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Abraham Flexner and the Era of Medical Education Reform
Abstract
Many forces, including the influential report of Abraham Flexner, acted to reform medical education in the early 20th century. Most physicians were not prepared to adopt recent advances in health care due to their poor medical training. This deficit was recognized in the 20 years before Flexner's report by several organizations, including the Illinois State Board of Health, the American Medical Association, and the Association of American Medical Colleges. Before 1910, each organization had engaged in at least one review of medical schools using defined standards and had identified many of the existing deficits. The number of medical schools already had begun to decrease, dropping from 160 in 1905 to 133 in 1910. Flexner drew heavily, but not exclusively, on the standards for medical education previously developed by other organizations. He visited 155 medical schools in the United States and Canada between December 1908 and April 1910. His 1910 report included a conceptual model of how modern medical education should be conducted and descriptions of each medical school that were explicit in both praise and censure.In the decade following the Flexner Report the number of medical schools decreased from 133 to 85. The actions of state medical licensing boards to deny recognition to poor schools sealed their fate. The remaining schools had higher entrance requirements, longer terms, and better resources. The author describes key factors that contributed to the success of the changes recommended by Flexner and others, and then posits why Flexner is still remembered.
... En 1891, la Junta de Salud del Estado de Illinois, de la Asociación de Colegios Médicos Americanos, junto con la AMA publicaron un informe sobre las facultades de medicina en EEUU y Canadá, en el que señalaron diferentes problemas en las instancias formadoras como la muy poca educación preliminar, que dificultaba comprender los principios científicos, el exceso del trabajo didáctico por parte de los profesores, el muy poco trabajo clínico de parte de los estudiantes, las pocas pruebas de trabajos prácticos, y los tiempos acotados para el trabajo y el estudio (41) . ...
... Esos señalamientos llevaron a que, entre 1900 y 1910, se cerraran o se fusionaran 70 escuelas, a la vez que se crearan otras 50 (41) . ...
... En 1905, la AMA y la Asociación Americana de Escuelas de Medicina (AAMC), en la voz de su presidente Arthur Dean, sostenían que la calidad de una escuela de medicina requería de ayuda estatal y privada y que no podía llevarse adelante la educación médica solo con los ingresos que pagaban los estudiantes (41) . En 1910 se calculó que las 148 escuelas de medicina existentes gastaban cerca de cuatro millones de dólares para educar a sus estudiantes, los cuales aportaban el 70% de esa cifra. ...
Este trabajo se enfoca en la trayectoria de vida de Abraham Flexner, conocido en el campo de la salud por el Informe Flexner, publicado en 1910, considerado como una de las discusiones teóricas más importantes en la historia de la educación médica. Flexner fue ante todo un educador, perteneciente al movimiento progresista de educación en EEUU, encabezado por John Dewey. A lo largo del texto se analiza el momento histórico en que se inicia la conformación del campo de la salud en EEUU, sus actores, los intereses en juego, la constitución de la doxa, el rol de las fundaciones filantrópicas y de la American Medical Association. Las críticas de Flexner en el campo de la educación se centraron en los métodos pedagógicos en los diferentes niveles educativos, siendo especialmente crítico de la universidad, los posgrados y la ausencia de una formación humanista, desplazada por la investigación. La pregunta final del artículo es si los problemas enunciados por Flexner sobre la educación en general y la educación médica en particular entre fines del siglo XIX y principios del siglo XX, tienen aún vigencia en las escuelas de medicina y universidades de los países de América Latina.
... 5,16,17 Without residencies in anesthesiology, physician anesthesiologists received their training during medical school, which at the time were highly influenced by Abraham Flexner, an American educational reformer. 18 Flexner founded and directed a private school that aligned with cognitive/ rationalist and SPS learning theories. 2,19 At his school, students were not offered a standard curriculum that taught toward examinations and grades. ...
... 20 While Flexner was directing his private school with these novel approaches, the majority of American medical schools in the late 1890s to 1900s accepted students from high school with no college training. 18 Medical schools offered a repeating curriculum wherein the same topics were taught annually for 2 to 3 years. This approach aligned with the behaviorist/ empiricist theorists who suggested that repeated practices facilitates optimal learning retention. ...
... This approach aligned with the behaviorist/ empiricist theorists who suggested that repeated practices facilitates optimal learning retention. 3,18 Interested graduates would learn anesthesia informally during and after medical school. ...
Over the past couple of centuries, the training of American physicians, and anesthesiologists in particular, has undergone a radical transformation. The revolution of medical training has been and continues to be fueled by insights from learning theorists. In this historical review, we discuss the origins of American medical education in the 1700s and continue through the centuries illustrating the impact of learning theories on the education and training of anesthesiologists. In particular, we explore the impact of learning theories of the 1800s and the adult-centered teaching strategies of the 1900s. We also discuss the role of learning theories in molding medical education in the modern technological age.
... 4 The goal of this work is to provide a perspective on curricular reform in pharmacy and medicine through the lens of Flexner's landmark report, which was critical in shaping contemporary medical and pharmacy education, yet still contains many observations relevant to the challenges and opportunities of today. 5,6 HISTORY The practice of medicine was changing rapidly in the century prior to Flexner's assessment of medical education. 5 Advances in scientific knowledge -such as the understanding of bacteria as agents of disease, the development of clinical pathology, and the resulting adoption of aseptic surgical technique -led to an improved ability of physicians to diagnose and treat disease with a resulting shift away from the practice of empiricism. ...
... 5,6 HISTORY The practice of medicine was changing rapidly in the century prior to Flexner's assessment of medical education. 5 Advances in scientific knowledge -such as the understanding of bacteria as agents of disease, the development of clinical pathology, and the resulting adoption of aseptic surgical technique -led to an improved ability of physicians to diagnose and treat disease with a resulting shift away from the practice of empiricism. 5 Medical education, in the wake of this scientific revolution, likewise shifted from individual apprenticeships to schools of medicine. ...
... 5 Advances in scientific knowledge -such as the understanding of bacteria as agents of disease, the development of clinical pathology, and the resulting adoption of aseptic surgical technique -led to an improved ability of physicians to diagnose and treat disease with a resulting shift away from the practice of empiricism. 5 Medical education, in the wake of this scientific revolution, likewise shifted from individual apprenticeships to schools of medicine. 6 Formal medical education began with lectures in anatomy and physiology, designed to supplement the learning of physician's apprentices, but soon grew to replace experiential learning with "didactic lectures given in huge, badly lighted amphitheaters." ...
Abraham Flexner’s 1910 report on medical education in the United States and Canada propelled medical training forward into a contemporary renaissance. The report heralded many seismic changes that still resonate within medical and health professions education throughout the US. Today several factors are accelerating curricular reform within pharmacy education, including but not limited to accreditation standards, technologic advances, and student diversity. Despite the fact that Flexner’s
report is now over a century old, many of his observations and recommendations regarding education are as pertinent and timely today as they were in 1910. This commentary will discuss and reflect upon curricular reform in pharmacy education as it contrasts with some of the observations, findings, and recommendations of Flexner’s 1910 report.
... America consisted of a great variety of curricula among medical schools, with the existence of small proprietary schools founded by a few doctors on a for-profit basis with no higher academic affiliation and low entry standards in which students were awarded medical degrees after a few months of didactic lectures not requiring anatomical dissections, laboratory, or clinical work [5]. In 1900, 10 years prior to the Flexner report, a total of 151 medical schools existed in the USA, graduating over 25,000 medical doctors annually [6]. The curriculum and structure of medical education at the time was known as Brepititional.^Students were taught the same lecture-based content every year for up to 3 years [6]. ...
