Preface

As with many, if not all aspects of twenty-first-century society, contemporary medical education (ME) is evolving at a tremendous rate with the traditional models of education—learning and teaching—being challenged in the process. In the past, the roles and responsibilities of teachers and students were well defined, as the content and curriculum, at least in the context of ME, was based upon mastering the core topics of basic science, followed by the introduction of clinical curricula focusing on various medical and surgical specialties and subspecialties. While this basic paradigm still exists as a foundation for learning "facts" about diseases and their treatments, it is becoming clear that the topic of ME is much broader and more complex. The search continues for better tools and techniques aimed at teaching and objectively testing core knowledge, its application to patient care, and the early integration of basic and clinical sciences as the ME system continues to evolve. Furthermore, the key principles that described the "art of medicine" as historically lectured, tested, and applied are still emphasized, but the education of a contemporary physician is much more complex and will continue to get more so.

Traditionally, the physician is often viewed as the leader of the healthcare team. In a manner that was often viewed as absolute and without question, he (as most were males) directed the care of patients by generating hypotheses and ordering various diagnostic tests and procedures, and coordinating care with consultants and colleagues. As the role of the physician evolved, especially in the context of leadership, the focus moved toward healthcare team integration with the role often viewed as more of a politician who negotiates an agenda for care in which 'best practices' are often the subject of intense debate. The concept of effective teamwork, regardless of how defined, is a crucial component of being a successful physician. Consequently, physicians are now expected to learn how to lead, manage, and navigate a full spectrum of healthcare challenges, in addition to overseeing the overall care of an individual patient. Examples of multidisciplinary teams include Cancer Tumor Boards, Heart Teams, Trauma Teams, as well as various Critical Care and Emergency Specialty (e.g., Emergency Medicine, Stroke, High-risk Obstetrics, etc.) teams and, more and more, subsets of such teams for disease or therapy-specific situation. The physician is expected to develop, champion, and run such teams, recognizing and leveraging the unique value that each team member brings to the table. There is also a rapidly growing profession of non-physician providers such as physician assistants, doctors of nursing, and advanced nurse practitioners who are becoming critical members of the overall healthcare team. In addition to disease or organ-specific specialization, such individuals are often serving as de facto team leaders, champions, and coordinators or, as commonly described, navigators. As such, the current ME initiatives must provide the foundation that allows trainees to understand and appreciate the need for mutual respect, professionalism, and division of roles, expertise, and responsibilities that everyone brings to the bedside regardless of educational background or titles.

It is clear, as emphasized in this text, that the traditional approaches toward teaching (and learning) medicine have changed significantly over the past two decades, and even more so as we continue on in this digital information age.

In the past, lecture halls were filled with students taking notes while listening to a lecturer, never-ending group sessions debating papers and standard textbooks, various hands-on experiences in an anatomy lab, and even early bedside training experiences, all have changed to incorporate evolving ideas and theories of how teachers can best "teach" and how students can best "learn." Novel approaches incorporate the need for simulation labs and the integration/analysis of content from multiple sources. Modern sources of information include non-traditional media platforms, and the overwhelming amount of scientific content – some peer-reviewed, some non-peer-reviewed. Evolving content sources, and often the content itself, all require a great deal of critical thinking and the ability to detect various biases, and agendas, and to reconcile often conflicting points of view. A strong ME system will help the student decide how to use such content and, just as importantly, how not to use it, as the concept of a critical review is much more complex and difficult than in the past as statistical techniques, study purpose, and even patient selection and site investigators must be approached with the same inherent skepticism as one would challenge the methods and result of the study itself.

We must acknowledge that modern medicine is a "big business," and that health care in general (across the world) constitutes an increasing proportion of the global economy. This trend is inescapable, especially when both global development and changing demographics are considered. The financial implications, resource limitations, conflicting personal biases, and employment models all impact how care is delivered. While most medical students are familiar with the financial costs associated with ME in general, few understand the very complex issues that pertain to the different compensation, reimbursement, and practice models that currently exist. Even navigating local and regional politics and potentially questionable agendas can be more difficult than actual patient care and hence must be understood. There is an ongoing evolution of fee-for-service toward pay-for-performance, and a broad-based understanding of these issues, along with how employment models are structured and function, is critical. More and more, "being a good doctor" is no longer just about caring, compassion, and medical knowledge, but also about being a good steward in the setting of limited resources. An understanding of the challenges in caring for the uninsured, underinsured, and financially disadvantaged in the context of the tremendous costs associated with providing health care, in general, must be understood and integrated into a systems-based approach to resource management.

