Training in the Era of Machines by Bethany Doran

February 26, 2018 | Bethany Doran, MD

The medical industry is at a crossroads. A recent New York Times article highlighting emerging partnerships between hospitals, such as the Cleveland Clinic with Oscar Health and Aetna with CVS, signals a period of increased corporate collaboration. In addition, partnerships between the medical field and technology giants such as Amazon, Google’s Verily Health and IBM Watson suggest new potential for technologic innovation and acceleration of data driven research.

Novel integration of technology with providers and patients has the potential to result in significant advances in the understanding and treatment of disease. New advances in risk prediction through deep learning techniques, novel gene therapies and increasingly sophisticated mechanical forms of life support will result in an increasing complexity of discussions surrounding the optimal approach to health. However, despite these changes, medical curriculum and the way physicians are trained have largely remained unchanged since the early 1900s.

In 1910, the Flexner Report was first developed as a method to decrease the number of medical schools in the U.S. and improve the standardization of physician training. The modern era suffers from the opposite problem, with a projected looming physician shortage of roughly between 62,000 and 95,000 in the upcoming years, mostly affecting the poor and rural areas of the country. 

The Report, written during an era of medicine when suturing techniques were first being discovered, polio infection was a major health crisis and the first females were admitted to the surgical field shaped training within medicine, stipulating a training period of two years engaged in the study of physiology and anatomy and two years of clinical work in a teaching hospital. Although modern medical students still receive significant training in anatomy and memorization of physiologic topics that can easily be looked up in the search bar of a mobile device, there remains minimal incorporation of ethics or patient-centered decision-making into training.

New residents may be responsible for answering complicated questions involving nuanced estimates of risk, or be thrust into a discussion involving the use of artificial life support during their first week as a physician, but have minimal exposure to shared decision-making. Although training that encourages persistence and dedication through memorization and studying for exams is important, complex problem solving, empathy and communication are equally as needed for proper patient care.

The need for a re-alignment in medical curriculum is more pressing than ever. With new technologies emerging, as well as shifting roles within a landscape that has increasing integration with industry collaborators, it is important to begin rethinking our models of training within medicine. With new opportunities driven by technological advances, there is also an opportunity to evaluate and discuss what it means to not only be a provider, but also human.

This article is authored by Bethany Doran, MD.