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Commentary: A Century of Progress in Medical Education: What About the Next 10 Years?
Abstract
Abraham Flexner's seminal 1910 report, Medical Education in the United States and Canada, is widely credited with instigating important changes in U.S. medical education that have shaped today's system of training physicians. Although Flexner's report publicly articulated recommendations for widespread change, the stage had been set for reform for quite some time. In this commentary, the author examines the landscape of change in medical education at the turn of the 20th century, highlighting the roles of several important contributors, especially the American Medical Association's Committee on Medical Education. Now, 100 years later, academic medicine is poised for further reforms to enable medical schools and teaching hospitals to meet the needs of 21st-century patients and physicians. The author outlines the challenges that must be addressed today and argues that the immediate future-specifically, the next 10 years-must see reforms on the scale of those enacted a century ago in order to achieve a sustainable 21st-century model of medical education.
... However, we know that our graduates are not well prepared to address current patient care and health care system needs and additional effort is necessary to better prepare them. [27][28][29][30] A fundamental flaw in some of the arguments against the implementation of CBME is based on this assumption that the current or previous model has served us well. 4 Fifteen published reports from a broad spectrum of professional associations, foundations and government agencies identify how the US medical education system has not fulfilled its societal contract to meet the needs of the public and our health care system. ...
... 4 Fifteen published reports from a broad spectrum of professional associations, foundations and government agencies identify how the US medical education system has not fulfilled its societal contract to meet the needs of the public and our health care system. 29 Recommendations from these reports follow several themes, including the need to transform our education system so that graduates possess lifelong learning skills, are able to improve the health of communities and populations, are able to monitor their performance and improve the quality and safety of health care, and are able to function within interprofessional teams to provide patient-centred care. In the minds of those advocating for the implementation of CBME, views of our previous approaches to medical education as anachronistic lend further support to arguments for a transition to a more accountable paradigm. ...
... 63,97 Competency-based frameworks do not adequately capture the knowledge, skills and abilities requisite of contemporary physicians Current CBME frameworks are deliberate in addressing domains that are important for contemporary physicians, which many feel have not been well covered in previous educational models, such as teamwork, population management, quality improvement and stewardship. [28][29][30] In fact, two of the examples mentioned above as potential models for implementing CBME curricula include EPA content on important current challenges, including managing a patient hand-off and leading an interprofessional team. 46,47 The ability to obtain and make reliable judgements on a diverse sample of cases with varying contents and contexts through EPAs does provide some assurance regarding the abilities of the learner to execute a range of competencies in responding to new clinical challenges within the broad universe of possible patient presentations. ...
... However, we know that our graduates are not well prepared to address current patient care and health care system needs and additional effort is necessary to better prepare them. [27][28][29][30] A fundamental flaw in some of the arguments against the implementation of CBME is based on this assumption that the current or previous model has served us well. 4 Fifteen published reports from a broad spectrum of professional associations, foundations and government agencies identify how the US medical education system has not fulfilled its societal contract to meet the needs of the public and our health care system. ...
... 4 Fifteen published reports from a broad spectrum of professional associations, foundations and government agencies identify how the US medical education system has not fulfilled its societal contract to meet the needs of the public and our health care system. 29 Recommendations from these reports follow several themes, including the need to transform our education system so that graduates possess lifelong learning skills, are able to improve the health of communities and populations, are able to monitor their performance and improve the quality and safety of health care, and are able to function within interprofessional teams to provide patient-centred care. In the minds of those advocating for the implementation of CBME, views of our previous approaches to medical education as anachronistic lend further support to arguments for a transition to a more accountable paradigm. ...
... 63,97 Competency-based frameworks do not adequately capture the knowledge, skills and abilities requisite of contemporary physicians Current CBME frameworks are deliberate in addressing domains that are important for contemporary physicians, which many feel have not been well covered in previous educational models, such as teamwork, population management, quality improvement and stewardship. [28][29][30] In fact, two of the examples mentioned above as potential models for implementing CBME curricula include EPA content on important current challenges, including managing a patient hand-off and leading an interprofessional team. 46,47 The ability to obtain and make reliable judgements on a diverse sample of cases with varying contents and contexts through EPAs does provide some assurance regarding the abilities of the learner to execute a range of competencies in responding to new clinical challenges within the broad universe of possible patient presentations. ...
Competency-based medical education (CBME) has emerged as a core strategy to educate and assess the next generation of physicians. Advantages of CBME include: a focus on outcomes and learner achievement; requirements for multifaceted assessment that embraces formative and summative approaches; support of a flexible, time-independent trajectory through the curriculum; and increased accountability to stakeholders with a shared set of expectations and a common language for education, assessment and regulation.
... The Carnegie Foundation for the Advancement of Teaching's report, Educating Physicians: A Call for Reform of Medical School and Residency, 9 is a recent addition to a body of literature calling for comprehensive reform of educational standards, including work by the American Medical Association, 11 Institute of Medicine, 12 and others. 13,14 Professional organizations have not been unresponsive. They must follow a methodical path for reviewing and channeling such recommendations. ...