... In 1900, 10 years prior to the Flexner report, a total of 151 medical schools existed in the USA, graduating over 25,000 medical doctors annually [6]. The curriculum and structure of medical education at the time was known as Brepititional.^Students were taught the same lecture-based content every year for up to 3 years [6]. By 1900, most schools adopted the Bgraded^curriculum that spanned over 4 years with different subjects being taught each year [6]. ...
... The curriculum and structure of medical education at the time was known as Brepititional.^Students were taught the same lecture-based content every year for up to 3 years [6]. By 1900, most schools adopted the Bgraded^curriculum that spanned over 4 years with different subjects being taught each year [6]. Abraham Flexner, a teacher and the author of BMedical Education in the USA and Canada,^recognized the shortcomings of medical education in North America and the superiority of medical education in Europe. ...
Medicine is a field that has evolved through the ages and continues to do so with the advancement of basic, clinical, and technological sciences. Accordingly, the roles and requirements of the medical doctor have also been subject to evolution. It is basically based on the need to develop effective and adaptable graduates that can tackle new problems as they arise in an ever-changing environment, which shifted the emphasis of medical education to the acquirement of generic skills, competency-based learning, and recognition for an increasing level of student autonomy. Medical education and its tools, the foundation upon which physicians base their competence in practice, have as a result, had to adapt to meet the ever growing demands of the profession. This review aims at (a) identifying teaching tools such as lecture-based learning, case-based learning, problem-based learning, team-based learning, flipped classrooms, and blended learning and (b) bringing to attention their development, purpose and how they compare in medical education in North America through time.
... 3 However, rapid developments in the clinical sciences, which have led to better care of patients, are threatening the concept of instruction in the traditional basic sciences and leading to downsizing, and even downgrading, of the basic sciences. [4][5][6] In the early 1900s, the Flexner report led to major reforms in medical education in the USA. A number of medical schools closed and their number came down from 457 to 85 in the next decade. ...
... This debate aside, all studies agree that the basic sciences provide critical knowledge for medical education. 3,6,13 Hence, in the present scenario, the way the basic sciences are being taught is a matter of concern. However, it might not be premature to say that the time is ripe to review the changing trends in the teaching of the basic sciences. ...
... These fragments tend to lose their relevance and are not reinforced in the clinical years. 6,14 Are these subjects not basic sciences that are required for an understanding of the clinical sciences? We must take another look at these sciences and define which are the basic sciences that are relevant to clinical teaching and regional needs. ...
A number of medical schools throughout the world have tried to downsize the basic sciences, but studies have shown that teaching of basic sciences is of importance for the clinical years that lie ahead. While some students endorse this finding, others want instruction in these sciences to be limited in terms of content and time. With the increasing cost of medical education and healthcare, medical schools the world over are trying to contain expenditure on the teaching of the basic sciences. In India, too, instruction in these sciences has been curtailed. This trend may need to be reviewed and the new challenges in this area must be addressed.
... It advocated minimum admission standards for an undergraduate medical school establishment (two years of college/ university science education after a high school). The four years' duration medical course comprised of two years each of basic sciences and clinical training through problem based, student-centered instruction by full-time regular teachers.This transformed medical education in America and Canada into a scientific training rather than apprenticeship employing full-time academic staff(11,51,86) and hospitals training by academic staff.(87) Canadian medical education adopted Flexner report recommendations as well.(11,51,86) ...
... The four years' duration medical course comprised of two years each of basic sciences and clinical training through problem based, student-centered instruction by full-time regular teachers.This transformed medical education in America and Canada into a scientific training rather than apprenticeship employing full-time academic staff(11,51,86) and hospitals training by academic staff.(87) Canadian medical education adopted Flexner report recommendations as well.(11,51,86) A large number of substandard schools were closed. ...
Background: Medical education in Pakistan has evolved from a very unpretentious status to the present position. Only a patchy log is available with any authenticity. The recorded evidences dispersed in various sources, including occasional subjective scripts provide insufficient mechanistic explanations. No comprehensive systematic and authentic research has been available on evolution of Medical Education in Pakistan to date. Interviewing a few living key informants, a firsthand research based narration may explain the events of evolution of medical education in Pakistan.
Aim: To explore the experiential narrations and explanations of Key Informants regarding evolutionary process of medical education since inception of Pakistan.
Methods: The qualitative, case study based on audio recorded key informant’s in-depth interviews, with triangulation where possible, was conducted. Most of the key informants (KIs) were presently, or in the past, remained on such key post to have information and understanding of the subject under study. Majority had under gone training of medical education through valid workshops. Data collected were analyzed through a process that included transcription and condensation. Thematic analysis followed the codification, categorization, patterns development and themes generation.
Results: All KIs agreed that King Edward Medical College (KEMC) was the only MBBS training institution at inception of Pakistan, followed by Dow Medical College (DMC) and then others. Pre-partition era legacy educational program was and is being followed by and large. The medical education has never remained a priority in the government policy. The establishment of first medical education department at undergraduate level was not concurred by KIs. However, the College of Physicians and Surgeons Pakistan (CPSP) Department of Medical Education (DME) is agreed to be the first at postgraduate level. Initiatives and training of the trainers in Pakistan by the WHO did not lag behind that of other countries. In spite of training of many senior faculty with wider expectation of dissemination, it did not materialize.
Conclusion: The evolution of medical education cannot be seen in isolation from prevailing conditions of culture, society and state.
Key words: Education, medical; Education, medical, graduate; Education, medical, undergraduate; Education, medical, continuing; Education, Professional; Faculty, medical; Teaching education; Education reform; Educational leadership; Qualitative research.
... His 1910 scathing critique outlined recommendations for medical schools to enact higher standards. These included robust entrance requirements, better resource utilization, enhanced instructional delivery, and patient-centered care [2][3][4]. ...
... Flexner's self-described "unfettered lay mind" and focus on teaching allowed him to say what other reformers could or would not [2,9]. But his was not a lay mind. ...
... The majority felt that one year was insufficient to grasp basic sciences and advocated for a higher student-teacher ratio. Historical consensus, since Flexner's time, suggests at least a two-year foundational period in basic sciences for competent clinical practice [51,52]. Students often overlook the significance of basic sciences during their early medical years, only to realize their importance later. ...
... The majority felt that one year was insufficient to grasp basic sciences and advocated for a higher student-teacher ratio. Historical consensus, since Flexner's time, suggests at least a two-year foundational period in basic sciences for competent clinical practice [51,52]. Students often overlook the significance of basic sciences during their early medical years, only to realize their importance later. ...
Introduction. Since the early 20th century, medical education has evolved, notably with the Flexner report emphasizing the fusion of foundational sciences and clinical reasoning. As the field grew, educators adeptly incorporated new sciences and technologies, ensuring curriculum balance and depth. Aim. This research aimed to explore the role of basic sciences in contemporary medical education, focusing on their integration with clinical practice. Methods. An institutional-based cross-sectional study design was implemented at Umm Al Qura University, College of Medicine, Makkah, Saudi Arabia, from March to June 2023. This study involved surveying 470 medical students, from a total campus population of 1,360 students (excluding preparatory year), using a pre-tested and structured self-administered questionnaire. All questions in the survey were formatted to elicit dichotomous responses, namely “yes” or “no”, and the collected data were analyzed using SPSS version 20. Results. The study discovered that while a high percentage of medical students (96.6% in earlier years to 94% in senior years) recognized the importance of basic sciences in the MBBS curriculum, there was a noticeable decline in this belief as students advanced through their clinical years. Similarly, the perception of the utility of foundational knowledge of basic sciences for understanding clinical subjects decreased slightly from 93% in earlier years to 85% in senior years. About 92.7% of students across all years believed a strong understanding of basic sciences was crucial for clinical proficiency. However, the perceived benefit of suggested readings/textbooks declined from 82% in earlier years to 77% in senior years. Feedback on curriculum enhancements showed robust support for more engaging teaching methods, with over 90% favoring the incorporation of multimedia tools and group-based sessions. Conclusions. Our findings underscore the foundational role of basic sciences in medical education for clinical competency, highlighting a gradual shift in student perceptions as they progress through their training. This shift signals the necessity for adaptive teaching strategies that effectively integrate basic sciences with clinical practice to maintain relevance and efficacy in medical curricula.
