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VCU School of Medicine faculty opinions highlighted in New England Journal of Medicine essays

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Richard Wenzel, left, and Alan Dow were published in the New England Journal of Medicine in August.

Two Virginia Commonwealth University School of Medicine faculty members published essays in the New England Journal of Medicine in August. The NEJM is among the most prestigious peer-reviewed medical journals in the country and the oldest continuously published journal in the United States.

“We appreciate our faculty contributing in such an erudite manner to the important national dialogue regarding medical education, as exemplified in the recent expert opinion articles in the NEJM,” said Peter Buckley, M.D., dean of the School of Medicine.

Richard P. Wenzel, M.D., professor emeritus and former chairman of the Department of Internal Medicine at VCU School of Medicine, published “Medical Education in the Era of Alternative Facts,” on Aug. 17. An increasing concern with the financial focus of medicine punctuated by more recent troubling societal trends inspired Wenzel to write the essay, in which he asserts that the challenges for medical education are imminent and formidable.

“I have been concerned that medicine, with its heavy focus on finances, has lost some of its emphasis on teaching,” Wenzel said, referencing the resource-based relative value scale to which most physician services are billed. The highly criticized schema uses a complex formula to determine payment due to a physician for patient services. “The relative value scale era of measuring clinical productivity and paying salaries has eroded time for many aspects of the medical education academy, including teaching, research, committee work, working with and gaining trust in colleagues, and thinking time in general,” he said.

In addition to distractions presented by the relative value scale, Wenzel cited three societal trends that erode truth and have the potential to delegitimize medical education: The increasing distrust of large institutions, the expanded use of social media for information, and the political lexicon of “fake news” for uncomfortable facts when fabrications masquerade as reality.

“Entering medical students emerge from the country’s social fabric,” Wenzel said. “This is the societal setting from which our students come to us in medical school.”

Wenzel offers remedies in the essay to assuage these trends, such as transparently reviewing the history of ideas in medicine, emphasizing the value of scientific inquiry to students and expanding curriculum for critical reviews of literature.

We should applaud students for curiosity and inquiry, and for showing reasoned doubt about what they read and hear.

“We can let medical students know that whereas throughout their previous schooling they were judged by their answers, in their medical education and their careers they will often be judged predominantly by their questions,” Wenzel said in the essay. “We should applaud students for curiosity and inquiry, and for showing reasoned doubt about what they read and hear.”

He intends the essay to serve as a beacon to guide faculty who are charged with teaching incoming medical students. “I hoped to inspire people to look at what is at stake, make changes that can begin to remedy the problem, and reclaim the ideals that have been a legacy of our profession,” he said.

On Aug. 30, Alan Dow, M.D., assistant vice president of interprofessional education and collaborative care at VCU, published “Interprofessional Education — A Foundation for a New Approach to Health Care.” The professor of medicine and health administration co-authored the essay with George Thibault, M.D., president of the Josiah Macy Jr. Foundation. The Macy Foundation is the only national foundation solely dedicated to supporting projects that broaden and improve health professional education.

Dow, who counted Wenzel as a mentor during his tenure as chief resident of VCU’s internal medicine department, wrote his essay in an effort to inspire health care practitioners around the world to think and act more interprofessionally.

“My hope is to raise awareness about interprofessional education,” Dow said. “I hope to inspire my colleagues to be more interprofessional in their work and to teach about interprofessional practice to their trainees.”

In the essay, Dow provides arguments for the benefits of interprofessional educational programs and encourages other health institutions to follow VCU’s lead.

He references VCU’s Caring for Complex Patients program in the essay. The interprofessional program aims to identify and serve the small percentage of complex patients who account for almost half of the total health care expenses in the U.S. In the program, VCU students from disciplines including medicine, nursing, pharmacy, social work and anthropology work together to identify underlying health barriers by visiting patients in their homes and accompanying them on health care visits. The students combine expertise from their individual disciplines to collaborate on health care solutions. The program has proven successful in teaching students how social determinants affect health and in the benefits of interprofessional teamwork for addressing the unmet health and social needs of complex patients. It was highlighted in a July issue of the Journal of the Association of American Medical Colleges.

Dow also discusses the history and importance of interprofessional education, details interprofessional education’s value to society and discusses additional interprofessional experiences available to VCU students.

“At VCU, about 2,000 students and 100 faculty members participate each year in a series of IPE experiences,” Dow said in the essay. “These experiences are sequenced across each participating program’s curriculum to build interprofessional competency in parallel with students’ professional development.”

He hopes the increasing popularity of interprofessional education will ultimately result in better patient outcomes.

“We face so many complex challenges in our society and, for many patients, navigating the health care system to get the care they need is one of the biggest challenges,” Dow said. “Interprofessional education trains teams to better adapt to the needs of patients and families so that the teams can help people address challenges and live healthier lives.”

 

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