At TEDMED we also had a a very interesting conversation with Jacob Scott (watch Jacob’s TEDMED talk) whose impressive background was strong enough to throw us out of concentration a couple of times. But behind all this great history there is a very simple and cool guy who we befriended along the conference social gatherings and with whom we hope to stay in touch. We spoke mainly about how med school need to change and we were surprised when later on fellow speaker Sandeep Kishore (watch Sandeep’s TEDMED talk) echoed the same feelings and thoughts about who is educating our future physicians. “Sunny” also was one of our favorite guys from TEDMED, he already added me to his Young Professional Chronic Disease Network (YPCDN) and we will definitely do anything in our power to help. Giving the fact that these two similarly made such an influence on us and on the crowd –and based on their common ideas– we decided to ask them the same questions.
MC: You argue that the system selects the least creative candidates for medical school. What is the reason for this?
Jacob: Not necessarily the least creative. It’s not selecting for creative people and I think that the more creative people generally don’t go along with ‘getting the highest grade’ attitude. And so I think that is not purposefully selecting against them, but in general is selecting a lower proportion than it could.
Certainly medicine is a hard discipline, one that requires an immense amount of devotion and dedication to a single task which is learning about an amazing and mysterious field, and I think that for some more creative types of intelligence that sort of focus is difficult or not something that you’d want to do, so I think that probably withdraws people for that reason. I think that is true especially now in 2012 where you pay a lot for medical school (I had over $200,000 in debt and that’s a lot!), and then you have to work your buns off in medicine for a long time. I think more creative people typically do this for a little while, do that for a little while and the idea of being locked into that kind of pathway is something that scares them a little.
Sunny: I think it has to deal with the evolution of the medical system in the 20th century where we selected for people who had really strong backgrounds in science and part of that goes back to the 1920’s when we came out with selection procedures; and this was because 1/3 of the medical students dropped out of school because they couldn’t handle the basic sciences, so the MCAT got revised to be very very focused on the sciences, that I think was an upstream ’cause of the cause,’ and then we began to say: “if you’re good in science or have a good science GPA you’ll be a good doctor.” Turns out that the part of the MCAT that has the best predictive validity of your clinical performance is verbal reasoning, it has nothing to do with the basic sciences. So I think we haven’t locked ourselves out of that mind because we’re still used to thinking about scientists fighting malaria.
Thinking about a problem in one way is never going to solve the actual problem. When I was in medical school I realized there was this myopic biomedical approach to all problems, whether they are psychosocial or political, even biomedical we sort of lock in to individual disciplines. So I was introduced to a professor based in Cornell who studied malaria and he said: “Have you thought about malaria from a nutrition perspective? Have you thought about if from a health economics perspective? Have you thought about it from other perspectives than just clinical medicine?” I have to confess I never thought about it differently, but turns out one of the best approaches to prevent malaria is actually proper nutrition. If you think about nutrition in general is one of the best medicines that you can give somebody but I knew nothing about food, I knew nothing about micronutrients. So we came out with a little course that studied malaria from 4 different disciplines, 4 different perspectives and it forced the med students to actually interact with a health economist, to think about numbers, to think as an economist thinks, a basic scientist and a nutritionist who each gave their own approach. That changed me, because from then on I started to think differently and see how each approach could complement each other, it wasn’t like “my approach is better than yours,” it was like this synergistic thing.
There isn’t a space for lateral thinkers. If you’re Jacob or Sunny you get sort of pushed into a copy hole to think a certain way and what I think Jacob and I are doing is to rebel against that.
MC: What are the first steps that need to be taken towards a change in the system and who are the main players that could impulse it?
Jacob: I think a root cause of this is the rise of the common application. Nowadays is not uncommon for students to apply to 20, 30, 40 med schools, that makes weaving people apart really hard because every medical school gets 3, 4, 5 times as many applications as they did 15 years ago. Back then, when every school had their own application which were different, different questions that you had to fill in or type out, you couldn’t apply to 40, it would be impossible. So you’d actually have to apply to those ones you really wanted to go to and thought were a good fit for you. So if we would’ve get rid of the common application, abolish it, and now every school must have their own application, I would think that this will reduce at least by a factor of a half the amount of applicants that each school had, and I think that it would also focus that group of applicants to ones that are more appropriate for that school’s mission and guidance. And if you did that you could also spend more time investigating each applicant, because you’ll have 400 applicants for 60 spots, you have to do massive sweeps to get to a number you could actually consider in a reasonable amount of time. You out of all know that the first cut is probably the MCAT, they use what they call the “secretary cut-off” (as if asking a secretary not to deliver any application with an MCAT below a certain score). This is why I’d start by abolishing the common application. Take Netter for example, he changed the way we learn anatomy, that’s transformative, one person… he would’ve never got in. Probably even got C’s in biochemistry, God forbid! But then he changed the way all of us learned everything, there isn’t any physician in the country that doesn’t have that book.
