences such as anatomy, biochemistry, microbiology, pathology, and pharmacology. They also take participate in labs and learn the basics of interviewing and examining a patient.
So, what about practicing in a real setting? You might be thinking that’s what clinical rotations and residency programs are for, and you’re not completely wrong. But, there are many issues that physicians have noticed with the institutional-centered learning in the first two years.
The information taught within the institution is taken as the complete truth, and this can cause discrepancies in treating patients. It’s also common that the reasons for treating a patient a certain way are based on information that has been passed through several generations. But, what was true and a proper practice a few generations ago might not be the best solution now. Many patients who are concerned with their conditions and illnesses will present information to their physicians. If what the patient says contradicts what was learned in med school, the patient is considered wrong, and sometimes even devalued. Patient-centered learning can help close this gap.
While clinical rotations and residency programs can be considered patient-centered learning programs, schools are starting to see the benefits of patient-centered learning in the first two years. The focus would be to have the students listening to the patient early in their training, making the patient the focus from the start. In patient-centered learning, students would have the chance to perform their own research on the patient’s condition. This approach can take them far beyond the practices of institutional-centered learning and aid in knowledge retention. In addition, more time can be devoted to the patients and to exploring non-prescription treatments.
In 1998, the University of North Dakota School of Medicine and Health Sciences introduced a patient-centered learning curriculum for 1st and 2nd-year med students. In one article, authors highlight some of the factors and changes that resulted. The purpose of the “intervention” was to promote professionalism and institutional culture change. This was possible by presenting students with new opportunities for professionalism education. Also, a new institutional culture was created on all levels that support and promotes relationship-centered professional values. More schools are starting to recognize the benefits of these changes, and are working to make the transition.
Patient-Centered Learning vs. Institutional-Centered Learning
Institutional-centered learning in the first few years of training can lead physicians to focus only on their formal education and to ignore what the patient is telling them. It’s a common finding that doctors and physicians don’t spend enough time with patients, to begin with, so it’s likely they aren’t giving enough attention to their patient’s stories either. This cannot only cause dissatisfied patients but could also lead to misunderstanding and improper treatment.
By using a patient-centered learning approach in the early years, students are taught to consider their own knowledge, as well as what matters to the patient. Students also experience better retention of information and can even explore non-traditional treatment options. In addition, these programs lay the foundation for forming better doctor-patient relationships in their professional career.