Following in Flexner's Footsteps
MODERN PROBLEMS IN MEDICAL EDUCATION
Today’s medical training is riddled with problems not addressed in the Flexner Report because they were not concerns early 20th century medical education. The inflexibility of modern medical education is one of the major issues faced by medical students today along with the unnecessarily long duration of training which is not learner-centered. In these years of training, students do not have sufficient contact with their supervising faculty members who have become so busy that they are forced to hand off the majority of their teaching duties to residents.
Similar to the problems faced in the later part of the 20th century, “the pace and commercial nature of health care impede inculcation of the fundamental values of the profession.” (Cooke, Irby, and O’Brien)
As schools began experimenting with new curricula, dual degree programs were established both combining undergraduate with graduate degrees as well as one graduate degree with another.
The combination programs that include undergraduate degrees are usually designed to eliminate one year from the time spent earning degrees. This fast track to professional education accepts students with outstanding high school performances who demonstrate a serious interest pursuing such challenging curricula. Colleges and universities across the country offer these programs including Boston University School of Medicine’s seven year Liberal Arts and Medical Education Program and eight year Engineering/Medical Integrated Curriculum for BU Engineering Sophomores and the George Washington University School of Medicine and Health Sciences’ seven year BA/MD Program which allows students to complete a bachelor’s degree in the discipline of their choice in three years before beginning their medical education which is specialized to follow the “track” they choose. Other programs are geared toward residents of the state in which the school is located like the University of Nevada School of Medicine where a seven year BS/MD Accelerated Early Admission Program for Nevada Residents is offered. Some programs are not designed to cut out a year spent in school. Brown University Warren Alpert School of Medicine offers an eight year Program in Liberal Medical Education, Mount Sinai School of Medicine has an eight year Humanities/Medicine Early Acceptance Program, and the University of Southern California Keck School of Medicine offers an eight year BA/MD Program. These programs which follow the traditional eight year timeline still allow accepted students entrance into medical school without the completion of the traditional application process including the report of MCAT scores.
Medical schools themselves have also revamped their curricula to offer more flexibility and personalization to their students. Abandoning the traditional set up designed by Flexner over 100 years ago, an increasing number of schools have redesigned their curricula in the hopes of better accommodating the modern medical student and of creating a more efficient system. Putting into simple words the goals of today’s medical education, the Columbia University Medical Center has a description on their website stating “the College of Physicians and Surgeons is guided by the principle that medical education is university education.”
At the Perelman School of Medicine at the University of Pennsylvania, the goal of added flexibility was to make it possible for students to pursue dual degree opportunities (MD/PhD, MD/Master’s). The modules put in place afford students the option of added research time, time to take nonmedical classes, and time to spend on clinical work- a solution to the concern that research has over taken clinical training and other academic pursuits.
At the Duke University School of Medicine, they have compressed the traditional four years into three with the goal being to “encourage and entice students to pursue any of a wide range of careers.” Students at Duke spend their first year studying core basic sciences, their second year on core clinical clerkships, their third year on what is called “scholarly investigation” or biomedically related research, and their fourth year doing elective rotations which are designed to expose students to potential career paths. This allows students to gain early exposure to the different types of medicine and helps them to make educated decisions about their chosen career paths later on and also alleviates the concern that modern medical education is too drawn out over a four year period before residency.
The University of Michigan Medical School took an early interest in curriculum reform and has recently changed their curriculum to allow medical students access to patients as early as their first semester in an effort to get students out of the lab and into hospitals. Students also have access to a clinical simulation center where technology allows for experience without posing a risk to patients. Early access to patients and the availability of a simulation center refocus medical education on clinical skills. Also in line with this approach is perhaps one of the points most deviant from Flexner’s model - at Michigan, research is an option and not a requirement, the school offers a first rate research facility but does not require its medical students to do research.
Finally, the University of North Carolina Medical School is a prime example of a refocus on the humanistic objectives of medical education. The competency objectives for graduation include medical knowledge, patient care/clinical skills, intrapersonal and communication skills, professionalism, and managing the health populations. With the belief that mastering benchmarks within these categories will lead to the development of a well-rounded and well-qualified physician, UNC has implemented a curriculum that allows students to meet such requirements and measure their progress along the way.
Other schools nationwide have implemented similar curricula looking to reform medical education and make it more fitting in today’s society. The pioneers of curriculum reform are being followed by other schools using their example and personalizing it further to fit the missions of their individual schools. As we move forward in this era of reform we can expect to see a greater divergence from the standard curricula to more creative and individualized programs of study. It is up to students to identify what they themselves find important about a curriculum and what about various curricula will best allow them to pursue their desired medical careers.
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