BHA-FPX4002_Nunnally_Taylor_Assessment2_Attempt1

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1 Changes in Medical Education Taylor Nunnally Capella University BHA-FPX4002: History of the United States Health Care System Chanadra Whiting June 2nd, 2023

Changes in Medical Education The first medical school in the United States is said to be the College of Philadelphia founded in 1765 by John Morgan and William Shippen Jr. Prior to the funding of Pennsylvania’s medical school, training physicians had been limited to apprenticeships with practicing doctors unless you could go over to Europe, for instance, and obtain formal medical education. In this paper, I will discuss the changes in medical education from the 1800s to today. I will also disclose information about the apprenticeship and academic models of medical learning from the 1800s, 1960s, early 2000s, and today. The Changing Scope of Medical Education “In the beginning, Galen and Hippocrates gathered their apprentices for instruction. As medical services became more prominent, journal clubs were introduced…printing press scaled works by great teachers and scientists…medical schools and professors curated and controlled access to medical knowledge. Those who became physicians would make pilgrimages to learn from great teachers in the classroom and clinical spaces, as this was the only path toward apprenticeship in medicine” (Chan et al, 2020, p.87). In the 1800s, United States medical schools were small, for-profit, and non-university affiliated as well as having a non-standardized, wide-ranging medical curriculum. (Schwartz et al, 2018). Medical societies were taking charge of establishing regulations and standards of practice along with doctor certifications by creating society-affiliated programs. These programs were known as proprietary medical colleges, and they began to pop up everywhere, but later phased out due to Flexner’s Report in 1910. ( Doctor of medicine profession (MD): MedlinePlus medical encyclopedia, 2019). In 1846, a national convention was held to address changes needed in medical education. These changes included a standard code of ethics for the profession, 2

adoption of uniformed higher educational standards, and the creation of a national medical association. Thus, the American Medical Association was born the following year. (Young, 2018). The AMA set educational standards for doctors such as liberal education in arts and sciences, requirements of completing an apprenticeship before entering medical school, and a MD degree covering three years of study, two 6-month lecture sessions, three months of dissection studies with a minimum of one 6-month session of hospital attendance. ( Doctor of medicine profession (MD): MedlinePlus medical encyclopedia, 2019). Over the years, these standards were revised or added to, to allow competency of medical professionals. In 1910, Flexner’s Report arose and drastically changed medical education along with recognizing African American’s practicing medicine and coed of men and women in medical schools. Alongside this, American doctors started to truly invest in specialties in the 20 th century. The delay was due to a controversial conversation about specialty practices downgrading general practitioners. In 1933, the American Board of Medical Specialties was established. Therefore, the rise of residency training and specializations arose by the 1930s to 40s. ( Doctor of medicine profession (MD): MedlinePlus medical encyclopedia, 2019). Out of 15 specialty-certifying boards that existed in 1942, 12 mandated at least three years of residency training. By the 1960s and 70s, the basic components of modern American medical educational systems were in place. These individuals would attend medical school for four years then complete an internship followed by a residency while taking board exams along the way. “In 1964, the National Institute of General Medical Sciences launched the Medical Scientist Training Program to fund MD-PhD programs to train physician-scientists. The prior medical student research training program was phased out. A National Institute of Health policy change allowed training grant support for the medical curriculum phase in the context of dual-degree integrated 3

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MD-PhD training” (Harding et al, 2017). Funding and support toward medical research and medical education of all types continued to be an up and down process of progression through the years. Although, “by the early1980s, federal support had increased the number of medical schools to 127” (Young, 2018). Medical Centers were enhanced by adding programs such as nursing, pharmacy, dentistry, and other health curriculum to aid in Academic Health Centers progression of health education knowledge and standards. (Young, 2018). In the year 2000, the National Institute of Mental Health “created the Council Work Group on Training for Diversity to ensure adequate opportunities to pursue research careers regardless of gender, country of origin, and race and to track the success of related Institutional programs” (NIMH, 2017, p.5). By year 2012, the Accreditation Council for Graduate Medical Education was fully implemented despite being initiated in 1998. The ACGME assisted with making “major changes in how the nation’s medical residency programs are accredited through the establishment of an outcomes-based evaluation system called the ‘Outcome Project’” (Young, 2018, p.146) Medical education had another drastic alteration in 2013 when the American Medical Association embarked on the ‘Accelerating Change in Medical Education’ project. AMA awarded grants to 11 medical schools as well as added 21 more schools to the project in 2016 and then five more in 2019. Lastly, AMA ushered in the newest six-year project called the ‘Reimagining Residency’ grant program for the purpose of transforming residency training to best address our current and future health systems. Apprenticeship Model vs. Academic Model Description and Comparison of Both Models An academic model refers to teaching primarily from books and other reading materials available while in a classroom type setting. Now a days, this looks like our lecture courses we 4

