Reforma en la malla curricular de la carrera de medicina

In Medical School Shift, Meeting Patients on Day 1 http://www. nytimes. com/2010/09/03/nyregion/03medschool -html [pic] Dr . Steven Abramson with a patient, Sharon Smith-Sanders, who has lupus, as the N. Y. U. Medical School students Jennifer Millman and Christine Stahl, right, listen and learn. BY ANEMONA HARTOCOLLIS, september 2, 2010 For generations, med classrooms and labo dissecting specimens year when they woul Ist ori PACE 1 orfi sp two years in y parts and triumphant third g with actual people who have actual diseases.

Upending that century-old tradition, the aspiring doctors who tarted their training at New York University School of Medicine last week got to meet real patients on their very first day. But not to worry — they were armed only with laptop computers, not scalpels «l am possibly the worst patient in the world to have,» an H. I. V. – positive tuberculosis patient told the 162 first-year students in a cavernous lecture hall in Midtown Manhattan, as they diligently jotted down notes. «l thought I had the common cold.

It went on for months. » The model of modern medical education was set bv the Flexner — followed by two years of clinical studies. But in the last few years, medical schools including those at N. Y. U. and Harvard university have been doing some soul-searching about whether this lock-step curriculum creates doctors who lack humano’, who see patients as diseases rather than as whole people and who have What the medical literature calls «ethical erosion» a loss of idealism, empathy, morality.

The result has been an increasing focus on clinical studies and, in a curriculum introduced by N. Y. U. last week, on fostering from the beginning more personal relationships between medical students and patients. More than a year in the making, the N. Y. IJ. urriculum makes connections, professors say, between the relatively abstract science being taught in the classroom and the way it plays out in real life. It brings the progressive «hands-on» approach to education from kindergarten into higher education, said Dr.

Steven B. Abramson, the medical school’s vice dean for education: instead of playing with blocks, the medical students are, with all due respect, learning to play well with patients. By advancing sorne of the clinical component into the first two years, the new curriculum also gives students more time in their third and fourth years to study popular public health issues ike nutrition and how diseases might affect people differently depending on race, ethnicity and socioeconomic status.

For a few ambitious students, Dr. Abramson said, the new curriculum might make it possible to ea For a few ambitious students, Dr. Abramson said, the new curriculum might make it possible to earn both an M. D. and a master’s degree in public health or administration in four years instead of five. Many medical schools have experimented with providing earlier clinical experience, but such efforts may be gaining traction now because of incentives to promote primary care in federal health are reform, said Dr.

Atul Grover, chief advocacy officer for the Association of American Medical Colleges. «This is a good market signal,» Dr. Grover said of the N. Y. U. program. «Periodically we go through this phase where people don’t want to go into primary care, and we’ve just seen the worsening of that. » + He noted that the last time medical schools aggressively pushed primary care was in the mid-1 990s, with the advent of managed carea Students were told, mistakenly, «If you want to be driving a cab, go into anesthesiology and radiology. Dr. Fitzhugh Mullan, a professor of public health and pediatrics at George Washington University, suggested that N. Y. U. and other universities might be responding to concerns about a lack of What he called «social mission» among their graduates. In a study published in June, Dr. Mullan and his co-authors ranked N. Y. lJ. ‘s medical school fifth worst in the nation at promoting socially conscious medicine. (N. Y. U. responded that the study failed to take its relationship with Bellevue Hospital Center, which sen. es the poor, into account. ) In another effort to connect stude 31_1f6 Bellevue Hospital Center, which serves the poor, into account. ) In another effort to connect students with patients sooner, the new medical school at Florida International University WII place second-year students in underserved neighborhoods beginning this fall- A team of medical, nursing, social work and perhaps even law students Will be assigned to a family, with the goa’ of understanding how factors like poverty and other stresses may complicate medical care.

At Hamard, the traditional third-year hospital rotations have been revised to foster more personal relationships with patients and to give students a sense of the continuity of care. A dopen students ave been paired with faculty members to See their regular patients over an extended period of time at Cambridge Health Alliance, a system of hospitals and clinics. At N. Y. U. last week, new students were introduced to the «four pillars» ofthe new curriculum: diabetes, colon cancer, tuberculosis and heart disease, emblematic public health scourges of the 21st century.

Dr. Ann Danoff, an endocrinologist, told the students that the four-pillars concept updated the medical school adage «Know syphilis, know all of medicine. » Dr. Danoff and her colleagues then proceeded to introduce the tudents to patients with diabetes, colon cancer and tuberculosis. As the term goes on, the students Will visit clinics and hospitals once a week to meet more patients. The goa’ is for them to learn to listen and communicate, to use a stethoscope and to patients.

The goal is for them to learn to listen and communicate, to use a stethoscope and to conduct a basic physical exam, as well as to connect the diseases they see in the patients to the science they are learning in class. On Day 1, Courtney Butler, 28, a guest patient, said to the students that she had been told at 13 that she had diabetes, ut that her symptoms had been missed at first because, as an athlete, losing weight and being thirsty seemed normal. She shared her embarrassment at being the only child who went to the nurse’s office to check her blood sugar.

As she spoke, a student in the front row who seemed perplexed flipped open his MacBook and scanned Wikipedia entries on endocrinology, insulin pumps and finger sticks. Was N. Y. U. putting the cart before the horse by introducing a patient befare teaching students about the basics of a disease? Dr. Abramson said later that he thought the Web surfing meant the student was engaged. Dr. Craig T. Tenner, an internist, talked to students about the pros and cons of preventive medicine, asking them to imagine they were tied to railroad tracks.

Should they be given a pair of binoculars? «Would you want to See the train coming or not? » he said. Would they want to see it when it was two miles away? One mile away? Then, a gastroenterologist, Dr. Michael Poles, introduced a retired physician, no Senape, with colon cancer who ruefully confessed to having skipped his screenings, despite a family history of the disease. Dr. Ellie Dr. Ellie Carmody introduced the tuberculosis pillar, telling the tudents that TB was not just a disease of underdeveloped countries.

She put up a slide of the locked Ward at Bellevue Hospital Center, where tuberculosis patients who refuse to take their medications can be involuntarily confined if they are found to be a threat to public safety. Her patient, a 42-year-old Navy veteran, took the stage to describe how his doctor had notified the citys health department when he skipped his medication. «They said we’re gong to lock you up, and they were not kidding,» he recalled. He told the students that when he was hospitalized, the doctors saved his life, but the nurses saved his sanity. It was a chastening remark. In traditional medical education,» said a student, Hannah Kirsch, 22, «you don’t have a patient come in the first day and say, ‘Sorry, guys, it was really the nurses who carried me through. ‘ » As Dr. Danoff welcomed the new class, she reminisced about her own first day, in 1976, at the Medical College of Pennsylvania. Her first assignment was to learn all about the sternocleidomastoid, a Word that seemed to encompass all the mysteries of medicine in its many syllables. (It is the columnlike muscle on either side of the neck that Sticks out when you rotate your head. ) Her first patient was a cadaver.