I am perplexed by the status quo that traditional medical education has maintained. Though the form of medical education has changed over the past 200 years (how medical education is done), the content (what is being taught), for the most part, has not. We are required to learn fundamental subjects like pharmacology or anatomy, as we should be. But, in our premedical education, we are also required to learn subjects that haven’t changed very much from the medical school curricula of the 19th century, like chemistry and physics — when there are many subjects not on our curricula that are much more relevant to today’s medical needs and challenges.
For me, the top three of these are nutrition/lifestyle modification, business and leadership, and physician advocacy. All reflect the situation of the modern-day physician, and all are conspicuously absent from med school curricula.
Nutrition/Lifestyle Modification
According to the CDC, most of our health care expenditure (90% of an annual $4.1 trillion) is spent on managing and treating chronic diseases like hypertension, diabetes, and mental health conditions. Poll any physician and I’d wager that none would be surprised that chronic conditions are extremely prevalent in our society. In fact, that’s basically what we spend countless hours learning in medical school and residency: how to identify diseases and how to treat them. Obviously, that is extremely important to saving lives, but if we’re spending so much to treat chronic diseases, what has gone wrong? Put bluntly: If the management of chronic diseases is utilizing so many of our health care dollars and we have evidence that lifestyle changes like physical activity and eating a healthy diet can help prevent or even sometimes reverse chronic disease states, why is it that less than 20% of medical schools have a required nutrition course?
According to an article from the American Heart Association, physicians are “uniquely positioned to encourage individuals to adopt healthy lifestyle behaviors” but “report they lack the necessary knowledge about how various diet and physical activity regimens affect specific medical conditions.” In addition to feeling burned out and busy, physicians simply don’t feel equipped to discuss nutrition and lifestyle changes with their patients. I think this is a major problem. Clearly, something has gone missing or ignored and medical schools must shift and adapt to tackle this public health crisis.
On a brighter note, I am thankful for the few organizations out there doing this work. One is Loma Linda University, which has created a Lifestyle Medicine Specialist Fellowship. Another is the American College of Lifestyle Medicine (ACLM), which certifies and trains physicians to use lifestyle interventions to treat and prevent chronic conditions. I was lucky enough to hear about ACLM through a supervisor during my residency training. I decided to take a look into what ACLM was, and I’ve not looked back since. Last year, I became board-certified in lifestyle medicine, and I encourage other physicians to consider becoming board-certified as well.
Lifestyle medicine includes six pillars: 1) a whole-food, plant-based diet, 2) physical activity, 3) stress management, 4) avoidance of risky substances, 5) restorative sleep, and 6) social connection. While these are things that come up naturally during my patient encounters as a psychiatrist, through ACLM’s resources and tools, I have learned how to better engage my patients through lifestyle change, and my confidence in speaking to and counseling my patients about these factors has increased as well. Also, just as importantly, I began a journey of applying lifestyle changes in my own life so that I make sure I am also practicing that which I counsel my patients about. I have heard from many physicians that applying and incorporating lifestyle medicine into their practices has rejuvenated them, as they see health, autonomy, and vitality restored to their patients.
Business and Leadership
Another area that would be useful to have in medical school education is business and leadership. With burnout rates so high and a whopping 40% of physicians having interest in leaving their organization, it’s clear that there’s much to be desired and much to be worked on in today’s practice of medicine. Most physicians are employed by large hospitals and corporations, and perhaps some physicians would feel more fulfilled, have more autonomy, and experience less burnout by, say, running their own practice. Unfortunately, many physicians don’t even know where to start. It’s here that medical school and/or residency programs must step in — they can play a pivotal role in introducing physicians-in-training to diverse options (e.g., private practice, administration, medical director roles) that extend beyond or augment traditional routes.
Beyond business, we need more physicians in positions of leadership. We need physicians in government so they can create laws and policies that make sense in our day-to-day duties and responsibilities. We need physicians in leadership who care about quality of care, about the health and well-being of all groups of clinicians, and about how health care is delivered. We need physicians in leadership positions who know what it’s like to directly care for patients, not administrators who have never seen a patient. We need physicians in positions of leadership so that we can change what needs to be changed and keep good physicians doing what we desperately want to do — providing effective and quality care in environments where we feel valued and not seen or treated as robots. And to do all this, we need medical schools to instill leadership in our aspiring physicians so they stay in practice and create the change we want to see.
Fortunately, there are a few medical schools that already have some form of leadership courses integrated into their curriculum. Duke University School of Medicine has a Leadership Education and Development Curriculum; Mayo Clinic College of Medicine and Science offers a Resident Leadership Academy, which is a resident leadership course for a select cohort of residents; and the University of Michigan Medical School has a leadership program embedded into its medical school curriculum.
Physician Advocacy
As physicians, we need to know how, why, and when to advocate for ourselves. Instead, in medical school, we learn to just take whatever comes our way, don’t complain, grind through it. Anything else might be seen as weakness. I hope that one day medical schools teach that strength isn’t just about grinding through whatever awful conditions exist, but is instead about having the boldness to speak up and develop creative solutions to the issues that exist in every facet of where we train, learn, and work. I hope medical schools teach future physicians how to speak with state representatives, and how to read bills and testify against ones that don’t help or are dangerous or inappropriate. Medical students eventually become doctors and doctors need to know that it’s OK to advocate for themselves, their colleagues, and their patients.
I believe these three issues are just as important as learning human anatomy — and definitely more practical to a physician than organic chemistry. It would make a substantial difference to medicine if they were incorporated into medical school curricula. But even if medical schools never decide to teach these things, we as practicing physicians must have the courage and desire to learn them ourselves — the future of medicine depends on it.
What are the top three things you would add to the medical school curriculum? Share in the comments!
Dr. Mallory Grove is a psychiatrist in Seattle, WA. In her spare time, you can find her enjoying time with her family, thrifting, adding to her houseplant collection, baking, playing her flute, or learning to sew. Dr. Grove is a 2023–2024 Doximity Op-Med Fellow.
Image by Denis Novikov / Getty Images