... The most revolutionary change to the system occurred in 1910 as a result of the Flexner research [1] which reorganised the North American and Canadian medical education system. The report included a brief summary of the deficiencies in medical education at that time, which were as follows: insufficient pre-medical education, which prevented students from understanding scientific principles; an excessive amount of didactic work done by the teachers; a dearth of student clinical work; a dearth of tests of practical work; and an insufficient amount of time spent working and studying [2]. More than a century has passed since the Flexner report from 1910 criticised the overall standard of medical education. ...
The modern medical education system has gradually evolved starting from 1910 incorporating the suggestions by Abraham Flexner, his public disclosure of the poor conditions at many medical schools provided a means to galvanize all the constituencies needed for reform to occur. He could say what other reformers could not, due to their links to the medical education community. But now we are again going back to a pre-Flexnerian state due to multiple reasons such as gradually diminishing importance of basic science subjects for the students, the decline in the number and quality of investigator initiated research among clinical researchers, lesser emphasis to bedside training by means of detailed clinical examination and making appropriate observation of signs to reach to a diagnosis rather than over reliance on the laboratory tests and radiological modalities for the diagnosis, poor exposure to basic clinical skills starting from college throughout residency and the trend of disrespect and absenteeism from both theoretical and clinical/practical classes. The attitude of students is just to complete their required attendance so that they are not barred from appearing in examinations. This de-Flexnerization trend and regression to pre-Flexnerian era standards, ideologies, structures, processes, and attitudes, are bound to beget pre-Flexnerian outcomes, for you get what you designed for.
... The parties initially involved also included allies of the AMA such as the American Academy of Medicine and the Association of American Medical Colleges (AAMC). A few years after this meeting, modern undergraduate medical education in the United States as we know it today gained footing in 1910 after Abraham Flexner released his scathing report on schooling quality across the nation [2]. A few decades later, the Liaison Committee on Medical Education (LCME) was founded at a 1942 meeting between leaders of the AAMC and the AMA [3]. ...
In the United States, medical schools are accredited by either the Liaison on Committee Medical Education (LCME) or the Commission on Osteopathic College Accreditation (COCA), which assesses the quality and standards of Doctor of Medicine (MD)-granting and Doctor of Osteopathic Medicine (DO)-granting institutions, respectively. Thereafter, new MD and DO physicians complete graduate medical education (GME) training. Historically, the two physician licensure pathways have been predominantly separate, but in 2020, the Accreditation Council for Graduate Medical Education and American Osteopathic Association finalized a single accreditation GME system. Now, other elements of MD and DO physician training that have traditionally remained separate, such as undergraduate medical education (UME), are increasingly being scrutinized. Since 2010, when the accreditation of UME was last qualitatively criticized, the standards and competencies set forth by LCME and COCA have converged. COCA, in particular, has updated its requirements to emphasize scholarly activity, improve inpatient clinical rotation requirements, engage medical students, and enhance clinical faculty qualifications. Such convergence brings to question the continuing need for two independent accreditation pathways and barriers that may prevent a single accreditation. We argue that although MD and DO physicians are unique, the natural confluence of UME accreditation represents an opportunity to simplify and improve physician training in the United States. Our analysis suggests the major barriers to implementing a single accreditation system surround the requirement of Osteopathic Manipulative Medicine (OMM)-focused faculty by COCA and the two separate licensing exams (USMLE (United States Medical Licensing Examination) and COMLEX (Comprehensive Osteopathic Medical Licensing Examination)). However, with a continuing decline in osteopathic physicians practicing OMM and growing debate over a new single licensing exam, a single accreditation UME system may be practically achieved.
... They are also not exclusive to those who teach anatomy or basic medical sciences, but all aspects of medical and allied health science. This reality becomes much more appreciated when considered in line with the significant evolution in medical education and training, globally and the need to have effective and dynamic educators, educational leaders, and mentors for trainees [22] [23] [24] [25] [26]. The implication of the current scenario or situation therefore will include that, a significant proportion of course time and resource allocation should also emphasize the training of anatomist as educators since the curricular philosophy specifically emphasizes this as a core competency based on their expected roles in the educational industry upon graduation. ...
Anatomy, a foremost basic medical science (BMS) has evolved in content and context, while remaining the most fundamental BMS subject. Stakeholders have continually made efforts especially in recent time to achieve an evolution of this subject. The primary aim of this work was to study the perceptions and experiences of Anatomists towards contributing to programme and career advancements. Following ethical approval, structured questionnaire was administered to Nigerian anatomists using a Google form. It is a total population study. The questionnaire had 13 sections, with each section addressing a theme that was integral to the subject of research interest. The last section collected free responses as qualitative information. After indicating informed consent, 106 anatomists properly completed and returned the questionnaires. Statistical and quantitative analyses of results were done. The most popular field amongst respondents was Neuroscience (60.9%); followed by Histology or Microscopic Anatomy (53.6%), Embryology or developmental anatomy (35.5%), Gross anatomy (34.5%) and Histochemistry (30.9%). About half of Nigerian anatomists involved in the study had a PhD degree. Training emphasized the cognitive domains the most. Consequently, emphasis should be laid on the psychomotor (skills) and the affective domain (attitude) to improve capacity, competences, and the job prospects of trainees. The consensus was that the programme trained students and prepared graduates as medical educators, scientists, and researchers. Anatomy has significant potential to contribute to development with proper programme design, emphasis on re-How to cite this paper: Owolabi, J. Health search, teaching and applied services competencies, effective policy formulation and implementation and adherence to best practices.
... [25][26][27][28] Flexner advocated establishing more stringent admission criteria, requiring basic science studies prior to clinical medical education, centralising medical education to university hospitals, and instituting full-time teachers grounded in the basic sciences at medical schools. 23 [25][26][27][28][29] In short, his credo at the time reads as direct opposite of the current movement towards teaching in DLE today. 3 5 18 30 Flexner's ideas of a scientific base and bedside teaching were deemed universally applicable and shaped ideas on the quality of teaching for a global medical curriculum. ...
Health systems need medical professionals who can and will work in outpatient settings, such as general practitioner practices or health centres. However, medical students complete only a small portion of their medical training there. Furthermore, this type of training is sometimes seen as inferior to training in academic medical centres and university hospitals. Hence, the healthcare system’s demand and the execution of medical curricula do not match. Robust concepts for better alignment of both these parts are lacking. This study aims to (1) describe decentral learning environments in the context of traditional medical curricula and (2) derive ideas for implementing such scenarios further in existing curricula in response to particular medicosocietal needs.
This study is designed as qualitative cross-national comparative education research. It comprises three steps: first, two author teams consisting of course managers from Brazil and Germany write a report on change management efforts in their respective faculty. Both teams then compare and comment on the other’s report. Emerging similarities and discrepancies are categorised. Third, a cross-national analysis is conducted on the category system.
Stakeholders of medical education (medical students, teaching faculty, teachers in decentral learning environments) have differing standards, ideals and goals that are influenced by their own socialisation—prominently, Flexner’s view of university hospital training as optimal training. We reiterate that both central and decentral learning environments provide meaningful complementary learning opportunities. Medical students must be prepared to navigate social aspects of learning and accept responsibility for communities. They are uniquely positioned to serve as visionaries and university ambassadors to communities. As such, they can bridge the gap between university hospitals and decentral learning environments.