... In both undergraduate and graduate medical education, faculty members have limited experience as meaningful users of health IT themselves. 14 ...
Nationwide, as physicians and health care systems adopt electronic health records, health information technology is becoming integral to the practice of medicine. But current medical education and professional development curricula do not systematically prepare physicians to use electronic health records and the data these systems collect. We detail how training in meaningful use of electronic health records could be incorporated into physician training, from medical school, through licensure and board certification, to continuing medical education and the maintenance of licensure and board certification. We identify six near-term opportunities for professional organizations to accelerate the integration of health information technology into their requirements.
... The effectiveness of our existing approach in today's health care environment and cultural and societal context is questionable. 13 Medical and health professions literature increasingly calls for educational transformation so that graduates function as master adaptive learners, are self-reflective and monitor their own performance, and are able to function within interprofessional teams to provide safe, high-quality patient-centered care. 14 2) Successful implementation requires academic and clinical faculty development, particularly for those faculty who received training and are experienced in a normative model of physical therapist education. ...
Over the past several years, the number of physical therapist professional education programs has increased dramatically. There are currently 264 fully accredited and 60 developing doctor of physical therapy (DPT) programs the United States alone.¹ Alongside this increase in the number of programs, many existing programs are increasing their class sizes.² These programs implement a variety of curricular models (eg, traditional, blended/hybrid, problem-based learning [PBL], modified PBL) as well as different program lengths. Regardless of type and program length, education programs strive to prepare graduates for practice in a wide range of settings and with diverse patient populations.
Postprofessional education is undergoing similar patterns of growth. The number of specialty practice and subspecialty areas recognized by the American Board of Physical Therapy Residency and Fellowship Education is increasing. Currently, there are more than 322 accredited residency programs representing 11 specialty practice areas, and 44 fellowship programs representing 9 subspecialty areas.
... In response, medical schools' efforts have focused on enhancing their own UME programs but typically with minimal connection to innovations happening at other schools or across the medical education continuum (Novak et al. 2019). UME innovation processes are frequently insular, not grounded in external knowledge and experiences, and unlinked to parallel changes occurring in other educational programs and across disciplines (Skochelak 2010a;2010b;Skochelak and Stack 2017;Novak et al. 2019). ...
Introduction:
The American Medical Association formed the Accelerating Change in Medical Education Consortium through grants to effect change in medical education. The dissemination of educational innovations through scholarship was a priority. The objective of this study was to explore the patterns of collaboration of educational innovation through the consortium's publications.
Method:
Publications were identified from grantee schools' semi-annual reports. Each publication was coded for the number of citations, Altmetric score, domain of scholarship, and collaboration with other institutions. Social network analysis explored relationships at the midpoint and end of the grant.
Results:
Over five years, the 32 Consortium institutions produced 168 publications, ranging from 38 papers from one institution to no manuscripts from another. The two most common domains focused on health system science (92 papers) and competency-based medical education (30 papers). Articles were published in 54 different journals. Forty percent of publications involved more than one institution. Social network analysis demonstrated rich publishing relationships within the Consortium members as well as beyond the Consortium schools. In addition, there was growth of the network connections and density over time.
Conclusion:
The Consortium fostered a scholarship network disseminating a broad range of educational innovations through publications of individual school projects and collaborations.
... Responding to concerns about the preparation of graduates to deliver care in our current health care system, experts called for standardized outcomes and individualized learner pathways to achieve them, integration of material across traditional areas, attention to an environment of inquiry, and professional identity formation. The medical education community has responded, and much has been achieved in the last decade, but much work remains to be done (Skochelak 2010). ...
A hundred years after the Flexner report laid the foundation for modern medical education, a number of authors commemorated the occasion by commenting on how the medical education system had to change once more to serve 21st century patients. Experts called for standardized outcomes and individualized learner pathways, integration of material across traditional areas, attention to an environment of inquiry, and professional identity formation. The medical education community responded and much has been achieved in the last decade, but much work remains to be done. In this paper we outline how the American Medical Association Accelerating Change in Medical Education Consortium, launched in 2013 through significant funding of transformation projects in undergraduate medical education, expanded its work into graduate medical education, and we look to the future of innovation in medical education.
... In parallel, more than a dozen national and international reports focused on the need for innovation in medical education in the United States and throughout North America. The recommendations of these reports were in remarkable congruence to the Lancet Commission's findings and recommendations, calling for a focus on competency-based education; training that included content on population health, quality and safety, team-based care, and social determinants of health; deeper partnerships with health care systems for training purposes; and addressing issues of the learning environment to implement new technology-assisted instruction and assessment and the well-being of trainees (Skochelak 2010a(Skochelak , 2010b. ...
