The Training of the 21st Century Physician

by Blake McConnell, MD

At the beginning of medical school, I remember thinking four years was such a long time. After all the rigorous pre-medical schooling, gathering clinical experience, and–for many of us–working a job, getting into medical school felt like reaching the summit. With steep acceptance rates per year, getting that acceptance letter felt like the ultimate prize; it felt elite. However, as most know, reaching that pinnacle is only the starting point, and the real work begins day one when the classroom opens. It turns out training to become a 21st century doctor poses many challenges, and those challenges are not unique to the students themselves. The journey of “making a doctor” involves not only a serious time investment from the pupils themselves, but also the larger educating body, its professors and its curriculum. What is important in making of the modern doctor? It is a serious set of questions that many medical schools are trying to figure out.

As society changes and evolves, so does medical education. My medical school – Oregon Health & Science University (OHSU) – like many other medical schools, have all been faced with the same challenge: how do we adapt the current clinical training to match what Americans need in their doctors? The answer to this question has proven very difficult indeed. Classically, medical school is split up into the pre-clinical and clinical years. Traditionally, the first two years of medical training involve gross anatomy, physiology, histology, pathology, biochemistry and pharmacology while the second two years are spent rotating through a variety of specialties from general surgery to psychiatry. There is little room in the traditional model for elective time in non-mandatory electives or exploring interests in different practice settings.

At OHSU, I was apart of the 2nd inaugural class to go through the “new” curriculum. This new curriculum recognized that there was too much focus on the traditional first two years of medical school and not enough time for clinical electives. Thus, instead of 24 months of hard classroom time and book study, my class spent only 18 months in the classroom, allowing a full additional six months to spend as the student chose: various elective rotations, research time, or unique options like time in rural medicine. This pivotal change shifted the emphasis from book knowledge and the “science of medicine” toward more exposure to the “art of medicine”: more exposure to different specialties, different forms of practices, different settings, and ultimately more doctors, working and practicing around the region.

Six months of more electives allowed more flexibility and more time for students to ponder the ultimate question: what specialty am I going to choose to practice for the rest of my life? During my six extra months of elective, I choose to do a rural family medicine rotation in Prineville, Oregon. Here I was exposed to a completely different style of practice than I was exposed to in the city of Portland. I saw how crucial a family doctor is to a community and the realities that many modern family medicine doctors face. These challenges were unique to rural communities in which physician shortages abounded and many patients required their doctor to not only be knowledgeable, but also adaptable, savvy and personable. The style and “art of medicine” of these physician leaders in these communities was very strong, and my time spent in Prineville, Oregon significantly strengthened a pull I already was feeling toward the specialty: a specialty I ultimately ended up choosing.

While there isn’t going to be a consensus on how to train doctors, I do believe that allowing medical students more time to explore their natural interests provides a solidifying boost in choosing a specialty that many will practice for 20-30+ years. Four years may seem like a long time, but in reality it goes by so fast, and so many decisions are needed to be made over that period. To train smart, caring doctors, we need those doctors to genuinely enjoy their field and desire to serve patients. Allowing young trainees the time to explore and deepen those natural interests will allow us as a society to achieve that goal, and is one step forward in the right direction for training the modern 21st century physician.   

Dr. McConnell is from Aumsville, Oregon. He went to Oregon State University and received his undergraduate degree in computer science. Prior to medical school he worked for Garmin, Department of Forestry, and several other jobs developing software. His medical interests are sports medicine, rural health, and addiction medicine. His personal interests are visiting national parks, mountain biking, playing tennis, and staying in fire lookouts. He chose the University of Utah because of the camaraderie between residents, the outdoors, and the incredible opportunities in sports medicine and addiction medicine.

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