... 5 This brief list omitted several of the panel's other salient findings, such as AMA support for the Flexner Report as part of a broader education reform movement that contributed to the closure of all but 2 historically Black medical schools. 6,7,8 In addition, as our reports were limited to the mistreatment of Black physicians, we did not describe the AMA's support for other racist policies, such as the Chinese Exclusion Act 9 or eugenic policies. 10 Nevertheless, reflecting back on the research that we and our colleagues in the Writing Group carried out, we now believe that the deeper point we unearthed was that the AMA played a key role in establishing and encouraging foundationally racist structures for organized medicine, even while sometimes arguing against interpersonal racism. ...
This article reassesses and recontextualizes findings of an independent writing group commissioned in 2005 by what was then known as the Institute for Ethics of the American Medical Association (AMA). The authors were members of this group, which uncovered a paradigm case of structural racism that has perpetuated health inequity since the issue of admitting African Americans was first raised at the AMA's national meetings immediately after the Civil War ended, in 1868. Upon publication of the writing group's findings, the AMA publicly apologized for its social, cultural, and political roles in the racist history of organized medicine. Now, in 2021, the authors of this article seek to situate this aspect of the AMA's history as it prepares itself for antiracist leadership in the health care sector.
... His report strongly demanded, appropriate knowledge and skills application to avoid compromised patient care, as the most important characteristic required for ailing humanity and this also includes oral/ dental health care. 1 The current Dental Education Pakistan (DEP) also needs Flexner related academic efforts to attain excellence & "globalization" to be at par with international standards. In this regard for a national cause, we hope to continue contributing the same. ...
Abrahim Flexner, considered “Father of Modernday Medical Education” about a century ago revolutionized entire Health Education & Service Structure bypublishing his shivering report based on standards, resulted in closure of compromised academic institutes and transformed the entire USA/Canadian Health Sector, including Dentistry. His report strongly demanded, appropriate knowledge and skills application to avoid compromised patient care, as the most important aspect required for ailing humanity and this also includes oral/ dental health care. We feel that the current Dental Education Pakistan (DEP) also needs similarreports to attain excellence & “globalization” to be at par with international standards.
... The discovery of specific bacteria causing common diseases lead to the utilization of microscopes as common clinical practice. 3 In 1907, JAMA estimated that adequate medical education would now require two to three times the current tuition paid by medical students. 2 Given this call to reform, the Council on Medical Education (CME) was established under the American Medical Association to evaluate all medical schools to determine whether they were able to meet this new standard. ...
... The origins and importance of the physicianscientist date back more than 100 years ago to Abraham Flexner. The Flexner report called for radical changes, such that the physician should have rigorous scientific training [35,36]. Surgeon-scientists are pivotal to future health care translation, defined by the 21st Century Cures Act [37] by the U.S. House of Representatives to bring health care discoveries to patients. ...
Introduction
Neurosurgeons represent 0.5% of all physicians and currently face a high burden of disease. Physician-scientists are essential to advance the mission of National Academies of Science (NAS) and National Institutes of Health (NIH) through discovery and bench to bedside translation. We investigated trends in NIH neurosurgeon-scientist funding over time as an indicator of physician-scientist workforce training.
Methods
We used NIH Research Portfolio Online Reporting Tools (RePORTER) to extract grants to neurosurgery departments and neurosurgeons from 1993 to 2017. Manual extraction of each individual grant awardee was conducted.
Results
After adjusting for U.S. inflation (base year: 1993), NIH funding to neurosurgery departments increased yearly (P < 0.00001). However, neurosurgeon-scientists received significantly less NIH funding compared to scientists (including basic scientists and research only neurosurgeons) (P = 0.09). The ratio of neurosurgeon-scientists to scientists receiving grants was significantly reduced (P = 0.002). Interestingly, the percentage of oncology-related neurosurgery grants significantly increased throughout the study period (P = 0.002). The average number of grants per neurosurgeon-scientists showed an upward trend (P < 0.001); however, the average number of grants for early-career neurosurgeon-scientists, showed a significant downward trend (P = 0.05).
Conclusion
Over the past 23 years, despite the overall increasing trends in the number of NIH grants awarded to neurosurgery departments overall, the proportion of neurosurgeon-scientists that were awarded NIH grants compared to scientists demonstrates a declining trend. This observed shift is disproportionate in the number of NIH grants awarded to senior level compared to early-career neurosurgeon-scientists, with more funding allocated towards neurosurgical-oncology-related grants.
... On one hand Flexner has been lauded for the enormous contribution in bringing medical education into the twentieth Century progressive education movement [2], and on the other hand, arguments are made that the Flexner Report led to an individualistic, expert-centric culture which may now work against the collaboration needed in modern health-care [3]. The debate has led to discussion and speculation about what is required of medical education to produce doctors equipped to practice effectively over the next century [4][5][6][7][8][9]. ...
Background
Medical education should ensure graduates are equipped for practice in modern health-care systems. Practicing effectively in complex health-care systems requires contemporary attributes and competencies, complementing core clinical competencies. These need to be made overt and opportunities to develop and practice them provided. This study explicates these attributes and generic competencies using Group Concept Mapping, aiming to inform pre-vocational medical education curriculum development.
Methods
Group Concept Mapping is a mixed methods consensus building methodology whereby ideas are generated using qualitative techniques, sorted and grouped using hierarchical cluster analysis, and rated to provide further quantitative confirmation of value. Health service providers from varied disciplines (including medicine, nursing, allied health), health profession educators, health managers, and service users contributed to the conceptual model’s development. They responded to the prompt ‘An attribute or non-clinical competency required of doctors for effective practice in modern health-care systems is...’ and grouped the synthesized responses according to similarity. Data were subjected to hierarchical cluster analysis. Junior doctors rated competencies according to importance to their practice and preparedness at graduation.
Results
Sixty-seven contributors generated 338 responses which were synthesised into 60 statements. Hierarchical cluster analysis resulted in a conceptual map of seven clusters representing: value-led professionalism; attributes for self-awareness and reflective practice; cognitive capability; active engagement; communication to build and manage relationships; patient-centredness and advocacy; and systems awareness, thinking and contribution. Logic model transformation identified three overarching meta-competencies: leadership and systems thinking; learning and cognitive processes; and interpersonal capability. Ratings indicated that junior doctors believe system-related competencies are less important than other competencies, and they feel less prepared to carry them out.
Conclusion
The domains that have been identified highlight the competencies necessary for effective practice for those who work within and use health-care systems. Three overarching domains relate to leadership in systems, learning, and interpersonal competencies. The model is a useful adjunct to broader competencies frameworks because of the focus on generic competencies that are crucial in modern complex adaptive health-care systems. Explicating these will allow future investigation into those that are currently well achieved, and those which are lacking, in differing contexts.
... Moreover, the "2+2 model" of medical education (two years of classroom instructions in the basic and clinical sciences, followed by two years of clinical rotations) he recommends, becomes the standard across the nation, even to this day. Although the report is subsequently criticized as being overrated or misunderstood (Berliner 1975, Ludmerer 2010, the medical profession continues to pay homage to its impact (Barzansky 2010, Burch 2011. Finally, the Flexner report paves the way for the scientification of medicine and its practice, especially in terms of the rise of the biomedical model during the twentieth century (Duffy 2011, Finnerty et al. 2010. ...
... On one hand Flexner has been lauded for the enormous contribution in bringing medical education into the 20th Century progressive education movement [2], and on the other hand, arguments are made that the Flexner Report led to an individualistic, expert-centric culture which may now work against the collaboration needed in modern health-care [3]. The debate has led to discussion and speculation about what is required of medical education to produce doctors equipped to practice effectively over the next century [4,5,6,7,8,9]. ...
