Medical Education - Page 2
into discipline-specific departments. Both
generalists and specialists conducted
classroom and clinical instruction. Over time a
changed learning environment
developed that encouraged students to become
independent thinkers, develop
medical problem-solving skills, and become
active short- and long-term, self-
directed learners. Ultimately, a traditional
four-year curriculum developed, con-
sisting of two years of basic science and two of
clinical training. After the fallout
from the Flexner report (see page 4), this
arrangement became the standard for all
U.S. medical schools.
· Phase III--Organ system era
(1951–present). In this curriculum, the basic and
clinical sciences are integrated within an
organ-system framework. The appeal of
this program, which remains a component of many
current curricula, is due to the
belief in the independent integration of
information during clinical training, and
the utilization of learning objectives. It
involves program design by curriculum
topic, which is a more effective tool than the
rigid disciple-based approach.
· Phase IV--Problem-based era
(1968–present). This program seeks to view the
patient from the perspective of a whole person
rather than as an individual with
some organ system dysfunction. This curriculum
is structured within the context
of clinical problems. Students are exposed to
small-group, problem-based learn-
ing. Thus, the educational approach involves a
student-centered, active setting,
minimizing attendance at large group lectures.
Discussions of clinical problems
serve as vehicles for integrating the basic and
clinical sciences into coherent and
clinically relevant learning
experiences.
The consequences of the curricular changes that
have taken place during Phases III
and IV are discussed on page 414 under The New
Medical School Curricula. As this
title implies, curriculum modification and
innovation is, as it should be, an ongoing
process.
Recent reports suggest that we may soon be
entering Phase V, with the development
of a Clinical Presentation Curriculum. This
approach focuses on the manner of patient
presentation, which serves as the context for
imparting to students relevant basic and
clinical science information.
THE TRADITIONAL CURRICULUM
The First Year
This introductory phase is devoted to the study
of normal human biology, which
includes anatomy, biochemistry, and physiology.
The scope and emphasis within each of
these areas are gradually being altered as new
experimental approaches result in fresh
data. Thus, for example, while the time
allotted to gross anatomy is being diminished,
the time spent on histology (microscopic
anatomy) is being increased, and more empha-
sis is being placed on ultrastructural and
histochemical findings. Most schools incorpo-
rate clinical demonstrations within basic
science lectures so as to relate subject matter to
actual medical problems. Many schools offer
some introductory lectures in the behav-
ioral sciences and genetics during the first
year.
The first year is about 35 weeks long, with
about 35 hours of required class work
per week. Half or more of the class time is
spent in lectures; the rest is spent in the
laboratory.
The Second Year
The second year is the bridge between the
preclinical sciences and the clinical subjects
that occupy the bulk of the final two years of
study. This year establishes the scientific
basis for understanding abnormal states of
human biology. The standard courses taken
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