Preparing medical students to work in the new
managed health care environment is
another major challenge. In such settings, a
health care team effort involves such allied
health care professionals as physician
assistants or advanced practice nurses, but this
experience does not usually occur while one is a
student.
There are those who feel that interpersonal and
communication skills are not ade-
quately emphasized during the educational phase.
In addition, the system tends to
diminish the students' sense of altruism during
the course of their demanding education
but some efforts to improve this situation have
been initiated.
Educators argue that the curriculum is
presently full and will become overloaded as
biomedical information expands into new areas.
Incorporating new information presents
another challenge. Problem-based learning is an
approach being tried in order to address
this issue. The supporters of this educational
method believe that the teaching under this
system is more relevant and the students are
therefore more inclined to become lifelong
learners. Many are using actors as standardized
patients to present certain symptoms
and thus better evaluate clinical competence.
Increased use of computers can prove ben-
eficial in the learning process.
Impeding better integration of the basic and
clinical sciences is thought by some to
be the timing of the USMLE, with Step 1
covering the basics and Step 2 the clinical sci-
ences. Some have urged combining them, with
both steps taken at the end of the medical
education program, thus eliminating the focus
of teaching solely for board preparation.
Reforms that involve providing students with
earlier clinical experience are difficult and
costly to bring about. Translating sound ideas
into practice presents major problems. In
addition, central curriculum planning is
frequently opposed at the departmental level.
There are those who call for reexamining the
mission of medical schools, especially
at state institutions. The reassessment, if
undertaken, can result in significant reforms.
Another problem is the lack of continuity
between undergraduate and graduate edu-
cation. Several schools are initiating programs
that serve to combine both of these
phases, with the usual aim being to encourage
primary care.
More radical suggestions being heard are
related to shortening medical education by
accepting students into medical schools after
their junior year in college and to eliminat-
ing the last year of medical school, which is
in significant part devoted to securing a res-
idency appointment. Thus, the undergraduate
process would be reduced to six years,
which is an option offered by a number of
schools and is standard in Europe. Shortening
the educational process would lower the debt
obligations of medical students and, con-
sequently, may reduce the pressures to seek
training in higher paid subspecialties so as
to wipe out such debt sooner and easier. This
debt problem and its impact has prompted
calls to make medical school tuition-free, an
approach that in some quarters is being
seriously considered. Supporters of this goal
feel that it reinforces the concept that med-
icine is a profession with social obligations.
Behind this approach is the desire to man-
date that half of the residency appointments
should be in primary care. Tuition relief, if
elected, would be traded off by future
professional choice limitation. There are even
calls for a national program of mandatory
service obligation. While it is quite unlikely
that it will be introduced, some schools are
requiring that their students perform com-
munity activities.
To graduate more socially responsible
physicians, some schools are reviewing
admission criteria and are looking beyond
grades and MCAT scores to such factors as
altruism and community involvement. To better
judge this, some have appointed lay
people to their admissions committee. One of
the reasons for increasing minority repre-
sentation is the fact that such students may be
more responsive to community needs.
While medical schools can contribute to the
increase in the number of primary care
physicians, it is hoped that market forces will
impact on this issue so that an overabun-
dance of subspecialists will be translated into
more primary care physicians.
An awareness of the future needs of society,
which should be provided by medical
schools, can influence residency choices.
Health care reform may impact significantly
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