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Loss of Laboratory Instruction in American Medical Schools: Erosion of Flexner???s View of ???Scientific Medical Education???
Abstract
There has been a steep decline in the number of hours devoted to laboratory instruction in American medical schools. Medical students attending 1 of the 3 Washington DC medical schools now spend less than 10% of their first 2 basic science years in a laboratory. The paucity of laboratory instruction represents a reversal of the gains made in American medical education after the Flexner report and may partly account for our nation's missing physician-scientists. This situation is not expected to improve anytime soon, given the expenses that would be required to divert research-intensive faculty to laboratory instruction. The expenses would be particularly onerous for medical schools under intensive managed care pressures. Because it is unlikely that many American medical schools have either the will or means to make substantive changes in their laboratory-based curricula, novel solutions to restoring laboratory-based medical education may be required.
... Pre-clerkship medical students have traditionally learned a subset of laboratory medicine principles and skills in a microbiology teaching laboratory [19][20][21][22][23]. These hands-on laboratory sessions have also provided an opportunity to reinforce important principles in microbiology learned elsewhere in the curriculum [14]. ...
... Modern learning theory emphasizes active learning [24], and both the Association of American Medical Colleges and the Infectious Disease Society of America have endorsed the use of hands-on laboratories to teach diagnostic microbiology [25,26]. Despite support for laboratory teaching from educators, studies of laboratory instruction at individual [22], regional [23], and US [16] medical schools have noted reductions in the number of hours of laboratory instruction. However, these data are either limited in scope [22,23] or only report changes that occurred prior to 1999 [16]. ...
... Despite support for laboratory teaching from educators, studies of laboratory instruction at individual [22], regional [23], and US [16] medical schools have noted reductions in the number of hours of laboratory instruction. However, these data are either limited in scope [22,23] or only report changes that occurred prior to 1999 [16]. Alternative strategies for teaching laboratory medicine in microbiology have appeared in response to overarching curricular changes, time and financial constraints, and faculty resources [27][28][29][30]. ...
The teaching laboratory has long been a component of medical microbiology courses. Limited data suggest that many medical schools have eliminated their teaching laboratory for diagnostic microbiology despite support for active learning over didactic lectures and a concern that undergraduate medical student’s education in the area of laboratory medicine is inadequate. A survey study of North American medical schools was conducted to determine if there is a trend towards decreasing or eliminating this teaching laboratory. The study also documented reasons for changes to this teaching laboratory, curricular content of existing microbiology teaching laboratories, and use of computer-assisted instruction. There was a 53 % response rate to the survey. Forty-three percent of medical schools decreased the hours or eliminated the teaching laboratory in diagnostic microbiology entirely between 2002 and 2012, and an additional 7 % of schools have plans to decrease hours or eliminate this teaching laboratory. Changes to the teaching laboratory were most often due to limited resources, reduced teaching hours, and overarching curricular changes. Because the way in which medical students are taught laboratory medicine in microbiology is undergoing a significant change, educators need to ensure that the learning experience is sufficient, and the quality is not compromised as a result.
... resulta primordial favorecer la formación de profesionales capaces de formular hipótesis clínicamente relevantes que orienten las acciones de salud. De no ser así, el beneficio que producen los nuevos conocimientos, medicamentos y tecnologías se retarda excesivamente (Stewart, 2003;Cech y col., 2001;Pober y col., 2001;Hotez, 2003;Salas y Rigotti, 2005). De ahí que el estudio de la productividad científica y formación ética de los médicos graduados de los PPEM durante el último decenio constituye un aspecto clave para evaluar la eficacia de las propuestas programáticas y, de esta forma, asegurar la calidad en salud. ...
... La complejidad del problema amerita enfrentarlo con diferentes estrategias (Moskowitz y Thompson, 2001). Ejemplo de ello son el fortalecimiento de la investigación en el pregrado (Solomon y col., 2003;Hotez, 2003), lo cual implica asignar a las escuelas de medicina fondos especiales y realizar cambios curriculares que permitan alentar la práctica investigativa (Fang y Meyer, 2003;Swain, 1996). Otra posibilidad es incorporar cursos de investigación clínica y una tesis, ya sea directamente en los PPEM o por medio de la asociación del programa a un posgrado. ...
... resulta primordial favorecer la formación de profesionales capaces de formular hipótesis clínicamente relevantes que orienten las acciones de salud. De no ser así, el beneficio que producen los nuevos conocimientos, medicamentos y tecnologías se retarda excesivamente (Stewart, 2003;Cech y col., 2001;Pober y col., 2001;Hotez, 2003;Salas y Rigotti, 2005). De ahí que el estudio de la productividad científica y formación ética de los médicos graduados de los PPEM durante el último decenio constituye un aspecto clave para evaluar la eficacia de las propuestas programáticas y, de esta forma, asegurar la calidad en salud. ...
