Georgina De la Garza had finished her first year of medical school at Texas A&M Health Science Center when her family gathered at the bedside of her dying grandmother.
“Everyone turned to me,” she says. “‘Should we give her IV fluids, a feeding tube?’ I was afraid to tell them the wrong thing.”
Her grandmother died peacefully with few interventions. But the experience compelled De la Garza, 26, to volunteer to create a series of end-of-life scenarios that would allow A&M students to practice having tough talks with “patients” in the school’s simulation lab.
The move by Texas A&M is just one illustration of how medical schools are equipping future doctors with 21st-century skill sets. Across the country, curricula are being retooled to reflect fundamental changes in the nature and delivery of care, including in the following areas of study.
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1. Palliative and end-of-life care: Some 28 percent of Medicare dollars – about $170 billion annually – are spent during patients’ last six months of life, and often on futile treatments that add to suffering. One response has been the rapid growth in hospital hospice programs; palliative care, meanwhile, is now offered by about 87 percent of hospitals, up from just 5 percent 20 years ago.
Most of the training occurs in residencies and fellowship programs, says Sean R. Morrison, director of the Hertzberg Palliative Care Institute at the Icahn School of Medicine at Mt. Sinai in New York. Mt. Sinai now incorporates pain management and advanced care planning into first- and second-year course work. The fourth year includes a two-week rotation with the palliative care team – doctor, nurse practitioner, nurse, social worker, chaplain, and massage, art and yoga therapists.
2. Diet and exercise: Two-thirds of disease is preventable through healthy lifestyle choices, research shows, yet only about a quarter of medical schools have even a single course devoted to nutrition. That’s the finding of a 2010 study from the University of North Carolina—Chapel Hill.
But change is coming: Witness Tulane University School of Medicine’s new 28-day rotation in "culinary medicine."
The New Orleans school brings fourth-year students to Johnson & Wales University, the culinary school in Providence, R.I., to master the art of preparing nutritious meals and, when they’re not in the kitchen, to make the rounds with dieticians at Rhode Island Hospital.
In an elective at Baylor College of Medicine called Cooking Healthy, Eating Fresh, second-year students attend five classes each focused on a different theme, such as diabetes and hypertension. After a lecture on the topic, a local chef demonstrates theme-related recipes.
Meanwhile, at the University of South Carolina School of Medicine Greenville, which is just two years old, disease prevention is integrated into every part of the curriculum.
Besides building the research on lifestyle choices into discussions of cancer, for instance, the school encourages doctors-to-be to run, take yoga and work in the student-tended vegetable garden.
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3. Social responsibility and health: Improving patient outcomes requires addressing all the inequities that affect well-being and access to the system, so med students are beginning to explore such determinants of health as education, income and ethnicity.
The University of Chicago Pritzker School of Medicine was an early adopter, launching a health disparities elective class in 2006. After one group of students documented the lack of access to breast cancer screening among local uninsured women, university oncologists got state funding to provide 350 free mammograms annually.
Herbert Wertheim College of Medicine at Florida International University has baked social accountability throughout its four-year curriculum. First-year students are assigned to a family in an underserved community as part of a team that includes students of law, public health and nursing.
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4. Geriatrics: The ranks of people age 65 and older are expected to more than double from 2000 levels by 2030. A growing number of senior mentor programs at medical schools could help get physicians ready.
At the University of North Texas Health Science Center, all medical students are paired with an elderly resident in the Fort Worth area. During their first and second years, students meet regularly with their assigned seniors at home, in teams with the university’s physician assistant, pharmacy and physical therapy students.
Corrected on March 26, 2014: A previous version of this article misidentified the University of South Carolina School of Medicine Greenville.