As the modern educational process is better understood, which also includes more refined theories and their applications, there must be a critical awareness of the importance of diversity, equity, and inclusion (DEI). DEI initiatives run parallel and typically complement the much-needed reforms that focused on optimization of outcomes while providing highly individualized approaches and emphasis on "building on one's strengths." These concepts are extremely important as physicians must recognize that respect for others (and not just patients, but all the members of patient-care teams) is a cornerstone for being a good doctor and that learning and appreciating various cultural dynamics in a rapidly changing world is a critical component of being a modern healthcare provider. Consequently, our ME systems must instill at the very beginning of the educational process that even minor or subtle appearances of biased communications and/or behaviors may cause emotional harm, are unacceptable, and should not be tolerated. Even in the most innocent and well-meaning of circumstances, the perceptions of any form of bias can have

**V**

substantial negative implications. ME systems must acknowledge that many students, as a function of their own limited individual experiences and exposures, will require and benefit from a broader and more standardized curriculum that must consider participant age, maturity, and a variety of geo-social, cultural, and

This test is designed to provide a solid and useful foundation and resource for all of those interested in and involved in ME, regardless of their role. After all, another aspect of ME is a realization that the lines that separate educators, students, and administrators are sometimes overlapping and poorly defined, as we are all lifelong learners. This text considers the full spectrum of topics such as curriculum building, student-guided learning, nursing staff integration into teaching programs, surgical education, and learning through art. Other equally important topics included in this text address the importance of the creation of learner support structures and systems, the need for mentorship, and a balance between emotional intelligence,

The rapid changes that are occurring in modern ME are happening near or potentially at the levels at which real-time integration is no longer possible. Nevertheless, it is important that everyone involved at all levels of ME recognize their role in being active – not passive – participants in this evolutionary period of transformation and growth. It is also important to recall that the very tools that are used to assist us during this never-ending journey are themselves evolving continuously. This is a concept that can be both positive (such as the immediate availability of knowledge to a global community) and negative (biased, conflicting agendas, non-peer-reviewed, political/cultural censorship) and must be mastered. The challenges that the current generation of medical students face may seem overwhelming to the students of the past, but the opportunities and tools for success – as reviewed in this text – when used properly are aimed toward assisting the educational systems to be as effective and efficient in ways that were never possible or available in the past. In conclusion,

**Stanislaw P. Stawicki**

**Michael S. Firstenberg**

St. Elizabeth Medical Center, Appleton, Wisconsin, USA

Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA

Department of Cardiothoracic Surgery,

economic factors.

work-life integration, and empathy.

now is a great and exciting time to be a medical student!

substantial negative implications. ME systems must acknowledge that many students, as a function of their own limited individual experiences and exposures, will require and benefit from a broader and more standardized curriculum that must consider participant age, maturity, and a variety of geo-social, cultural, and economic factors.

This test is designed to provide a solid and useful foundation and resource for all of those interested in and involved in ME, regardless of their role. After all, another aspect of ME is a realization that the lines that separate educators, students, and administrators are sometimes overlapping and poorly defined, as we are all lifelong learners. This text considers the full spectrum of topics such as curriculum building, student-guided learning, nursing staff integration into teaching programs, surgical education, and learning through art. Other equally important topics included in this text address the importance of the creation of learner support structures and systems, the need for mentorship, and a balance between emotional intelligence, work-life integration, and empathy.

The rapid changes that are occurring in modern ME are happening near or potentially at the levels at which real-time integration is no longer possible. Nevertheless, it is important that everyone involved at all levels of ME recognize their role in being active – not passive – participants in this evolutionary period of transformation and growth. It is also important to recall that the very tools that are used to assist us during this never-ending journey are themselves evolving continuously. This is a concept that can be both positive (such as the immediate availability of knowledge to a global community) and negative (biased, conflicting agendas, non-peer-reviewed, political/cultural censorship) and must be mastered. The challenges that the current generation of medical students face may seem overwhelming to the students of the past, but the opportunities and tools for success – as reviewed in this text – when used properly are aimed toward assisting the educational systems to be as effective and efficient in ways that were never possible or available in the past. In conclusion, now is a great and exciting time to be a medical student!

> **Stanislaw P. Stawicki** Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA

**Michael S. Firstenberg** Department of Cardiothoracic Surgery, St. Elizabeth Medical Center, Appleton, Wisconsin, USA

**Chapter 1**