... La complejidad del problema amerita enfrentarlo con diferentes estrategias (Moskowitz y Thompson, 2001). Ejemplo de ello son el fortalecimiento de la investigación en el pregrado (Solomon y col., 2003;Hotez, 2003), lo cual implica asignar a las escuelas de medicina fondos especiales y realizar cambios curriculares que permitan alentar la práctica investigativa (Fang y Meyer, 2003;Swain, 1996). Otra posibilidad es incorporar cursos de investigación clínica y una tesis, ya sea directamente en los PPEM o por medio de la asociación del programa a un posgrado. ...
RESUMENEl presente artículo informa acerca de una investigación que explora la formación decompetencias en investigación clínica y en actitudes éticas en los programas de postítulode especialista en Medicina de siete universidades chilenas. Se analizaron cualitativa ycuantitativamente 56 programas de estudios, correspondientes a seis especialidades médicasprimarias y seis derivadas, las asignaturas y los estudiantes graduados en el periodo 1999-2005. Los resultados muestran que los programas corresponden a propuestas formativas de carácter tutorial, con énfasis en la relación personalizada docente-estudiante. Además,revelan una elevada intención de formación en investigación clínica, en menor medida enactitudes éticas e incipiente productividad en publicaciones ISI y SCIELO.
... Laboratory teaching in U.S. medical schools has experienced dramatic changes, from its rise in the 1870s (Milacek, 1966) through its peak years in the first half of the 20th century following the release of the Flexner report (Flexner, 1910), to its gradual decline during the past half century (Barzansky, 1992;Genuth et al., 1992;Hotez, 2003). Gartner (2003) documented a steady decline in laboratory hours in all of the anatomical sciences in U. S. medical schools between 1967S. ...
... Widespread use of laboratory instruction in U.S. medical schools began in the 1870s (Milacek, 1966), peaked during the first half of the 20th century, and declined during the second half of the 20th century (Barzansky, 1992;Genuth et al., 1992;Hotez, 2003;Bloodgood, 2005). Ludmerer (1999) suggested that this decline, like changes in other aspects of medical education, likely resulted from the post-WWII rise in research-intensive medical schools and the somewhat later advent of managed care, both of which contributed to shifting faculty time away from the educational mission. ...
Owing to competition for faculty time among the three major missions of today's academic medical centers, as well as the rapid development of computer-based instructional technologies, laboratory instruction in medical schools in the United States has been undergoing dramatic change. In order to determine recent trends in histology laboratory instruction at U.S. medical schools, a detailed Web survey was administered to histology course directors, with about two-thirds of schools responding. The survey was designed to identify trends in the number of hours of histology laboratory instruction that each medical student receives, the amount of faculty effort devoted to histology laboratory instruction, and the use of various computer-based technologies (including virtual microscopy and virtual slides) in histology laboratory instruction. Consistent with the long-term trend of declining total laboratory teaching hours in U.S. medical schools, there is an ongoing reduction in the number of hours of faculty-directed histology laboratory instruction that each medical student receives, with a concomitant reduction in hours of faculty time devoted to histology laboratory instruction. In terms of the tools used in the histology laboratory, there has been a dramatic increase in the use of various forms of computer-aided instruction (including virtual slides). The large increase in the number of schools using computer-aided instruction has not been accompanied by an equivalent decrease in the number of schools that utilize microscopes and glass slides. Rather, the clear trend has been toward a blending of the new computer-based instructional technologies with the long-standing use of microscopes and glass slides.
... Following the keynote lecture, Dr. Oksana Shynlova provided a brief overview of several recently published reports highlighting the sharp decline of basic science publications in major medical journals over the past 20 years [2][3][4][5][6]. These findings point to the growing disconnect between basic science and clinical medicine [7,8]. ...
The International Urogynecological Association (IUGA) brought together senior and junior members actively engaged in scholarly and educational activities for a consensus conference centered on developing a strategy for sustainable training of the next generation of mechanistic researchers in female pelvic medicine.
Four a priori identified major foci were explored in a half-day virtual consensus conference. Participants included representatives from various countries and disciplines with diverse backgrounds—clinicians, physician-scientists, and basic scientists in the fields of urogynecology, biomechanical engineering, and molecular biology. Following a keynote address, each focus area was first tackled by a dedicated breakout group, led by the Chair(s) of the most relevant IUGA committees. The break-out sessions were followed by an iterative discussion among all attendees to identify mitigating strategies to address the shortage of mechanistic researchers in the field of female pelvic medicine.
