Opinion – Sidney Klajner: Medical training: nothing will ever be the same

Traditionally, doctors are trained to carry out their activity within the hospital. This model dates back to 1910, when the Flexner Report inspired a major overhaul of medical schools in the United States and around the world. Teachers taught based on their practical experience (not on evidence), and the concept was of absolute autonomy for physicians to decide what was best for the patient. In the early 1970s, evidence-based medicine placed limits on this autonomy. But, as we saw in the pandemic, it is still used to justify prescribing drugs that have been shown to be ineffective.

Both scientific evidence and the experience with patients are essential, as well as the articulation between theory and practice since the beginning of the course, which may not occur frequently in traditional medical courses. In addition, technical capacity must be accompanied by socio-emotional skills, such as knowing how to listen and communicate and working as a team, in collaboration with other physicians and other professionals. The “lone wolf” doctor is a thing of the past, as is the view of the patient as a passive being.

The patient is an active part of the process, with the right to make choices and participate in decisions. And here comes another component that medical schools do not always prioritize: humanity, that is, the physician needs to have a vision of the human being under their care, understanding their fears and desires, respecting their values, preferences, life contexts, etc.

How to train doctors with this new profile? To get different results, you have to do it differently. Therefore, when we created the Einstein Faculty of Medicine, we sought references in international institutions to structure an innovative course.

The changes begin with the selection process, with a first phase that measures knowledge and a second, socio-emotional assessment, with dynamics and mini-interviews in which aspects such as empathy, ethics and the ability to work as a team are observed. Many “geniuses” from stage 1 fail at stage 2.

In the course, we adopted the TBL (Team Based Learning) model. Students gathered in groups study the subject beforehand and go to class to build knowledge. The teacher is a provocateur/director of discussions. Theory has been combined with practical lessons from the beginning. A four-semester axis addresses humanization. We also emphasize topics such as bioethics, digital transformation and the importance of primary care in disease prevention and health promotion (in the early stages, students develop activities alongside the Family Health Program teams). At the internship, they work both in the Einstein private network and in the public hospitals under their management. Specific subjects and simulations exercise students in management tools and leadership practices, developing their ability to influence changes that help overcome the many health challenges, including expanding access, reducing waste, better coordination of care, boosting digitalization and new compensation models that encourage health promotion.

This December, we are graduating the first class at the Einstein Faculty of Medicine. In their baggage, these young professionals carry the best technical content and all the other essential skills to practice medicine connected with the present and the future. Working in ours or any other organization, they will be carrying out Einstein’s purpose: to deliver healthy lives to an ever-increasing number of people.