In the last two decades, prompted by the anticipated arrival of the 21st Century and on the centenary of the publication of the Flexner Report, many in medical education called for change to address the expanding chasm between the requirements of the health care system and the educational systems producing the health care workforce. Calls were uniform. Curricular content was missing. There was a mismatch in where people trained and where they were needed to practice, legacy approaches to pedagogical methods that needed to be challenged, an imbalance in diversity of trainees, and a lack of research on educational outcomes, resulting in a workforce that was described as ill-equipped to provide health care in the current and future environment. The Lancet Commission on Education of Health Professionals for the 21st Century published a widely acclaimed report in 2010 that called for a complete and authoritative re-examination of health professional education. This paper describes the innovations of the American Medical Association Accelerating Change in Medical Education Consortium schools as they relate to the recommendations of the Lancet Commission. We outline the successes, challenges, and lessons learned in working to deeply reform medical education.
... Over the past decade, calls to align the continuum of medical education and better prepare learners for 21st-century practice have spurred collaboration among medical schools. [1][2][3][4] One aspect of this reform is to better prepare medical students for residency and clinical practice as collaborative, systems-based, and effective stewards of care. 5 To this end, medical schools working together as part of the American Medical Association (AMA) Accelerating Change in Medical Education Consortium 6 developed a health systems science (HSS) curricular framework that articulates emerging practice needs within an educational program. ...
The health systems science (HSS) framework articulates systems-relevant topics that medical trainees must learn to be prepared for physician practice. As new HSS-related curricula are developed, measures demonstrating appropriate levels of reliability and validity are needed. The authors describe a collaborative effort between a consortium of medical schools and the National Board of Medical Examiners to create a multiple-choice HSS examination in the areas of evidence-based medicine/population health, patient safety, quality improvement, and teamwork. Fifteen schools administered the 100-question examination through 2 academic years a total of 1887 times to 1837 first-time takers. Total test score mean was 67% (SD 11%). Total test reliability as measured by coefficient α was .83. This examination differentiated between medical students who completed the examination before, during, and after relevant training/instruction. This new HSS examination can support and inform the efforts of institutions as they integrate HSS-related content into their curricula.
... Unfortunately, most of the physicians are involved in their own branch and sometimes their knowledge on other fields of internal medicine is regressed. 13 This will lead to some problems in diagnosis and treatment and also medical education because medical students and residents who are out of the field are not involved in diagnosis and treatment process most of the time. Procedures like endoscopy, bronchoscopy, echocardiography and hemodialysis are not medial students' or even residents' responsibility. ...
Introduction: It is apparent that having a good inflammation in hemodialysis indications, methods of the procedure, recognition of the complications are common mistakes in emergency and internal medicine and they are life saving for patients most of the times. It is clear that our medical students have many problems in this field (hidden curriculum). Therefore, we decided to do a study on the subject. Methods: During 2011, forty interns of nephrology ward enrolled in this study. They filled a questionnaire containing questions about their general hemodialysis knowledge before passing the classes. After having six one -hour classes on HD essentials, complications and emergencies, they filled the questionnaire again. The data analyzed using paired t-test and the reported Mean ± SD P< 0.05 considered significant. Results: The interns were satisfied in all the trained aspects like general hemodialysis knowledge (P< 0.001), dialysis essentials (P
... systems leaders are calling for significant reform of undergraduate medical education (UME) and graduate medical education (GME) programs to meet the evolving needs of the health care system. [1][2][3] One critical component of recommended reforms is physician education in health systems science (HSS), which includes topics such as value-based care, health system improvement, clinical informatics, and population and public health. 4,5 Considered the "third science" that integrates with the traditional basic and clinic sciences, HSS can be viewed as the methods and principles of improving quality, outcomes, and costs of health care delivery for patients and populations of patients. ...
Educators, policy makers, and health systems leaders are calling for significant reform of undergraduate medical education (UME) and graduate medical education (GME) programs to meet the evolving needs of the health care system. Nationally, several schools have initiated innovative curricula in both classroom and workplace learning experiences to promote education in health systems science (HSS), which includes topics such as value-based care, health system improvement, and population and public health. However, the successful implementation of HSS curricula across schools is challenged by issues of curriculum design, assessment, culture, and accreditation, among others. In this report of a working conference using thematic analysis of workshop recommendations and experiences from 11 U.S. medical schools, the authors describe seven priority areas for the successful integration and sustainment of HSS in educational programs, and associated challenges and potential solutions. In 2015, following regular HSS workgroup phone calls and an Accelerating Change in Medical Education consortium-wide meeting, the authors identified the priority areas: partner with licensing, certifying, and accrediting bodies; develop comprehensive, standardized, and integrated curricula; develop, standardize, and align assessments; improve the UME to GME transition; enhance teachers' knowledge and skills, and incentives for teachers; demonstrate value added to the health system; and address the hidden curriculum. These priority areas and their potential solutions can be used by individual schools and HSS education collaboratives to further outline and delineate the steps needed to create, deliver, study, and sustain effective HSS curricula with an eye toward integration with the basic and clinical sciences curricula.
... 5 They may use this time to increase their chances of succeeding in an increasingly competitive Match. [5][6][7][8][9][10] Such strategies could include applying to a larger number of programs, doing ''away'' rotations at desired programs, or performing well in key rotations. ...
Background:
Little is known about the advice fourth-year medical students receive from their advisors as they prepare to apply for residency training.