The major focus areas included: research priorities for IUGA basic science scholar program; viable strategies for sustainable basic science mentorship; core competencies in basic science training; and the challenges of conducting complex mechanistic experiments in low-resource countries. Key gaps in knowledge and core competencies that should be incorporated into fellowship/graduate training were identified, and existing training modalities were discussed. Recommendations were made for pragmatic approaches to increasing the exposure of trainees to learning tools to enable sustainable training of the next generation of basic science researchers in female pelvic medicine worldwide.
The attendees presented multiple perspectives to gain consensus regarding critical areas of need for training future generations of mechanistic researchers. Recommendations for a sustainable Basic Science Scholar Program were developed using IUGA as a platform. The overarching goal of such a program is to ensure a successful bench-to-bedside-and-back circuit in Urogynecology and Pelvic Reconstructive Surgery, ultimately improving lives of millions of women worldwide through scientifically rational effective preventative and therapeutic interventions.
... At the same time, there was a report on poor knowledge retention in anatomy among medical students entering surgical rotation (2). Besides, the loss of laboratorybased learning impacted the physiology education (3). However, the community of physiologists reacting swiftly to these changes by introducing clinically oriented physiology teaching to improve students' performance (4). ...
... Indeed, the disappearance of laboratory instruction parallels a similar trend in our nation's medical schools, and reflects budget cuts because of managed care competition. 6 Compounding the problem, our nation's SPHs are now so depleted when it comes to qualified microbiology laboratorians that many of our leaders in public health have no one to even inform them of the shortage. For example, in the 300-page landmark report by the Institute of Medicine (IOM) on educating public health professionals for the 21st century, 7 mention of infectious disease training is limited to two pages in a section on global health. ...
... As scientists and clinicians at an academic center, we have anecdotally noted fewer basic science advances being presented in widely read, high-impact medical journals. This is mirrored by a decreased emphasis on basic research and the mechanisms of disease within North American clinical and academic programs (3,4). Indeed, medical trainees perceive biomedical sciences as being less relevant to clinical care (5), paralleling a long-standing concern in medical education over the retention of basic science knowledge (6). ...
Explosive growth in our understanding of genomics and molecular biology have fueled calls for the pursuit of personalized medicine, the notion of harnessing biologic variability to provide patient-specific care. This vision will necessitate a deep understanding of the underlying pathophysiology in each patient. Medical journals play a pivotal role in the education of trainees and clinicians, yet we suspected that the amount of basic science in the top medical journals has been in decline. We conducted an automated search strategy in PubMed to identify basic science articles and calculated the proportion of articles dealing with basic science in the highest impact journals for 8 different medical specialties from 1994 to 2013. We observed a steep decline (40-60%) in such articles over time in almost all of the journals examined. This rapid decline in basic science from medical journals is likely to affect practitioners' understanding of and interest in the basic mechanisms of disease and therapy. In this Life Sciences Forum, we discuss why this decline may be occurring and what it means for the future of science and medicine.-Steinberg, B. E., Goldenberg, N. M., Fairn, G. D., Kuebler, W. M., Slutsky, A. S., and Lee, W. L. Is basic science disappearing from medicine? The decline of biomedical research in the medical literature.
... Both integrated and problem-based curriculums are associated with important reductions in the time allotted to individual basic science courses or even their disappearance (Vander, 1994;Seifer, 1998). Likewise, a steep decline has also occurred in the number of hours devoted to basic science laboratory instruction in most medical schools (Hotez, 2003). In some of them, laboratory exercises have been totally eliminated; thus, medical students are insufficiently trained in the skills, values, and habits of science. ...
A steep decline has occurred in the number of hours devoted to basic sciences laboratory instruction in most medical schools. This trend seems to be inevitable because basic science departments in many medical schools are probably not capable of running an animal laboratory; hence, computer simulations have substituted live animals in medical laboratory learning. This article describes the laboratory program developed at our Pharmacology department. The laboratory manual contains a total of 33 computerized laboratory sessions; many of them are used to reinforce basic pharmacology concepts and principles, whereas others emphasize application of the scientific method to pharmacological and clinical problems. This program constitutes an effort for a better formative and less factual instruction to medical students.
... En esos aspectos, los ejercicios de laboratorio juegan un papel determinante. Durante muchos años parte medular del proceso formativo 23 , ahora el número de horas dedicadas a la instrucción de laboratorio de ciencias básicas también ha declinado o desaparecido de los planes de estudio 26 . ...
