← All Of It with Alison Stewart
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Tiffany Hansen
This is all of it. I'm Tiffany Hansen in for Alison Stewart today. Well, in our previous segment we were talking with a doctor about her medical training and now we're going to turn our attention to a new medical school curriculum from an institution on Long island that aims to raise the next generation of doctors to be competent, compassionate and collaborative. Dr. David Elkowitz is the associate dean for academic programs and educational culture at the Zucker School of Medicine at Hofstra Northwell. He's also the director of the Academy of Medical Educators and he joins us now to talk about the Zucker School's innovative approaches to medical school. Welcome, doctor.
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Dr. David Elkowitz
Hi. How are you doing?
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Tiffany Hansen
Great, thank you. All right. So in that last conversation we talked about see one, do one, teach one, it's a common expression as we learned. So I'm wondering how Zucker curriculum stays true if it does to that three tiered approach.
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Dr. David Elkowitz
Oh, 100%. You know, we have very small group classrooms here, a very, very small class size. So our students right from day one not only learn medical education, they are exposed to patients, but they actually go through almost a teaching fellowship. They from very, from day one, they start teaching each other about things they learned the night before, things that happen in the classroom. So, you know, as we, you know, have a discussion over the next few minutes, you'll start seeing how this concept of not only learning but teaching is woven through our entire four year medical education program.
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Tiffany Hansen
We talk about this as a new approach. So I'M curious what was lacking in the older approach, the more traditional, quote unquote, traditional approach to medical education that you think needed a little bit of tweaking?
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Dr. David Elkowitz
Yeah, you know, first of all, I came through that old medical type of approach, more of a traditional type of approach where, you know, you sit in a classroom for eight hours a day and you have a professor or sage on the stage, so to speak, that's essentially delivering information to learners, just passively sitting there in the classroom, trying to collect all this information in order for them to, you know, learn it or at least be introduced to it. Here at our school, we're a student centered curriculum, a very active curriculum where our students essentially develop learning objectives and learn the material in part on their own, and then come into the classroom here and apply it with professors, patients, right from day one. So it's a very active approach. Students, when they come here to our school, not only learning and applying medical information in real time with patients as certified EMTs, right from day one, but, you know, they're also teaching each other as well. So, you know, why these, this shift, you know, technology over the years have changed. You know, when I went to medical school, in order for me to stay on the floors during my clinical years and stay with the team, I would have absolutely have to know a lot of information, memorize a lot of information, and have it at my disposal in order for me to stay with the team, so I wouldn't have to go down to the library and look up information I should know. You know, these days, you know, we all of us are walking around with cell phones and we all have the medical information at our disposal, at our fingertips. So really, when we're on the floors with patients and doctors, we need a different skill set. How do we apply? We can get the facts very quickly, obviously, but first of all, where do we get the facts from? So scrutinizing sources is something that we teach our students right from day one. How to go about doing that, how to apply that information, those facts that we have at our fingertips to the patient right in front of us. That's very, very important. Technology has really guided medical education from a passive approach to much more of an active approach.
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Tiffany Hansen
Specifically, when we're talking about technology, what are some pieces of technology that have really made it so that parts of that older style of education are just no longer useful? Or in fact, like, is there a specific thing. I know we talked in our previous segment about, we used to see on TV doctors carrying around clipboards. Right now, everything Is a medical record on the computer when you walk in, a concrete example like that of another way maybe, that a patient might see technology changing the way doctors are interacting?
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Dr. David Elkowitz
Oh, I, you know, as you were asking that question, I had a big smile on my face because when I was a resident and fellow and even new attending as a pathologist, I would have my pockets stuffed with notes and cheat sheets and review books and all sorts of sources, just so I have that fact that my fingertips and patients would absolutely see that. And our reliance on that information, you know, now in these days, you know, whether it's, you know, all the interventions that are obviously electronic and technology forward, but certainly the facts that on our cell phones we have at our fingertips that are evidence based and the sources are good, we can get that information quicker and much more reliably in front of the patient. So now what do we expect out of our students? Our students have that. We don't have to memorize all this stuff that we had to do 20, 30 years ago. But how do we apply those facts to have better patient outcomes in real time? The patients absolutely see that, and their visits are more efficient. And maybe the technology is helping, if used in the right way, for much better outcomes.
