Dr. Thomas Rea knelt at the side of the man lying motionless on the ground. “Hello! Hello! Are you OK?” he said urgently, feeling for a pulse in the man’s neck — and finding none.
Rea locked his hands together and started the rhythmic chest compressions used in cardiopulmonary resuscitation. In a circle around him, four University of Washington medical students watched closely.
In reality, the “person” suffering from cardiac arrest was a mannequin, and the exercise is one example of a big change in medical education — one that relies far less on lectures and far more on hands-on activities, such as learning CPR with some of the area’s most skilled paramedics, EMTs and doctors.
Before last year, the UW was one of scores of schools still using a 100-year-old curriculum that emphasized eight-hours-a-day, five-days-a-week lectures. Medical students didn’t escape the confines of the lecture hall and begin taking care of patients until their third year.
Then last year, following a national trend, the School of Medicine tossed its old curriculum and began teaching students using a hands-on approach.
A few weeks after starting medical school, for example, students now begin shadowing doctors, allowing them to connect lessons from the classroom with real-life examples. And this year, instead of learning standard CPR, the students learned an innovative method of CPR that relies on teamwork.
Around the region, patients are likely to notice the difference.
They’ll encounter more young medical students helping to make the rounds. First- and second-year students will do physical exams in hospitals, for example, or take a patient’s medical history before the physician enters the room — a history that the doctor will then repeat back to the patient to make sure it’s accurate.
“This is a much better experience for students — it gives them much more of a flavor of what they’re going to do for the rest of their careers,” said Suzanne Allen, the UW School of Medicine’s vice dean for academic, rural and regional affairs.
First-year medical student Alex Martinez agreed. “We get to learn it and then do it, and that is helping us not only retain the information, but apply it much better,” he said.
The new way of training also acknowledges a new reality: While it was once important for doctors-to-be to memorize extensive amounts of medical information, much of that is now just a few clicks away in professional medical databases.
The new curriculum is being used at all of the UW’s medical-school locations through the program known as WWAMI, in which four relatively small neighboring Western states (Wyoming, Alaska, Montana and Idaho) share in the cost of educating students through the UW School of Medicine, rather than building their own separate medical schools.
It’s also being used in the UW School of Medicine’s newest partnership, with Gonzaga University in Spokane.
WSU’s new Spokane-based Elson Floyd College of Medicine plans to take a similar active-learning approach. The school is in the middle of accreditation work, and hopes to accept its first class of students in fall 2017.
Shift to active learning
The UW’s new curriculum kicks off with two weeks of intensive training, including the CPR course, and lessons on how to take a medical history and perform a physical exam.
When those weeks are up, the students get their first white doctor coats. From that point on, they’ll spend one day a week in hospitals and clinics, shadowing doctors and doing basic clinic work.
Patients as well as students will benefit, said Allen, the vice dean. Students have more time to sit and talk to patients, she said, and sometimes they’re able to uncover information about a medical condition that initially might have been missed by a time-pressed doctor.
Students also get a chance to practice their bedside manner from the start of their training. “We spend more time in medical school now on the communications piece,” she said.
Martinez, the first year-medical student, said he and his peers began learning how to take a medical history on the second day of class, and on the third day they practiced taking medical histories with patients who volunteered to be part of the training at Harborview.
The first week of medical school was “really fast-paced, kind of a lot at once, but they’re really showing us the ins and outs really fast,” said Martinez, who grew up in the Eastern Washington town of Warden, near Moses Lake.
Lectures outside of classIn what’s known as the “flipped” classroom, students watch prerecorded lectures outside of class and then spend more time in class discussing case histories and working on problems in groups — for example, learning how to read an EKG.
Medical education’s modern roots can be traced back to 1910 with a document known as the Flexner Report, after American educator Abraham Flexner, who outlined how medicine should be taught in colleges and universities.
In 2010, the Carnegie Foundation for the Advancement of Teaching published a study, Educating Physicians, that called for a major overhaul of the way doctors are taught, including more active learning at the start of medical school. More than half the nation’s medical schools are shifting to that approach, Allen said.
CPR training, like the type led by Rea with the mannequin, was taught during the first weeks of medical school under the old curriculum. But even that training has been tweaked: Students this year learned a method called High-Performance Cardiopulmonary Resuscitation, or HPCPR, a tightly choreographed method of providing the lifesaving resuscitation that has improved the local survival rates for patients from 20 percent in the 1970s to 62 percent in 2014. The national average is 16 percent.
Dr. David Carlbom, director of the Michael K. Copass Paramedic Training Program at UW Harborview Medical Center, led this month’s training session. He says CPR training transforms young medical students from timid spectators to confident leaders.
And it’s not a lecture.
“I logged more than 2,000 hours in this room, in lectures,” Carlbom told the UW students. “You won’t — thank God!”