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

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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, Published: September 2, 2010

For generations, medical students havespent two years in classrooms and laboratories, memorizing body parts and dissecting specimens, eagerly anticipating the triumphant third year when they would be immersed in working with actual people who have actual diseases.

Upending that century-old tradition, the aspiring doctors who started their training at New York University School of Medicine last week got to meet real patients ontheir very first day. But not to worry — they were armed only with laptop computers, not scalpels.

“I 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. “I thought I had the common cold. It went on for months.”

The model of modernmedical education was set by the Flexner report of 1910 and has since gone virtually unchanged at many top medical schools: two years of foundational science — gross anatomy, biochemistry, cell biology, virology, pathology and the like — 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 somesoul-searching about whether this lock-step curriculum creates doctors who lack humanity, 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 morepersonal relationships between medical students and patients.

More than a year in the making, the N.Y.U. curriculum 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, themedical 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 some 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 like nutrition and how diseases might affect peopledifferently depending on race, ethnicity and socioeconomic status. 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 nowbecause of incentives to promote primary care in federal health-care 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 thelast time medical schools aggressively pushed primary care was in the mid-1990s, with the advent of managed care. 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...