The relevance of basic sciences in medical education has been recognized for centuries, and the importance of exposing medical students to science was acknowledged and reinforced by the recommendations of Flexner in 1910. Since then, traditional medical education has been divided into preclinical and clinical subjects; within this scheme, the first terms of undergraduate medical education usually concentrate on basic sciences, while subsequent ones focus on clinical sciences and clinical training. Since 1956, this educational scheme has been questioned and, in some schools, the medical curriculum has undergone significant structural changes; some of these reforms, especially integrated curricula, are associated with important reductions in the time allotted to individual basic science courses or even with their removal. The removal of basic science subjects from the medical curriculum is paradoxical because nowadays the value of biomedical knowledge and the scientific reasoning to make medical decisions is more appreciated than ever. To maintain its relevance in medical education, basic sciences have to confront three challenges: a) increasing its presence in clinical education; b) developing nuclear programs; and c) renewing laboratory instruction.
... En el último tiempo, se ha dado un énfasis importante en atención primaria y salud pública, lo que no ha sido balanceado por igual vigor en estimular la formación de egresados dedicados a investigar 6,24,25 . El currículo de muchas escuelas de medicina tampoco provee de instancias suficientes para la formación en investigación, evidenciándose una disminución significativa del número de horas dedicada a prácticas de laboratorio 26 . Probablemente, esta disminución no será modificada, debido a los costos, tanto en recursos humanos como en renovación tecnológica, que se requieren. ...
Several studies have reported a progressive reduction in the number of grant applications and research projects approved by medical doctors (MD) in the United States. The overall trend and current situation of MDs actively involved in biomedical research in Chile has not been defined. Thus, we analyzed the professional profile of the principal investigators (PI) that have led research grants approved by the Technology and Medical Sciences study groups of the Fondo Nacional de Desarrollo Científico y Tecnológico (FONDECYT), during the last 20 years. The results show that the projects led by MDs corresponded to 80% in 1984, decreasing to 50% in 2003, with further reduction projected for the next years. We think that the physician doing biomedical research represents a human resource indispensable to preserve a genuine academic environment within medical schools; thus, it is necessary to design and apply strategies to reverse this worrying trend of less MDs actively involved in research in Chile. Among these, we consider important to stimulate research activities at both the undergraduate and postgraduate levels of MD training particularly increasing the flexibility of the postgraduate fellowship programs. In addition, it is necessary to support both in terms of money and spare time those physicians who are beginning an academic career involved in biomedical research. Finally, we consider important that non-academic institutions (e.g., pharmaceutical companies, health medical organizations, and philanthropic foundations) should also support academic development and biomedical research in our medical schools (Rev Méd Chile 2005; 133: 121-8)
... [1][2][3][4][5] Decreases are evident as clinician/scientists are becoming a smaller minority of individuals obtaining National Institutes of Health (NIH) project support, the number of first time applicants possessing a medical degree for NIH research project grants are decreasing, the number of individuals interested in following a clinician/scientist career is declining, and medical school faculty with an MD/PhD degree spend more time assigned to patient care duties rather than research. 6,7 To address this issue, support for research training for clinician/scientists is increasing, debt relief for individuals following a career in research is now being provided, and the priority for clinical research has been stated. 8 None the less, many feel that inadequate numbers of clinician/scientists are being trained. ...
Basic medical research is the foundation for change and advancement that occurs in medicine. Discoveries at the bench can lead to innovative approaches at the bedside. To foster “bench-to-bedside” research, an integrated approach involving both the basic researcher as well as the clinician/scientist is necessary. The training of new clinician/scientists is critical to this process. Important aspects of this training include: identifying individuals with the desired interest, providing adequate basic science and clinical
mentoring, fostering development of a firm scientific approach, and developing writing skills. Even though current time constraints and budgetary limitations make development of these individuals a challenge, quality training of new clinician/scientists is a vital investment in our future.
... En el último tiempo, se ha dado un énfasis importante en atención primaria y salud pública, lo que no ha sido balanceado por igual vigor en estimular la formación de egresados dedicados a investigar 6,24,25 . El currículo de muchas escuelas de medicina tampoco provee de instancias suficientes para la formación en investigación, evidenciándose una disminución significativa del número de horas dedicada a prácticas de laboratorio 26 . Probablemente, esta disminución no será modificada, debido a los costos, tanto en recursos humanos como en renovación tecnológica, que se requieren. ...
