After Dr. Robert Gaynes’ presentation informed the class of the historical evolution that led to the medical education system we have today, I began to wonder if the demands of the changing healthcare system also called for a change in the American medical education.
In his presentation, Dr. Gaynes explained how Johns Hopkins University was the first American medical school to reconstruct its medical school curriculum, prerequisites, and training. With the influence from Germany and Paris, Johns Hopkins hired full time PhD and MD faculty, implemented laboratory-based training, and partnered with JH Hospital to establish bedside training in the medical education (Ludmere, 2010). One of the modifications in the prerequisites to enroll in JH Medical School required undergraduate students with a strong academic standing, especially in science based courses such as, Biology, Chemistry, etc. With the establishment of a new and improved medical education system, the Flexner Report in 1910 declared Johns Hopkins as the “American model for medical education” (Ludmerer, 2010). Although the Flexner report led to the closing of hundreds of unregulated “propriety” schools in the 19th century, the medical education has largely remained unaltered (Gishen, 2014).
However, the new healthcare reform will not be successful without a reform in the current medical education system. The future healthcare calls for improved and expanded primary care along with the necessity for a medical system that can support a growing population (Geshin, 2014). Therefore, in order to remain synchronized with the rapid evolution of medical discoveries, emergence of scientific technology, and the value of patient care, it is critical to modify medical education at many levels, specifically the undergraduate premedical education and medical school.
Modification of the undergraduate education level included changes in course requirement to prepare for the Medical College Admission Test (MCAT). The MR5 committee, responsible for changes to MCAT, has created a new set of core competencies required for success in medical education including molecular genetics, biochemistry, and concepts in multicultural sensitivity, ethics and philosophy (AMA, 2014). A shift in current trend to be Humanities major versus a traditional science major is also one of the various changes taking place at this level (Gishen, 2014). This trend towards having a well-rounded area of knowledge can address the problems in doctor-patient communication by helping doctors gain humanistic skills to see the patient not as a collection of organs or a machine, but see the patient as a whole person.
Medical schools, on the other hand, are also evolving with different and unique options for students to adapt to the dynamic changes taking place in America’s healthcare system. According to Bandaranayake (2011), many medical schools are transitioning from an individual course block format with courses including biochemistry, anatomy, physiology, etc., to a more organ system-based approach in which blocks are organized into modules that integrate subject matter from various science discipline and apply it to specific organ systems. However, with this in mind, Dr. William T Branch Jr, a Primary Care Physician, used scientific data and his personal reflections to also emphasize the importance of establishing a proper balance of science and humanism in medicine in order to know and meet the needs of the “whole” patient (Branch, 2013). Furthermore, in order to deliver medical education to a wider group of incoming physicians more efficiently and effectively, medical schools are encouraging students to learn at their individual pace by combing traditional lecture with self-directed study. Establishing scheduled, small-group, case-based learning session and incorporating organ system-based modules into short videos are a few of the features that medical schools want to implement in their new strategies of medical education in school (Gishen 2014).
Another current trend in the medical school that has caught my attention is the emergence of 3-year accelerated medical school programs. Two out of the three accelerated medical school programs in the US are geared towards training medical students to practice as Primary Care physicians with the benefits of graduating a year earlier, practicing in the field early, and saving one year worth of medical school tuition. These programs are being created to find a solution for the growing demand for Primary Care Physicians. In fact, the Mercer University School of Medicine in Savannah, Georgia opened a similar program in 2011. It is one of the few medical schools with a similar program consisting of summer course work and shorter breaks during the school year; the total length of the program is 131 weeks, which is just above the 130-week minimum mandated by the Liaison Committee on Medical Education (LCME) according to Leigh Page, AAMC reporter (Paige, 2012).
The main purpose of modifying the medical education at different levels is to develop an effective and efficient strategy to best prepare the future generation of medical physicians and professionals in the new healthcare system. Just from the undergraduate and medical school level, we can see more emphasis on perceiving a holistic perspective of a patient, having a well-rounded area of knowledge, enforcing more teamwork in small-group case study sessions, and providing more options and incentive to go into a high-demand field such as Primary Care.
(AAMC) American Association of Medical Collages. Table 18: MCAT and GPAs
for Applicants and Matriculants to U.S. Medical Schools by Primary
Undergraduate Major. Available at: https://www.aamc.org/download/
(AMA) American Medical Association. Historical Timeline. (2014) Available at: http://
Bandaranayake RC. “The Integrated Medical Curriculum.” (2011) London:Radcliffe.
Branch, William T. Jr., “Treating the whole patient: passing time-honoured skills for building doctor–patient relationships on to generations of doctors.” (2013) John Wiley & Sons Ltd. Medical Education, 48: 67-74.
Gishen, K., Ovadia, S., Arzillo, S., Avashia, Y., & Thaller, S. R. (2014). “The Current Format and Ongoing Advances of Medical Education in the United States.” Journal of Craniofacial Surgery, 25(1), 35-38.
Ludmerer, Kenneth M., “Understanding the Flexner Report.” (Feburary 2010) Academic Medicine, 85(2): 193-196
Paige, Leigh. “New Three-Year Track Seeks to Boost Family Medicine, Reduce Student Debt.” (October 2012). https://www.aamc.org/newsroom/reporter/october2012/308506/family-medicine.html/