Support medical student education in CSRA by expanding opportunities

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Columbia County’s desire to have its own hospital has stirred up strong feelings about which Augusta hospital (Doctors, University or Georgia Regents University) should be chosen. Each hospital has provided a strong case for why it should be chosen.

However, as a recently retired (currently working part-time) pediatrician at the Medical College of Georgia, there is an important aspect about this issue that has been neglected. The issue I’m referring to is education.

MEDICAL SCHOOL LASTS four years. The first two years are predominantly classroom-based, when students learn anatomy, biochemistry, pathology, pharmacology, etc. They also spend time learning how to communicate with patients and how to perform a physical examination. Medical students spend their next two years in hospitals and doctors’ offices, practicing and honing their skills under the tutelage of skilled physicians. It is during these years that students decide which medical specialty they would like to pursue.

When they graduate from medical school, doctors still have to complete three to seven years of additional residency training in their chosen specialties (surgery, internal medicine, etc.) before they can begin to practice medicine. One of those medical students could one day be your doctor!

Medicine has changed a great deal in the past 20 years. Fewer patients are hospitalized and hospital stays are shorter. More care is delivered in outpatient settings. If medical students are to be properly prepared to practice medicine in America in the 21st century, they must train under the same conditions in which they will practice. In other words, they must train in both inpatient and outpatient settings, and see a variety of economically and culturally diverse patients with a variety of acute and chronic medical conditions.

DURING THE LATE 1990s MCG began sending third-year medical students to work with private physicians in community practices around the state (Rome, Albany, Statesboro, Covington, etc.) for some of their required clinical experiences. Decreasing numbers of hospital-based patients at MCG necessitated part of this, but much of this occurred because many local physicians in the CSRA were unwilling to teach students in their offices and local hospitals.

What does it take to train tomorrow’s physicians? First of all, it takes talented people.

In the past 15 years, MCG has demonstrated that volunteer private physicians in other Georgia communities outside the CSRA can do a superb job serving as role models and teachers for medical students. But locally the story is much different. Doctors Hospital and University Hospital have benefited tremendously from MCG, as a large proportion of their physicians trained at MCG either as students or residents. Unfortunately, neither hospital has shown a strong willingness to help participate in the education of medical students.

Similarly, even though they benefit significantly from the expertise of MCG’s subspecialists and the economic impact of GRU in Augusta, very few local physicians are willing to teach MCG medical students. Interestingly, however, as one travels farther away from Augusta, more doctors are willing to volunteer their time and make the commitment to teach medical students.

Second, it takes patients. When you go to your doctor for care, it’s easy to take for granted the skills he or she has. But learning how to listen to patients; ask the right questions, accurately record findings in a medical record; perform an accurate physical examination; and order appropriate laboratory studies and X-rays are skills that must be learned. These skills cannot be learned in the classroom – only in an office or hospital setting with real patients.

THE MCG AUGUSTA campus trains 190 students each year, and this number will rise to 240 students a year after the new Education Commons building is completed. If the CSRA is to enjoy the economic benefits of having the 10th-largest medical school in America, there needs to be a commitment by all the people of the CSRA to help provide MCG medical students opportunities to learn.

My wife, two sons and I all have been treated in academic medical centers (including MCG) by doctors, residents and medical students. In some cases this was a minor inconvenience, but at other times we actually felt the care was enhanced by the extra attention we received.

William Osler (1849-1919), known as the “Father of Modern Medicine,” arguably was one of the most famous and skilled physicians in the past 100 years. Dr. Osler observed: “Medicine is learned by the bedside, not in the classroom.” If the CSRA wants to truly demonstrate its support for MCG, then it must provide more opportunities for medical students to learn by:

• encouraging and enabling physicians to voluntarily teach medical students in their offices;

• providing opportunities in all our local hospitals for medical students to see patients under the guidance and supervision of their physicians;

• providing medical students opportunities to care for diverse patients of all socioeconomic levels.

REGARDLESS OF which hospital is chosen for Columbia County, I hope it will not only serve the needs of the community, but also support the critical educational needs of Georgia’s future physicians as well.

(The writer is professor emeritus of pediatrics and a part-time pediatric infectious disease specialist at the Medical College of Georgia. His opinions are his own, and do not necessarily reflect those of the MCG or GRU administration.)

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Riverman1 03/16/14 - 05:52 am
Trust Me, He's Spot On

I’ve often reported the reluctance of University Hospital and local physicians to train MCG students and residents. University pays lip service to resident training when pressure is applied by the community, but slips out of the arrangements when it’s convenient for them. Look at the history of MCG resident training at University. Many local physicians have the same attitude. Do you know why?

It’s money and competition. Physicians do not want future physicians and specialists competing with them. Remember the discussions about the way to keep physicians in the state was to have more resident training programs? That’s absolutely true and everyone in the medical community knows it. That’s why the local medical establishment impedes the process as much as they can.

jimmymac 03/16/14 - 10:19 am

With an expanding population we need more doctors. It's as simple as that and how anyone could argue that fact is beyond me. All hospitals should have to train medical students. They can be of great help and it will give them the exposure they'll need to be practicing physicians.

Scratch 03/18/14 - 07:40 am
Not Just MCG

A few points for clarification. Residents are "doctors" who have graduated from medical school and received M.D. or D.O. degrees. Not all readers of this article might understand that. The author also makes no mention of another medical facility that is an integral part of the area's medical education community, i.e. Eisenhower Army Medical Center (EAMC). Eisenhower provides training for military medical residents as well as MCG/GRU residents and medical students. I am told that the medical students believe that EAMC provides training superior to that of GRU. Regretfully, the education and training provided by this great institution is often forgotten in the community. Another point, is that providers in the private sector are besieged by influences external to clinical care. The pressures of 3rd party payers, the gov't (Medicare/'caid), and electronic records (and a host of other administrative requirements) restrict the resources that provides can direct toward education and training of students who only restrict one's ability to see patients. I agree with the author's assessment, but I suggest that efforts to free private providers from all the admin hassles might be more useful in enabling them to train and educate students.

grateful man
grateful man 03/18/14 - 09:53 am
Comments for Scratch

Good points, Scratch. You are right about Eisenhower and the quality of the training that students (and residents) receive there. You may not be aware of this, but MCG also sends medical students to Ft. Benning (Columbus, GA) and Ft. Stewart (near Savannah) in addition to Ft Gordon.

Regarding your comment: "Another point, is that providers in the private sector are besieged by influences external to clinical care. The pressures of 3rd party payers, the gov't (Medicare/'caid), and electronic records (and a host of other administrative requirements) restrict the resources that provides can direct toward education and training of students who only restrict one's ability to see patients." I totally agree. However, the 600+ community physicians outside the CSRA who voluntarily train MCG students across the state are faced with the exact same issues, yet they are willing to teach students . . . . And these physicians don't enjoy the economic and professional benefits that come from practicing in Augusta, where there are experts in many medical specialties and subspecialties readily available and innumerable opportunities to attend medical education and research conferences if desired . . . . .

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