Background: Health professionals’ education should ensure graduates are equipped for practice in modern health-care systems. One hundred years after the Flexner Report on medical education, transformation in health-care systems has warranted reflection on priorities for medical education. Practicing effectively in modern health-care systems requires contemporary attributes and competencies, complimenting core clinical competencies. These need to be made overt and opportunities to develop and practice them provided. This study explicates these attributes and generic competencies using Group Concept Mapping methodology, with the aim of informing curriculum development in pre-vocational medical education.
Methods: Group Concept Mapping consists of four phases: 1) Idea generation, review and synthesis; 2) Sorting and rating 3) Analysis of data using quantitative and qualitative techniques to produce a visual concept map; and 4) Confirmation and interpretation of results using logic model transformation. Multiple stakeholders contributed to the development of the conceptual model, including junior doctors who rated competencies according to importance to their practice and preparedness at graduation.
Results: Sixty-seven participants from stakeholder groups generated 338 responses to the prompt: ‘An attribute or non-clinical competency required of doctors for effective practice in modern health-care systems is...’ These responses were synthesised into 60 statements which were sorted by participants into groupings according to similarity. Multi-dimensional scaling and hierarchical cluster analysis led to a conceptual map of seven clusters representing: Value-led professionalism; Attributes for self-awareness and reflective practice; Cognitive capability; Active engagement; Communication to build and manage relationships; Patient-centredness and advocacy; and Systems awareness, thinking and contribution. Logic model transformation identified three overarching meta-competencies: Leadership and systems thinking; Learning and cognitive processes; and Interpersonal capability. Ratings indicated that junior doctors believe system-related competencies are less important than other competencies, and they feel less prepared to carry them out.
Conclusion: Group Concept Mapping was used to conceptualise the attributes and generic competencies required for effective practice modern health-care systems. The operationalization of the model through logic model transformation further identifies the links between attributes, their application through competency, and the outputs that they lead to. Rating of items can identify priorities for ensuring a medical education which addresses contemporary health-care needs.
... 1 . Influenciado por sus estudios en Alemania, Flexner identificó el currículum de la escuela de Medicina de The Johns Hopkins University como el estándar contra el cual comparó todas las escuelas visitadas. ...
For more than a century the training of medical professionals has been organized according to the Flexnerian model, which comprises three cycles: basic, clinical and clerkship. On the other hand, the accelerated development of biomedical sciences modified the competences of the first cycle. Additionally, new skills required for medical practice, such as teamwork and innovation as a tool to solve health problems, challenged in recent years the classic paradigm of medical education. Therefore, the medical schools have developed multiple strategies to deal with it, such as curricular integration using competency-based education models, incorporating basic and clinical sciences in parallel during the curriculum, ensuring a relevant and applicable scientific knowledge throughout the training process. Although in Chile the Flexner prototype is still followed, the basic sciences are taught as single or integrated courses or using a systems approach. In this article we report a diagnosis about the local integration of fundamental sciences in medical training. We also compare our schools with those of Canada, Europe and Latin America. Recommendations aimed at modernizing medical school curricula are made.
... 1 . Influenciado por sus estudios en Alemania, Flexner identificó el currículum de la escuela de Medicina de The Johns Hopkins University como el estándar contra el cual comparó todas las escuelas visitadas. ...
For more than a century the training of medical professionals has been organized according to the Flexnerian model, which comprises three cycles: basic, clinical and clerkship. On the other hand, the accelerated development of biomedical sciences modified the competences of the first cycle. Additionally, new skills required for medical practice, such as teamwork and innovation as a tool to solve health problems, challenged in recent years the classic paradigm of medical education. Therefore, the medical schools have developed multiple strategies to deal with it, such as curricular integration using competency-based education models, incorporating basic and clinical sciences in parallel during the curriculum, ensuring a relevant and applicable scientific knowledge throughout the training process. Although in Chile the Flexner prototype is still followed, the basic sciences are taught as single or integrated courses or using a systems approach. In this article we report a diagnosis about the local integration of fundamental sciences in medical training. We also compare our schools with those of Canada, Europe and Latin America. Recommendations aimed at modernizing medical school curricula are made.
... In the US medical education did not originate in universities, nor was it regulated by professional guilds, and training varied widely. 1 It was not until the early 1900s with the concerted efforts resulting from the Flexner report and a number of governing associations, that requirements for medical education were developed and education evolved to resemble something more consistent with what we see today. 2 As education has continued to evolve, so has the certification process for cardiothoracic surgery. The oral board examination for many trainees is the most challenging and intimidating part of the certification process. ...
... Over the last few decades, medical curricula in most countries have aimed to integrate basic science into medical education, a need first foreseen by Abraham Flexner and, publicized as Flexner report. The Flexner report advocated the notion that formal analytic reasoning, the kind of rational thinking fundamental to the basic sciences especially the natural sciences, should hold precedence in the intellectual training of physicians [1,2]. Succeeding the publication of Flexner report medical curricula in most countries especially in Europe, UK and North America, have evolved from a "science based" to a more "system based" approach, where the primary focus is on the development of core competencies beyond the command of knowledge and facts. ...
... When, in the late 19th century, the AMA and AAMC began developing standards and conducting site inspections, the United States had as many medical schools as in the rest of the world combined 17 -and graduated twice the number of physicians needed to care for its population. 18 Although half of the medical schools in the United States closed between 1900 and 1920, 19 the physician workforce was still sufficient to meet clinical and educational needs and to manage medical school quality improvement. Accreditation in the United States matured gradually over decades as the nation's wealth grew. ...
In 2010, the Educational Commission for Foreign Medical Graduates (ECFMG, Philadelphia, Pennsylvania) announced that, beginning in 2023, graduation from a formally accredited medical school would be necessary for an international medical graduate (IMG) to be eligible for ECFMG certification. The announcement is notable since ECFMG certification is required for graduate medical training and practice in the United States. Graduating from a school accredited by an agency formally recognized by the World Federation for Medical Education (WFME), which has been formally evaluating and recognizing accrediting agencies since 2012, would fulfill the new ECFMG requirement. In 2015, ECFMG applicants came from 1,141 medical schools located in 139 countries or territories. As of December 2018, the WFME had formally recognized 14 accrediting agencies, which would cover only approximately a third of these recent ECFMG-certified IMGs. In this Perspective, the author compares the context of the original ECFMG announcement to the beginning of accreditation in the United States so as to provide insight into the challenges the WFME faces as it seeks to evaluate and recognize what could ultimately be over 100 more accrediting authorities. The author then explores the possible effects of the requirement-specifically its potential to restrict the ECFMG applicant pool-on the quantity and quality of the U.S. physician workforce. The author ends the Perspective by considering the implications of three broad policy options that the ECFMG could consider starting in 2023: implementation as announced, maintenance of the status quo, or a policy modified from the original announcement.
... The parallels to training in health service psychology just a little more than 100 years later are striking. The Flexner report had major repercussions and led to the closing of numerous institutions and a significant increase in the rigor and quality of medical education (Barzansky, 2010;Riggs, 2010). It is our hope that the articles contained within this series (Callahan & Watkins, 2018a, 2018b, 2018c, 2018d may be a small step toward a much-needed conversation on how to improve the quality, rigor, and training practices of health service psychology in the 21st century. ...
Articles in this series (Callahan & Watkins, 2018a, 2018b, 2018c, 2018d) elucidate a concerning lack of research on training in the field of health service psychology. There are many factors that impact the scant evidence available, including aspects of training programs themselves, aspects of our current funding climate, the structure and influence of universities, a lack of diversity in graduate students and faculty, and the flexibility (or the perception of a lack thereof) inherent in the practice of psychology and the accrediting bodies that influence our training. There are numerous ways to improve our evidence base for training, especially those related to supporting and growing the number of researchers engaged in this area of study. Some external factors outside individual program control will likely limit the speed with which improvements can be made, but a great deal can be done within our programs to make significant changes that have the potential to influence both training and client outcomes.