must take when pursuing a degree. On the other hand, apprenticeship model refers more to the trainee watching the trainer starting with observation through to participation in order to demonstrate the skills which could be compared to clinical/lab courses. During the 1800s, you would complete two years of schooling and three years of apprenticeship if you were 21 and up. The doctors/physician’s training students would lecture them with little oversight or structure. There was no grading rubric applied at all in the 1800s and all apprenticeships were separate from the medical school curriculum. (Young, 2018). Sometimes an apprenticeship might have been more doable to find near you depending on your geographical location and sacristy of medical schools. By the 1960s, a basic layout of American Medical System schooling had been put in place. Students would attend medical school for about four years then proceed to an internship and finally a residency, all while taking board exams. The Association of Academic Health Centers was established in 1969 and represented 120 high-ranking American Academic Health Centers. In 1981, the Accreditation Council for Graduate Medical Education was established. Also, medical schools started to decrease course work, but increased the opportunity of electives, and started providing early clinical experiences. In the early 2000s, students and residents found it difficult to find time to learn by doing or to study their patients in depth and so changes were made. Students were required to hold a BA/BS before entering medical schools. (Young, 2018). This allowed for future health professionals to have more competency and confidence in their schooling. Also, implementation of accreditation was a huge factor in the idea of reliable, knowledgeable, trusted physicians. “As of 2016, ABMS (American Board of Medical Specialties) member boards offered specialty certifications in 37 specialties and 85 subspecialties” (Young, 2018, p.150). 5

Analysis of Evolution and Impact Standards and requirements of medical schools have drastically changed over time but in order to continue a prosperous future in medical education we need to take the necessary steps to innovate medical training. It is clear to see that the American Medical Association endorses the same perspective. Thus, academic and apprenticeship type models are in a sense equally offered in medical programs; it allows for better quality of care due to students utilizing literature knowledge combined with simulation-based learning skills. Some of the educational goals of using technology in medical education include facilitating basic knowledge acquisition, improving decision-making, enhancement of perceptual variations, improving skill coordination, practicing for rare or critical events, learning team training, and improving psychomotor skills. Medical education will and has changed rapidly due to influences such as changes in health care environments, physician roles, societal expectations, growth in medical sciences, and the diversity of learning techniques. Therefore, medical knowledge is always advancing and in return, medical education changes will always be pertinent. Importance of Understanding History of Medicine By understanding the history of medicine, we can value the importance of the amount of progression that has been made in medical education. This is important because it has shaped the way we learn today. If it wasn’t for the knowledge of adapting to an academic plus apprenticeship type of curriculum also known as an equal opportunity to learn through lectures and hands-on clinicals, then we would not be able to give the quality of care our patients deserve. For example, “among available active learning approaches, simulation-based learning is uniquely suited to employ continuing technological innovations towards the development of more effective learning tools that not only engage students, but also enable them to go beyond surface 6

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understanding of disciplinary content” (Hallinger & Wang, 2020, p. 25). This allows for students to apply knowledge and skills to medical challenges they may face. Conclusion To conclude, the health care industry in the United States evolved from a primitive, family-oriented craft to one of the largest industries we have today. The American Medical Association gaining the power to control medical education back in the 1800s genuinely innovated medical education to what it is today. Standards and regulations were crucial to allow for proficient competency in medicine. Combining hands-on training and literature-based teaching has given our medical professionals the tools they need to be confident and knowledgeable in their practice. Furthermore, “physicians and machines working in combination have the greatest potential to improve clinical decision making and patient health outcomes. AI, Artificial Intelligence, can curate and process more data such as medical records, genetic reports, pharmacy notes, and environment data and in turn retain, access, and analyze more medical information” (Paranjape et al, 2019, p.7). 7

References Chan, T. M., Stehman, C., Gottlieb, M., & Thoma, B. (2020). A Short History of Free Open Access Medical Education. The Past, Present, and Future. ATS Scholar , 1 (2), 87–100. https://doi.org/10.34197/ats-scholar.2020-0014ps Doctor of medicine profession (MD): MedlinePlus Medical Encyclopedia . (2019). Medlineplus.gov. https://medlineplus.gov/ency/article/001936.htm Hallinger, P., & Wang, R. (2019). The Evolution of Simulation-Based Learning Across the Disciplines, 1965–2018: A Science Map of the Literature. Simulation & Gaming , 51 (1), 9–32. https://doi.org/10.1177/1046878119888246 Harding, C. V., Akabas, M. H., & Andersen, O. S. (2017). History and Outcomes of 50 Years of Physician–Scientist Training in Medical Scientist Training Programs. Academic Medicine , 92 (10), 1390–1398. https://doi.org/10.1097/acm.0000000000001779 NIMH. (2017, February 17). National Institute of Mental Health (NIMH) . National Institutes of Health (NIH). https://www.nih.gov/about-nih/what-we-do/nih-almanac/national-institute-mental-health- nimh Paranjape, K., Schinkel, M., Nannan Panday, R., Car, J., & Nanayakkara, P. (2019). Introducing Artificial Intelligence Training in Medical Education (Preprint). JMIR Medical Education , 5 (2). https://doi.org/10.2196/16048 Schwartz, C. C., Ajjarapu, A. S., Stamy, C. D., & Schwinn, D. A. (2018). Comprehensive history of 3- year and accelerated US medical school programs: a century in review. Medical Education Online , 23 (1), 1530557. https://doi.org/10.1080/10872981.2018.1530557 Young, K. M., & Kroth, P. J. (2018). Sultz & Young's health care USA: Understanding its organization and delivery (9th ed.). Jones & Bartlett Learning. 8

BHA-FPX4002_Nunnally_Taylor_Assessment2_Attempt1

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