Several studies have reported a progressive reduction in the number of grant applications and research projects approved by medical doctors (MD) in the United States. The overall trend and current situation of MDs actively involved in biomedical research in Chile has not been defined. Thus, we analyzed the professional profile of the principal investigators (PI) that have led research grants approved by the Technology and Medical Sciences study groups of the Fondo Nacional de Desarrollo Científico y Tecnológico (FONDECYT), during the last 20 years. The results show that the projects led by MDs corresponded to 80% in 1984, decreasing to 50% in 2003, with further reduction projected for the next years. We think that the physician doing biomedical research represents a human resource indispensable to preserve a genuine academic environment within medical schools; thus, it is necessary to design and apply strategies to reverse this worrying trend of less MDs actively involved in research in Chile. Among these, we consider important to stimulate research activities at both the undergraduate and postgraduate levels of MD training particularly increasing the flexibility of the postgraduate fellowship programs. In addition, it is necessary to support both in terms of money and spare time those physicians who are beginning an academic career involved in biomedical research. Finally, we consider important that non-academic institutions (e.g., pharmaceutical companies, health medical organizations, and philanthropic foundations) should also support academic development and biomedical research in our medical schools.
... Although he would relish the use of tutorials for getting students engaged in their own learning, he may not be entirely sold on problem-based learning and wonder whether everyone would be able to get the general principles without more direction. What would be particularly disturbing to him would be the gradual erosion of laboratory instruction from a number of medical schools (13,6,25). He would read with some concern Davenport's detailed analysis of that decline and be perturbed at comments made that "the basic sciences have grown too much, and too far from clinical concerns, to be usefully approached by medical students in the manner of graduate students. ...
In the early 1900s, teachers of medical physiology faced a problem familiar to those teaching the subject in a contemporary setting: too much information, too little time, too many students in crowded rooms, and exams that discouraged real learning. They wanted students to question authority and demand evidence and thus be better prepared for medicine. Their solution was to bring students into laboratories and minimize didactic learning as they felt strongly that useful information could not be obtained merely from books. Thus, they were strong proponents of what we now call active learning.
The aim of this paper was to study the top-cited per year (CPY) original articles published in the leading subspecialty journals in gynecologic oncology and in the leading general obstetrics and gynecology journals. We used the Web of Science and iCite databases to mine the original articles and review articles in the field of gynecologic oncology in the following journals: Gynecologic Oncology, The International Journal of Gynecological Cancer, The American Journal of Obstetrics and Gynecology and the Obstetrics & Gynecology. Top CPY articles from the four journals were analyzed and compared in a two-time point analysis. A total of 23,252 original articles and reviews were identified. The 100 Top-CPY articles were published from 1983 to 2021. Seventy (70%) in Gynecologic Oncology journal, 20 (20%) in The International Journal of Gynecological Cancer, eight (8%) in Obstetrics & Gynecology and two (2%) in The American Journal of Obstetrics and Gynecology. The most common study methodology was observational studies (20%), followed by guidelines/consensus papers (19%). The most common study topic was ovarian cancer (41%). North America originating authors composed 62% of the top CPY publications, followed by Europe (21%). The most common country of authorship was the United States (52%) followed by Canada (10%). CPY were similar in the publications before vs. after 2014 (P=.19). Study designs, study topics and continent of authorship were similar in both periods. The proportion of multi-center studies was higher after 2014 (66.6% vs. 28.8%, P=0.002) and the proportion of open access publications was higher after 2014 (66.6% vs. 15.4%, P<.001). Funded studies were more common after 2014 (75.0% vs. 53.8%, P=0.028). Ovarian cancer is the top CPY area of research in gynecologic oncology. This field is leaded by authors from the United States with multi-center studies proportion increasing in recent years. It is important to promote further high-quality research in other countries to disseminate knowledge and equality.
Scientific research has been changing medical practice at an increasing pace. To keep up with this change, physicians of the future will need to be lifelong learners with the skills to engage with emerging science and translate it into clinical care.
How medical schools can best prepare students for ongoing scientific change remains unclear. Adding to the challenge is reduced time allocated to basic science in curricula and rapid expansion of relevant scientific fields. A return to science with greater depth after clinical clerkships has been suggested, although few schools have adopted such curricula and implementation can present challenges.
