By Daniel Ehrmann, fourth-year medical student, University of Michigan Medical School
I have fond memories of the beginning of medical school. The first weeks were a whirlwind. As we adjusted to this new way of life, we developed an early camaraderie. It seems like so long ago when we used to all go to a barbecue after class. Literally, almost all 170 people attended. Looking back on those days, I think what united us all was a common interest in one another (combined with a common goal to survive the next four years).
Then, as my training continued, something odd happened. We started to split into factions. We put up our own silos—self-contained towers only big enough for our like-minded colleagues. The lecture-goers hung out with the lecture-goers. The home podcasters hung out with the home podcasters. The people who were more interested in bench research found collaborators with shared interests, as did those who were more interested in community advocacy, or health disparities, or medical education.
But that, in itself, was not the problem. Surely, it’s unrealistic to remain friends with every single person in your medical school class. What was more troublesome to me was that we all began to lose our connection with one another. Not only did we build our own silos, but we stopped caring as much about the others. We identified those who were like us, who were likely to share the same goals and interests, and frankly ignored most of the rest.
Then we entered our clinical years of medical school. Many of us were disillusioned because we found more silos than even before. I can’t count how many times I heard statements like “Who cares what the emergency room doctors say, we’re the surgeons” or “Why don’t the nurses just do their job and let us be doctors.” We were inculcated with the belief that when you do your psychiatry rotation, you are to think like a psychiatrist and when you do your internal medicine rotation, you are to think like an internist and so on.
It’s ok and even healthy to think like your mentors when you’re trying to learn more about their specialty. This is especially true when patients have problems that require a specialty-specific knowledge base and approach. But what happens when there’s a problem that’s bigger than any one specialty or way of thinking? I’m thinking about the kind of situation that I wrote about in my commentary. I bet most of us stay in the silos that we’ve been building since the first year of medical school. We’ve been too busy critiquing others’ silos from inside ours to sit down and have a meaningful conversation about a problem where our interests and goals are likely to be shared.
The ideas broached by Dr. George and colleagues in their article in November issue of Academic Medicine are essentially ways to prevent trainees from erecting our silos in the first place. It will be vital to expose trainees to the system-wide issues (e.g. care coordination) that are likely to affect all of us as aspiring physicians, nurses, and public health professionals, no matter what specialty we choose to pursue.
I’m imaging one of many changes in medical education that can be made to address this problem. Instead of reserving quality improvement electives for the fourth year of medical school, long after many of our silos have been erected, why not try something else? First- and second-year medical, nursing, and public health students can join a quality improvement “track” early in their graduate training. As part of this track, students voluntarily meet in small, fifteen-person groups tasked with defining a relevant quality improvement project (e.g. care coordination). Through concurrent formalized leadership and communication training by interdisciplinary graduate school faculty, students will learn how to gather data to quantify the problem, work with consultants in the hospital and medical school (e.g. residents, attending physicians, hospital and medical school administration, etc.), and implement pilot projects. Distinction can be given upon graduation, and the additional benefits of joining such a track (e.g. networking, problem-solving skills, etc.) will make it very attractive to future employers. Not to mention, quality may actually improve.
This is just one idea. I challenge you to think about other solutions to the problem of care coordination, where we all have a shared interest in pursuing a common goal. It is only in this context where we can lay the foundation for an anti-silo culture that can last the rest of our careers.