In the past decade, the practice of medicine has transformed in a big way.
Today's doctors are jotting notes on an iPad, and navigating various electronic medical record systems. And payment models are shifting to reward physicians for improving patient outcomes, rather than for ordering expensive tests and procedures.
The top medical schools are adapting slowly to these changes. Many schools are in the process of exploring which new skills should be taught to young doctors, either through the core curriculum or as an elective, and which are better learned as part of professional development. The American Medical Association recently doled out $11 million to about a dozen schools for new programs on the future of medical education.
"We're grappling with this big question of what should be the job of the medical school in the 21st-century," said Lawrence Sherman, a New York-based medical educator and TED speaker. "We're still determining what the new skills should be, how they're taught and when they're taught."
KQED asked more than 20 doctors of all ages and specialties about the skill they wished they had learned (or learned about in more detail) in medical school. Some physicians wanted help understanding the new technologies; others saw benefit in focusing more on keeping their patients healthy, rather than just treating the sick. Here are their top picks:
Data Science and Statistics
A handful of physicians said they could benefit from a richer understanding of data science. It's not just businesses, but also medical practices and hospitals that are dealing with a deluge of data.
Top academic hospitals like Mount Sinai in New York are forging ahead with initiatives to collect data about a large patient population and connect that to outcomes in order to understand disease and improve treatment.
"Medicine is increasingly data-driven," said Michael Turken, an internal medicine resident at Stanford Healthcare and a graduate of UCSF's medical school. "And yet, almost none of us is equipped to understand the data as fully as we should, as fully as we need to."
Nutrition and Disease Prevention
Do you regularly talk to your doctor about nutrition and exercise? If so, you're an anomaly. According to recent polls, fewer than 25 percent of doctors say they got sufficient education to give nutritional or fitness advice to a patient. In fact, the number of hours dedicated to teaching nutrition in medical school has declined in recent years.
"We received two or three hours of instruction on nutrition in four years of medical school," said Amanda Angelotti, a UCSF medical school graduate and clinical systems designer at primary care chain One Medical Group. "Lifestyle diseases drive some of the biggest costs in healthcare and have some of arguably the biggest impacts on patients' lives."
Ultrasound imaging is now pervasive, but many doctors said they lacked sufficient training in medical school. Instead, they learned how to leverage the technology over time and on an ad-hoc basis.
Eric Topol, a cardiologist and the chief academic officer for Scripps Health, said ultrasound technology has evolved in the past decade to be portable and compatible with mobile devices. These days, he said, "exquisite" imaging can be achieved with a probe connected to a smartphone. "But I need remedial training."
Information Technology 101
Doctors are increasingly using technology in their practices, whether it's to record notes or store patient data in an electronic medical record. Some doctors are using the newest telemedicine tools to consult with patients online.
Mia Finkelston, a medical director and practicing physician at Online Care Group, said she wished she'd learned basic word-processing skills, and shortcuts such as how to copy and paste in different formats. "It would have saved me time on so many levels."
Communications and Empathy
The most effective doctors understand how to communicate with patients. That doesn't mean rattling off a diagnosis and sending them home. It requires picking up on the subtle indications that a patient has not understood something, or is too upset to take in information.
"[We need] ways to sustain empathy and provide reassurance to patients," said David Scales, a resident physician of internal medicine from the Cambridge Health Alliance in Massachusetts and a graduate of Yale Medical School. "And that goes beyond trying to teach doctors how to be nice people."
Some medical schools do teach communications skills, but several graduates said the instructors were often senior physicians, rather than people with training or credentials. "That's starting to change," said Alex Djuricich, the associate dean for continuing medical education at the University of Indiana. "A lot of schools are looking to bring in communications experts. We need to have the emotional intelligence to understand how patients are really feeling."
It's now imperative that doctors learn to manage their money, or they risk drowning in debt. Several recent medical school graduates said they could benefit from some formal education about how to use the latest web and mobile tools to manage their finances.
Management and Leadership
Connie Chen, a San Francisco-based physician and entrepreneur with Vida Health, said physicians are often placed in leadership roles early in their careers. Even in their residency years, doctors have to run teams of interns, coordinate with other physicians and nurses, and align families around shared treatment goals, she said.
"And yet there is almost no training on how to succeed in the working world," she said.
Chen said she would have benefited from basic management skills, such as providing feedback and motivating others, as well as tips on how to collaborate and manage projects. Cyrus Yamin, a Harvard Medical School graduate who now works at Kaiser Permanente, said medical students could use training on how to lead a room full of people with different roles, experiences and emotions, especially in the trauma bay.
[Editors' Note: I received a fantastic response questioning the premise of the article. It's from Chris Chen, a second-year resident in internal medicine at Massachusetts General Hospital: "We all know 20 percent of patients consume 80 percent of healthcare resources and our energy as doctors: The old, the chronically ill, the functionally limited. But in med school, we spend 80 percent of our time on 20 percent of diseases, including a litany of esoteric rare disorders that are academically illuminating but most clinicians will never see in their entire careers. I don't need to know the enzyme defect in Fabry disease. I need to know how to manage dementia; to manage pain thoughtfully; to assess patient home safety. I suspect the biggest gap in 21st century medical training is a lack of old-school skills, and not high-tech coding."]