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Tiffany Hansen
I'm wondering, though, like, for example, if you are speaking with a physician about a particular ailment and you say, you know, my ankle hurts when I do this, when I do this doctor, is it. How is it for the patient experience when the doctor then just immediately looks at their phone or looks at the computer versus the old days, you know, when. When Dr. Elkowitz would just rattle it off the top of his head, you
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Dr. David Elkowitz
know, at the end of the day, the way a patient looks at their physician, it's not just, you know, where they're getting the information from, whether it's a phone or whether it's from a review book or maybe they have to excuse themselves and go down to the library. At the end of the day, a patient's confidence is going to be predicated on first the rapport that the physician builds with that patient, the communication. Is that patient being listened to? How transparent is that, you know, doctor. And you know, are. Is that doctor becoming a partner with that patient to figure out the information that they need to be treated appropriately. So at the end of the day, that's really the secret sauce. Listen, I have a personal experience. You know, right now I'm a stage 4 cancer patient being treated and, you know, walked into one of my visits and asked the question of my doctor, and she didn't know the answer, but she goes, you know what, let me grab my computer and let's figure this out together. And just rolled her chair around with me sitting on the table, you know, with my robe on. And we kind of figured it out together. So it, the technology is important and it certainly facilitated change in medical education. But the reality is that a patient is only going to look at their physician with trust if they know that they're being listened to, if the physician built rapport and if the physician is knowledgeable and it's evidence based.
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Tiffany Hansen
First of all, best of luck with your recovery.
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Dr. David Elkowitz
Oh, everything is going well.
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Tiffany Hansen
Okay, great, great. Second, let's talk about this memorization a little bit just from the perspective of teaching, because I know you say that we've some of that off the table for medical students. They're not required to memorize as much or keep as much in their rolling around in their pockets on little pieces of paper, pieces of paper that they can't keep memorized. How do you know if they're not doing that? How are you as an educator assessing their knowledge?
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Dr. David Elkowitz
That's a great question because I'm, you know, I'm faced with having to give evaluations to medical students all the time and that's, it appears to be a conundrum, but it's really not many times we'll actually give the facts on an examination. Listen, I'm telling you that these were, these are the facts. But we'll ask a question in a way that they would have to take those facts and apply it to solve a problem. So what we're really assessing is critical thinking and problem solving with a set of facts that they already are given. So we kind of flip it around and you know, when they take boards, that's essentially what boards are testing now. You know, back in my day, boards were very fact based. You know, do you know this or do you not know this today? Yes, medical information, they have to know a certain amount of medical information, certainly. But a big part of what they're being tested on is for them to be able to answer a kind of a higher order question, to test their critical thinking and problem solving. So very, very often we'll give them the facts and we are actually testing not only how they problem solve, how they're going to critically think, but also their communication skills, how they're going to talk with the patient, how they're going to explain these tough concepts in a way that a patient is going to be able to understand. That's how we go about testing here. So to that end, we have a lot of essays, we have oral examinations, which is a very, very unique thing in medical education, especially on the medical school, the. The UME education.
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Tiffany Hansen
You talked about that. We talked about the technological changes and how that sort of necessitated this change in the way we view medical training in med school, in residency. I'm wondering how much societal changes are also pushing the need for change here. Because we can imagine a day in the past or when the doctor, usually a man, was really his. His advice, his knowledge was taken as gospel, right? You do what this person says, you believe everything this person says, and he's going to sort of hand it down to you as an edict, and you'd better do it. Otherwise, you know, tough luck. And obviously, that's not the case anymore, and that's not what people expect anymore, and that's not what people are. Have become used to or are demanding. And so how much of what we see in the changes from medical school are precipitated by that change in the culture around physicians, people who are becoming physicians the way we are expecting them to behave?
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Dr. David Elkowitz
It's important that physicians, you know, certainly have the heart, the spirit that when they see a patient, that it's a partnership. So I think that's first and foremost, and developing a relationship with that patient built on trust and rapport, that's very, very important. The second thing is that, as you know, half of our class, half of the medical school class, just in general across the country, are men and women. So, you know, that that's a seismic change from, you know, 40, 50 years ago as well. But, you know, again, you know, what makes, I think Hofstra, the Zucker School of Medicine, unique is that these elements that we're talking about are kind of embedded right in the curriculum from day one. So our students are very, very sensitive to this whole idea that the patient is part of the team. Certainly the patient and the physician have to work together in order to have great outcomes. Trust has to be built. Even as a pathologist, I read a lot of slides, look at a lot of images. Our students have to understand that behind every slide, behind every blood test, behind every image, there's a human being, there's a patient that's worried, there's a family that's worried. And, you know, I think that society expects physicians to be able to function with patients and families in that way very, very differently than 40, 50 years ago, where essentially, like you described, you know, you just going to do what I'm told and you know, that's what's going to be.
