Changes in Medical Education
docx
keyboard_arrow_up
School
Capella University *
*We aren’t endorsed by this school
Course
4002
Subject
Medicine
Date
Apr 3, 2024
Type
docx
Pages
4
Uploaded by dpatel2812
Changes in Medical Education
Healthcare in 1800s was very unstructured. During that time, medical education was in its infancy. The development of sciences and social sciences were not taught. It suffered from a lack of common standards, the absence of any type of certification and there was no type of postgraduate or resident training required. This paper analyzes the transformations occurred in medical education from 1800s to present.
The Changing Scope of Medical Education
Low standards and practices were flourishing in 18th-century medicine. The instructive technique was the craze of the day. Hands on clinical coaching was not an option. Students got their education by a series of lectures, four classes each day, typically duration in at eight hours total. It was two 16-week semesters. Winter and spring semester both included the same material. Looking back the classes include, biology, pathology, chemistry, obstetrics with no grading system or laboratory time. There was no medical license issued either around that time.
In 1876, American Medical Association (AMA) was formed. The main goal of AMA was to enhance medical education with this, more medical schools required a four-year degree in order to qualify for medical practice. Around that time, the old school physicians were set in their ways so the path was difficult when it came to quality of education. Medical schools were in a state of chaos. There were no standards followed among the medical school. The efforts were only seen after pressure was felt to enforce certain standard by outside. The only medical school that stood out around that time was
John Hopkins. They taught students using the scientific method. In 1876 the Johns Hopkins Medical School debuted a model that would fundamentally change the way doctors were educated. Admissions now required a degree. Memorization learning was retired and replaced with laboratory, clinical work and core science classes. The curriculum expanded to four years. Discontentment among the AMA leaders brought the formation of CME, Council on Medical Education in 1904. Regular evaluations of medical education were done by CME. With the evaluations, it
was recommended that curriculum should include 4100 hours in which 1970 hours should focus on the basic sciences. In order to create same standards, CME gave the periodic evaluations collected to Abraham Flexner who was an educational theorist. Flexner examined 155 institutions of medical educations. In 1910, Abraham Flexner issued his searing report. Flexner criticized the medical schools of
being loose with apprenticeship. In his report, the schools lacked defined standards beyond the generation of financial gain. The schools were focused on doctors’ financial prosperity instead of patients health. His report caused many medical schools to close down. “Within 20 years after the report's publication, the original 131 medical schools from 1910 were reduced to 76, although not 31 as Flexner originally suggested.” During the late 1800s, the medical schools only required a high school education to enter. By 1929, all medical programs required at least 2 years of college education. Flexners, recommendations to reform medical education with uniform admissions, coursework and graduation requirements, and licensing regulated by the state, were adopted broadly. The report also concluded that medical schools should strictly adhere to the protocols of mainstream science in both teaching and research. After the report, medical schools increased their lectures to cover much more material and extended the length of training to four years. Schools were opened near the hospital to provide more hands-on experience.
Clinical roations gained favor and were considered crucial before getting any medical degree. Today, Internships and residencies became the rule rather than exception. With changes in medicine, specialization of medical education began to develop. For example, specilation in medicine like being a pathologists anesthesiologists, cardiologist, ophthalmologist or radiologist came into play. Board certifications became common and has moved from lifelong certification to an ongoing process that requires much more than sitting through classes. In recent years there has been a push for undergraduates to demonstrate competencies rather than cognitive knowledge. The goal is to have competent physicians. Today, variety of learning approaches are introduced, including small group sessions, problem-based learning, self-directed learning and team based learning. Currently, medical students uses clinical checkbook tool to track all of the services provided to their assigned patients during clinical rotations. “New York University, Indiana University, and others are using data from their health system's electronic medical records to assign students virtual patient panels as teaching tools.” In present time, having great communication skills are given the highest importance. Many schools are changing admission criteria to reflect qualities that may not be teachable such as empathy and openness. Presently, Applicants take part in short interviews from which they are assessed on listening, feedback response, articulating a rational argument and defending it. A related development is the implementation of the new MCAT that aims to balance testing in the natural sciences with testing in the social and behavioral sciences and assessing critical analysis and reasoning skills. The redesign is based on the premise that tomorrow’s physicians need broader skills and knowledge than in the past.