The authors describe an innovation at Harvard Medical School, the Advanced Integrated Science Courses (AISCs), which are taken after core clerkships. Students are required to take 2 such courses, which are offered in a variety of topics. Rather than factual content, the learning objectives are a set of generalizable skills to enable students to critically evaluate emerging research and its relationship to medical practice. Making these generalizable skills the defining principle of the courses has several important advantages: it allows standardization of acquired skills to be combined with diverse course topics ranging from basic to translational and population sciences; students can choose courses and projects aligned with their interests, thereby enhancing engagement, curiosity, and career relevance; schools can tailor course offerings to the interests of local faculty; and the generalizable skills delineate a unique purpose of these courses within the overall medical school curriculum.
For the 3 years AISCs have been offered, students rated the courses highly and reported learning the intended skill set effectively. The AISC concept addresses the challenge of preparing students for this era of rapidly expanding science and should be readily adaptable to other medical schools.
for the past 100 yr or so, the Flexner 2+2 model of medical education has been the dominant paradigm for undergraduate medical curricula ([4][1]). The recognition of disadvantages with this approach has prompted a growing movement of curricular reform, beginning with a focus on pedagogical format
This study was conducted for the first time based on the evidence that cadaver practice is not easy in the university without medical school where cadaver dissection is not easy to look for. The purpose of this study was to evaluate the effect of osteology practice at human anatomy course for students at the freshman stage in college of health science without medical school. Both self report questionnaires and evaluation paper were analyzed depending on the course of higher education and gender. As a result of analysis, most students thought that osteology practice was interesting and it helped to understand of anatomy lecture. But students from liberal arts had poor understanding of bone`s direction compared with students from natural sciences. And most students wanted to do cadaver dissectionafter osteology practice. In conclusion, osteology practice was recommended to student`s expectation as well as education of gross anatomy in department of biomedical laboratory science, collage of health science without medical school. This study suggested that practice of gross anatomy should run parallel with lecture.
Recent progress of scientific research has notably increased the basic knowledge in genetic and molecular biology, required by medical doctors. Biochemistry educators in medical schools are challenged not only, to provide students with a strong and updated base with this new information, but also to engage them into the scientific process. One of the newest educational tools that could provide this achievement is the acquisition of information by learning-doing, like laboratory activities. In order to evaluate the impact of laboratory work over medical development a pilot experience was held at the Biochemistry Department of "Luis Razetti" Medical School, at Universidad Central de Venezuela from 2005 to 2006. Basic techniques in molecular biology were introduced to registered students and they were able to isolate DNA from different human samples, perform a PCR reaction and visualize the PCR product in agarose electrophoresis gel. We also included information about ethical issues regarding information for genetic and genomic research, such an informed consent and donation of biological samples to biobank, very actual and important information for medical doctor.At the end of the activity, the students were asked, by using a voluntary and anonymous survey, about the impact of the laboratory knowledge acquisition. The result of the survey reported, that the students considered these laboratory activities important and useful tools in their learning process. We received their suggestion to include more laboratory activities in the Biochemistry curricular program.
The relevance of basic sciences in medical education has been recognized for centuries, and the importance of exposing medical students to science was acknowledged and reinforced by the recommendations of Flexner in 1910. Since then, traditional medical education has been divided into preclinical and clinical subjects; within this scheme, the first terms of undergraduate medical education usually concentrate on basic sciences, while subsequent ones focus on clinical sciences and clinical training. Since 1956, this educational scheme has been questioned and, in some schools, the medical curriculum has undergone significant structural changes; some of these reforms, especially integrated curricula, are associated with important reductions in the time allotted to individual basic science courses or even with their removal. The removal of basic science subjects from the medical curriculum is paradoxical because nowadays the value of biomedical knowledge and the scientific reasoning to make medical decisions is more appreciated than ever. To maintain its relevance in medical education, basic sciences have to confront three challenges: a) increasing its presence in clinical education; b) developing nuclear programs; and c) renewing laboratory instruction.
The aim of this article is to identify roadblocks prohibiting effective education of medical students in the basic sciences and then propose strategies for designing and implementing a better curriculum in the basic sciences that remove the roadblocks thereby increasing the relevance to students' clinical experiences in medical training. Traditionally, the medical student experiences basic science education in a setting where there is little or no communication between the basic science and clinical science professors, where basic science content is given with very little clinical context, while clinical training does not enhance understanding of the scientific foundation for clinical practice. Herein, we re-address the purpose of basic science education proposing the concept of 'transfer' as a bridge to connect the basic and clinical science education. We also propose a continuing education program for staff development in the successful implementation of these proposals.
