Medicine has changed a lot in the past 100 years. But medical training hasn’t — until now. Spurred by the need to train a different type of doctor, some top medical schools around the U.S. are tearing up the textbooks and starting from scratch.

Most medical schools still operate under a model pioneered in the early 1900s by an educator named Abraham Flexner.

“Flexner did a lot of great things,” says Dr. Raj Mangrulkar, associate dean for medical student education at the University of Michigan Medical School. “But we’ve learned a lot and now we’re absolutely ready for a new model.”

Michigan is one of many med schools in the midst of a major overhaul of their curricula.

For example, in a windowless classroom, a small group of second-year students is hard at work. The students are not studying anatomy or biochemistry or any of the traditional sciences. They’re polishing their communication skills.

In the first exercise, students paired off and negotiated the price of a used BMW. Now they’re trying to settle on who should get credit for an imaginary medical journal article.

“I was thinking, kind of given our background and approach, that I would be senior author. How does that sound to you?” asks Jesse Burk-Rafel, a second-year student from Washington state.

His partner, also a second-year student, objects; he also wants to be senior author. Eventually they agree to share credit, rotating whose name comes first on subsequent papers related to the imaginary research project.

It may seem an odd way for medical students to be spending their class time. But Dr. Erin McKean, the surgeon teaching the class, says it’s a serious topic for students who will have to communicate life and death matters during their careers.

“I was not taught this in medical school myself,” says McKean. “We haven’t taught people how to be specific about working in teams, how to communicate with peers and colleagues and how to communicate to the general public about what’s going on in health care and medicine.”

It’s just one of many such changes, and it’s dramatically different from the traditional way medicine has been taught. Flexner’s model is known as “two plus two.” Students spend their first two years in the classroom memorizing facts. In their last two years, med students shadow doctors in hospitals and clinics. Mangrulkar says Flexner’s approach represented a huge change from the way doctors were taught in the 19th century.

“Literacy was optional, and you didn’t always learn in the clinical setting,” he says. Shortly after Flexner published his landmark review of the state of medical education, dozens of the nation’s medical schools closed or merged.

But today, says Mangrulkar, the two-plus-two model doesn’t work. For one thing, there’s too much medical science for anyone to learn in two years. And the practice of medicine is constantly in flux.

What Michigan and many other schools are trying to do now is prepare future doctors for the inevitable changes they’ll face throughout a long career.

“We shouldn’t even try to predict what that system’s going to be like,” he says. “Which means we need to give students the tools to be adaptable, to be resilient, to problem-solve — push through some things, accept some things, but change other things.”

One big shift at many schools is a focus on how the entire health system works — rather than just training doctors how to treat patients.

Dr. Susan Skochelak, a vice president with the American Medical Association, is in charge of an AMA project that is funding changes at 11 schools around the country. She says the new teaching focus on the health care system has had an added benefit: Faculty members are learning right along with the students about some of the absurdities.

For example, she says, only because they have to guide students through the system do they discover things like the fact that some hospitals schedule patients for MRI and other tests around the clock.

“And one of my patients had to come and get their MRI at 3 a.m.,” Skochelak says. ” ‘How do they do that?’ ” she says a faculty member asked her. ” ‘Do they have kids?’ ”

Physicians aren’t always the best teachers about how the system works.

Doctors tend to focus on patient care, since that’s what they know. However, Skochelak says, “If you hook [students] up with a clinic manager when you want them to learn about the system and what the system does, then the clinic manager focuses on the system.”

Another major change to medical education aims at helping future doctors work as team players, rather than as the unquestioned leaders.

In a classroom at the University of California, San Francisco, several groups of students practice teamwork by working together to solve a genetics problem.

Joe Derisi, who heads the biochemistry and biophysics department at UCSF, is guiding more than teaching when he gently suggests a student’s tactic is veering off course. “I would argue that it may not be as useful as you think,” he tells the student. “But I’m obliging.”

Onur Yenigun, one of the students in the class, says that working with his peers is good preparation for being part of a team when he’s a doctor.

“When I’m in a small group I realize that I can’t know everything,” Yenigun says. “I won’t know everything. And to be able to rely on my classmates to fill in the blanks is really important.”

