David Schleich, PhD
There are numerous drivers of change affecting the longevity and design of naturopathic medical education in North America these days. For example, genetics and information technology are disrupting medical systems and approaches almost every day. Pluripotent stem cell technology holds promise in the making of replacement tissues and organs for transplantation (watch for “regenerative medicine” to expand). GlaxoSmithKline’s recent experiment with stem cells and Alzheimer disease signals the kind of investment likely in this field (The uses of stem cells, 2013, p. 68). The spread of the Internet and digitalization is transforming delivery and protocols equally as fast. Meanwhile, the scrutiny on healthcare dollar expenditures and reengineering the highly commodified healthcare system in America is absorbing more political capital now that Mr Obama has been reelected.
A personal example of how dramatically these shifts can occur may be in order. Forty years ago this month, a friend of mine lost her job as the coordinator of a team of keypunch operators at a Canadian bank’s head office. These employees would “keypunch” tiny holes into cards that would be fed into a computer, processing data about deposits, loans, payments, and so forth. The future had seemed secure and friendly. Then suddenly someone invented the microchip, and the rest is history. Her job ended, but an entirely new career unfolded for her. She went on to become a “computer scientist.” Today, she works for Google at 10 times the pay (expressed in constant dollars) and, to cite her experience, “10 times the pressure.” Her experience is related as well to the meaning of the first two words of the title of this column. Those words translate: specialists in “drowned cities” rather than “city specialists” who inadvertently were drowned (say, by global warming floods). There are futurists who have already alerted those who will listen to build job descriptions like these for professions few people have ever heard of yet. The same phenomenon is before us in naturopathic medical education.
Take “gene screeners,” for example. Any young (or not so young) person looking for high-demand employment right now might want to check out the very few gene screener diploma programs out there and get his or her curriculum vitae into the healthcare market, where so-called personalized medicine (we knew what that meant a century ago; patient driven, the allopaths are catching on quickly, though) is ramping up into preventive mode. Systems biology and other new disciplines like in biotechnology, bioinformatics, cell biology, anatomical sciences, molecular pharmacology, and laboratory technology are carving out brand-new careers. In that emerging world, genetic screens will be as common as drug tests. For example, employers will need technicians to collect and analyze DNA as a normal part of choosing the best “human capital,” trying to screen out hires whose screens suggest a propensity for behaviors that could undermine productivity. Facebook already has a “get gene screener job” portal. Yikes. Human capital, as it is called, vibrates faster and faster in modern economies. That same shuddering shift is affecting how we have to plan and deliver naturopathic medical education for that same future.
For example, factored into how we put curriculum together is the reality that the average 20-year-old by 2025 will have not only used a computer frequently before starting kindergarten but will also be using technology none of us in 2013 have yet encountered. The Pew Internet & American Life Project has been studying this emerging world of education and social change massively impacted by the digital age. They wrote: “These young people are born into a digital world where they expect to be able to create, consume, remix, and share creations” (Horrigan, 2007, p. 49). The Pew Research Center is a nonpartisan data and analysis organization, a subsidiary of something called The Pew Charitable Trusts. The Pew Internet & American Life Project is one of seven under way at the Pew Research Center, which looks carefully at issues, attitudes, and trends shaping American and global society.
The PEW work on the Internet is especially important for those of us in the naturopathic medical education field who wonder about what the “millennial generation” will expect in terms of learning methodologies, tools, and outcomes going forward. In particular, the Pew Internet/Elon University (Elon, N.C.) survey (Quitney, Book, Donahue, & Scott, 2012) depicts a wild ride ahead. One thousand twenty-one survey participants (activists, commentators, researchers, Internet and web architects, technologists, policy experts, educators, information officers, and academics) had this to say about that future: “There will be mass adoption of teleconferencing and distance learning to leverage expert resources . . . a transition to ‘hybrid’ classes that combine online learning components with less-frequent on-campus, in-person class meetings” (Anderson, 2012, p. 52).
In related research released a year before that, Kim Parker noted:
More than three-quarters of college presidents (77%) report that their institutions now offer online courses, and college presidents predict substantial growth in online learning: 15% say most of their current undergraduate students have taken a class online, 50% predict that ten years from now most of their students will take classes online. (2011, p. 116)
Elon University School of Communications has recently provided summaries of earlier surveys that preceded their collaboration with Pew in 2012, which give us useful insight into what is emerging for educators dealing with a very different kind of learner. As reported in their “Imagining the Internet: A History and Forecast” (Quitney, Book, Donahue, & Scott, 2012) work, every aspect not only of student life but also of civil society will move through astonishing transformations arising because of the complex rollout of the digital age.
For example, we will see the current millennial generation transform into the “always-on generation.” They will have substantial ability to multitask. They already crave and expect instant gratification. They will be always “on” in their day-to-day lives. These learners will know how to access a wired world in which the web itself and “apps” will converge in the cloud as providers attempt to monetize online exchanges (not only e-mails and texts but also curriculum, webinars, and more). While the Pew research predicts abundant new applications that could span every discipline we teach, open access to knowledge may not be as exponential as the current attention to massive open online courses suggests. It will be a cashless world of e-wallets and smartphones, too, by the way, in which we will collect tuition, continuing education fees, and other revenue electronically, more and more. This has implications for the training of our business staff in relation to the shifts occurring in servicing Pell, Title IV, and Stafford loan processes, as well as private banking arrangements related to students. And, it will be a world of “gamification.”
