Verghese: #MedEd Must Restore 1:1 Training at the Bedside

By Jennifer J. Salopek

Verghese AbrahamTechnological advances in medicine and health care have caused providers to lose their human connection with patients, says noted author and teacher Abraham Verghese, MD; returning to an apprenticeship model that emphasizes training at the bedside can help to restore that connection. Verghese previewed his Wednesday Stanford MedicineX | ED keynote* in an interview last week, saying that he wants his diverse audience of students, educators, and patients to take away this key message: “Even as we change dramatically how we educate, the very nature of teaching requires more consideration than ever of the human element.”

*To watch the keynote live on Wednesday, September 23 at 5:25 PM Pacific time, click here.

What is the nature of that dramatic change? For one thing, knowledge has become very democratic: “It doesn’t have the cachet it once had,” Verghese says. He quotes William Stead of Duke University, who famously said, “If you can look it up, then it’s not something I need to teach you.” But there is much that medical students do need to be taught, nuanced ways of being with patients. Although testing a knee reflex may not be something you can codify perfectly, one-on-one teaching “ensures that students understand the technique and apply it properly; small adjustments can make all the difference,” Verghese says.

An overarching theme of Stanford MedX | ED this year is reaching the millennial learner. Of that cohort, Verghese notes that they learn well on their own and are well served by the flipped classroom model. “The paradox is on the wards,” he says. “The whole team ends up looking at the patient online—which is one person’s opinion, magnified—then going to see the patient, which can seem like an afterthought.” The at-your-fingertips accessibility of information means that health care providers focus on the “iPatient,” a term Verghese coined to denote this virtual representation of the patient, rather than the flesh-and-blood human before them.

“Although technology makes medical education ripe for innovation, it has introduced a complacency that the relationship is not important. There is no panacea for a one-on-one investment of time at the bedside with students. Medicine is an art and a science, but it is also a craft. There is much to be learned through apprenticeship, influence, mentorship, and modeling; we should reserve technology for evaluation,” Verghese says.

The increasing emphasis on empathy in patient care and the corresponding need to teach medical students to be empathetic further underscores the need for interpersonal education, Verghese says: “We can talk about empathy in the classroom but it’s much more effective through modeling. Students must see that people value and believe in these approaches.”

A hallmark of Stanford MedicineX is the inclusion of patients as planners, participants, and experts. This is key to getting the future of medical education right, says Verghese: “We need patients to drive us in ways that we’re failing to drive ourselves. I hear tremendous frustration from patients about the asynchronous communication they receive from their health care providers. They need to wake us up.” Academic medical centers owe patients a debt of gratitude for the role they play in educating tomorrow’s doctors, he reminds: “Any patient who comes through a teaching hospital, who is receptive to the process, who is generous with their suffering and finds meaning in sharing their stories—these patients embrace their legacy, even if it doesn’t help them in their present state. Those patients play a huge role in medical education.”

Jennifer-1990-webJennifer J. Salopek is founding editor of Wing of Zock. She can be reached at jjsalopek@cox.net, or follow her on Twitter @jsalopek.

2 thoughts on “Verghese: #MedEd Must Restore 1:1 Training at the Bedside

  1. I agree regarding the role of the patient in medical education. The patient should not be looked upon by the medical education system as an object, a disease for the student to practice upon but should be actually considered as a subject, a human being who is in fact a teacher for the student. What does the patient teach? The patient presents with concern, fear, confusion, symptoms, discomfort, misunderstanding and a host of other components both medical and social which make up an acute or chronic illness and how the patient responds to the communication and acts performed by the student provides an educational moment or longer for the student. And in that response by the patient, the student may see that their words or laying on of hands are defined by the patient as comforting, discomforting or something to ignore. The patient, thus teaches by rejection or signs of acceptance, a patient’s personal value of what is said or done. No textbook, professor lecture or educational video can simulate.

    And as at the medical school where I teach, this student-real patient interaction starting within the first two weeks and continuing on throughout those first two years certainly meet the goal of education and support the “legacy” of their participating patients. ..Maurice.

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