Recent progress of scientific research has notably increased the basic knowledge in genetic and molecular biology, required by medical doctors. Biochemistry educators in medical schools are challenged not only, to provide students with a strong and updated base with this new information, but also to engage them into the scientific process. One of the newest educational tools that could provide this achievement is the acquisition of information by learning-doing, like laboratory activities. In order to evaluate the impact of laboratory work over medical development a pilot experience was held at the Biochemistry Department of Luis Razetti Medical School, at Universidad Central de Venezuela from 2005 to 2006. Basic techniques in molecular biology were introduced to registered students and they were able to isolate DNA from different human samples, perform a PCR reaction and visualize the PCR product in agarose electrophoresis gel. We also included information about ethical issues regarding information for genetic and genomic research, such an informed consent and donation of biological samples to biobank, very actual and important information for medical doctor.At the end of the activity, the students were asked, by using a voluntary and anonymous survey, about the impact of the laboratory knowledge acquisition. The result of the survey reported, that the students considered these laboratory activities important and useful tools in their learning process. We received their suggestion to include more laboratory activities in the Biochemistry curricular program.
The teaching laboratory has long been a component of medical microbiology courses. Limited data suggest that many medical schools have eliminated their teaching laboratory for diagnostic microbiology despite support for active learning over didactic lectures and a concern that undergraduate medical student’s education in the area of laboratory medicine is inadequate. A survey study of North American medical schools was conducted to determine if there is a trend towards decreasing or eliminating this teaching laboratory. The study also documented reasons for changes to this teaching laboratory, curricular content of existing microbiology teaching laboratories, and use of computer-assisted instruction. There was a 53 % response rate to the survey. Forty-three percent of medical schools decreased the hours or eliminated the teaching laboratory in diagnostic microbiology entirely between 2002 and 2012, and an additional 7 % of schools have plans to decrease hours or eliminate this teaching laboratory. Changes to the teaching laboratory were most often due to limited resources, reduced teaching hours, and overarching curricular changes. Because the way in which medical students are taught laboratory medicine in microbiology is undergoing a significant change, educators need to ensure that the learning experience is sufficient, and the quality is not compromised as a result.
Kant taught that, 'Where we find . . . illusions and fallacies . . . , there seems to be required a . . . code of mental legislation . . . founded upon the nature of reason and the objects of its exercise . . . which no fallacy will be able to withstand or escape from . . . ' I address, critically, the Flexnerian and EBM conceptions of scientific medicine and Groopman's ideas about errors of reasoning in the practice of medicine; I underscore the need for theory of medicine, founded on reason and governing cognition about and in the practice of medicine; and I sketch the dawn of rationality in medicine.
A central tenet of Flexner's report was the fundamental role of science in medical education. Today, there is tension between the time needed to teach an ever-expanding knowledge base in science and the time needed for increased instruction in clinical application and in the behavioral, ethical, and managerial knowledge and skills needed to prepare for clinical experiences. One result has been at least a perceived reduction in time and focus on the foundational sciences. In this context, the International Association of Medical Science Educators initiated a study to address the role and value of the basic sciences in medical education by seeking perspectives from various groups of medical educators to five questions: (1) What are the sciences that constitute the foundation for medical practice? (2) What is the value and role of the foundational sciences in medical education? (3) When and how should these foundational sciences be incorporated into the medical education curriculum? (4) What sciences should be prerequisite to entering the undergraduate medical curriculum? (5) What are examples of the best practices for incorporating the foundational sciences into the medical education curriculum? The results suggest a broad group of experts believes that an understanding of basic science content remains essential to clinical practice and that teaching should be accomplished across the entire undergraduate medical education experience and integrated with clinical applications. Learning the sciences also plays a foundational role in developing discipline and rigor in learners' thinking skills, including logical reasoning, critical appraisal, problem solving, decision making, and creativity.
Physiology education, which occupies an important place in undergraduate medical education, exhibits diversities across the world. Since there was no specific source of information about physiology education in Turkish medical faculties, the authors aimed to evaluate the general status of undergraduate physiology teaching of medical students in Turkey. A questionnaire designed for the program used for medical students was sent to the physiology departments of 38 faculties that had academic personnel and had carried out medical education for at least 3 years. It questioned the educational load, content, and duration of the lectures, written materials, techniques, assessment methods, basic equipments, and subjects used in practical sessions. All 38 departments answered the questionnaire. This study investigating 38 faculties showed that the content and time devoted to lectures and practical sessions (169 and 35 h) differed, as it does throughout the world, and teaching laboratories constituting 17% of total physiology education were performed and assessed by all of the departments. The practical hours correlated with the number of teaching staff. Our results indicated an insufficient number of teaching staff with a heavy educational load. This survey showed that the number of teaching staff is critical for practical sessions. Considering that the actual number of medical schools is 61 schools, with some established but not yet admitting students and educating with their own staff, if the requirements for teaching staff are not met, physiology education in Turkey will face important problems in the coming years.
