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Case Western Reserve University medical students use a group approach to diagnose a simulated medical situation involving a man with shortness of breath. The is to build a sense of teamwork that doctors need to practice in today’s complicated health care system.
Dr. Steve Smith observes from the background the Case students as they work together to diagnose a simulated medical case.
A pediatric patient simulator at NEOUCOM. Medical students can safely practice invasive proceedures on the device.
An adult patient simulator at NEOUCOM.

As America's health care landscape changes, the way future doctors are being taught is also changing. Besides learning to treat diseases, tomorrow's physicians must know more about prevention, insurance and teamwork. Meanwhile, they also need to keep-up with rapidly evolving technology.... In part two of our series, "What You Don't Know Can Hurt You," we look at how medical schools are adjusting.....

WKSU's Kevin Niedermier reports:

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As American's health care landscape changes, the way future doctors are being taught is also changing. Besides learning to
treat diseases, tomorrow's physicians must know more about prevention, insurance and teamwork. Meanwhile, they' also need to keep-up with rapidly evolving technology....
In part two of our series, "What You Don't Know Can Hurt You,"
WKSU's Kevin Niedermier looks at how medical schools are adjusting.....

Treating a single patient today can involve several doctors, nurses, a pharmacist, plus social workers, various technicians and secretaries. And all the information must be correctly communicated within that group.....
Dr. Steve Ric-ah-naty oversees the new "case inquiry group program" at Case Western Reserve University's School of Medicine...

Ricanati: "Let's face it, medicine has become so complex, it has to be conducted in teams. Gone are the days when the physician can do everything themselves. And those days, frankly, were not so good. I think in order to keep our patients safe, to keep our patients
healthy, medical care has to be conducted in teams. Now, physicians
are often leaders of those health care teams, but they need to learn how to function in groups."

That's where the "case inquiry group program" comes in....
Around a table in a small conference room, a group of eight first year med students are brainstorming over the case of a middle-aged man with heart problems who just had a fainting spell.....

Students discussing case:

Dr. Steve Smith watches over the discussion...but stays in the background.....

Smith: "See, the idea here is that you don't have to be an expert in that field, you can't be an expert in everything. I'm a family doctor.
You know, the last block I taught, they learned oxidative phosphoralation, hemoglobin synthesis, you can't possibly know all these things, and so you have to facilitate the students learning. You know, you have the cases, you have sort of a broad set of goals, and you just have to let them do the learning. They formulate their objective from the case, they do the work, and it's not the kind of classical problem based learning that I was used to where each person would go and look up something, but they all do everything. So they'll all come prepared with all the different objectives of the case."

After today's session, the students research the case on their own, reconvening later to discuss their findings with the group.
In between, they still attend traditional lectures.
Dr. Lois Margaret Nora is President of the North-eastern Ohio Universities Colleges of Medicine or NEOUCOM in Portage County. She says it's very important for today's doctors to be independent, lifelong learners, because what they know now, will be outdated in five years.
She says advancing technology can help them keep-up with the rapid changes....

Nora "If I were to do bedside teaching rounds 15 years ago with
a group of medical students, and say we were seeing a stroke patient and the question came up about the causes of the stroke, or what appropriate therapy would be, it might be that one or more of the learners around there would be tasked to go to the library to get the literature to check the textbooks. Today it's dramatically different.
First of all, with stroke there are tremendous numbers of therapies
today that didn't even exist 15 years ago so it's a much more complicated question. But at the bedside today, the question might come up, and in fact we would engage the patient in the discussion more, and students would be pulling out little hand held computers and personal assistants, and we would be using that to evaluate medications, to evaluation the interactions of medications we would consider with the medications the patient is already on, things like that. A great deal of learning electronically as well as communication, ordering and maintaining the patient record electronically."

And Dr. Nora believes another big change in medical training will be more use of patient simulators, like this pediatric model being operated by NEOUCOM instructor Howard Gregory.....

Gregory: "As you can see he's blinking, he's actually breathing,
he has heart sounds, lung sounds bowel sounds. We can even hook him up, he's hooked up to a computer, but we could hook him up so that he could bleed. He's breathing right now and he can have problems breathing with the software we have. You can even shock him, see there are leads here. And basically he's a high fidelity task trainer. There are individual task trainers that teach different skills, but this is the guy that teaches them to work as a group. Our medical students, and pretty soon our pharmacy students, will be working as teams to treat this child."

Once in the real world of medicine, new doctors also have to deal with more non-medical issues than in the past.
NEOUCOM Associate Dean, Dr. Clint Snyder, says the school, like many others, provides more courses covering these areas....

Snyder: "Around business practice, along legal issues, ethics in health care. And like wise, that volume of paperwork that physicians
have is being addressed nationally by computer technology, making us have to adjust our curriculum to include bio-infomatics and computer applications within medicine. Those are significant shifts that are in response to the things that you mentioned, that insurance companies and paperwork are putting an increased burden on the business and practice of physicians that's totally non-clinical and

Neoucom and Case have also added public health and preventative medicine courses. Vice Dean for Education and Academics at Case,
Dr. Dan Ornt, says the new curriculums go beyond teaching how to treat disease. Students are now learning to teach patients how to stay healthy...and how health care policies impact the kind of medical care patients receive...

Ornt: "And how health disparities are real with respect to socio-economic background and race. And this is part of the content that we have to, that we are including, that we're introducing students to.
What is Medicaid and Medicare all about, and what are the health agencies that are available to patients in the community that have particularly chronic diseases, and how do you access those. Normally, more historically, a patient would go in and see a physician and leave, and the physician would not be in a position to make recommendations about there's this agency that could help you, or there's this agency. We need to teach students that those things are important as well as simply prescribing the right medication."

At Case, students can now also learn how to react medically and ethically to major disasters like hurricane Katrina....
I'm Kevin Niedermier....89-7 WKSU.....

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What You Don't Know Can Hurt You is presented with support from the Area Agency on Aging, the Center for Community Solutions and the Greater Akron Chamber of Commerce.