Gamification (or making data accessible or usable in learning, game format), these survey experts contend, will dramatically affect curriculum design and delivery. A report (Burke, 2011) suggests that the sheer volume of data that our students (and workers) will be confronted with represent immense distractions in the form of online data and ubiquitous media. Persistence with information gathering, risk taking, attention to detail, problem solving, and creative solutions finding are all part of this emerging universe. Games such as Gamestar Mechanic, Knewton Math Readiness, Immune Attack, and Arden are strong examples of the emerging game content that will influence curriculum delivery. Arden teaches Shakespeare. Immune Attack teaches immunology. Gamification describes the broad trend of applying game mechanics to nongame environments such as innovation, marketing, education, training, employee performance, health, and social change (Burke, 2011, p. 18).
| This transforming world in large measure lies outside the control of medical academics, but much change will emanate from inside academic medicine, too, though. The literature that is the catalyst for this conversation is growing. The Savill Report, published over a decade ago by the Academy of Medical Sciences (2000), called attention to the need for growing tenure track opportunities for clinician scientists. Just 2 years later, the Academy of Medical Sciences (2002) posited recommendations for change to overcome the jeopardy that clinical academic medicine was facing in a rapidly transforming global health environment. In 2003, that same Academy of Medical Sciences pointed out the urgent need for translating medical science directly into patient benefit, as well as for strengthening clinical research itself to feed that process, a dynamic between research and clinical application that its researchers concluded had slowed considerably in recent years.
Meanwhile, the American Association of Medical Colleges (2003) published a white paper calling attention to the impending shortage of primary care physicians in America, as well as to the weak areas of medical training that needed to be addressed at a time when the stress buckling delivery of medical care was being compounded by chronic underfunding of medical education itself. The Institute of Medicine (2003) in that same pivotal year of debate pointed to the academic health centers of the nation as underfunded agencies for meeting these same burgeoning needs. The following year, the Strategic Learning and Research Committee, Department of Health (2004) commented broadly on the very same urgent needs in the United Kingdom. Even academic medical journals weighed in during this period of the bruising and dilution of academic medicine (Academic medicine: Resuscitation in progress, 2004; Clark & Tugwell, 2004). In the British Medical Journal, Clark and Tugwell (2004) lamented the “off the radar” mindset of politicians and policy makers about the sustainability of academic medicine. These very same issues affect the naturopathic academic medical community. Its leaders huddle not often enough, though, to consider the capacity of the naturopathic medicine community to support a medical academic sector devoted to thinking, researching, discovering, studying, evaluating, and innovating at the same time as they are busy with teaching, learning, and improving our curriculum and its delivery—a wobbly business. It is tougher and tougher for our professors to sustain simultaneous competence in practice, research, and teaching within our current hiring practices and remuneration ability. There are instabilities in the naturopathic network of programs and colleges such as applicant pool competition inside and outside the natural medicine realm, as well as the impact of public policy shifts (e.g., the curriculum of colleges in certain states must reflect the primary care physician obligations of Oregon’s profession at the same time as it prepares graduates for unlicensed states, or for states or provinces where the naturopathic scope is quite different). Clinical academic staff in this changing environment have as much pressure adhering to standards of care and charting the process as they do mentoring students and residents in our limited clinic settings. Our young graduates face uncertainty about making enough money to pay off student loans, establish clinics, and support families. As the blend of teaching (classroom and clinic), research, and clinical practice becomes increasingly difficult in academic medicine to coordinate, we will have to introduce longer-term contracts or even tenure, in fact, for academic faculty at a time when productivity, work assignments, and cash flow are all moving targets. The value of that kind of expensive commitment is not well understood, and perhaps it is too late to be even doable as higher education in North America bends under persistent fiscal restraint. Finally, naturopathic academic medicine is not well positioned (although it is getting better) to be part of a comprehensive health sciences profession that communicates routinely with biomedicine, nursing, public health, social work, allied health educators, and other stakeholders. These larger goals imply leadership on a system level and much greater strength in numbers given the barriers that the allopathic profession puts in our way every time we approach a state legislature for licensing purposes. We now have a new organizational structure in the Association of Accredited Naturopathic Medical Colleges. We have several thousand ND students in our system with a wobbly, but consistent applicant pool. We have schools whose facilities are better than they have ever been. It’s the right time to create a friendlier future. It begins with our teachers and their deans. |
David Schleich, PhD is president and CEO of NCNM, former president of Truestar Health, and former CEO and president of CCNM, where he served from 1996 to 2003. Other previous posts have included appointments as vice pres-ident academic of Niagara College, and administrative and teaching positions at St. Lawrence College, Swinburne University (Australia) and the University of Alberta. His academic credentials have been earned from the University of Western Ontario (BA), the University of Alberta (MA), Queen’s University (BEd) and the University of Toronto (PhD)
REFERENCES
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