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how medical training is evolving to meet changing needs, aging patients and ai innovation
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the aim for medical students, health-care providers and the public is to recognize that a hospital is not “just a building that you come to, it's part of a service and a journey of health care.”
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medical education has evolved over time in response to the changes in our society, making a strong case for next-generation health-care professionals to adapt to new technology, a patient-partner approach and the shift to team-based care. the pressures of an aging and growing population—many of whom are coping without a family doctor—are being met by experts dedicated to building a resilient workforce.
so, what does all this look like? classroom learning is still part of the picture, but there is more real-world learning as part of the curriculum. the programs include hands-on ai innovation labs, simulation training for learners alongside hospital staff and placements in the community to work with other health-care providers to recognize the value of holistic care for people. the care goes beyond the er to connect patients with mental health services and other community supports for housing and homecare.
teams working together to meet higher complex demands
“we’re encouraging everyone and supporting everyone to work to their full scope of practice because we know that we’re better together and teams functioning together are going to better serve our patients with their higher demands and needs for higher quality healthcare,” says dr. alison freeland, executive vice president for academics at trillium health partners (thp) in ontario.
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she’s keenly aware of the projection that by 2040, one in four ontarians over age 30 will be living with a major illness that requires hospital care, up from about one in eight people in 2002. mississauga, home of two thp hospital sites, is one of canada’s most diverse and fastest-growing populations, where demands are already increasing.
“health care is such an evolving and dynamic experience, and just to see the shifts and everything, particularly as we’ve gone through the last number of years through the pandemic,” she adds. “health care has evolved precipitously since then.”
dr. freeland, a psychiatrist, notes that the overarching aim is to have people recognize that a hospital is not “just a building that you come to, it’s part of a service and a journey of health care.”
one of her team’s priorities is to offer a connected system for patients that integrates hospital, primary care, homecare, long-term care and community supports using digitally enabled pathways. she says a great example is a recent project for hip fracture patients where students experience the full care journey from the patient’s perspective. beyond the hospital rotation, students are placed in long-term care, doctors’ offices and primary care offices in the community. this is an important journey for patients, especially for vulnerable older adults, she says.
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the longer these patients with hip fractures are in the hospital for their recovery, the higher the risk for increasing frailty and decreased mobility.
“when you can see people getting back home and being mobilized more quickly with the right supports in place, students and health-care teams can then see the benefits of that and that extends to how we evolve thp at-home services for other populations.”
thp, like many hospitals, also runs simulation training for staff and learners as a safe place to learn, debrief and get feedback. dr. freeland adds these opportunities improve confidence working in teams to go out into the real patient environment. “so you can take fairly high-risk difficult situations, simulate them and then allow students to more safely be part of actual care of patients.”
learners part of evolution of care
all this supports the fact that medical learners have become part of the evolution of care, well-positioning them to anticipate and serve future patient needs.
dr. sarah cook, president of the college of family physicians of canada, talks about how family doctors, specifically, are educated with real-world, relevant training that reflects the dynamic nature of health care. “family physicians provide over 50 per cent of all medical care in canada. we are the foundation of primary care in canada, but we also provide care in a lot of different parts of the system.”
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she is based in yellowknife, northwest territories, where she practices community-based primary care, as well as maternity care and general practitioner oncology care.
“one of the beautiful things about family medicine training is that it is designed to allow us to meet community need. so in a place like where i’m working here, almost all of us work in multiple parts of the system. so we deliver babies, we staff the inpatient hospitalist wards, we staff the emergency department,” she says, adding that while rural areas may have more demand for these multiple functions, family doctors also fill a lot of different roles in urban settings.
“a few years ago, i did some extra training to become a gp oncologist, meaning that i deliver cancer care, so i oversee the delivery of chemotherapy and immunotherapy so patients don’t have to travel to edmonton (in alberta, far from home). even though i wasn’t a gp oncologist coming out of residency, i had the baseline training to be able to then say, ‘ok, i’m going to do a little bit of extra training.’ now i can provide this service. so there’s the ability with our training to really respond to community need.”
the college of family physicians of canada sets national standards for family medicine training across the country. dr. cook explains that culturally safe care, which reflects changing community needs, wasn’t part of her medical training 20 years ago.
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“we have entire groups of people at the college working exactly on this, on how should we integrate this into the curriculum. this is about indigenous health, but also culturally safe care for any cultural group that you are serving to try to make sure that the care you provide is respectful,” she says of sensitivity surrounding trauma, language and cultural preferences.
education plan to match curriculum to society’s needs
the college has an education action plan to address current challenges, such as aligning the curriculum with society’s needs, improving support for international medical graduates, transitioning to a team-based care model and re-energizing interest in family medicine as a profession. on that last note, dr. cook hosts a podcast for the college, family medicine matters, that highlights impressive initiatives across the country that are working well. “there’s so much out there about all the things that are going wrong. and i was like, wait a second. there are so many things that are going well, and we are doing a terrible job of sharing those. we are a country full of people with good ideas and lots of silos.”
one recent episode featured a family doctor in creston, b.c., talking about rural recruitment and retention, a tough issue that’s shared by many smaller centres. the community had very few doctors, but signed on seven new recruits this year. how did they do it? they started with a community recruiter to showcase the experience of living in that community with a quieter lifestyle close to nature.
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another shift in curriculum is technology, particularly looking at ai and how the capabilities are safely and responsibly incorporated into the practice of medicine. she notes its adoption to reduce administrative burden, like ai scribe for taking notes that can reduce paperwork by an estimated three to four hours per physician per week.
dr. freeland says new medical learners typically have an established comfort with technology, again reflecting society today. “they are immersed in social media, smartphones, computers. a lot of it is second nature, and it’s quite interesting because we do train them how to use the electronic medical record, which is at the hospital. they’re interesting because they will actually quickly say ‘here’s an idea or here’s an opportunity or why haven’t you guys thought about this?’ and so we have our learners very much be part of our team and part of the innovation.”
outside of their formal learning, medical students at thp in mississauga developed an innovation and entrepreneurship program where they bring in entrepreneurs who have developed new products and explored innovation to speak to students in the community.
she also talks about the reality of burnout in medical professions, brought to the forefront during the pandemic and its aftermath. there’s an emphasis on mental health and self-care for learners as they go through training.
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“the stigma around burnout and mental illness is much improved. it’s still there, but it’s much improved from even a decade ago. and i find that students are quite aware of wellness and the importance of that. some of their advocacy and what they do in terms of looking for events to support them are around wellness, how to bring their whole self to work, how to feel part of the team, how to have a difficult conversation if things aren’t going well,” she says. colleges and universities have wellness integrated into their curricula and training environments, and hospitals like thp make student and staff wellness a part of the culture.
training that protects against burnout
dr. cook, as well, points to a greater emphasis on well-being with the evolution in how people work. there are more women in medicine and more people who are in dual career families, where they need to sort out coordination of schedules and childcare.
“we do know that there are very high rates of burnout and the canadian medical association has put out lots of information from their surveys on that,” she says. “we need to start this in education so that people going through their training understand that this is not an afterthought, because it’s not. how do we help our profession to care for itself before burnout ever happens?”
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part of that wellness is promoting recognition and respect for the flexibility people need and how they work and providing ways for people to talk about it when they are struggling. “there’s, of course, still massive stigma. there’s massive stigma about mental health in general, but i would say particularly in physician training and medical education because it’s just a long history of the way that we are trained to work really long hours.”
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