Objective:
We collected information on recommendations given to medical students preparing to apply to internal medicine residencies regarding fourth-year schedules and application strategies.
Methods:
Clerkship Directors in Internal Medicine conducted its annual member survey in June 2013. We analyzed responses on student advising using descriptive and comparative statistics, and free-text responses using content analysis.
Results:
Of 124 members, 94 (76%) responded, and 83 (88%) advised fourth-year medical students. Nearly half (45%) advised an average of more than 20 students a year. Advisors encouraged students to take a medicine subinternship (Likert scale mean 4.84 [1, strongly discourage, to 5, strongly encourage], SD = 0.61); a critical care rotation (4.38, SD = 0.79); and a medicine specialty clinical rotation (4.01, SD = 0.80). Advisors reported they thought fourth-year students should spend a mean of 6.5 months doing clinical rotations (range 1-10, SD = 1.91). They recommended highest academic quartile students apply to a median of 10 programs (range 1-30) and lowest quartile students apply to 15 programs (range 3-100). Top recommendations involved maximizing student competitiveness, valuing program fit over reputation, and recognizing key decision points in the application process.
Conclusions:
Undergraduate medical advisors recommended specific strategies to enhance students' competitiveness in the Match and to prepare them for residency. The results can inform program directors and encourage dialogue between undergraduate medical education and graduate medical education on how to best utilize the fourth year.
... Some academic medical articles rediscover different Flexnerian elements in different eras (Barzansky, 2010;Cooke, Irby, Sullivan, & Ludmerer, 2006;Rabow, Remen, Parmelee, & Inui, 2010;Weatherall, 2011). Others set themselves up as moving 'beyond Flexner' or 'modernizing Flexner,' often in ways that take up only specific elements from Flexner (Anderson, 2011;Kirch, 2010;Morrison, Goldfarb, & Lanken, 2010;Prislin, Saultz, & Geyman, 2010;Skochelak, 2010). A general assumption that pervades these different readings of Flexner is that he promoted a system of medical training that greatly privileged and emphasized natural sciences (or biomedical sciences to use current terminology). ...
... The USA, on the other hand, has long had a diverse delivery of medical education. Since changes made to medical education following the Flexner Report (Flexner 1910), there have recently been further recommendations for reform (Irby et al. 2010;Prislin et al. 2010;Skochelak 2010). These include the standardisation of learning outcomes and general competencies, but with flexibility in the process of achieving these. ...
Earlier research indicated that medical graduates feel unprepared to start work, and that this varies with medical school.
To examine the extent to which graduates from different UK medical schools differed in their perceptions of preparedness for practice, and compare their perceptions with those of clinical team members.
An anonymous questionnaire assessing perceptions of 53 aspects of preparedness was devised, and administered to the graduating cohorts of three medical schools: Newcastle (systems-based, integrated curriculum); Warwick (graduate-entry) and Glasgow (problem-based learning). In addition, a triangulating questionnaire was cascaded via ward managers to doctors, nurses and pharmacists who worked with new graduates in their first posts.
The response rate for the cohort questionnaire was 69% (479/698). The overall mean preparedness score was 3.5 (on a five-point scale), with no significant difference between schools. On individual items, there were large differences within each site, but smaller differences between sites. Graduates felt most prepared for aspects of working with patients and colleagues, history taking and examination. They felt least prepared for completing a cremation form, some aspects of prescribing, complex practical procedures and for applying knowledge of alternative and complementary therapies, and of the NHS. A total of 80 clinical team questionnaires were completed, similarly showing substantial variation within each site, but smaller differences between sites.
New doctors feel relatively unprepared for a number of aspects of practice, a perception shared by their colleagues. Although medical school has some effect on preparedness, greater differences are common across sites. Differences may reflect hidden influences common to all the schools, unintended consequences of national curriculum guidance or common traits in the graduate populations sampled. Further research is needed to identify the causes.
In a review of U.S. medical education curricular guidance, from premedical studies through to continuing medical education, Maeshiro and colleagues found limited examples of public and population health topics. In this Commentary, the authors emphasize the importance of including public and population health in the curriculum, pointing to curricular reform efforts to integrate these topics into teaching of basic sciences and clinical studies. In addition, they consider the expectations placed on physicians to meet the needs of the population and argue that policies that support public health funding, infrastructure, and workers are also critical to improving the health of communities.
The American Medical Association’s (AMA’s) Accelerating Change in Medical Education (ACE) initiative, launched in 2013 to foster advancements in undergraduate medical education, has led to the development and scaling of innovations influencing the full continuum of medical training. Initial grants of $1 million were awarded to 11 U.S. medical schools, with 21 schools joining the consortium in 2016 at a lower funding level. Almost one-fifth of all U.S. MD- and DO-granting medical schools are represented in the 32-member consortium. In the first 5 years, the consortium medical schools have delivered innovative educational experiences to approximately 19,000 medical students, who will provide a potential 33 million patient care visits annually. The core initiative objectives focus on competency-based approaches to medical education and individualized pathways for students, training in health systems science, and enhancing the learning environment.