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Tiffany Hansen
That's right, listeners. We're talking with Dr. David Elkowitz, who's the associate dean for academic programs and educational culture at the Zucker School of Medicine at Hofstra Hofstra Northwell. He's also the director of the Academy of Medical Educators. And we are talking about new medical school curriculum and what that looks like going forward. Do you have questions about how doctors are trained? Do you have are you curious about how doctors talk about risk or death? How do you think doctors where do you think doctors could use more training? You can call us, you can text us at 2124-3396-9221-2433, 9692. Dr. Elkowitz will continue here with the conversation in just a minute. We're going to take a quick break. This is all of it. I'm Tiffany Hansen in for Alison Stewart. Stay with us. This is all of it. I'm Tiffany Hansen in for Alison, talking with Dr. David Elkowitz, the associate dean for academic programs and educational culture at the Zucker School of Medicine at Hofstra Northwell. Dr. Elkowitz, we're going to just go ahead and dive in here with one of our callers and bring Dr. Sherman into the conversation. Good afternoon.
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Dr. David Elkowitz
Hi.
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Dr. Sherman
Good afternoon, Dr. Alkowitz. I'm an 80 year old retired geriatrician, actually, and about 15 years ago I wrote an editorial called C1, Do One, have One, Teach One? As I was experiencing the onset of acute and chronic illnesses in late life. And that actually gave me new understanding and new empathy for my for teaching medical students about the subtleties of procedures, the unspoken issues that occur with some procedures because I actually experienced them myself. You want to comment on that?
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Dr. David Elkowitz
Yeah, I certainly understand where you're coming from. Over the last eight years, eight and a half years, I've been experiencing, as I just explained, my cancer diagnosis. And interestingly enough, I teach the pathology of cancer and use a lot of my own slides and a lot of my own images and all my blood work and my entire medical record I use to demonstrate, you know, basic understanding of molecular pathology and cancer. I will say that, you know, this experience that I went through or I'm going through still over the last eight and a half years made me much, much more sensitive to essentially the humanistic side of medicine, even pathology. You know, when I used to take a look at a slide as a medical student, you know, 30 years ago, yeah, it was a slide that I had to memorize but, you know, now our students realize that that slide had to come from tissue from a procedure that came out of the body. And behind that slide, you know, lives a patient with a lot of worries and concerns. You know, behind that slide lives a family that's worried, that's wondering what the outcome is going to be. So, you know, in a way, it turned out to be a wonderful thing where our students don't look at static images and slides and all sorts of other things just in kind of isolation. They understand that even a simple blood test, you know, had a human being behind it that was probably woke up and worried about what those results were going to be. So I couldn't agree with you more. This situation certainly made me a little more sensitive to that.
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Tiffany Hansen
Yeah. Dr. Sherman, thank you so much for your call. Dr. Elkowitz, we have a text here, too, from a Hofstra alum that says, I was a caregiver for my mother when she had dementia. And I think doctors need better training to work with patients who have Alzheimer's. Not necessarily to address the specific training around Alzheimer's, but there is training that would, in. That would be useful when dealing with Alzheimer's patients that can be taught more broadly, I would think, about compassion, about empathy. And how are you addressing those kinds of, kind of softer skills?
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Dr. David Elkowitz
Yeah, well, you can't have good patient outcomes without building a rapport in trust. And so how we're developing those skills here is at first, we are dealing with a very small class with very small class sizes. And in our case based curriculum, we call it pearls. Our students, certainly as they're learning about medical education, including Alzheimer's and the pathology and the mechanisms of what's creating Alzheimer's and how to treat it, our students are also learning the skills of teaching each other, communicating with each other. And then at the end, they do a group and self assessment on how that session went. And the assessment is a personal assessment on what they know, what they didn't know, and a group assessment on how everybody think it went. And everybody in that room does their own individual, group and self assessment. What makes this unique is that they are actually graded on that. They're graded on the quality of assessments, how transparent, how honest they were. And if there was an action plan that was created, are they going to fulfill that in the upcoming weeks? So, yeah, I mean, Alzheimer's or any disease has that secret ingredient of physicians that possess humility, reflection, that possess obviously medical knowledge. But when they know something and when they don't know something and how they're going to look it up and work in a team environment.
