Medical Education, Post Flexner - October 28, 2004

Last column, I posited that medical education was in need of a serious remake. This time, in the spirit of audacious abandon, I thought I would proffer a few recommendations for change.

We must, first of all, agree on the major problems needing to be addressed. Simply stated, I think they are:

1. The medical training period is too long.
2. The finished product is not suited for 21st century medicine.
3. The costs are too high (for student and for medical school alike)

This time out, I want to suggest how we might make the training period shorter. There! I’ve said it! But now how do we make it happen?

Fundamentally, the solution requires recognition that medical school curricula are often dictated by a group of department chairs who each believe his or her department’s existence is threatened if a significant chunk of that discipline is not a required part of the curriculum. So we insist our medical students take courses that may not be fundamentally necessary to the task at hand, or may be redundant. Not crediting college biochemistry, for example, leads to considerable duplication in medical school.

And how much basic science is enough? I am all for the advancement of basic biomedical science, but we must open the curriculum to other courses—on patient safety, bioethics and other pressing concerns. What we can’t do is simply keep adding more courses. Maybe we are teaching too much basic science, or perhaps not enough. One way or the other, a critical rethinking of curriculum content is in order.

One obvious and relatively easy time-saving change would be to reduce and try to eliminate teaching and training redundancies. We have this tremendous proliferation of pre-meds taking biological science courses. Why can’t we offer medical school courses to undergraduates? If we devote some of the undergraduate pre-med time to relevant courses, we can shorten the overall time between high school and completion of residency—which should be our goal. I am not suggesting we tell our pre-meds to avoid undergraduate courses in literature, philosophy, languages and so on—far from it. But by substituting medical school preclinical courses for some undergraduate science courses, we could potentially realize two gains. First, it would help shorten the training time. And second, it would enable us to focus the medical school curriculum on important courses that are not presently being taught.

There are really two parts to the medical training time equation, the second part being the time required for clinical training (both in medical school as well as in residency). This part of the medical education is predicated on the student acquiring enough experiential training, i.e., seeing lots of patients with different diseases in the clinical setting. Here again, we confront the force of tradition, but in this case the opportunities for real improvements are especially compelling. Next time, I will focus on ways to make clinical training more efficient and effective, both to reduce training times and to improve the overall finished product—the practicing physician.

Medical Education, Post Flexner

Last column, I posited that medical education was in need of a serious remake. This time, in the spirit of audacious abandon, I thought I would proffer a few recommendations for change.

We must, first of all, agree on the major problems needing to be addressed. Simply stated, I think they are:

1. The medical training period is too long.
2. The finished product is not suited for 21st century medicine.
3. The costs are too high (for student and for medical school alike)

This time out, I want to suggest how we might make the training period shorter. There! I’ve said it! But now how do we make it happen?

Fundamentally, the solution requires recognition that medical school curricula are often dictated by a group of department chairs who each believe his or her department’s existence is threatened if a significant chunk of that discipline is not a required part of the curriculum. So we insist our medical students take courses that may not be fundamentally necessary to the task at hand, or may be redundant. Not crediting college biochemistry, for example, leads to considerable duplication in medical school.

And how much basic science is enough? I am all for the advancement of basic biomedical science, but we must open the curriculum to other courses—on patient safety, bioethics and other pressing concerns. What we can’t do is simply keep adding more courses. Maybe we are teaching too much basic science, or perhaps not enough. One way or the other, a critical rethinking of curriculum content is in order.

One obvious and relatively easy time-saving change would be to reduce and try to eliminate teaching and training redundancies. We have this tremendous proliferation of pre-meds taking biological science courses. Why can’t we offer medical school courses to undergraduates? If we devote some of the undergraduate pre-med time to relevant courses, we can shorten the overall time between high school and completion of residency—which should be our goal. I am not suggesting we tell our pre-meds to avoid undergraduate courses in literature, philosophy, languages and so on—far from it. But by substituting medical school preclinical courses for some undergraduate science courses, we could potentially realize two gains. First, it would help shorten the training time. And second, it would enable us to focus the medical school curriculum on important courses that are not presently being taught.

There are really two parts to the medical training time equation, the second part being the time required for clinical training (both in medical school as well as in residency). This part of the medical education is predicated on the student acquiring enough experiential training, i.e., seeing lots of patients with different diseases in the clinical setting. Here again, we confront the force of tradition, but in this case the opportunities for real improvements are especially compelling. Next time, I will focus on ways to make clinical training more efficient and effective, both to reduce training times and to improve the overall finished product—the practicing physician.