A 55-year-old man tells his doctor he wants a prostate-cancer screening test. The physician isn't sure the test is indicated. Who's the doctor going to call?
Increasingly, practicing physicians can check facts and seek advice from experts at UC Davis School of Medicine, without leaving the office. A broad-based effort to rejuvenate medical education at UC Davis has created a long menu of interactive, Web-based learning options for medical students — and now these innovations, developed with the expertise of telemedicine specialists, are being extended beyond the Davis and Sacramento campuses.
"Our goal is to become the leader in medical education in the West," said Michael Wilkes, associate dean of medical education. "We want to create a learning environment here that begins in medical school, goes through residency programs and continues through retirement."
The doctor who wants up-to-the-minute prostate-cancer screening information, for example, can log onto the UC Davis Clinical Resource Center, a Web site that offers instant access to textbooks and other medical references. If the answer can't be found in this e-library, the doctor can pose the question to a UC Davis prostate-cancer expert, using an e-mail message form on the Web site. An e-mail answer arrives within 24 hours.
The UC Davis Office of Continuing Medical Education has long been the major provider for nationally accredited physician education in Northern California. Last year alone, it coordinated 70 major educational courses for 7,500 participants in California, the United States and the world, and held 20 teleconferences for rural health-care professionals.
Now education programs are adapted for the Web, so that learners who can't be present at a teleconference or a live session can log on to cme.ucdavis.edu. Continuing-education courses are being recorded on CDs, too.
Web streaming drives the monthly You-Asked-For-It series, which delivers updates on such topics as pain management, hepatitis C and smallpox directly to physicians' computers.
Videotapes of some autopsies are also available on the Web, enabling practitioners to see results without being present during the procedure.
Such efforts are unique, according to Wilkes. "It is going to be one of the things that puts Davis on the map," he predicted. "It is going to be a commitment to the practice community, and therefore a commitment to the patients and the public."
Tom Nesbitt, associate dean for regional outreach, telehealth and continuing medical education, emphasizes the same theme: "Medical science is advancing so fast that, for the average physician, the amount of information that he or she has to learn after leaving residency is more than was required during medical training. There needs to be life-long learning."
The medical school is also changing at UC Davis. A variety of reforms took effect last year: an end to letter grades, a reduction in classroom hours, increased small-group instruction, expanded contact with faculty mentors and greater emphasis on such previously slighted topics as preventive medicine and substance abuse.
As a result, faculty and students say today's physicians-in-training are spending more time acquiring the critical-thinking and clinical-reasoning skills they need to stay current in their fields.
Two new classes have proved especially popular: "Doctoring" and "Application of Medical Principles," both piloted during the 1999-2000 academic year. In Doctoring, students spend time in an operating room, burn unit or other clinical setting, then meet with faculty mentors to discuss and interpret what they've seen. In the AMP course, groups of eight to 10 students meet weekly with two faculty members to tackle actual patient cases.
Cinnamon Hampikian, who took the AMP course in her third year, found its active learning emphasis invaluable. "The facts we learn in textbooks will be accessible for the rest of our lives," she said. "However, learning new or different ways to think about problems, or learning to use facts and information, are much more difficult skills to develop."
Those are exactly the skills doctors will need most in the 21st century, said neurology professor Constance Bowe, who chaired the School of Medicine's Committee on Educational Policy when many of the reforms were put in place.
"Medicine is changing so fast that we can't possibly teach our students everything they ultimately will need to know," Bowe said. "However, we can engender a love of learning and encourage our students to be the best doctors possible."
Wilkes, who joined the faculty in August 2001, plans to expand the Doctoring course so that eventually it accounts for about one-quarter of the four-year medical school curriculum.
The new associate dean's other goals: Hiring and training 100 or so actors to serve as patients in simulated, interactive learning experiences; designing shared training programs to promote teamwork among doctors, nurses, psychologists and social workers; and creating foreign-study opportunities for medical students and faculty to learn how medicine is practiced elsewhere.
Leadership skills will be given increased emphasis from the first year of medical school on.
"I want our graduates to have the leadership skills to be able to move society, change opinion, get their agenda accomplished so that they can work to make this a better world locally, nationally and internationally," he said.
Wilkes joined UC Davis from UCLA, where he developed an international reputation for innovation in medical education, including introducing medical students to the humanistic side of being a physician, and adding social sciences to training.
An internist, Wilkes was a major force behind the creation of UCLA's Doctoring curriculum, which includes topics such as doctor-patient communication, clinical reasoning and end-of-life care. The curriculum has served as a model, not just for UC Davis, but for many other schools nationally and internationally.
"In five years," Wilkes said, "I want people to say, ‘You're going to UC Davis medical school? You're so lucky! I hear it offers a great education, and is a very fun place to go.'"
And he wants to make learning convenient and fun for these students for as long as they practice medicine.