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Tiffany Hansen
Let's talk with Jennifer at Harlem Hospital here. Hi, Jennifer.
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Jennifer from Harlem Hospital
Thank you so much for taking my call. And thank you for this excellent segment. I'm working as an administrator on a prenatal health program at the OB GYN Clinic at Harlem Hospital Center. And I just wanted to underscore the critical importance which we're increasingly aware of, about the social determinants issue. The majority of our patients are tackling such incredibly serious kind of social and economic issues that when they come in, in many ways, healthcare needs are so marginalized because they're so oppressed by everything else. And I'm hoping and assuming, Dr. Elkowitz, with the kind of focus that you're putting forth in your program that that is very much a centerpiece. It certainly was part of my training in psychology, mental health, medical anthro and public health. And I know increasingly it's very much a focus for clinicians. So I'd welcome your feedback on this.
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Tiffany Hansen
Thanks, Jennifer. Yeah. Dr. Alkowitz.
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Dr. David Elkowitz
Yeah. You know, we wrote papers stemming from this curriculum on leadership. We wrote papers on healthcare costs and introducing those concepts very, very early on with our learners. Because, listen, at the end of the day, you know, in order for there to be a great outcome, there has to be a right diagnosis. The patient then has to accept the treatment plan, but then someone's got to pay for that. Right? And so our students certainly are exposed very early on to insurance issues, to compassionate care issues with the drug companies. Through their cases, they become certified EMTs right from day one of their medical training. So they're exposed to a lot of what was just described, seeing patients on the ambulances as first year med students. And so again, what we try to do here is we try to take these types of threads that we're discussing and weave it through a medical education curriculum. And I think that that really is a unique part of who we are in order to ultimately achieve great outcomes.
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Tiffany Hansen
Dr. Elkowitz, another doctor here, Sarah in Brooklyn. Hi, doctor.
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Dr. Sherman
Hey.
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Sarah, Medical Student
Yes, going along those same exact lines in my medical education. I didn't rece receive any education about insurance companies, prior authorizations, and any really empowerment to like change the system. The system that exists is terrible for so many patients. And so many patients either can't afford the care or get these massive bills that they can't afford and end up going bankrupt because of it. And I just feel like medical education needs to do a better job to empower medical students and physicians to become political to become lobbyists, to change the system. Because the system is just so broken and we see it every single day.
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Tiffany Hansen
Sarah, thanks so much for the comment. Dr. Alkowitz, I feel like that's a whole other segment that you and I could have about, about the system, the medical system. But any quick thoughts for on Sarah's comments there before we yeah, no, I,
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Dr. David Elkowitz
I, I hear what you're saying. And you know, one of the things that one of the challenges we have as a medical school, especially in the first two years we call it, the pre clinical years, is that, you know, we have a mission to make sure that our students are exposed to the medical material, the medical education material, and learn how to critically think. And that takes an enormous amount of time. But what we really tried to intentionally do is make our students aware of all the societal issues as they're learning about these cases. We embed them into their cases. They see a lot of these types of societal issues as they rotate with the ambulances as certified EMTs. When they rotate through the hospitals and their physicians offices in the very, very first year of the first day of medical school, they are very, very much exposed to all of these issues that are being described. So we intentionally make, we intentionally expose our students and with the understanding that medical education is not a two year or four year deal, it extends into residencies, you know, our North Wales residency and fellowship programs, and even as lifelong learners, as new attendings.
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Tiffany Hansen
We have been talking with Dr. David Elkowitz who is the associate dean for academic programs and educational culture at the Zucker School of Medicine at Hofstra Northwell. Dr. Elkowitz also the director of the Academy of Medical Educators talking about new approaches to medical school curriculum. Dr. Elkowitz, thank you so much for your time today and we really appreciate it. Appreciate it.
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Dr. David Elkowitz
My pleasure.
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Tiffany Hansen
Com.