Seven 21st-Century Skills Doctors Wish They’d Learned in Medical School

In the future, medical residents will learn a different set of skills to be able to function in a tech-driven world. (Flickr/Glenn O)

In the past decade, the practice of medicine has transformed in a big way.

Today’s doctors are jotting notes on an iPad, and navigating various electronic medical record systems. And payment models are shifting to reward physicians for improving patient outcomes, rather than for ordering expensive tests and procedures.

The top medical schools are adapting slowly to these changes. Many schools are in the process of exploring which new skills should be taught to young doctors, either through the core curriculum or as an elective, and which are better learned as part of professional development. The American Medical Association recently doled out $11 million to about a dozen schools for new programs on the future of medical education.

“We’re grappling with this big question of what should be the job of the medical school in the 21st-century,” said Lawrence Sherman, a New York-based medical educator and TED speaker. “We’re still determining what the new skills should be, how they’re taught and when they’re taught.”

KQED asked more than 20 doctors of all ages and specialties about the skill they wished they had learned (or learned about in more detail) in medical school. Some physicians wanted help understanding the new technologies; others saw benefit in focusing more on keeping their patients healthy, rather than just treating the sick. Here are their top picks:

Data Science and Statistics 

A handful of physicians said they could benefit from a richer understanding of data science. It’s not just businesses, but also medical practices and hospitals that are dealing with a deluge of data.

Top academic hospitals like Mount Sinai in New York are forging ahead with initiatives to collect data about a large patient population and connect that to outcomes in order to understand disease and improve treatment.

“Medicine is increasingly data-driven,” said Michael Turken, an internal medicine resident at Stanford Healthcare and a graduate of UCSF’s medical school. “And yet, almost none of us is equipped to understand the data as fully as we should, as fully as we need to.”

Nutrition and Disease Prevention 

Do you regularly talk to your doctor about nutrition and exercise? If so, you’re an anomaly. According to recent polls, fewer than 25 percent of doctors say they got sufficient education to give nutritional or fitness advice to a patient. In fact, the number of hours dedicated to teaching nutrition in medical school has declined in recent years.

“We received two or three hours of instruction on nutrition in four years of medical school,” said Amanda Angelotti, a UCSF medical school graduate and clinical systems designer at primary care chain One Medical Group. “Lifestyle diseases drive some of the biggest costs in healthcare and have some of arguably the biggest impacts on patients’ lives.”

Cardiologist Eric Topol says he would have benefited from ultrasound imaging training.
Cardiologist Eric Topol says he would have benefited from ultrasound imaging training. (Ed Uthman/Flickr)

Ultrasound Training

Ultrasound imaging is now pervasive, but many doctors said they lacked sufficient training in medical school. Instead, they learned how to leverage the technology over time and on an ad-hoc basis.

Eric Topol, a cardiologist and the chief academic officer for Scripps Health, said ultrasound technology has evolved in the past decade to be portable and compatible with mobile devices. These days, he said, “exquisite” imaging can be achieved with a probe connected to a smartphone. “But I need remedial training.”

Information Technology 101 

Doctors are increasingly using technology in their practices, whether it’s to record notes or store patient data in an electronic medical record. Some doctors are using the newest telemedicine tools to consult with patients online.

Mia Finkelston, a medical director and practicing physician at Online Care Group, said she wished she’d learned basic word-processing skills, and shortcuts such as how to copy and paste in different formats. “It would have saved me time on so many levels.”

Communications and Empathy 

Continuing medical education expert Alex Djuricich said medical schools are recruiting communications experts.
Continuing medical education expert Alex Djuricich said medical schools are recruiting communications experts. (Alex Djuricich/Twitter)

The most effective doctors understand how to communicate with patients. That doesn’t mean rattling off a diagnosis and sending them home. It requires picking up on the subtle indications that a patient has not understood something, or is too upset to take in information.

“[We need] ways to sustain empathy and provide reassurance to patients,” said David Scales, a resident physician of internal medicine from the Cambridge Health Alliance in Massachusetts and a graduate of Yale Medical School. “And that goes beyond trying to teach doctors how to be nice people.”

Some medical schools do teach communications skills, but several graduates said the instructors were often senior physicians, rather than people with training or credentials. “That’s starting to change,” said Alex Djuricich, the associate dean for continuing medical education at the University of Indiana. “A lot of schools are looking to bring in communications experts. We need to have the emotional intelligence to understand how patients are really feeling.”

