WORCESTER MEDICINE
Game Changers Breakthroughs in Medical Education B. Dale Magee, MD, Curator
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state of medical education in the mid-19th century in the United States was poor. There were numerous schools and virtually no admission requirements, beyond having fees for courses. Medical schools taught theory but there was no clinical experience. Classes were held for about four months and the same lectures were repeated a second year. Those who passed exams were issued diplomas. Another approach was to undergo an apprenticeship for a few years and be granted a letter from the doctor certifying the apprentice’s qualifications. Even licensing wasn’t standard. For example, in Massachusetts, the Massachusetts Medical Society would have “censors” examine applicants, the Worcester District assumed this role for MMS locally, and issue certificates. A book containing the recommended reading list as well as logs of those examined are in the WDMS archives. It was not until 1894 that the Massachusetts Board of Registration in Medicine was founded. In 1869, Charles Eliot, president of Harvard University, recommended that Harvard Medical School move to a three-year curriculum, extend the academic year and utilize written exams. He was cautioned against this because a majority of students at that time could barely write. Eliot persisted and a few years later his wish was granted. In subsequent years, the enrollment dropped by over 40%. Students of medical education are familiar with the founding of The Johns Hopkins University School of Medical in 1893. This raised the level of education and introduced a model that looks familiar today: a college education was required for admission, medical school started with two years of basic science and progressed to two years of clinical education using a hospital connected to the medical school. Lost in this is the role of Elizabeth Blackwell and her sister, Emily, the first and third women in the U.S. to earn medical degrees. Elizabeth was a strong advocate of mainstreaming medical education for women and having them attend the same schools and meet the same standards as men. But, in the mid-1860s, she became aware of the fact that women were getting a second rate education. As a result, the two sisters started the Women’s Medical College of the New York Infirmary in 1868. They extended the length of the academic year, expanded to three years with each year progressing to new material. Clinical experience was provided by integrating their New York Infirmary for Indigent Women and Children, as well as other New York hospitals, into the curriculum. Students were examined by outside experts prior to graduation. One of the first two women admitted to the WDMS in 1885, Rebecca Barnard, was an 1878 graduate of the Women’s College of the New York Infirmary. As other, better-financed medical schools began admitting women, the Women’s Medical College of the New York Infirmary closed in 1899. In its tenure, however, It had not only opened doors for women but also elevated the level of medical education decades before Johns Hopkins. + he
EMR: Missed Opportunities and Unfulfilled Promises, Why Patients and Physicians Deserve Better Fred Baker, MD, FAAFP
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he joy derived from meaningful work that
positively, and perhaps profoundly, impacts people’s live inspires many to a career in medicine. Unfortunately, much of that joy is infringed upon by some of the execution and design of the electronic medical record, or EMR. According to the American Medical Association, for every one hour spent with the patient, two hours are spent on documentation. Many physicians cite the EMR as a major cause of physician burnout, particularly the often-expressed concern with the rise in perceived overwhelming non-meaningful tasks or workflows. The New England Journal of Medicine noted, “about 80% of physician burnout is really due to workflow issues and, as it turns out, the way the electronic medical records have evolved — unlike in other industries where automation has made work easier — [they] have added work.” Nowhere is this egregious reality more evident than a scene that plays out in most physician offices, several times a day. A doctor electronically transmits a prescription during a patient visit, then the patient arrives at pharmacy where the pharmacist notes the medication is denied as insurance requires an alternative or preauthorization. Next, the pharmacist calls the physician’s office to request new orders and the physician and their staff must disrupt another patient’s visit, diverting time and resources, as they scramble for a new treatment with no clear direction of what’s available. Additionally, the initial patient must incur a delay in treatment and the added burden of having to return to the pharmacy. How is it possible that — with all the dedicated, highly trained professionals; sophisticated technology, resources and data available in real-time — inefficient and disruptive workflows can be found acceptable? The problem is not a lack of resiliency or desire on the part of the health care professional, rather much of the blame must fall on the two entities most complicit and responsible for the dysfunction — namely EMR
NOVEMBER / DECEMBER 2021
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