The last two decades have witnessed significant changes in American medical student education. Among the most obvious of these changes is the disappearance of laboratory instruction. At all but a handful of medical schools, our nation's physicians-in-training no longer spend blocks of time in laboratories of biochemistry, physiology, and microbiology, 1 This is a far cry from the early parts of the 20th century when, as a consequence of the Flexner report and the vigorous efforts of leading university presidents such as Daniel Coit Gilman (Johns Hopkins), Charles Eliot (Harvard), Paul Rainey Harper (Chicago), and others, laboratory instruction provided the core of U.S. medical education. The erosion in laboratory time for American medical students may partly account for the absence of physician-scientists in U.S. universities and biomedical research institutes. The Commonwealth Fund and other organizations have documented parallel reductions in the number of physicians who become National Institutes of Health (NIH) funded scientific investigators. 2 Together, these findings have led some to call for reforms. Are the Masters of Public Health (MPH) students in our 32 nationally accredited schools of public health also being deprived of laboratory training?.
1MEDICAL EDUCATION IN THE UNITED STATES TODAY IS STRIKinglystandardizedanddemanding.Itwasnotalwaysso.Prior to the widespread implementation of educational reforms, medical training was highly variable and frequently inadequate. It was not until the early decades of the 20th century that a “uniformly arduous and expensive” system of medical education was instituted nationally. Inthe19thcentury,mostmedicaleducationintheUnited States was administered through 1 of 3 basic systems: an apprenticeshipsystem,inwhichstudentsreceivedhands-on instruction from a local practitioner; a proprietary school system, in which groups of students attended a course of lectures from physicians who owned the medical college; orauniversitysystem,inwhichstudentsreceivedsomecombination of didactic and clinical training at universityaffiliated lecture halls and hospitals. These medical schools taught diverse types of medicine, such as scientific, osteopathic, homeopathic, chiropractic, eclectic, physiomedical, botanical, and Thomsonian. 2 In addition, wealthy and industrious medical students supplemented their education with clinical and laboratory training in the hospitals and universities of Europe, primarily in England, Scotland, France, and Germany. Because of the heterogeneity of educational experiences and the paucity of licensing examinations, physicians in America at the turn of the 20th century variedtremendously intheir medical knowledge, therapeutic philosophies, and aptitudes for healing the sick. 3,4 Throughoutthesecondhalfofthe19thcentury,theAmerican Medical Association (AMA) lobbied for the standardization of American medical education. These efforts were largely unsuccessful, both because political traditions in America dissuaded national regulation of professions and because the American public and much of the medical professionwerenotconvincedthatanyparticularbrandofmedi
Since 1997, an unprecedented amount of American philanthropy from both private and federal sources has been directed toward research and control programs for the major tropical infectious diseases of developing countries. The US and Canadian capacity to respond to these new initiatives might prove inadequate, however, as tropical disease research and training infrastructures have deteriorated at most North American academic health centers over the last three decades. Training opportunities in clinical tropical medicine, parasitology laboratory diagnostics, vector control, and public health practice are especially depleted and portend a lost generation of experts in these areas. In addition, unlike some of the European schools of tropical medicine, no North American medical or public health school currently boasts a comprehensive faculty in the global health sciences, with expertise that spans laboratory investigation, clinical and translational research, health policy, and international development. To meet the challenge presented by the new philanthropy targeting the global diseases of poverty, a North American school of global health sciences should be established. The North American school, possibly in association with one of the existing schools of medicine or public health, would provide interdisciplinary training to produce a new generation of global health scientists.
The Linköping Health University is an example of a medical school which has succeeded, not only with a major curricular change, transforming itself into a problem-based learning school, but also in contributing to innovations in medical education.
To analyse the Linköping example in order to better understand how to succeed with innovations in medical education.
By applying a framework developed within the strategic management literature to the case study, the authors hope to understand how this innovation was achieved.
Linköping Health University was able to break boundaries and create a divergent profile through eliminating, reducing, raising, and creating different aspects of the curricula.
A strategic management framework can be applied to medical education to better understand innovation. The authors discover that many of the later innovations were in fact more aimed at sustaining the initial innovation rather than creating new trends. It remains unclear from the case study how to stimulate innovation without the use of fear or threats.
From bench to bedside: preserving the research mission of academic health centers
- Commonwealth Fund Task Force on Academic Health Centers
The growth and divergence of the basic sciences
- Barzansky