... T he traditional approach to medical education has been dichotomous, with a lack of integration between basic sciences and clinical medicine (1). Recent reforms have called for individualizing the learning process, integrating knowledge with practice, and cultivating a spirit of lifelong learning (2). Vertical integration breaks the traditional division between clinical and pre-clinical sciences, resulting in better understanding and application of concepts (3). ...
... -The challenges in the training of health professionals. The health professionals training model is still based on the Flexner model, a model designed and implemented in 1910 to address the health problems of North American society and subsequently exported and adapted to the rest of the Western world [47]. Certainly, this is the origin and greatest ally of the current biomedical-healing model in all MICs. ...
Background:
Despite more than 20 years of reform projects in health systems, the universal coverage strategy has not reached the expected results in most middle-income countries (MICs). Using evidence from the Mexican case on diabetes and hypertension as tracers of non-communicable diseases, the effective coverage rate barely surpasses half of the expected goals necessary to meet the challenges that these two diseases represent at the population level. Prevalence and incidence rates do not diminish either; they even grow. In terms of the economic burden, this means that lack of financial protection and catastrophic expense rates have increased, contrary to what could have been expected.
Discussion:
As any complex system, health systems present challenges and dilemmas that are difficult to solve. In terms of universal coverage, when contrasting normative coverage versus effective coverage, the epidemiological, cultural, organizational and economic challenges and barriers become evident. Such challenges have not allowed a greater effectiveness of the contributions of state of the art medicine in the resolution of health problems, particularly in relation to diabetes and hypertension.
Conclusions:
Despite of the existence of many universal coverage projects, strategies and programs implemented in MICs, challenges remain and, far from disappearing, unresolved problems are still present, even with increasing trends. The model of care based on a curative biomedical approach was enough to respond to the health needs of the last century, but is no longer adapted to the needs of the present century. The dilemmas of continuity vs. rupture require to review and discuss the background and structure of health systems and their underlying models of care. These two elements have not allowed the different coverage schemes to guarantee greater effectiveness in the application of state of the art medicine, nor a greater health care financial protection for patients and their families. We thus can either accept the fragmented health systems and bio-medical-curative models of care approach or, instead, we can move towards integrated health systems that would be based on a socio-medical-preventive approach to health care.
... Which schools closed as a result of the Flexner report? Within 10 years of the report's publication, 48 of the 133 schools Flexner visited were shuttered, all having been recommended for closure because they lacked the finances for improvements in areas such as laboratories and facilities, quality of professors, and prerequisite medical training [6]. Not coincidentally, many of these schools were small, were unaffiliated with universities, and served the urban or rural poor [7][8][9]. ...
... Restructuring of undergraduate medical education (UGME) has occurred from time to time over the past century. Many influences, including the persuasive report of Abraham Flexner in 1910, acted to reorganize medical education in the early twentieth century [1,2]. In his report, Flexner called on American medical schools to enact higher graduation standards and to stringently adhere to the protocols of mainstream science in their teaching. ...
Restructuring of undergraduate medical education (UGME) has occurred from time to time over the past century. Many influences, including the persuasive report of Abraham Flexner in 1910, acted to reorganize medical education in the early twentieth century [1, 2]. In his report, Flexner called on American medical schools to enact higher graduation standards and to stringently adhere to the protocols of mainstream science in their teaching. Prior to this report, UGME had changed little over the previous century but over the last several decades, reform within medical education has become routine. This increasing rate of change has been challenging for those within the realm of undergraduate medical education and can be frustrating to those outside this sphere. Today, the Association of American Medical Colleges (AAMC) and Liaison Committee on Medical Education (LCME) are typically the driving forces behind such changes, along with acceleration of advances in medical care and technology. The number of changes in the last decade is significant and warrants review by those interested or involved in education of medical students. This article aims to provide a summary of recent changes within UGME. Within the article, changes in both the pre-clerkship (1st and 2nd years) and clinical years (3rd and 4th) will be discussed. Finally, this review will attempt to clarify new terminology and concepts such as the recently released Core Entrustable Professional Activities (EPAs). The goal of these UGME changes, as with Flexner's reform, is to ensure future physicians are better prepared for patient care.
... Shelton, Kyle, and Corral start this special section discussing advancements in undergraduate medical education, elaborating on changes that have taken place in order to meet the challenges of an evolving world of medical education. They discuss impact of Flexner's report [1,2] on American medical schools' enactment of higher graduation standards and on their adherence to the protocols of mainstream science in their teaching. They further discuss the roles of Association of American Medical Colleges (AAMC) and Liaison Committee on Medical Education (LCME) as the driving forces behind such changes, along with acceleration of advances in medical care and technology. ...
This special section of the journal focuses on the expanding horizons, challenges, and opportunities for the psychiatric educators. In the six papers that comprise this special section, the authors have covered a broad range of topics in both undergraduate medical education and graduate medical education including topics such as accreditation, technology, how providers can locate education resources, how trainees are taught about professionalism in the digital age, telepsychiatry, manualized psychotherapy treatments, and cultural competence. We hope that psychiatric educators, and others interested in this field, will find these papers helpful.
... It is more than a century since Flexner published his report "Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching" [1] that reformed medical education in the United States, which Committed Medical Education to the German Tradition of Strong Biomedical Sciences followed by hands-on clinical training Medical education has since evolved with many innovations introduced since then, which prompted the Carnegie Foundation for the Advancement of Teaching to Commission another report that was published in 2010 Two key recommendations from the report were "to integrate formal knowledge with clinical experience" and "to imbue habits of inquiry and improvement to achieve lifelong learning and excellence" [2] Vertical integration as defined so clearly by Bradley and Mattick as a "…combination of basic and clinical sciences in such a way that the traditional divide between preclinical and clinical studies is broken down" [3] Integration of basic sciences with clinical medicine during the initial years of medical undergraduate education is being done in many institutions with the advent of medical education reforms [4] Clinicians often allude to basic sciences to improve student's understanding of a patient's clinical presentation and correlate it to the pathophysiology and anatomical localization of disease; however, the benefit of detailed basic science learning of the preclinical years of a medical student is not optimally utilized to better understanding, synthesis, and analysis of a patient's problem A refresher class of basic sciences which is completely contextual would benefit and achieve this purpose. Formal vertical integration during the final year is not currently practiced routinely probably due to the pressure of time which clinicians constantly face [5] Vertical integration during the final year of an undergraduate curriculum can enable a deep understanding of the biological mechanisms and result in better synthesis and application of knowledge gained through the years in medical school This study was planned to evaluate the benefit and acceptance of vertical integration in the final year of medical training from the students and the teachers' perspective ...
Background:
Development of health professionals with ability to integrate, synthesize, and apply knowledge gained through medical college is greatly hampered by the system of delivery that is compartmentalized and piecemeal. There is a need to integrate basic sciences with clinical teaching to enable application in clinical care.
Aim:
To study the benefit and acceptance of vertical integration of basic science in final year MBBS undergraduate curriculum.
Materials and Methods:
After Institutional Ethics Clearance, neuroanatomy refresher classes with clinical application to neurological diseases were held as part of the final year posting in two medical units. Feedback was collected. Pre- and post-tests which tested application and synthesis were conducted. Summative assessment was compared with the control group of students who had standard teaching in other two medical units. In-depth interview was conducted on 2 willing participants and 2 teachers who did neurology bedside teaching.
Results:
Majority (>80%) found the classes useful and interesting. There was statistically significant improvement in the post-test scores. There was a statistically significant difference between the intervention and control groups' scores during summative assessment (76.2 vs. 61.8 P < 0.01). Students felt that it reinforced, motivated self-directed learning, enabled correlations, improved understanding, put things in perspective, gave confidence, aided application, and enabled them to follow discussions during clinical teaching.