Sunny: Right now I am working with the Institute of Medicine on developing new curricula for medical students. We are looking to bring faculty, students and lateral thinkers to actually talk about it. Imagine if medical school is like TEDMED, why do we have to come to this and get it for only 4 days? Imagine if we were thinking like this every day, you’d get so much more innovations and insights. Students should be the number one players impulsing this change. Students know the best about what our education lacks and they know what the real world is like and they are powerful. We know how we learn. Number two are like my ‘new champions’ idea, faculty members that could back students in doing this. That combination in getting curricular reform can, and will happen.
MC: Will these steps or changes be accepted? What would it take?
Jacob: No (laughs)… Do you know why? It is because the company that handles all these common applications makes a lot of money.
Sunny: I have actually spoken to my medical school about these changes and they have been receptive. The four-week course I took about malaria has now expanded to a full-year course, and the only issue that I see is that it’s still an elective but we now have the dean to support it and to finance a lot of the program. So it’s actually quite good and we have about 30% of the students enrolled as well. But the fact that it’s still an elective sends a signal, its like “if you have time” or “it’s not normative,” “it’s not real medicine.” I think we’re working on it, and it’s because of our success that I feel confident about coming here and say: “I see this happening, but we need to take it to the next stage.”
MC: What specific subjects/curriculum changes do you think must be sought to achieve the goal of more creative MDs?
Jacob: I think it would be pretty cool to see some flexibility on the medical school curriculum. Right now I haven’t seen any med school that has any flexibility, maybe they might have a couple of tiny electives that students can take one or two, two-week electives that meet once a week… what I mean is that it is a very small thing. I think we teach too much molecular biology to medical students, I think there’s too much certainty in the biology that we teach. There are some things that we can teach certainly, such as anatomy, basic physiology that we’ve known about for 60 years, but I think that all these new gene names, all these new mutations… they might be proven wrong in the next years, and I think that to load up on that stuff is silly, a waste of medical student’s time that could be better spent studying physical diagnosis or anatomy. I’d love to see free science electives, go take a physics class; if you’d like to be a surgeon who works with laser ablation, go take a class on lasers. Get out of the medical school classroom, go mingle with non-medical graduates, it is good to hear how other people think.
Sunny: I’d start with more public health. We need to introduce people to ‘the causes of the causes.’ When you talk about social determinants of health or behavioral determinants of health or nutritional… people don’t quite get it. You say ‘social’ and most think is people having fun; No! it has to do with where you live, what your income is and wether you have access to healthy food or not. What’s the point in telling someone to go exercise if they can’t afford a gym? If they’re like a single mother with three kids… we just loose that kind of context. What’s the point in writing a prescription for someone if they can’t read? There are those things that doctors don’t think about. I’d put anthropology in there as well, I think nutrition has to go in there. Another thing I think we need is urban planning; if you think about cities… we talk about go exercise, go walk around but what if we could encourage it from a public health perspective? Then make cities that actually facilitate this, this could be a nonconventional solution to the obesity epidemic. I’d also like to see political science, I think we don’t talk enough about this; we tend to stay away from politics because we think it’s dirty. And that’s why I think doctors don’t engage in those debates, we just react and say: “ok this person is sick.” We kind of confine ourselves because is messy and it’s yucky to talk about this. One of my favorite quotes from one of the fathers of social medicine is:
“Medicine is a social science, politics is nothing but medicine on a grand scale” – Rudolph Virchow
The fact that Francis Collins, Peggy Hamburg, Tom Frieden are all here, makes me love this thing –these are all political appointees, and we’re in Washington, DC. We doctors need to engage in the politics of medicine as well, the policies behind medicine.
MC: What is the profile of the MD candidate the future of healthcare needs?
Jacob: I think is a diverse profile, first of all. I don’t think there is any single profile that fits, there is always strength in diversity. If I were selecting a class myself I would want to build in diversity, that would be the measuring stick that I’d start with. My class would be comprised of different types of people. I wouldn’t say I want the highest scoring class, I want the smartest kids, I want the best prepared… I would say I want some proportion of this type of thinkers, some proportion of that type of thinkers, some proportion of physicists, some proportion of engineers, some proportion of biologists, some proportion of fine arts major, even if it’s small, doesn’t matter, I want to have the spectrum. So to answer the question of what profile we need, I’d say a diverse profile, a diverse portfolio if you will.
Sunny: I think someone who has shown evidence of doing independent projects, someone who has studied two or three different disciplines in his college, someone who has articulated a vision of what they think health should be in 50 years. You want leaders and not just people who would react to things.
We were so excited to have met these two guys and will definitely like to work at their sides on the future. One of the best things about their talks at TEDMED is that the AAMC was actually there –and they got pretty rattled– sponsoring simulcasts that reached almost every med school in the country. Their message was spread and resonated in every med student that attended these simulcasts. We can only hope that Jacob’s and Sunny’s seed grows out to be a true ‘Revolution’ of creative or lateral thinkers for the sake of the our healthcare’s future. We support you all the way!