Monday, August 1, 2011

New Hofstra Medical School Doing It Right

If we are to apply inductive reasoning to medical education, we must think of creative ways to expose novice level medical students early on in their education to the undifferentiated patient.  We should not expect students to try to understand the basic science behind a myocardial infarction without those students first witnessing chest pain, without them witnessing what a heart attack actually looks like.

The brand new Hofstra/North Shore - Long Island Jewish  School of Medicine has taken advantage of its unique advantage of creating a medical school curriculum from scratch.  The school's first class will have the opportunity to learn via inductive reasoning by seeing patients with chest pain before they learn all the factual parts of what makes up a myocardial infarction.  They will know chest pain and from that knowledge point, as they continue onwards with their more traditional studies, they will then have the advantage of context.  The students will know what cardiac cell necrosis looks like, and what troponin bumps look like, and what statins are designed to prevent, and what the past event is that pathological q-waves represent.

Here is an excerpt from an article found on PRNewswire-USNewswire from July 27, 2011:

"Within the first weeks of their arrival, students will be trained and certified as emergency medical technicians and begin working in ambulances. By learning to be EMTs and practicing emergency care from the beginning of their studies, students will be exposed as members of an emergency-response team to patients in crisis situations. The school's ground-breaking academic course content offers students the unique opportunity to learn medicine through a new and innovative curriculum that integrates basic science with hands-on clinical experience throughout the four years of medical school."

If you know of other schools practicing novel approaches to expose medical students early to patients, especially to patients who are in their first stages of presentation, please leave a comment.

Thank you to Hofstra for getting it right.

-Teach, MD


  1. Enjoyed reading your blog. Very interesting approach that they are taking at Hofstra/NSLIJ. I would be curious to see how many of the programs' graduates end up pursuing a career in EM after having EMT certification as their first medical school experience?

  2. This is a great point – and a point that reveals one of the major difficulties with educational reform: how does one quantify and research if interventions or changes in curriculum make a significant difference in outcomes or not? Hofstra is probably not going to support two major curricula concurrently and so a control group with which to compare the EMT-intervention group cannot be obtained. So, how can we honestly evaluate that Hofstra’s intervention of having students become EMT trained leads to more EM docs?

    This means research in med ed needs to answer questions in creative and novel ways, which is a challenge that makes medical education such an exciting field.

    - Teach, MD

  3. Coming from the point of view of someone who spent many years as a paramedic prior to medical school, I find the Hofstra plan to be brilliant. Many (in fact the majority) of my classmates had no clinical experience entering medical school, and our only patient encounters prior to the 3rd year were extremely contrived environments that lacked any real clinical relevance. But in the defense of that curriculum, being shoved into a clinic or inpatient setting prior to learning how to take a history and complete a physical exam makes little sense...thus contrived patient encounters were the compromise.

    And this is where EMS becomes a perfect solution. EMT basic courses are quick and relatively easy to conduct, and provide useful skills (CPR, ABCs, basic history and physical, AED use, etc) that are an excellent foundation for the inexperienced clinician to build upon. And by working independently in the field, outside of the hierarchy of the hospital, these new medical students both see "real life" pathology, and also start to develop clinical decision making skills much earlier than any of their non-EMT peers. Also not to be overlooked is the value in firsthand exposure to where patients come from, how they live, and the barriers to care many of them experience. Necessary for this to work would be a well established local EMS system with experienced pre-hospital providers that can mentor the new EMTs (perhaps as 3rd riders on existing trucks), and this may not be available to all medical schools.

    I will certainly be interested in learning how this works for Hofstra, and applaud them for initiating a needed change in medical school curriculum.

  4. I am currently a second year med student and work simultaneously as an EMT. Seeing things in the field and heading home immediately to read about them definitely helps cement things in my mind.

    I remember the second week of first year treating a gout patient the day after having just learned about Lesch-Nyhan. As a consequence, I'll never forget the HPRT enzyme!

  5. This is a great example of the value of clinical encounters during pre-ward medical education. Many schools have integrated clinical skills and controlled bedside ward teaching into their pre-clinical curricula, but the approach to the undifferentiated patient is less utilized. These experiences can be achieved on the truck (like in Rick's case), in the ambulatory care clinic, in the ED, or in other 1st line healthcare settings.

    If your school is incorporating the undifferentiated patient into the first years of it's curriculum, please leave us with a comment. I'm very interested in following this trend.

    - Teach MD

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