One hundred years after the publication of a report that helped determine the direction of medical education in the United States and Canada, the journal Academic Medicine has released a special issue examining how doctors are being educated at a time when proposed changes in health-care delivery are once again in the national spotlight.
The publication commemorates the 100th anniversary of a landmark document known as the Flexner report, published in 1910 by Abraham Flexner for the Carnegie Foundation for the Advancement of Teaching.
Articles in the special issue question two of the Flexner report's key recommendations: that medical schools be based at nonprofit universities and that they follow a four-year curriculum.
The new publication examines the growth in for-profit models among Caribbean medical colleges and American osteopathic medical schools, which emphasize holistic treatments and primary care. The authors suggest this model could be expanded to other medical schools in the United States soon.
The publication also questions whether the traditional four-year curriculum should be shortened by a year to reduce student debt and graduate doctors more quickly. This would not only help address a projected physician shortage but, if done correctly, would not jeopardize the quality of physician training, the authors conclude.
Comments
1. davi2665 - January 28, 2010 at 11:09 am
Two comments on the basic contentions of the report. The first, that a Caribbean model be considered, has significant merit. This model utilizes the master educator plan, in which one or two outstanding educators, with extensive content expertise in the course material and stellar teaching reputations, teach the course or block or unit of instruction to the medical students to achieve consistency and cohesiveness. There also can be some supplemental presentations by visiting faculty who usually are internationally known experts with outstanding educational reputations. For the basic sciences instruction, this is VASTLY better than the typical US medical school, in which basic sciences courses often are taught by the cavalcade of research superstars (sometimes 30 or more) who present complicated research discourses on "what I do in research," otherwise known as death by powerpoint. These learned research presentations usually are miles off the mark from what a medical student needs to know to become a physician. In research-intensive medical schools, these courses become a vehicle for justifying a huge research faculty, who all must show that they "teach" for their promotion and tenure process. The Caribbean model is far better, and the medical students in the best of those schools have the same first time pass rate for the US Medical Licensure Examination as do the students in the big US research universities, despite the fact that the top US medical schools get to hand pick "the cream of the crop." The clinical years for students in the Caribbean medical schools often are spent in the US, in major teaching hospitals in NY, NJ, etc, or in the UK; these students are side by side with medical students from the US or the UK, so they get the same clinical education.
The second point, potentially reducing medical education to three years, is an absurd idea whose time should never come. While student debt is a problem, ramming an already-intensive curriculum down students' throats even faster will inevitably cut out much of the basic sciences foundations, encourage quick rote fact grubbing, will reduce the ability of the students to use evidence-based thinking, and will drive them into even further dependence on expensive imaging procedures and testing, rather than depending on what is the heart and soul of good medicine- the history and physical. Of course, in order to use the information from a good history and physical, the clinician needs to actually know something. Otherwise, we can just turn over medicine to robotic programs that mindlessly play the odds and have no aspect of clinical insight, integrative thinking, or reasoning power based on subtle findings. The idea that a 3 year curriculum can help grind out more physicians to alleviate the shortage is ridiculous- turn out more doctors faster who are unprepared to handle the needs of a rapidly changing healthcare and scientific environment. Great idea!! With increasing needs for medical schools to teach cultural aspects of medicine, community-based practice, team strategics in health care, ethics, good health care resource utilization, cost-benefit analysis and best practices, etc., I think that a good case could be made for medical school being a five year curriculum, certainly not a three year curriculum. Medical training is not just a quick in-and-out apprenticeship.
Behind many of these educational proposals and plans are foundations, organizations, and groups of individuals with distinct social (and sometimes political) agendas. They should stop tinkering with a process that works, and stop trying to engineer changes that are likely to be ultimately detrimental to health care.
2. rightwingprofessor - January 28, 2010 at 11:45 am
Just don't go to any doctor who graduates from the University of Massachusetts after 2012 or so. They just instituted quotas (set-asides) for minority applicants, which of course means lowered admissions standards. Not sure I want an affirmative action beneficiary cutting me open.
http://www.boston.com/news/education/higher/articles/2010/01/25/umass_to_offer_minorities_college_medical_school_opportunity/
3. dkmmd2002 - January 28, 2010 at 02:25 pm
@#2 Are there not " set asides " for relatives of alumni and the magnanimous donors to medical colleges and hospitals who are not the brightest of students. I went to medical school with a few of them