At the close of the initial 5-year grant period, AMA leadership sought to catalogue outputs and understand how the structure of the consortium may have influenced its outcomes. Themes from qualitative analysis of stakeholder interviews as well as other sources of evidence aligned with the 4 elements of the transformational leadership model (inspirational motivation, intellectual stimulation, individualized consideration, and idealized influence) and can be used to inform future innovation interventions. For example, the ACE initiative has been successful in stimulating change at the consortium schools and propagating those innovations broadly, with outputs involving medical students, faculty, medical schools, affiliated health systems, and the broader educational landscape. In summary, the ACE initiative has fostered a far-reaching community of innovation that will continue to drive change across the continuum of medical education.
Phenomenon: Medical education is better aligning with the needs of health systems. Health systems science competencies, such as high-value care, population health, and systems thinking, are increasingly being integrated into curricula, but not without challenges. One challenge is mixed receptivity by students, the underlying reasons of which have not been extensively explored. In this qualitative study, we explored the research question: “How do students perceive health systems science curricula across all four years, and how do such perceptions inform the reasons for mixed quality ratings?” Approach: Following large-scale health systems science curricular changes in their medical school, we used students’ open-ended comments obtained from course evaluations related to 1st-, 2nd-, and 4th-year courses and performed a qualitative thematic analysis to explore students’ perceptions. We identified themes, synthesized findings into a conceptual figure, and agreed upon results and quotations. Findings: Five themes were identified: (1) perceived importance and relevance of health systems science education, (2) tension between traditional and evolving health systems science-related professional identity, (3) dissatisfaction with redundancy of topics, (4) competition with basic and clinical science curricula, and, (5) preference for discrete, usable, testable facts over complexity and uncertainty. The relationship between themes is described along a continuum of competing agendas between students’ traditional mindset (which focuses on basic/clinical science) and an emerging medical education approach (which focuses on basic, clinical, and health systems science). Insights: Health systems science education can be viewed by learners as peripheral to their future practice and not aligned with a professional identity that places emphasis on basic and clinical science topics. For some students, this traditional identity limits engagement in health systems science curricula. If health systems science is to achieve its full potential in medical education, further work is required to explore the adoption of new perspectives by students and create activities to accelerate the process.
Introduction:
Although better medical training on sexual and reproductive health (SRH) is an unquestionable global need, and recent research has emphasized the importance of SRH education, few studies have presented alternative teaching models to conventional approaches.
Aim:
To examine the structure and evaluation of a curricular unit that uses an active teaching and learning strategy, and to evaluate both the cognitive and affective student learning outcomes.
Methods:
This study used retrospective and cross-sectional analyses of a curricular unit with 8 weekly lessons structured into individual activities before the class, group activities monitored in class, feedback, and the development of medical empathy.
Main outcome measure:
Student performance was evaluated through summative and formative activities. The process was evaluated quantitatively by a questionnaire containing Likert-type and open-ended questions with speech analysis and with categorical evaluation.
Results:
The final average of the analyzed group was 7.95 ± 0.5 on a scale of 10. Likert-type assessment (Cronbach's α = 0.86) revealed strong student adherence and, through responses to open-ended questions, positive evaluations of the proposed SRH teaching model. The Jefferson Scale of Physician Empathy showed a high index of self-reported general empathy (117.3 ± 11), with a significantly higher index for female students (P = .019) than male students; however, this gender difference disappeared after the intervention (P = .086).
Conclusions:
The curriculum model was developed and continuously adjusted based on grounded theory for teaching SRH and included both cognitive and affective stimuli; the results showed favorable student evaluation of the unit, and it proved feasible to implement in the time available. de Oliveira R, Montagna E, Zaia V, et al. The Development of Cognitive and Affective Skills Through a Sexual and Reproductive Health Medical Education Unit. Sex Med 2019;7:326-336.
Health system leaders are calling for reform of medical education programs to meet evolving needs of health systems. U.S. medical schools have initiated innovative curricula related to health systems science (HSS), which includes competencies in value-based care, population health, system improvement, interprofessional collaboration, and systems thinking. Successful implementation of HSS curricula is challenging because of the necessity for new curricular methods, assessments, and educators and for resource allocation. Perhaps most notable of these challenges, however, is students’ mixed receptivity. Although many students are fully engaged, others are dissatisfied with curricular time dedicated to competencies not perceived as high yield. HSS learning can be viewed as “broccoli”—students may realize it is good for them in the long term, but it may not be palatable in the moment. Further analysis is necessary for accelerating change both locally and nationally.
With over 11 years of experience in global HSS curricular reform in 2 medical schools and informed by the curricular implementation “performance gap,” the authors explore student receptivity challenges, including marginalization of HSS coursework, infancy of the HSS field, relative nascence of curricula and educators, heterogeneity of pedagogies, tensions in students’ perceptions of their professional role, and culture of HSS integration. The authors call for the reexamination of 5 issues influencing HSS receptivity: student recruitment processes, faculty development, building an HSS academic “home,” evaluation metrics, and transparent collaboration between medical schools. To fulfill the social obligation of meeting patients’ needs, educators must seek a shared understanding of underlying challenges of HSS innovations.