The Apprenticeship versus Academic Model
In 1800s, aspiring physicians learned by following the doctors. Training under a single physician remained the most common method oh physician education. The apprentice learned from the master by observing him treat patients. The apprentiveship model only provided clinical oportunties with involvement directly with patients.. The apprenticeship model showed hands on approach and showed common medical challenges doctors faced everyday. Apprenticeship involves learning a physical, tangible activity. The traditional system was failing to adequately prepare doctors to provide safe and complex care. Apprentcrship model was unregulated and of low quality, offered little professional training, practice skills. Academic model focused on theoretical knowledge on sciences related fields. It is more of assessments and lectured learning. Academic model helps grasp a concept better. Academic model gives deeper understanding of a concept through seeing it in the context of understanding the why behind it. Both models were unregulated and of shallow standards when used separately in the past. Both offered low quality education. Now both models are well regulated, have lot of information from extensive research and are now high standards. The value of solid education cannot be challenged. The need for a
solid foundation before practicing is crucial. Both models formed a foundation for professional improvement for learning medicine. Before boarding on a clinical experience, students often participate in small group learning about how to take a medical history and perform a physical examination. Standardized patients, who are trained actors, role-play with faculty and students. Students are then assigned a preceptor and try taking a history and completing a physical exam on a real patient in the preceptor’s practice. Today, with both models morphed together, students gain comprehensive medical
education which helps them offer quality medical care to patients. Until nearly the turn of the 20th century, direct patient contact was considered beyond the abilities of medical students, but Sir William Osler, MD, firmly believed in the value of learning from patients. The concept that surgery and medicine are founded on scientific knowledge and the overarching principle of apprenticeship with progressive transfer of patient care responsibilities is still the building block of residencies. The reality of this model quickly materializes for the third-year medical student, who overnight is thrust from didactic coursework
in the classroom to full immersion into the clinical environment. Suddenly, the physiologic minutiae become less immediately relevant, and students actually begin to learn what it takes to take care of patients. Our Clinical Clerkships and Residency programs are modern day vestiges of the apprenticeship model, the major points of departure being the organizational (school-based) rather than individual focus, and considerably expanded, highly defined and rigorously regulated educational expectations. However, the delicate interlacing of the two fundamental components-education and supervised clinical
practice-remains the core, defining characteristic.
Improving Medical Education by Understanding history
In 1800s, medical schools were proprietary had few entrance requirements, and provided no clinical training. The turning point for medical education was Flexner’s report which had some positive and negative implications and findings. First, it pushed for medical schools to perform higher admission and graduation standards. Second, it supported for four-year medical school since at the time there were a lot of two-year medical schools. Those two-year medical schools were pushed to get rid. History does not just explain past but also provide the groundwork for understanding the present which helps to move forward. For example, handwashing was not something that was given high importance in the past. Looking back at the infection rates, health care workers puts handwashing above anything else. Learning the history of the past helps improve the changes by identifying the weakness and strength.
Nowdays, constant improvements are needed because of the continuous change in demographics of the people be treated. For example , over this two-year period, Coronavirus has engulfed the whole world in its web. Challenges are faced by teachers and students to teach and learn the subjects during this tough times. Technology, as it has in so many fields, has moved medical education ahead. Anatomy training may now include virtual learning with holograms, while communication may be enhanced through avatars with faculty-inspired responses.
Conclusion
The methods of diagnosis and treatment that have evolved and the health care infrastructure are dramatically different than 100 years ago. As well, education has evolved. Sitting and taking instructive lecture for 6 months, or for any length of time, is not necessarily efficient. Prior to Flexner’s report, there
were no state standards for licensing or education. Medical school curricula were varied and often did not adhere to scientific principles. Many students did not have access to patients before being sent out to practice. That all changed in the years after the report came out.
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help