21st Century Medical Education

Medical education is at a crossroads. While the health care workforce requires rapid expansion to accommodate the aging Baby Boomers, medical schools are tasked with inculcating ever-expanding scientific knowledge in the same limited four-year timeframe allotted to physicians of generations past.

A 35-member panel led by the former president of the Association of the American Medical Colleges (AAMC) released a report in early 2009, entitled “Revising the Medical School Mission at a Time of Expansion.”  The authors here provide commentary on the report from the dual perspectives of medical educators who seek reform and practitioners of public health.

The authors applaud the report for acknowledging the current skew in racial, economic, and geographical backgrounds within the current medical school student pool.  The panel states that admissions criteria fail to yield a physician workforce that is representative of the society at large.  Recommended changes that should be adopted are decreasing the emphasis on the MCAT (Medical College Admissions Test) score and the grade point average.

An additional theme that the panel highlighted was the preparation of future physicians in the areas of globalization, scientific and technological advances, and demographic shifts.  Increases in global trade, travel, and associated health concerns drives the need for an emphasis on health and well-being as impacted by multiple determinants: biology, behavior, and environment.  The authors commend the panel for recommending that physicians therefore have a greater background in population health and the role that social factors play in affecting patient health.  Within medical education, the panel recommends moving away from the classroom and hospital based settings in order to adopt a more community-based approach.  Such a setting would underscore the recognition of non-biological risk factors for disease that may be exacerbated by community conditions and systems.  The authors point out that current medical school and residency curricula offer little opportunity for students to develop knowledge of the contribution of non-genetic factors to human disease and premature death.

Commentary

The recommendations as highlighted by the authors here are indeed broad and will undoubtedly cause a great deal of friction from current medical educators.  Not only does a focus on population health and community settings adjust the focus of medical education, but it also refocuses the entire practice of medicine away from the individual patient and the traditional academic environment.  Questions remain:

• How can we adopt such a new perspective in the limited timeline of our medical training as it currently stands?
• What topics, if any, will need to be sacrificed?
• How do we staff the shift away from academia into the community?
• Will universities be open to accepting community physicians onto their faculty on a larger scale, and how will that interaction be maintained in the face of research, tenure, and other typical university criteria?
• Students trained under these newer programs might not have as much access to the big name faculty in the university hospitals – will this affect their applications to residency and fellowships?

Such reforms will need to be addressed along the entire spectrum of medical training and advancement in order to assure that students using the reform curricula are not neglected as they move forward in their careers.

J Health Care Poor and Underserved. 2009; 20:617-624.

by

Kameron L. Matthews, MD, Esq.