When a new educational system for college students in South Korea was established in 1946, the National Committee for Educational Planning adopted a 6-year curriculum of medical education, consisting of a 2-year premedical component and a 4-year medical component. For more than half a century, the premedical curriculum has received little attention. However, it is very important for premedical students to have a range of experiences that could be useful in their future medical careers. In 2005, another change was made to the system of medical education, in which medical schools without a 2-year premedical curriculum were established. This began to stimulate interest in premedical education, and more and more professors have become interested in premedical education as 6-year medical colleges have become more popular than before. Since 2015, the Education and Cultural Center of the Korean Association of Medical Colleges has annually hosted a workshop for redesigning premedical education; these workshops quickly fill up with registrants, reflecting the participants' lively interest in premedical education. The problems of premedical education are mostly due to students' and educators' attitudes. A more effective approach will be needed in the educational system of the future to train highly competent medical doctors. To judge whether an educational program is successful, its aims must be clearly articulated. For this reason, medical colleges must prepare premedical education curricula based on their educational aims. It is expected that the system of premedical education will be strengthened in the future due to the growing awareness of its importance.
Purpose:
To develop entrustable professional activities (EPAs) for psychiatry and to demonstrate an innovative, validity-enhancing methodology that may be relevant to other specialties.
Method:
A national task force employed a three-stage process from May 2014 to February 2017 to develop EPAs for psychiatry. In stage 1, the task force used an iterative consensus-driven process to construct proposed EPAs. Each included a title, full description, and relevant competencies. In stage 2, the task force interviewed four, non-psychiatric experts in EPAs and further revised the EPAs. In stage 3, the task force performed a Delphi study of national experts in psychiatric education and assessment. All participants completed a brief training program on EPAs. Quantitative and qualitative analysis led to further modifications. Essentialness was measured on a five-point scale. EPAs were included if the content validity index was at least 0.8 and the lower end of the asymmetric confidence interval was not lower than 4.0.
Results:
Stages 1 and 2 yielded 24 and 14 EPAs, respectively. In stage 3, 31 of the 39 invited experts participated in both rounds of the Delphi study. Round 1 reduced the proposed EPAs to 13. Ten EPAs met the inclusion criteria in round 2.
Conclusions:
The final EPAs provide a strong foundation for competency-based assessment in psychiatry. Critique by non-psychiatry experts, a national Delphi study with frame-of-reference training, and stringent inclusion criteria strengthens the content validity of the findings, and may serve as a model for future efforts in other specialties.
Despite wide consensus on needed changes in medical education, experts agree that the gap continues to widen between how physicians are trained and the future needs of our health care system. A new model for medical education is needed to create the medical school of the future. The American Medical Association (AMA) is working to support innovative models through partnerships with medical schools, educators, professional organizations, and accreditors. In 2013, the AMA designed an initiative to support rapid innovation among medical schools and disseminate the ideas being tested to additional medical schools. Awards of $1 million were made to 11 medical schools to redesign curricula for flexible, individualized learning pathways, measure achievement of competencies, develop new assessment tools to test readiness for residency, and implement new models for clinical experiences within health care systems. The medical schools have partnered with the AMA to create the AMA Accelerating Change in Medical Education Consortium, working together to share prototypes and participate in a national evaluation plan. Most of the schools have embarked on major curriculum revisions, replacing as much as 25% of the curriculum with new content in health care delivery and health system science in all four years of training. Schools are developing new certification in quality and patient safety and population management. In 2015, the AMA invited 21 additional schools to join the 11 founding schools in testing and disseminating innovation through the consortium and beyond.
The Federation of State Medical Boards celebrates its centennial anniversary in 2012. In honor of this milestone, the Journal of Medical Regulation offers the first in a series of articles presenting the history of the FSMB within the context of the growth of America's medical regulatory system. These articles are adapted from Medical Licensing and Discipline in America: A History of the Federation of State Medical Boards, set for release later this year by Lexington Books, a subsidiary of Rowman and Littlefield Publishing Group.
Abraham Flexner was the sixth of nine children and brother of the medical researcher Simon Flexner, who was employed by the Rockefeller Foundation from 1901 to 1935. Flexner graduated from Johns Hopkins University at age 19 and then attended Harvard University and the University of Berlin. Flexner returned to Louisville and founded a private school based on small classes, personal attention, and hands-on teaching. Most graduates of his school were accepted at leading colleges, and Flexner's school attracted considerable attention. In 1908, Flexner published The American College, strongly critical of many aspects of American higher education such as the university lectures as the main (or unique) method of instruction. Flexner's book attracted the attention of Henry Pritchett, president of the Carnegie Foundation, who chose him to lead a study of American medical education. Two years later he published the "Flexner Report", which examined the state of American medical education and led to far-reaching reforms in medical education. The Flexner report led to the closure of most rural medical schools and all but two of America's African American medical colleges. The response to Flexner's report was rapid and profound and the medical schools operating in the United States declined from 160 in 1904 to 85 in 1920. All remaining schools became university based, and all came under tight regulatory scrutiny. Between 1912 and 1925, Flexner served on the Rockefeller Foundation's General Education Board, and after 1917 was its secretary. With the help of the Board, he founded another experimental school, the Lincoln School, which opened in 1917, in cooperation with Columbia University. With funding from the Rockefeller Foundation, he worked toward restructuring the nation's medical schools, essentially forwarding large amounts of money in the best US Universities. In his volume Universities: American, English, German, Flexner, published in 1930, returned to his earlier interest of the direction and purpose of the American university. Flexner founded with Louis Bamberger the Institute for Advanced Study in Princeton, heading it from 1930 to 1939. The Flexner Report has been exalted and denigrated for a century; however, today a balanced opinion should be possible. Surely, the Report was instrumental in allowing the best and brightest US Schools of medicine to overtake European schools (even if probably the Flexner's role in providing large amount of funds was much more important than the Report itself). However, the inconsistent distribution of health care in US, the large chasm between the highest level of care and the care available to many millions of underprivileged citizens has a root in a sort of elitarism promoted by the Flexner report.
