Reforming medical education requires redefining the physician’s role

Much like the COVID-19 pandemic has shed light on long-time cracks in the
 U.S. healthcare system, it also highlights gaps in medical education. What needs to change for the future of medical education? Enhancing physician training to bolster improvements to Americans’ health first requires an institutional shift in defining 
the physician’s role.

Though U.S. healthcare and medical education have advanced in the last century, both still fall short of the goal to protect and promote the health of every American. Even before a global pandemic, Americans have long been plagued by public health crises including socio-economic challenges, structural racism, widespread inequity, and a recent decline in life expectancy.

Consequently, a multitude of recommendations to improve the medical education of future providers is complicated by increasing demands on medical students. Perhaps the fundamental question to guide solutions for training future generations of physicians is: What role is a medical student taught to fill?

Some say the physician’s role should remain focused strictly on providing care. Others, like Dr. Donald Berwick, believe “it is important and appropriate to expand the role of physicians and healthcare organizations into demanding and supporting societal reform.” For decades, health has been defined to include overall social, mental and physical well-being, not just the absence of disease. It would then follow that physicians, as healthcare leaders, would embrace stewardship of any sector that intersects with patient health, affirming Rudolf Virchow’s 1848 claim that “physicians are the natural attorneys of the poor, and social problems fall to a large extent within their jurisdiction.”

Amid the COVID-19 pandemic, the indispensable role physicians play in protecting the health of their patients and colleagues makes clear the connections between professional responsibility and advocacy. Although the pandemic has clarified these connections, doctors’ responsibilities to their communities have always included advocating for patients.

At its foundation, the structure of medical education since the landmark Flexner Report more than a century ago has been criticized for facilitating excellence in science that was not matched by clinical caring. A focus on improving medical education through the lens of the expanded physician role—health advocate, social change agent, healer who embraces the moral determinants of health to mend the fabric of communities—would lead to a greater appreciation of the gaps in medical student training. 

A modern curriculum would need to include advocacy, social determinants of health, health equity, healthcare finance and delivery, civic engagement, implicit bias and empathy, preventive medicine, public health and epidemiology, value-based care, human-centered design and innovation, and health policy. That is a heavy lift, but such reforms in medical education would equip medical students to later pursue much-needed reforms in individual and community health.

Some of these solutions are not unprecedented. The Accreditation Council for Graduate Medical Education outlines advocacy training in residency programs, but medical students would benefit from an earlier start to such training. Other reforms would counter poor integration of existing curriculum requirements. Racial bias in medicine is pervasive, including among medical students, which suggests that current training on social determinants of health is at best inadequate. Some interventions can be instituted as early as the admissions level, to increase the number of medical students from underrepresented communities. Embracing broader medical education drawn from the expanded role of physicians would create a framework to consider solutions at every level of training. 

Absent such a North Star measure, the future of medical education is more likely to remain driven by historical patterns.

Fortunately, medical schools are introducing innovative curriculums and organizations are pushing for social mission-driven changes in medical education. While the barriers to improving the health of Americans are vast and complex, reforming medical education would help secure a healthier future. 

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