Associate Professor of Medicine John K. Roberts, MD, brings a wealth of expertise, experience, and a deep dedication to teaching to his new role as director of Undergraduate Medical Education (UME).
Known for his resolve and talent for teaching and actively engaging with students and trainees in fostering their growth, Dr. Roberts is pedagogically motivated by the “awe-inspiring, transformative nature of medical education.”
“Because the clinical years of medical school are challenging and take place in the real-world with real patients, students are always working at the edge of their existing knowledge, and they have opportunities to act according to their highest values. Seeing a student self-actualize in the real world will never get old for me,” he said.
John Roberts joined the Duke faculty in 2015 after completing his internal medicine residency and nephrology fellowship here. He earned his doctor of medicine degree from the University of Alabama at Birmingham. His academic contributions at Duke have been recognized with several prestigious awards, including the 2017 William and Sandra Bennett Clinical Scholar Award from the American Society of Nephrology.
Dr. Roberts has been the driving force behind Duke’s first-year medical school curriculum as the inaugural clinical correlations course director since 2019, receiving accolades such as the Eugene A. Stead Teaching Award in 2019 and the School of Medicine Golden Apple awards for preclinical and clinical teaching in 2021 and 2023, respectively.
In his new role, Dr. Roberts considers the challenges that lie ahead and how he plans to move medical education forward while working to strengthen new opportunities at the undergraduate level.
Moving Undergraduate Medical Education Forward
In terms of innovation, Dr. Roberts wants to improve tracking student behaviors and their clinical competencies over time with the development of new assessment tools that teach and assess higher-order cognitive skills , or clinical reasoning, and leadership skills such as emotional self-awareness and self-management.
“I don’t think sets of multiple-choice/single-best-answer style questions have been able to do that,” said Roberts, who wants to develop a single app that allows students to log their patient encounters, communication skills (explaining new diagnosis, diet counseling, delivering bad news), and clinical skills (exam maneuvers, interpreting labs, ECG, diagnostic imaging).
The app would also allow faculty to be assigned to sign off and/or evaluate the behaviors they observe. Students would then generate a dashboard of all these skills and everyone (deans, clerkship directors, students) can track them over time and across all clerkships.
“Imagine if we could add patient evaluations of the student,” said Dr. Roberts, who got the idea from earning merit badges as an Eagle Scout. “I would love to have in this system a way to earn badges for different medicine-related clinical skills, perhaps new skills collected on fourth year electives/sub-specialty rotations. That could allow a student to showcase their unique interests and strengths for residency applications.”
Roberts wants to address the tension between splitting time for patient care and studying for national board exams with new formative and summative assessments that better measure clinical reasoning and emotional intelligence.
“In my UME role for the MS1 curriculum, I did this using interactive, simulated patient videos,” he explained. “I’m open to a new summative assessment that allows the student to ‘show me what they learned’ so to speak. This could be an oral exam or something else. Bottom line: I want the final assessment strategy to better align with their everyday experiences on the clerkship.”
When it comes to student assessment for certification, licensing, and reassurance to the public, Roberts believes that the high stakes exam of only multiple-choice/single-best-answer style questions will be replaced by assessments that are more complex and authentic. These newer assessments will measure clinical reasoning skills, perhaps using AI simulated patients or standardized patients over teleconferencing software. Newer assessments will also have students respond in narrative forms to assess reasoning and complex decision making where students explain their thought process, next steps, or write an entire progress note.
The test-maker in this case would probably use natural language processing or AI to assess the narrative data. Roberts’s hunch is that AI will be developed and implemented with hospitals and clinics being first adapters followed by medical educators and, as AI becomes more useful, medical education and doctoring will still be necessary to interview and examine patients.
AI further begs the medical education question to what extent will every student need to be taught about a broad range of diseases and constructing a differential. When it comes to knowing a lot and processing data, the computer will beat the human, Dr. Roberts said.
“Maybe medical education will be more about thorough information gathering, physical exam, patient communication, and showing empathy. Less note writing for sure and more time with patients. A bonus for UME: the AI in the wall would also be a 24/7 tutor where students converse with it, ask questions, get advice, and receive tailored instruction anytime, anywhere.“
Tough Lessons, Best Teachers
But perhaps the greatest challenge for medical students today, Roberts noted, is learning while experiencing the moral distress associated with joining health care systems associated with marked health disparities.
“Duke’s UME and Graduate Medical Education programs are top-class with teaching what is needed to diagnose and treat both common and complex problems, and Duke students become excellent at diagnosing and treating things — especially acute problems,” he said. “However, in the U.S. we’re having a hard time covering basic needs for the average citizen. Our system is functionally an opt-in, if-you-can-afford-it or your-job-happens-to-provide-it system. Too many people fall through the cracks and get sick for reasons mostly related to things they had little control over. Witnessing these large disparities in health outcomes (those driven by income, insurance access, and health literacy) is morally challenging, and especially so when you are face to face with some of your first patients.”
But what makes Duke special is the people, Dr. Roberts noted.
“The faculty in the Department of Medicine are incredibly diverse and our clinical educators are top-notch humans who will mentor you to become whatever you want to become,” he said. “We retain the best teachers. Many of our residents and fellows stay on as faculty because they feel at home and are supported to pursue some interest near and dear to their hearts. Your future is wide-open here. We have no agenda other than to help you become an amazing doctor plus whatever else it is you want to do. If some of the innovations I mentioned come to fruition, well that’s just icing on the cake.”