Personal Finance

The average doctor today graduates with a massive $166,750 in medical school debt. Meanwhile, many doctors’ salaries are dropping, according to recent survey from personal finance tool NerdWallet.

It’s now imperative that doctors learn to manage their money, or they risk drowning in debt. Several recent medical school graduates said they could benefit from some formal education about how to use the latest web and mobile tools to manage their finances.

Connie Chen, cofounder of Vida Health, said medical students need more exposure to management training.
Connie Chen, cofounder of Vida Health, said medical students need more exposure to management training. (Josh Cassidy/KQED)

Management and Leadership

Connie Chen, a San Francisco-based physician and entrepreneur with Vida Health, said physicians are often placed in leadership roles early in their careers. Even in their residency years, doctors have to run teams of interns, coordinate with other physicians and nurses, and align families around shared treatment goals, she said.

“And yet there is almost no training on how to succeed in the working world,” she said.

Chen said she would have benefited from basic management skills, such as providing feedback and motivating others, as well as tips on how to collaborate and manage projects. Cyrus Yamin, a Harvard Medical School graduate who now works at Kaiser Permanente, said medical students could use training on how to lead a room full of people with different roles, experiences and emotions, especially in the trauma bay.

[Editors’ Note: I received a fantastic response questioning the premise of the article. It’s from Chris Chen, a second-year resident in internal medicine at Massachusetts General Hospital:

“We all know 20 percent of patients consume 80 percent of healthcare resources and our energy as doctors: The old, the chronically ill, the functionally limited.

But in med school, we spend 80 percent of our time on 20 percent of diseases, including a litany of esoteric rare disorders that are academically illuminating but most clinicians will never see in their entire careers. I don’t need to know the enzyme defect in Fabry disease. I need to know how to manage dementia; to manage pain thoughtfully; to assess patient home safety. I suspect the biggest gap in 21st century medical training is a lack of old-school skills, and not high-tech coding.”]

Seven 21st-Century Skills Doctors Wish They’d Learned in Medical School 24 September,2015Christina Farr

  • GaDoc3650

    as a 60 year old, now full time primary care pediatrician, who does some specialty work, as well as hospital work, as well as primary care pediatrics, without a doubt, the skill I NEED is to be a secretarial typist.

    lets be clear — I am NOT a secretarial typist, but I do type about 50-60 words a minute with 10 mistakes — far from great, but far from horrible

    I have seen ONE physician (out of my CLINICAL contact with ~ 750 -1000 clinicians over the last 10 years of using an EMR, in various contexts, young and old, recent grads and experienced physicians) manage an EMR the way it is designed to be managed: chart while looking at the patients, talking with the patient, conversing with the patient, while in the room, develop the plan, document, order the appropriate studies, etc, and then, when one leaves the room, go to the next patient — and she put herself through medical school as a medical transcriptionist.

    Several dozen other physicians, manage EMR’s very well — and type VERY, VERY well, but none, met the skill set of this one physician

    THAT is the skill, that allows an EMR to be more efficient; the skill of a TYPIST

    nothing to do with medicine, nothing to do with communication, nothing to do with continuing education, nothing to do with resource stewardship, nothing to do with building relationships — everything to do with a middle school skill: typing

    nothing the best and the brightest will ever focus on

    tragic -and we will never go back to the days of being first and foremost a physician; rather we are now first and foremost data entry techs

    • Many EMR’s allow the use of text shortcuts or macros, which allow a lot of boiler plate text to be entered quickly. As long as it is done with consideration of documenting only what is been asked or done, these shortcuts can be a big time saver.

  • stanley64564@mail.ru

    Another thing that you should remember is that some grammar and spelling checkers are designed for specific groups of people. So, you should ask yourself why you need a grammar and spelling checker. check grammar english.

  • Kenneth

    Another thing that you should remember is that some grammar and spelling checkers are designed for specific groups of people. So, you should ask yourself why you need a grammar and spelling checker. check grammar english.

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Christina Farr

Christina Farr (@chrissyfarr) is the former editor and host of Future of You. She was previously with Reuters, covering digital health and Apple and before that, she reported for Venture Beat. Christina was born and raised in London and has graduate degrees from University of London and the Stanford School of Journalism. Farr’s work has appeared in a variety of publications, including the New York Times, the Daily Telegraph, the Bay Citizen and SFGate.com. She has appeared as a featured expert on NBC, ABC and Reuters TV, among others, and frequently speaks at health and technology conferences. She is also co-founder of Ladies Who Vino, a networking group for women in technology and business.

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