Nov 24, 2015

Brian Hodges: Preparing the Next Generation

Professor Brian Hodges

Professor Brian Hodges has been stimulating an international dialogue about how to best prepare the next generation of physicians for a rapidly changing future. He was instrumental in projects that redefined competence for future physicians. He was also a major contributor to the Educating Future Physicians for Ontario project and its successor, the Royal College of Physicians and Surgeons of Canada CanMEDS framework, as well as the Future of Medical Education in Canada project. For his efforts, he was recently recognized by the Association of American Medical Colleges with the 2015 Abraham Flexner Award for Distinguished Service to Medical Education.

Hodges is a professor in the Department of Psychiatry, Executive Vice-President of Education at the University Health Network, a scientist at the Wilson Centre for Research in Education, Richard and Elizabeth Currie Chair in Health Professions Education Research, Senior Fellow at Massey College and the Project Lead for the AMS Phoenix Project. Recently, he shared his thoughts about the future of medical education with writer Erin Howe.

Why is an international medical education metamorphosis important?

While biomedical and social sciences — and the societies we live in —have evolved significantly in the last century, medical education has been slower to adapt. The Global Commission on Education of Health Professions for the 21st Century stated worryingly: “Professional education has not kept pace … largely because of fragmented, outdated, and static curricula that produce ill-equipped graduates.” The 21st century is already characterized by profound discussions about what health professionals are and should be. Many of us are concerned about unprecedented levels of burnout among clinicians coupled with growing demands for equitable, safe and compassionate care — the delivery of which is more often systems-based than under the control of individual clinicians.

What will medical education need to look like in the future?

The explosion of technological advances including computers that solve problems and display forms of empathy, challenges us to question what a health professional of the future will be. The progression of robotics will recast which technical skills are needed from human healthcare professionals.

What skills or qualities will tomorrow’s doctors require?

From the moment Laennec used the first stethoscope to auscultate the sounds of a patient’s breath, he put a little distance and a bit of technology between the doctor and patient. Technology is neither inherently good nor bad. In this example, the stethoscope greatly advanced our ability to help patients. The same can be said for the panoply of imaging, laboratory and surgical technologies being used today and being developed for tomorrow. Physicians of the future will need to do what machines cannot - integrate complex knowledge, adapt their expertise to different contexts, work in teams to address complex problems and, most importantly, find ways to convey a warm, compassionate and caring human presence.

What might determine competency in the future?

I believe we will move away from the big, high stakes examinations that currently characterize the pre-certification portion of training and recognize that learning and competence assessments must be done continuously across our professional lives. My hope is that health professionals will voluntarily work to create opportunities to regularly expose themselves to challenges using tools like simulation, e-learning and peer-based case discussions which push the boundaries of their knowledge and skills and that we will learn regularly from the challenges, near misses — and even the inevitable medical errors — that affect us all.

As patients become more engaged as ‘partners in care’, how can physicians support them in doing this?

The Internet has given patients access to the whole domain of biomedical and social science knowledge that underpins healthcare. Formal medical education gives the physician the advantage of being able to filter, critique and integrate the mass of unsorted knowledge that is now online. I believe physicians will play a more educational role in the future, working side by side with patients and their families to understand, filter and apply the most relevant knowledge to their care and that of their family members. A writer in the October 2015 issue of The Economist recently wrote that the professions are now "in the eye of the storm" and that "their exclusive license to apply their expertise to an unordained laity" is being challenged." Putting it bluntly, I believe that the survival of the health professions will be linked to our success in proving our worth by working with patients and their families to improve the care of individual people while responding to the health care needs of our populations and society.