Teamwork has become textbook at top medical schools. Why it was a necessary shift, and how Michigan Medicine has led the charge.
There's long been a disconnect between how we select people to become doctors and the demands of our calling.
The competition for admission to medical schools is so intense — roughly 3 percent of applicants are accepted by top schools — that even Darwin would blush. As a result, many applicants have rightly spent much of their young lives focusing on one person, themselves: their grades, their MCAT scores, their resumes. Then — presto! — we expect them to be models of kindness, compassion and empathy whose lives are in service of others.
It is amazing and gratifying to see how many of them live up to that ideal.
Still, those of us training tomorrow's doctors must do more to help all of our students navigate the transition between the worlds of competition and caring. This begins with a counterintuitive idea — helping them become leaders by seeing themselves as good team players who have learned how to work with and care about others.
This is not easy in concept or execution. Medicine and scientific research tend to attract ambitious, self-directed people. Years of being at the top of the class, the best and the brightest, do not dampen self-regard. The heroic myths of singularly gifted surgeons and brilliant researchers — the Michael Jordans of our field — reinforce notions of exceptionalism.
We still need singular talents, but modern medicine has become a team sport. Many patients now suffer from a range of infirmities. Instead of receiving treatment from a single physician, their care must often be coordinated among a group of physicians — and nurses, pharmacists and others. The challenge is to get five Michael Jordans to see how their success depends on one another.
This, in turn, is changing the demands of leadership.
Leaders must be able to articulate a vision and be decisive, and they must be able to listen and learn from others. They must be able to see themselves not as only the heads of teams, but also as team members who know when to step forward and step back.
These skills will be at an even greater premium in the years ahead as medicine and science continue to evolve from specialized fields to cross-disciplinary operations.
To wit, some of the greatest medical breakthroughs have been made by people outside of the biological sciences. Experiments that rely on robotics and the manipulation of massive data sets are routine today. And tools developed from fields outside biology, such as microfluidics and X-ray diffraction, have become integral to basic biological research. One of the most important and certainly most famous recent discoveries — mapping the human genome — was made possible because of supercomputers.
In the years ahead, doctors will increasingly have to understand and interact with highly accomplished engineers, mathematicians, statisticians, chemists, physicists and computer scientists. And this trend is expanding as we learn more about devastating and debilitating diseases and how to best treat them. But beyond these disciplines that seemingly fit into a futuristic "high-tech" vision for health care is the growing reality that our patients benefit from breadth among their health care providers. An interdisciplinary team, including social workers, pharmacists, nurses, dentists and others amplifies technology in treating and preventing disease. Today's complex social and physical environments require that we look to public health and environmental research to address these critical health issues.
To navigate all of this, the doctors we train today will need a bedside manner on steroids.
In response, medical schools across the country are beginning to revamp their entire approach — from the admissions process to curricula to fellowships. I am proud to say that we at the University of Michigan Medical School are part of this effort, where we have put in place new courses, structures and approaches these past three years.
We expect students to be change agents — collaborative leaders who will solve complex problems and have a demonstrable impact on improving our world.Marschall S. Runge, M.D., Ph.D.
Starting with students
These changes begin with whom we admit.
To be well-rounded, people need to interact with those with different life experiences. It may seem surprising that only about half of the first year medical students who will arrive soon on campus majored in the biological sciences as undergraduates. The rest included those in who majored non-biological scientific fields but also history, language, psychology, economics, political science, sociology, and other fields that don't address the difference between the femur and the fibula.
As a result, we put together a class — a community, really — of truly diverse individuals with broad life experiences who will not just learn from the faculty, but from one another.
Beginning with orientation, we stress that we expect students to be change agents — collaborative leaders who will solve complex problems and have a demonstrable impact on improving our world. Then, we break them into small teams to work together during the next four years.
Together they begin to understand their own values, and those of others on their teams, which brings diversity to their group. They craft mission statements about what they want to accomplish together, and they set goals for themselves and for their teams.
Our medical students also engage in problem-solving exercises with students from our schools of nursing, pharmacy and dentistry. And they interact with many of the 470 experts — in medicine, nursing, public health, engineering, social work, law, business, public policy and other fields — connected to Michigan's Institute for Healthcare Policy and Innovation.
We have also rejiggered our curriculum so that they begin interacting with patients in their very first year to understand the systems and how teams work in the clinical system. The bottom line must, and always will be, producing better outcomes for the patients we serve.
Medical students have always faced a daunting challenge: how to keep pace with the wondrous discoveries and innovations that will transform health care. But the physicians of tomorrow will face an even greater ultimate goal — how can we, as physicians, work with others who bring unique insights and skills to address the big problems we face in health care? Transformational success will require new approaches to medical education, ingenious and highly motivated students and dedicated medical educators.
Together, we will make a better tomorrow for health care locally and across the globe.
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