Leaders in Medical Education

Dr. George Mejicano, Oregon Health & Science University

Osmosis Team
Published on Jul 28, 2014. Updated on Invalid date.

Dr. George Mejicano is the Senior Associate Dean for Education at the Oregon Health & Science University School of Medicine. He also serves as a Professor of Medicine in the Division of Infectious Diseases at OHSU. We were excited to speak with Dr. Mejicano about his interest in medical education and how he manages the OHSU medical school curriculum.

How did you decide on a career in medicine?

My father is a retired gastroenterologist, and medicine was always something that was part of the family. I wasn’t really sure I wanted to go into medicine until the summer between my sophomore and junior years in college. I had the opportunity to shadow a number of physicians in Chicago and I just loved what they did. Medicine was always in the realm of possibilities in terms of my interests, but my interest was cemented by shadowing physicians in college.

What made you interested in infectious diseases?

That’s easy! It was a combination of two things. The first was the role models that I worked with in medical school and residency. The physicians that I most admired were ID doctors. I admired how they approached the patient, their knowledge set, their diagnostic acumen, etc. The second was the diagnostic puzzles. It was what I love most about medicine — when everyone is scratching their head and trying to figure out what is going on with the patients. In ID we do a lot of that work. I am less interested in managing chronic diseases, which is important but not what I truly love; I am much more interested in figuring out what clinical problem is going on with a person.

It seems that more medical students are pursuing interdisciplinary careers and degrees (MD/MPH, MD/MBA, etc). Can you describe how your experiences in medicine have influenced your career in medical education?

I enrolled in college as an engineer. I liked the approach that engineers have and I liked the math and quantitative perspectives. As I realized that medicine was really exciting, the next question was whether or not I could bring those two together. I enrolled in an MD/PHD program, but the one at the University of Illinois (where I went to medical school) had us fulfill the master’s in engineering first. It was then that I realized I wanted much more time to see patients. That’s when I stopped with the MD/PHD program and went straight though with the MD at that point.

My interest in education was completely different. I had done an internal medicine residency and an infectious diseases fellowship. I was near the end of my fellowship when I went to my department chair and  said, “I would love to stay here, but I’m not sure if a place like this would want someone like me.” The chair said, “We need people who really understand education and I know that you like education.” He offered to pay for me to go back to school to earn a master’s in adult education. I thought that I would be a residency program director way back when. So that’s the crazy path that I’ve taken!

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What has been the biggest challenge in your medical career?

I would say that the speed of change is not fast enough and I get frustrated by that. For better or worse, I think we need to make some very big changes for the future and we need to do them quickly. Medicine does not move fast in terms of its education and academic design; the world is moving much faster than the medical field. My frustration is having to deal with the politics and the culture of medicine when I think that we need to move far faster and more aggressively in medical education. We need to incorporate flipped classrooms, blended learning, stimulation, competency based systems, value purchasing...I could go on and on and on. We are simply not going close to the speed that we have to go.

What changes do you believe we need to make to medical education to improve medical practice?

Competency based systems — we need to truly embrace this. If you think about medical education in the last 110 years, we have embraced a system that is “time-fixed and outcome variable.” In other words, we teach  students for 4 years  and produce a wide range of abilities. We need to go to an “outcome-fixed, time variable” system, so that some students graduate earlier and some later. If we go to a competency based system, students will progress when they show that they are competent. If I said I won’t let you be on the team unless you run 100 meters in 12 seconds, then I don’t care how you train or who your coach is; all I care is that you can run 100 meters in 12 seconds or less.

In the information age and with our technology search engines, we need to step away from medical knowledge being the critical component of what makes a good doctor. The information explosion continues to occur and there is no way someone can learn the entire field. There is simply too much content. Instead of memorizing, we can search for answers using informatics and data bases. At this point, it doesn’t matter what you memorize; it matters how you frame a question, filter the responses and determine whether you should apply the answers to patient care. The classic pre-med curriculum needs to be thrown out. The kinds of learners that we need, and the kinds of problems that they address, needs to change rapidly. Otherwise, we are going to be in a world of hurt. It doesn’t matter what you know; it matters if you can search for it.

At the same time, patients are becoming more sophisticated and can access more information. Classic example: people used to go to a library, but now they use their smart phones because it holds the worlds’ libraries. The same is true in medicine. Why can’t we do home visits electronically? We can take medical histories, labs, EKGs, blood sugars, pregnancy exams, etc. -- all through your smartphone using various adapters. The point is that, just as the music and publishing industries have changed, the healthcare industry doesn’t know the revolution that is about to hit it. People want to interface with their doctors in new ways and we need to change not only the profession, but the people going into the profession.