A century ago in the U.S., the American Medical Association (AMA) created the Council of Medical Education (CME) to evaluate the standard of medical education.
In 1908, the committee recruited the Carnegie Foundation to survey the 155 medical schools operating at the time in order to see whether they met the standard of medical education set by the CME. The Carnegie Foundation in turn asked Abraham Flexner, a professional educator, to create the report. Two years later in 1910, the Flexner Report was released, citing shocking disparities in the quality of education and surprisingly stating that there were too many physicians being educated!
Subsequent to its release, nearly half the medical schools in the U.S. merged or simply closed. A hundred years later, what would Abraham Flexner write if he surveyed America’s medical schools today?
As before, Flexner would have to visit every medical school to survey the conditions present. In the 1910 Report, Flexner’s main recommendations were simple. First, he suggested that every individual entering medical school have at least a high school diploma and have completed at least two years of education at a collegiate level. Second, medical school education should consist of four years, two with pre-clinical education in anatomy, physiology, and pathology followed by two years of clinical education with active participation on the behalf of the students. And third, the medical schools should be run as non-profits under the auspices of a larger university setting as too many were being run by private doctors as for-profit enterprises.
Considering the evolution of medicine, many of Flexner’s recommendations still should be pursued. While it is clear that a high school and college education should be pre-requisites, the content of those pre-requisites should evolve. Do medical students really need to have taken a full year of physics and organic chemistry / biochemistry to succeed in medical school? While some scientific background is definitely necessary, those four semesters may be better spent pursuing either more biology courses or perhaps courses in ethics or business, fields that complement the practice of medicine well. Furthermore, while two years of clinical training still appears appropriate, the overlap and redundancy in the pre-clinical education wastes students’ time. The two years could be condensed into one. While this may seem too extreme, excellent medical schools such as the University of Pennsylvania and Baylor College of Medicine already compressed the first 2 years into 1.5 years; Duke University compress the two years into one! For some students, such as a the presumed MD/PhD neurosurgeon, the extra year would be much more useful down the road either practicing or performing research.
The content of medical education itself must also evolve. Much of what we learn as students has not changed significantly over the hundred years. Given the complex interplay between patients, providers, insurance companies, and hospitals, medical students should have more education about the medical-industrial complex, specifically courses on business, reimbursement, and public healthcare policy. The latter should specifically address what Medicaid and Medicare are and how they function. A graduating medical student’s lack of knowledge on billing, coding, and reimbursement is frankly shocking and often leaves them unprepared for the realities of private (or even academic) practice down the road.
Along with increasing education about the structure of healthcare today, medical education must adapt to the beneficial uses of technology. Many of my peers in medical school did not actually attend class, but would stream lecture videos online to watch in the comfort of their own homes. The benefits were obvious: one could pause to finish writing a note, or even rewind to re-listen to a confusing portion of a lecture. Attendance actually reflected the ability of the lecturer to present material (ie, how entertaining they were) versus that importance of the material being covered. All medical schools should adapt to this reality and provide streaming videos to their students. Furthermore, lectures should be shortened to thirty minutes each in order to force lecturers to focus on the important points within in a topic instead of simply reciting all the known esoteric data on a particular disease entity.
Whether the medical education system chooses to evolve or not is difficult to predict. However, technology shall continue to move forward. If medical education does not, many future physicians will gravitate to other fields that are more “with the times,” leaving medicine looking for its next Abraham Flexner to replenish the once-filled lecture halls of the medical schools of 2010.
Scrub, MD is a recent medical graduate and currently a resident physician who blogs at Scrub Notes.
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