Conclusion:
Vertical integration of basic science in final year was beneficial and resulted in knowledge gain and improved summative scores. The classes were found to be useful, interesting and thought to help in clinical care and application by majority of students.
... Meanwhile, graduates from approved medical schools accounted for an increasing percentage of all licensees -reaching nearly 94 percent in 1932. 9 Another factor may have been the practice of crediting extra points, or an additional percentage, to the exam results of established practitioners previously licensed in another state. Texas, Illinois and Massachusetts utilized this practice. ...
The Federation of State Medical Boards celebrates its centennial anniversary in 2012. In honor of this milestone, the Journal of Medical Regulation offers the second in a series of articles presenting the history of the FSMB within the context of the growth of America's medical regulatory system. These articles are adapted from the forthcoming Medical Licensing and Discipline in America: A History of the Federation of State Medical Boards set for release in September 2012 by Lexington Books, a subsidiary of Rowman and Littlefield Publishing Group.
... In response, we, as regulators, are attempting to establish a greater collaborative presence with educational programs, one that is appropriate for state medical boards to have. 13 One example of this is the "Partners in Professionalism" program established by the Ohio Medical Board. The board has worked with educational institutions in its state to present information to students about medical regulation. ...
Purpose
China recently proposed a series of important policies intended to reform and improve the quality of medical education on the national level. This paper presents the findings of a national survey of China's medical schools conducted to review the development of undergraduate medical education over a five-year period (2013–2018).
Design/Approach/Methods
The National Center for Health Professions Education Development implemented the China Medical Education College Survey. Approximately 64% of the targeted medical schools participated in the survey, constituting a representative sample of higher education institutions offering educational programs in clinical medicine in China.
Findings
Following new policy orientations, medical schools showed positive developments in terms of the types of medical education programs offered, teaching and assessment methods, medical education resources, participation in accreditation, and quality of incoming students. However, the survey also revealed several worrying trends, including the coexistence of various types of education programs, significant regional differences in educational resources, dominance of traditional teaching and assessment methods, inconsistencies in quality, and an increase in graduates seeking employment in professions outside healthcare.
Originality/Value
Findings of the first national survey of China's medical schools show that there is still a long way to go to ensure high quality and efficient medical education on a national level.
Is care founded upon epistemically unwarranted medical claims and methods an appropriate publicly-funded remedy for America's underserved and vulnerable populations' rampant healthcare inaccessibility and inequality issues? The case of Bastyr University's Center for Natural Health and BU's satellite community clinics.
Also in podcast format at https://archive.org/details/naturocrit_podcast_s02e05b1
Reviewing the history of clinical educational curricula reveals enormous change and progress through successive antiquity up-to the current 21th century. Surely, there are stable fundamental criteria which are pillars in designing any curriculum; however there are torrential inevitable reforms which are important in filling the changeable gaps and fulfilling the ecological and temporal aspects. Over the last 20th century, numerous new paradigms for curricula reforms were constructed to adapt ebullient millennium needs, interactive pedagogical approaches and psychological/sociological learning theories. These reforms fostered clinical practice, integrating core competencies and reflection on designing, and achieving clinical curricula depending on outcome-based models such as clinical competences milestones. On the other hand, systematic approach of Kern′s framework adopts curriculum development through six consecutive interlinked and intersected steps which are refined to eight steps later. Moreover, taking contextual factors into account during curricula planning was evolved in other models such as PRISMS model. Despite all these pearly efforts, there are still caveats about inclusive gaps negligence between education process and overall health system. 3P-6Cs toolkit is deemed a recent novel paradigm that enrolls this role of health systems in clinical training during curricula design.
Amaç: İyi bir hekimden, klinik becerilerin yanı sıra iletişimci, ekip üyesi, lider, sağlık savunucusu, profesyonel ve bilim insanı gibi yetkinliklere de sahip olması beklenmektedir. Hekimin bilim insanı rolü, tıbbi bilgi ve yöntemlerin uygulanması, yayılması, yorumlanması ve oluşturulması ile ilişkilidir. Hekimin iyi bir sağlık hizmeti sunabilmesi, kanıta dayalı uygulama ve araştırma bilincine sahip olmasına bağlıdır. Bu nedenle tıp eğitimi müfredatı, hekimi, bilimsel yöntem ve ilkeleri konusunda bilgi, beceri ve tutum ile donatacak bir yapıda olmalıdır. Bu çalışmada, hekimin bilim insanı rolü ile ilişkili olarak tasarlanan Bilim Okuryazarlığı Dersinin fakültemiz mezuniyet öncesi tıp eğitimi müfredatına entegrasyon sürecini sunmak amaçlanmıştır.Yöntem: Ulusal standartları karşılayacak bir mezuniyet öncesi tıp eğitimi programının yeniden yapılandırılması sürecinde, fakültemizin ders programında oluşturulan dikey koridora öğrencilerimizin bilim okuryazarlığına ilişkin bilgilerini kullanabilmelerine olanak sağlayacak Bilim Okuryazarlığı adlı bir ders eklenmiştir. Bilim Okuryazarlığı Dersi’nin Trakya Üniversitesi Tıp Fakültesi mezuniyet öncesi tıp eğitimi müfredatına entegrasyonu Kern Program Geliştirme Modeli kullanılarak “Problemin Tanımlanması ve Genel İhtiyaç Analizi”, “Katılımcıların İhtiyaçlarının Analizi”, “Amaçlar ve Hedefler”, “Eğitim Stratejileri”, “Uygulama”, “Değerlendirme ve Geribildirim” olmak üzere altı adımda gerçekleştirilmiştir.Bulgular: Tıp eğitiminde Flexner Raporu ile başlayan değişim süreci, hekim yetkinliklerinin yeniden tanımlanmasını sağlamıştır. Bilim İnsanı, hekimin sahip olması gereken yetkinliklerden biridir ve diğer yetkinlikler için sağlam bir temel oluşturur. İyi hekim, klinik uygulamalarla birlikte bilimsel bilgi ve becerilerini geliştiren hekimdir. Bilim insanı olarak hekimin, yaşam boyu öğrenme, öğretme, kanıta dayalı karar verme ve araştırma gibi yeterliklere sahip olması gereklidir. Bu bağlamda mezuniyet öncesi tıp eğitimi müfredatının, hekimi bu yeterlikler ile ilişkili bilgi, beceri ve tutum ile donatması önem arz etmektedir.Sonuç: Öğrencilerimizin bilim insanı yetkinliklerini geliştirmelerine destek olmak amacıyla müfredata eklenen “Bilim Okuryazarlığı Dersi” kurullarla entegre ve kendi içinde sürekliliği olan beş yıllık kompakt bir program olması ve tüm öğretim üyelerinin danışman olarak görev alması açısından özgün olma özelliği taşımaktadır. Bilim Okuryazarlığı Dersinin, öğrencilerimizin bilim insanı yetkinliklerinin gelişmesine ne denli katkıda bulunduğu program değerlendirme süreçleri ile ortaya konulabilecektir.
A formação médica esteve centrada nas disciplinas técnico-científicas, privilegiando o raciocínio científico e as intervenções clínico-cirúrgicas. Ainda que as inovações curriculares denotem a necessidade de reformulação deste modelo, reorientando-o para uma formação mais generalista e humanista, perpetua-se um ensino pautado pelas tecnologias duras. O desenvolvimento das aptidões propedêuticas pouco valoriza o despertar da sensibilidade para aspectos subjetivos e relacionais. Este trabalho pretende evidenciar a importância da sensibilidade na formação médica pela inclusão da competência narrativa nos currículos médicos. Argumentamos que o cuidado integral, ampliado, se constrói pela integração da sensibilidade para os elementos biológicos, subjetivos e relacionais do processo saúde-doença-busca de cuidado, num enredo que dá sentido à experiência do adoecimento. Quanto melhor os clínicos souberem ouvir, absorver e interpretar os relatos que lhes trazem, melhor poderão estabelecer uma conexão que promova a mudança, cumprindo o cuidado.
