When the 40 students in Hofstra North Shore-LIJ School of Medicine’s inaugural class arrive at the school’s new campus in Hempstead, N.Y., on July 25, they will receive a rather humbling initiation into their chosen profession: they will be required to ride on dozens of ambulance tours over the next two years.
“These students will not be there as the privileged medical school observer. They’ll do the full spectrum of ambulance work,” notes Dr. Lawrence Smith, dean of the new school, which will be the first in the country to require its first-year medical students to train and be licensed as emergency medical technicians. He adds, “being an EMT teaches them teamwork,” an increasingly important skill for aspiring physicians.
With both the prestige and income of being a doctor dwindling in recent years, the demand for practitioners with better people skills has surged. An increasing number of physicians are choosing shift work at a hospital — where working well with colleagues is essential — over setting up a more autonomous private practice. And the rise of nurse practitioners and physician assistants working side by side with medical doctors has further eroded physicians’ once undisputed place at the top of the clinical pecking order.
One way to cultivate better people skills is to give medical students more hands-on experience with patients as well as by having them interact with other medical professionals in a team-based setting.
Despite this sea change, nurturing hands-on skills, and the people skills that go with them, still isn’t a priority at most medical schools. “There is a fairly severe mind-body split in medicine and medical education,” notes Dr. Molly Cooke, and internist at the University of California at San Francisco and co-author of a report from the Carnegie Foundation for the Advancement of Teaching, on the urgent need to rethink how doctors are trained in the U.S.
Some schools have tried to fix the problem by adding courses on humanism or “doctoring,” with mixed success. Students often view the touchy-feely sessions as a waste of their precious free time, since their content is barely addressed in the standardized, multiple-choice exams they must pass in order to become licensed and land a residency.
A newer approach is to teach the science and art of medicine simultaneously. At UCSF School of Medicine, for example, students take a course called Molecules, Methods and Malignancies, which spans everything from basic cell biology to how cancer begins to how to break bad news to a patient.
Beyond its team-building focus, Hofstra’s EMT training is also a novel way to integrate clinical skills with hard science. Far from a standard EMT course (which costs a mere $1,000 in New York), Hofstra’s iteration will teach not only the signs and symptoms of, say, a heart attack, which all EMT students must master, but will also explore exactly what is happening to the body on a biological level when that crisis is in progress.
“Our students will be taught the cellular basis, how they develop thrombi or acute plaque within the coronary vessels, as opposed to just learning the terms,” says Dr. Thomas Kwiatkowski, who is developing and leading the new medical college’s EMT training.
The course will be sandwiched between more traditional subjects like anatomy, pathology, pharmacology and biochemistry. As an added perk for being guinea pigs, students in the inaugural class (who range in age from 21 to 36 years old) will receive a $20,000 discount on the estimated $69,494 cost of attendance each year.
UCSF’s Dr. Cooke notes that working as an EMT far outstrips passive shadowing of doctors, which can be not only boring, but fairly useless. “The student is actually providing a service. Patients being attended to by EMTs by definition need help and, while EMTs cannot provide more than limited medical interventions in the settings in which they work, they actually are more capable than physicians, as any honest doctor who has stopped at an accident scene will tell you,” says Cooke.
The incoming Hofstra medical students seem excited about their trial-by-fire. “Traditionally, there is this fear of letting a medical student touch a patient. That’s silly,” says Maxine Ames, 23, a 2010 Cornell University graduate. “A lot of medical schools are really set in how they do things,” she adds.
Ames’ classmate Asaph Levy of Kennesaw, Ga., says the EMT program played a key role in his decision to attend Hofstra. “You get to see the patient in the environment they’re in [as opposed to first meeting them in the hospital]. You get to put together the pieces of the puzzle,” says the 22-year old, who is interested in becoming a pediatric surgeon.
The EMT training isn’t the only unique aspect of Hofstra’s medical program. Tedious lectures are replaced with small-group discussions. Multiple-choice tests are out; instead instructors will evaluate students both on the quality of what they learn as well as on their performance on clinical skills. “We really want to get way beyond that passive boring memorization model [used by many other medical schools],” says Dean Smith, who adds that the incoming students “are risk takers who are absolutely enthralled to be going to a new medical school.”
Fiore Mastroianni, 23, says some of his undergraduate professors advised him to choose a more established school over Hofstra — to “take the known over the unknown,” as he puts it — in order to ensure a decent residency placement after graduation, but he went against their advice. “It didn’t seem like I’d be missing out,” he says, adding, “the newness excited me.” And will hopefully make for better doctors as well.