The medical schools that are part of the AMA project are already sharing what they’ve learned with each other. Plans are in the works, as well, to begin sharing some of the more successful changes with other medical schools around the country.

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.

Transcript :

AUDIE CORNISH, HOST:

Medicine has changed a lot in the past 100 years, but medical training hasn’t kept up with modern needs. To train doctors equipped for today’s fast-paced environment, medical schools around the country are tearing up the textbooks and starting from scratch. Julie Rovner of Kaiser Health News paid some of these new medical classrooms a visit.

JULIE ROVNER, BYLINE: In a windowless classroom at the University of Michigan Medical School, a small group of second-year students are hard at work. They’re not studying anatomy or biochemistry or any of the traditional sciences. They’re polishing their communication skills. In one exercise, Jesse Burk-Rafel and a classmate are trying to settle on who should get credit for an imaginary medical journal article.

JESSE BURK-RAFEL: I was thinking, kind of given our background and approach, that I would be senior author. How does that sound to you?

ROVNER: It may seem like an odd way for medical students to be spending their class time, but Burk-Rafel says it’s a serious topic for students, who’ll have to communicate life-and-death matters to patients and medical colleagues during their careers.

BURK-RAFEL: We’re trying to pilot some new approaches to leadership, and that’s one of them.

ROVNER: It’s also a far cry from how medical students have traditionally been taught. The longtime model is known as two-plus-two; students spend their first two years in the classroom memorizing facts and the last two shadowing other doctors in hospitals and clinics. It was devised in 1910 by an educator, Abraham Flexner.

Raj Mangrulkar, the associate dean at Michigan who’s spearheading the medical school’s new curriculum, says it’s persisted even as medicine has changed.

RAJ MANGRULKAR: I think the vast majority of medical schools still have more of a Flexnerian model.

ROVNER: But today, says Mangrulkar, the two-plus-two model simply doesn’t work. For one thing, there’s too much medical science for anyone to learn in two years; and for another, medicine is constantly in flux. What Michigan and many other schools are trying to do instead is prepare doctors for the inevitable changes they’ll see over their practice lives.

MANGRULKAR: We shouldn’t even try to predict what that system’s going to be like, which means that we need to just give students the tools to be adaptable, to be resilient, to problem-solve, to push through some things, accept some things, but change other things.

ROVNER: One big change at many schools is a new focus on learning not just about how to treat patients, but about how the entire health system works.

Susan Skochelak is a vice president with the American Medical Association. The AMA is funding changes to med school programs at about a dozen schools around the country. She says the new focus on looking at the system has had an added benefit; faculty members are learning right along with the students about some of the absurdities in health care today.

SUSAN SKOCHELAK: The faculty themselves said do you know that when I schedule an MRI for my patients, we have a 24/7 scheduling. And one of my patients had to come and get their MRI at three in the morning? How do they do that? They have kids.

ROVNER: And sometimes it’s not even doctors who are the best teachers about how this system works.

SKOCHELAK: If you hook them up with the clinic manager when you want them to learn about the system and what does the system do, then the clinic manager focuses on the system.

ROVNER: Another big emphasis is making sure the next generation of doctors is ready to work as part of a team, rather than the unquestioned leaders. In another classroom at the University of California, San Francisco, several groups of students are practicing teamwork by working together to solve a genetics problem.

UNIDENTIFIED WOMAN: How confident are you that that’s what it is?

JOE DERISI: OK, there’s been a request over here for the normal…

ROVNER: That’s Joe Derisi, who heads the biochemistry and biophysics department at UCSF. Right now, he’s more guiding than teaching.

DERISI: You know, I would argue that it may, you know, not be as useful as you think, but, you know, I’m obliging.

ROVNER: Onur Yenigun, one of the students in the class, says that working with his peers is good preparation for working as part of a team when he’s a doctor.

ONUR YENIGUN: When I’m in a small group I realize that I can’t know everything. I won’t know everything. And to be able to rely on my classmates to, you know, fill in the blanks is really important.

ROVNER: The medical schools that are part of the AMA project are already sharing what they’ve learned with each other. Plans are in the works to begin to share some of the more successful changes with other medical schools around the country as well. For NPR News, I’m Julie Rovner. Transcript provided by NPR, Copyright NPR.