BHA-FXP4002, Emilia Bagiryan, assessment 2, attempt 1
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Changes in Medical Education
Emilia Bagiryan
Capella University
BHA-FPX4002: History of the United States Health Care System
Dr. Shad Smith
July 26, 2023
Changes in Medical Education
This paper explores the U.S. medical education system, how it has changed from the
1800s to the present, the academic and apprenticeship models, and the value of knowing the
background history of health care. Understanding the primary extent of change in medical
education as it currently exists requires knowledge of the history of health care (Shi & Singh,
n.d.). Developments in science and technology have significantly shaped the U.S. educational
system. Over the centuries, medical education has evolved dramatically, including curriculum,
teaching methods, accreditation, and the incorporation of new technologies. The critical
historical influences that have continued to define U.S. healthcare delivery are deeply rooted in
American values and traditions, social developments, improvements in technology, financial
limitations, opportunities within politics, and environmental pressures; the same components' ups
and downs will determine future healthcare developments.
The Changing Scope of Medical Education
The healthcare field in the U.S. during the preindustrial era (which spanned from the
middle of the 18th century to the latter half of the 19th century) was missing scientific element.
Medical techniques were simple, and the lack of scientific foundation in medical school led to
medical practice becoming more of a craft than an occupation (Shi & Singh, n.d.). Medical
education was often based on traditional remedies and religious beliefs, with limited emphasis on
scientific inquiry. The almshouse, a poorhouse, was an early version of today's hospitals; they
had poor air circulation and terrible sanitary conditions ("History of Public Hospitals," n.d.).
Nurses did not have experience and were not educated. According to Schwartz et al., many
American medical schools in the 1800s were modest, for-profit, unrelated to universities, and
had non-standardized courses and academic goals (2018). Only four medical schools existed in
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the United States by 1800: College of Philadelphia (1756; later became the University of
Pennsylvania), King's College (1768; Columbia University), Harvard University (1783), and
Dartmouth College (1797).
The postindustrial phase (late 19th century) was characterized by the expansion and
advancement of the medical profession, which profited from fresh discoveries in science, and
improvements in the study of medicine. Doctors gained power and prestige and opened private
practices. The American Medical Association developed authority by regulating medical
education (Shi & Singh, n.d.). It actively encouraged states to enact medical licensing legislation
that made it unlawful to specialize in medicine without a license from a state. One of the
mandated changes that impacted medical education was the Doctor of Medicine (MD) degree,
which became the qualification benchmark. Medical education underwent a radical change due
to the Flexner Report 1910 (Schwartz et al., 2018). It demanded higher requirements, greater
scientific rigor, and better facilities, and as a result, many academic medical centers with poor
treatment were shut down.
The corporate stage involves developments that began around 1970 and have persisted
into the twenty-first century. Large business corporations have expanded and consolidated over
this time, and there have been enormous improvements in international trade, transportation, and
communications. Freedom and accessibility were becoming increasingly important in medical
studies and teaching. Many doctors were forced to merge into larger group practices and
establish tactical alliances with hospitals. Due to improvements in technology in image data
transfer over a distance, telemedicine gained popularity in the 1990s (Shi & Singh, n.d.). Remote
medical care is now possible because of this modern technology. The delivery of healthcare in
the United States has changed as a result of these advancements.
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Numerous legislative changes have been made throughout the era of healthcare reform to
improve medical education and healthcare delivery. The main goals of reforms have been to
advance patient-oriented care, quality enhancement, and cost efficiency. Recognizing the
importance of primary care, supporting the community's health, and addressing health inequities
are examples of cultural transformations. The Affordable Care Act of 2010 (ACA) is the most
significant change since Medicare and Medicaid were established in 1965 (Shi & Singh, n.d.).
The ACA is currently the primary cause of transformation in healthcare delivery in the United
States. Despite a decline in the number of uninsured, the reform attempt fell short of expectations
(Aizawa & Fang, 2020).
Apprenticeship Model vs. Academic Model
Description and Comparison of Both Models
The academic and apprenticeship models are two different ways to approach medical
education. The study of medicine has typically been unstructured and practical under the
apprenticeship framework. Prospective doctors gained knowledge through practical training
under the supervision of a veteran doctor. There was no established structure for the training
(Billet, 2016). The academic model is a formally organized method of teaching medicine. It
entails enrolling in medical schools with set education programs, attending informative lectures,
working in laboratories, and participating in clinical internships across many specializations.
Both models encourage students to gain practical skills in healthcare environments by
participating and taking part in patient care. The apprenticeship approach does not provide
formal theoretical training or a defined program. It greatly depends on the mentor's knowledge
and skill, the caliber of which can vary. The academic approach prioritizes evidence-based
procedures, an established program, and outcomes in a medical degree.
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Analysis of Evolution and Impact
Both models have developed over time to include components from one another. While
the apprenticeship model now consists of some formally structured theoretical education, the
academic approach involves more practical interaction. The apprenticeship model locked the
standardized training, and the unreliable knowledge of the doctors' resulted in poor quality care
of the patients. Academic model offers organized coursework for healthcare professionals and
focuses on evidence-based medicine, which likely improves patient care quality and impacts
their safety.
Importance of Understanding History of Medicine
Learning the history of medicine is crucial because it offers significant background and
perspective on how medical knowledge and practices have changed over time. Students can
better appreciate the advancements in healthcare since it enables us to understand the difficulties
and innovations that have formed the modern medicine. Understanding the history of medicine
can assist healthcare administrators in developing their professional identities.
Conclusion
In a little over a century, healthcare delivery in the United States has advanced
significantly, changing from a crude, familial-focused trade to a technology-driven service that
now makes up a significant portion of the industry. Medical education has developed to satisfy
changing societal requirements, enhance patient outcomes, and address opportunities and
difficulties within the healthcare system. Legislative mandates and cultural developments have
influenced this evolution.
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References
Aizawa, N., & Fang, H. (2020). Equilibrium Labor Market Search and Health Insurance
Reform. Journal of Political Economy, 128(11), 4258–4336.
https://doi.org/10.1086/710535
Billet, S. (2016). Apprenticeship as a mode of learning and model of education.
Emerald Insight.
https://www.emerald.com/insight/content/doi/10.1108/ET-01-2016-0001/full/html
History of public hospitals in the United States
. (n.d.). America’s Essential Hospitals.
https://essentialhospitals.org/about/history-of-public-hospitals-in-the-united-states/
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
,
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(1), 1530557.
https://doi.org/10.1080/10872981.2018.1530557
Sheingold, B., H., & Hahn, J., A. (2014). The history of healthcare quality: The first 100 years
1860–1960.
International Journal of Africa Nursing Sciences,
(1),
18-22, https://doi.org/10.1016/j.ijans.2014.05.002
Shi, L. & Singh D., A. (n.d.).
Essentials of the
U.S. health care system
(4
th
ed.). Jones & Bartlett
Learning.
Zand, B. (2018). The evolution of American hospitals.
https://bzandmd.wordpress.com/2018/02/11/the-evolution-of-american-hospitals/
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