Medical Education

11 Medical Education

Evolution of the medical curriculum

The traditional curriculum

The curriculum in transition

The new medical school curricula

Attrition in medical school

Preparing for medical school

The making of a physician

United States Medical Licensing Examination

Until the early 1900s, medical education in the United States was unstructured and

unregulated. A person wishing to become a doctor would usually seek some didactic

training at a medical school and/or spend time as an apprentice with one or more physi-

cians. Since a license to practice was not needed, many unqualified individuals were

engaged in the healing arts. The caliber of many medical schools was also open to seri-

ous question.

In 1910, after an investigation into the state of affairs existing in medical education,

Abraham Flexner proposed a program of reorganizing medical education in a way that

would ensure that only qualified individuals would enter the profession. With the adop-

tion of the Flexner report, many medical schools of borderline quality became defunct

while others significantly improved their standards. Another result was that medical

education became a structured four-year program consisting of two years of basic sci-

ences or preclinical training followed by two years of clinical experience. This educa-

tional program was essentially the same in all medical schools.

To ensure the maintenance of high standards, today all medical schools must obtain

and maintain legal accreditation. The status of their educational programs is periodically

evaluated by the Liaison Committee on Medical Education (LCME) of the Association

of American Medical Colleges. This has not restricted medical schools, however, from

introducing modifications in their traditional programs. The two-phase traditional pro-

gram, nonetheless, still strongly influences the medical education process.

EVOLUTION OF THE MEDICAL CURRICULUM

The curriculum for educating physicians in the United States has evolved through four

phases since the first medical school was established in Philadelphia in 1765.

· Phase I--The apprenticeship era (1765–1871). During this period a student's

ability to pay tuition and not his or her academic qualifications was the sole crite-

rion for admission into medical school. The program involved two four-month

semesters of classroom attendance, with no patient contact. This critical educa-

tional gap was followed by a one- to three-year apprenticeship with a private

general practitioner, chosen by each student. Upon completion of this interlude

the individual embarked upon a career as a medical practitioner.

· Phase II--Discipline-centered era (1872–1951). During this lengthy period,

which was the traditional curriculum for many decades, the faculty was organized

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