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Medical Education Reform

Aliye Runyan
University of Miami Miller SOM 
Medical Education chair

It was refreshing to hear Marty Nemko’s perspective on medical education reform in the Washington Post article published recently as these are precisely the types of changes AMSA strives for, nationally and locally. Medical education, standardized by the LCME and varying little throughout medical schools across the country, has also changed little since Abraham Flexner wrote his seminal report in 1910.

The national AAMC conference in 2010 examined this very issue; titled “Shaping Physicians of the Future: A Century after the Flexner Report”, most of the meeting was dedicated to examining how medical education needs to move forward to best benefit the doctors and patients of our current and future generations. It is true, medicine and medical education remains entrenched in tradition, and while this helps institutional memory and provides structure to becoming a medical professional, it also makes innovation in teaching difficult to accept. The practice of medicine is extremely different than it was 100 years ago – more identified diseases, an upsurge of technology, the influence of business in medicine, the use of social media, the globalization of healthcare. 

The tradition of “old school” medical education – basic science, reading and regurgitating information (where the infamous medical school = drinking from a firehose analogy comes from), and learning the practice of medicine as one individual competing against his/her peers – is very outdated. 

Physicians practice in a collaborative and multi-faceted world – and medical students often enter residency ill-equipped to handle social issues, end of life care dilemmas, advocating for their patients who have lack of access to care, and navigating the stacks of paperwork required for each hospital and clinic visit. Recognizing this, many schools have moved to problem-based learning alongside lectures, introducing students to patient care early in their preclinical years, and some, such as Baylor and Duke, have moved to cutting down the second year of classwork so students can get into the hospital setting more quickly. While these are progressive moves, a more substantial push to comprehensive medical education reform is necessary, as Nemko points out. Reform should encompass the spectrum of training: from admission requirements (more balanced, liberal arts focused prereqs and patient advocacy/ethics focused admission interviews) to medical school graduation requirements (social medicine, advocacy, communication skills). 
One of my favorite lines from the article is ”A medical education that inculcates a measure of humility would help physicians understand the field’s current limitations, be more honest with patients and more motivated to contribute their clinical findings to the still adolescent field of medicine.” Too often, physicians and physicians in training become short sighted to the big picture of medical practice and their role in it. In fact, we have the power in our hands to change our field – from the bottom up, from the top down – it takes courage and creativity, yes, but more and more it will become absolutely necessary, in order to keep up with the progress of medical science.

Feel free to contact your Med Ed team with any questions and ideas!

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Comments  2

  • Matthias Gerhard 20 Jan

    A very interesting perspective, in the end I believe it is the doctor's interest in the patient that makes medicine evolve, and allows the physician to treat the patient correctly, based not only on symptoms but by taking into account everything he/she is going through.

    Kind regards,

    Matthias Gerhard (Schweiz)
    Blumenversand Zurich
  • Robert Schwab, MD 07 Mar

    Often overlooked in these discussions is the critical role of the humanities in shaping the professional identity, not only during premedical years, but continuing throughout the education of the physician.  The efforts to curtail "nonclinical" education, such as those at Duke and Baylor, and more recently at University of Texas-Southwestern, are well-intended, but should not be undertaken without careful consideration of the impact that an increasingly technological and rigidly scientific approach has on a profession that remains, at its core, based on the ability to create strong and trusting relationships.  The ability to create healers, rather than disease-fighters, depends upon our ability to impart a deep understanding of the human condition.
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