ZET Bu yıl Abraham Flexner tarafından hazırlanan ve tıp eğitimi için bir dönüm noktası olan Flexner Raporunun 100. yılı. Rapor tıp eğitimciler tarafından sıklıkla pek çok konuda kaynak olarak kullanılıyor. Ancak Flexner Raporu'nun tarihsel önemi ve gelecekteki eğitim programlarını planlamadaki etkisi yeterince anlaşılamamıştır. Hatta zaman zaman hakkında olumsuz görüşler ifade edilmektedir. Bu yazının amacı; Flexner Raporu'nun ülkemizdeki Tıp Eğitimcileri tarafından daha iyi anlaşılmasına katkıda bulunmaktır. Anahtar kelime: Flexner Raporu, tıp eğitimi, Abraham Flexner ABSTRACT This year, the centenary year of the report prepared by Abraham Flexner. This report is a milestone for medical education. The report often is used as a resource on many issues by medical educators. However, historical significance and impact of the report in planning for future training programs not well understood. In fact, from time to time it is expressed negative views about the report. The aim of the paper is provide the better understanding of the report by medical educators in our country.
Purpose: The authors performed a review of 30 Accelerating Change in Medical Education full grant submissions and an analysis of the health systems science (HSS)-related curricula at the 11 grant recipient schools to develop a potential comprehensive HSS curricular framework with domains and subcategories.
Method: In phase 1, to identify domains, grant submissions were analyzed and coded using constant comparative analysis. In phase 2, a detailed review of all existing and planned syllabi and curriculum documents at the grantee schools was performed, and content in the core curricular domains was coded into subcategories. The lead investigators reviewed and discussed drafts of the categorization scheme, collapsed and combined domains and subcategories, and resolved disagreements via group discussion.
Results: Analysis yielded three types of domains: core, cross-cutting, and linking. Core domains included health care structures and processes; health care policy, economics, and management; clinical informatics and health information technology; population and public health; value-based care; and health system improvement. Cross-cutting domains included leadership and change agency; teamwork and interprofessional education; evidence-based medicine and practice; professionalism and ethics; and scholarship. One linking domain was identified: systems thinking.
Conclusions: This broad framework aims to build on the traditional definition of systems-based practice and highlight the need for medical and other health professions schools to better align education programs with the anticipated needs of the systems in which students will practice. HSS will require a critical investigation into existing curricula to determine the most efficient methods for integration with the basic and clinical scienc
This paper presents a narrative summary of an increasingly important trend in medical education by addressing the merits of community-based distributive medical education (CBDME). This is a relatively new and compelling model for teaching and training physicians in a manner that may better meet societal needs and expectations. Issues and trends regarding the growing shortage and imbalanced distribution of physicians in the USA are addressed, including the role of international medical graduates. A historical overview of costs and funding sources for medical education is presented, as well as initiatives to increase the training and placement of physicians cost-effectively through new and expanded medical schools, two- and four-year regional or branch campuses and CBDME. Our research confirms that although medical schools have responded to Association of American Medical Colleges calls for higher student enrollment and societal concerns about the distribution and placement of physicians, significant opportunities for improvement remain. Finally, the authors recommend further research be conducted to guide policy on incentives for physicians to locate in underserved communities, and determine the cost-effectiveness of the CBDME model in both the near and long terms.
This lecture discusses a philosophy of educating health information professionals in a rapidly changing health care and information environment.
Education for health information professionals must be based upon a solid foundation of the changing paradigms and trends in health care and health information, as well as technological advances, to produce a well-prepared information workforce to meet the demands of health-related environments. Educational programs should begin with the core principles of library and information sciences and expand in interdisciplinary collaborations. A model of the health care environment is presented to serve as a framework for developing educational programs for health information professionals.
Interdisciplinary and collaborative relationships-which merge health care, library and information sciences, and other information-related disciplines-should form the basis of education for health information professionals.
To identify expert recommendations and examples of programs that could be incorporated into curricular renewal of the fourth year of medical school.