Background: The purpose of this study is to examine the clinical-instructors and junior-physicians (residents and interns) perceptions for the general-medicine training program by using bi-directional interactive and self-assessments computer-based feedback (CBF) and paper-based multisource feedback assessment (PBMFA) systems for the efficiency and benefit evaluation.Methods: Between 2011 January to 2013 December, junior-physicians and their clinical-instructors in the same medical team were enrolled consecutively for monitoring the CBF scores gave by each other after each clinical course. A total of 321 residents, 298 interns and 110 clinical-instructors who participated in the core competency general-medicine training program in 6-months period were included in the study. The CBF and PBMFA evaluations are undergone paralleled to gather the suggested information in different levels of Kirkpatrick evolutional theory.Results: The results showed that lecturers, being 5-10 years as attending physicians, internal medicine sub-specialty clinical-instructors are most benefit from the general medicine training program. Accordingly, the CBF scores of junior-physicians was positively correlated with the times (> 3-times) of exposure to the medical teams that leaded by qualified clinical-instructors. Both clinical-instructors and junior-physicians have positive attitude to the value of the general-medicine training program. Interestingly, a good consistency was existed between residents CBF scores and PBMFA grades for their core-competency performance. Comparatively, the overall perception of clinical-instructors and junior-physicians for the general-medicine training was very positive.Conclusions: Clinical-instructors and junior-physicians had positive perception of CBF and PBMFA systems which could give us different information to improve and strength the further core-competency general-medicine training program by appropriate utilization.
Background
Medical education has observed numerous reforms in the last hundred years. While most of the reforms are applied to the undergraduate teaching, postgraduate education and training have lagged behind in keeping the pace. Anesthesiology curriculum has witnessed a few new methods inducted into practice like problem-based learning, flipped classroom etc. We introduced vertical integration with anatomy at our department and assessed its impact.
Methods
After a five-week schedule of integrated anatomy classes, a self-structured questionnaire was circulated amongst the 41 anesthesiology residents to know their perceptions and attitudes towards the classes. Their suggestions were also sought. The responses were analyzed with descriptive statistics (percentages).
Results
Thirty-six responses were received leading to a response rate of 87.8%. Fourteen residents (38.9%) believed that the integrated classes would be very helpful in their clinical practice, 20 (55.5%) residents believed them to be helpful while two (5.5%) residents believed that the classes would be little helpful in clinical practice. Hundred percent of the residents recommended the classes to be continued for the future batches. Half of the residents wanted the classes to be conducted twice in the three-year tenure (in the first and last semester) while 11 (30.5%) residents wanted the classes to be conducted every year. Seven (19.4%) residents thought that it's enough to conduct the classes once during the three-year tenure. Resident's suggested that they would like to have integrated classes with other departments like physiology, radiology, emergency medicine etc.
Conclusion
The integrated classes with anatomy were well perceived by the anesthesiology residents. Vertically integrated curriculum should be introduced in postgraduate training of various specialties for better education and hence, better patient care.
Contexto: el presente trabajo describe el proceso de rediseño curricular de la Carrera de Medicina de la Universidad Central del Ecuador.Discusión: se desarrolló conforme a las disposiciones y lineamientos del Reglamento de Régimen Académico (RRA), con base al análisis de mallas curriculares de Medicina a nivel regional y mundial; sumado a estudios de documentos de pertinencia, prospectiva, empleo; y talleres de consenso y mesasde discusión en la que intervinieron: docentes, estudiantes y otros actores involucrados con la formación médica. Se reformuló el objeto de estudio de la Medicina y sus núcleos problémicos; se adaptó el perfil de egreso de la carrera, lo que propició la inclusión de nuevas asignaturas y la reforma de las existentes, mejorando la interrelación e integración mesocurricular.Resultados: el producto obtenido es una malla curricular con 72 asignaturas que se cursan en 12 semestres. Este proceso fue una oportunidad para innovar y debatir la matriz curricular de la carrera.Conclusión: el rediseño curricular aprobado, con un adecuado ajuste microcurricular horizontal y vertical, lo eleva a categoría cinco en la escala de Harden, es decir, es un diseño curricular de enseñanza integrada que favorece la coordinación metodológica de las asignaturas, visionando en el mediano plazoa lograr un programa de aproximación transdisciplinar o nivel once de Harden, donde se reemplazan las asignaturas por constructos de ideas que llegan a ser parte de la experiencia real y globalizada del estudiante, a través de tareas concretas y tangibles que las aplica en el mundo real y capaz de resolverproblemas del entorno.
The career of Medicine at the Pontificia Universidad Catolica de Chile was established from the beginning (1929), with a classical Flexner curriculum design. In seven years, the career is divided in three cycles: basic sciences, clinics and internship. It obtained Chilean accreditation and fulfilled American Association of Medical Colleges accreditation requirements. Changes in the Chilean epidemiological profile and health system, and new teaching methods in medicine, stimulated a process of deep curricular analysis, identifying strengths and weaknesses of the medical career. The curricular strengths were well-developed scientific and clinical components, fully committed students and faculties, well defined learning objectives and excellent clinical campuses. Curricular weaknesses included a poor vertical and horizontal integration, few student centered methodologies and a weak emphasis concerning doctor's professionalism. Subsequently, the whole community of teachers, students and medical educators worked on the design of a new curriculum, establishing a new graduate profile and designed it oriented by learning objectives, of six years of duration, with an optimized course sequence that melds basic science and clinical concepts, with strong emphasis on humanities and professionalism. It prioritizes an early contact with patients from the first year and expands teaching methods. The main objective of this process was to achieve a new curriculum with an integrative structure. This was implemented in 2015 with an approved protocol to evaluate the outcomes.
The career of Medicine at the Pontificia Universidad Católica de Chile was established from the beginning (1929), with a classical Flexner curriculum design. In seven years, the career is divided in three cycles: basic sciences, clinics and internship. It obtained Chilean accreditation and fulfilled American Association of Medical Colleges accreditation requirements. Changes in the Chilean epidemiological profile and health system, and new teaching methods in medicine, stimulated a process of deep curricular analysis, identifying strengths and weaknesses of the medical career. The curricular strengths were well-developed scientific and clinical components, fully committed students and faculties, well defined learning objectives and excellent clinical campuses. Curricular weaknesses included a poor vertical and horizontal integration, few student centered methodologies and a weak emphasis concerning doctors professionalism. Subsequently, the whole community of teachers, students and medical educators worked on the design of a new curriculum, establishing a new graduate profile and designed it oriented by learning objectives, of six years of duration, with an optimized course sequence that melds basic science and clinical concepts, with strong emphasis on humanities and professionalism. It prioritizes an early contact with patients from the first year and expands teaching methods. The main objective of this process was to achieve a new curriculum with an integrative structure. This was implemented in 2015 with an approved protocol to evaluate the outcomes.
In this commentary, the author discusses medical education reform before Abraham Flexner's 1910 report, Medical Education in the United States and Canada, the reforms for which Flexner campaigned, and the report's impact on the future of the discipline. To honor Flexner's contributions to medical education, the author then exposes the myths that surround Flexner's ideals and accomplishments 100 years later. The author argues that Flexner's achievement lies in how he transformed medical education reform into a broad social movement, aligning it with John Dewey's popular "progressive education" movement, and in how Flexner succeeded in establishing the university model as the standard for all medical schools. The author also argues that Flexner, at the most fundamental level, stood for academic excellence and public service in medical education. This dedication, the author argues, is Flexner's greatest legacy and a commitment that should continue to shape the future of the discipline.