Why changing the way we educate physicians could change the entire health care system

Jun 16, 2019

Changing the way medical schools educate future physicians may be an important step in changing the entire health care system for the better, an Austin, Texas, educator argues.

With us on “Take Care” is Dr. Clay Johnston, dean of Dell Medical School at the University of Texas at Austin (UT Austin) and vice president for medical affairs at the university. He envisions a reworking of the medical education system to include what he calls a “health ecosystem” that maximizes efficiency and personal care.

Johnston has been at UT since 2014, with his constant focus on improving medical education and the greater health care system. He said there is a lot of attention placed on the doctor/patient relationship, but he tries to broaden that vision to include the whole system and how to best create a healthy life for each patient.

“Our current notion is that, if the doctor makes the right diagnosis and sends a patient out with the right prescription, that that’s success,” Johnston said. “Our notion of it is that relationships actually weigh more important on how the patient perceives what they’ve learned, how much trust exists in that relationship.”

Johnston said the biggest change in approach he is helping to integrate into classrooms is building on that personal relationship with patients and other physicians to increase care effectiveness. This includes educating patients on their perscriptions and working with the patient to help them consistently take the medication.

“For that script to land, the patient actually has to be able to fill it and afford it and fit it into their complex life and understand why it’s important,” Johnston said. “All of those aspects are really critical to our success as a health system.”

It is important to train medical students to be future leaders so they consistently try to improve the system and achieve better outcomes, Johnston said.

"We're interested in thinking about the whole health system and how it could be, should be better aligned with society's interests."

“That does translate to a different kind of curriculum,” he said. “We want them to understand better the importance of communications, the importance of systems of care … and so, we carve out more time for that.”

Among the curriculum shifts are the de-emphasis of rote memorization and tests that rely on personal achievement, which was the past method. Instead, Johnston said, classrooms at UT have turned to team-based problem-solving lessons, including teaching students how to gather and analyze information to make tough decisions.

“Showing off that you’re better than others is really not what medicine needs to be about,” Johnston said. “It needs to be about how we are working together to solve these issues.”

Johnston also sees advancing technologies as an opportunity to change the tool kit students use at UT and beyond, especially artificial intelligence. Technology can gather and analyze vast amounts of data, freeing up physicians’ time to focus on building personal relationships with patients and increasing communication between patient and physician.

This means primary care responsibilities will change, too, Johnston said. Technology will start to do more primary care practices, but there will still be an increasing need for primary care physicians as the position adapts to the changing times.

“As we focus more on populations, primary care docs are going to become even more critical as the kind of captain of the ship,” Johnston said. “The key for us is to train them in a way in which they can adapt to whatever new technologies are thrown at them.”

UT’s new approach may be great for Austin, but a lack of doctors mean certain areas of the country, particularly rural areas, are just trying to cover the basic needs, let alone create an ecosystem. Johnston said he sees huge potential for telemedicine to help fill the gap between urban and rural standards of care and educates students on this problem as well.

But education is only one piece of the larger puzzle that is the health ecosystem, Johnston said, which is why his approach is multi-faceted, finding solutions in and outside of the classroom and hospital to find solutions that work best for patients.

“We’re interested in thinking about the whole health system and how it could be, should be better aligned with society’s interests,” Johnston said. “[It is] also recognizing that we have limited resources, … and we need mechanisms to think about how we reduce the waste in our system.”

In the end, Johnston has more changes in store and sees education playing a crucial part in creating a better system of care for all patients.

“We’re envisioning a future health system that effectively uses technology, uses other practitioners in team-based care, learns constantly from every person that’s in the system and focuses on community as well,” Johnston said. “That then translates to a different kind of education, but it also translates into new models of health care.”