In 2009, the authors searched the relevant literature published from 1974 to 2009 using PubMed; they then searched bibliographies and related articles. They consulted clerkship and residency program directors at their institution and accessed recommendations from national organizations.
Of the 66 publications reviewed, 40 focused on aspects of fourth-year education and 26 included the fourth year in general reviews. Long-standing concerns included clarifying the purpose of the year, the optimal type and organization of courses, and academic quality of courses. Specific concerns included excessive focus on securing residency positions ("preresidency syndrome"), uncertainty about the optimal ratio of required and elective courses, and grade inflation.
Despite representing a substantial proportion of the student experience, the fourth year has received significantly less attention than other phases of the curriculum. The authors conclude that goals for the year should be clarified, reflect the mission of the school, and be designed to both complete the medical school experience and facilitate the transition to residency. Schools should decide the types of courses and organization of the year based on these goals. Organizational strategies for the fourth year should incorporate the requirements of the United States Medical Licensing Examination examinations and the residency application process. Fourth-year curricula and their constituent courses should be well designed and stringently evaluated to ensure educational goals are met and appropriate grades awarded.
This article introduces a series of reports on medical education. It outlines the main areas of success and the problems that have arisen since the Flexner report was issued.
In his article, "Abraham Flexner and the Black Medical Schools," Todd Savitt, MD critically describes how the Flexner Report effectively decimated African-American medical education as it existed at the beginning of the 20th century. We are now in the 21st century, and there are still few black physicians and medical students.
In response to declining funding support and increasing competition, medical schools have developed financial management models to assure that resource allocation supports core mission-related activities. The authors describe the development and implementation of such a model at the University of Wisconsin Medical School. The development occurred in three phases and included consensus building on the need for mission-based budgeting, extensive faculty involvement to create a credible model, and decisions about basic principles for the model. While each school may encounter different constraints and opportunities, the authors outline a series of generic issues that any medical school is likely to face when implementing a mission-based budgeting model. These issues include decisions about the amounts and sources of funds to be used in the budgeting process, whether funds should be allocated at the department or individual faculty level, the specific metrics for measuring academic activities, the relative amounts for research and teaching activities, and how to use the budget process to support new initiatives and strategic priorities. The University of Wisconsin Medical School's Mission Aligned Management and Allocation (MAMA) model was implemented in 1999. The authors discuss implementation issues, including timetable, formulas used to cap budget changes among departments during phase-in, outcome measures used to monitor the effect of the new budget model, and a process for school-wide budget oversight. Finally, they discuss outcomes tracked during two years of full implementation to assess the success of the new MAMA budget process.
The so-called Flexner report,1 published in 1910, is probably the most grossly overrated document in American medical history. Its reputation superbly illustrates the post hoc ergo propter hoc fallacy: medical education underwent great changes after the Flexner report appeared; therefore the credit belongs to Flexner. This reasoning has endowed the report with canonical status that has resulted in some horrendous distortion of the historical record.2
Long before 1910, vast changes were gathering momentum, whose force has received all too little attention. Only recently have scholars given us a better perception. In 1959 Jarcho effectively reviewed some of the trends prior to the Flexner report and discussed relevant causal factors. Hudson emphasized that the "the tide of reform was running heavy by 1910" and that Flexner's "enduring legacy" really derived from what he accomplished later through the General Education Board. Chapman, in a cautious reappraisal, admitted that "the effect
In response to declining funding support and increasing competition, medical schools have developed financial management models to assure that resource allocation supports core mission-related activities. The authors describe the development and implementation of such a model at the University of Wisconsin Medical School. The development occurred in three phases and included consensus building on the need for mission-based budgeting, extensive faculty involvement to create a credible model, and decisions about basic principles for the model. While each school may encounter different constraints and opportunities, the authors outline a series of generic issues that any medical school is likely to face when implementing a mission-based budgeting model. These issues include decisions about the amounts and sources of funds to be used in the budgeting process, whether funds should be allocated at the department or individual faculty level, the specific metrics for measuring academic activities, the relative amounts for research and teaching activities, and how to use the budget process to support new initiatives and strategic priorities. The University of Wisconsin Medical School's Mission Aligned Management and Allocation (MAMA) model was implemented in 1999. The authors discuss implementation issues, including timetable, formulas used to cap budget changes among departments during phase-in, outcome measures used to monitor the effect of the new budget model, and a process for school-wide budget oversight. Finally, they discuss outcomes tracked during two years of full implementation to assess the success of the new MAMA budget process.
I invited Kathryn L. Moseley, MD to write the editorial appearing on the pages before this one as to whether she thought that the original Flexner Report was unduly harsh on the existing black medical schools. I invited her to choose whether she wanted to write the "pro" or "con" editorial, and that I would write the opposite piece for the sake of a presentation-although I might not necessarily believe in the position on which I was to write. She elected to write the "yes, it was harmful" piece, and I had to assume the editor's burden. In fact, as I began doing my internal soul searching for answers, I began to believe that the original Flexner Report actually helped preserve two black schools--Howard and Meharry--both of which might well have closed along with the other five schools scattered across the southeast, absent Flexner's direct and tangential support.