In 1910, education expert Abraham Flexner took a hard look at American medical education and chronicled its shortfalls on behalf of the Carnegie Foundation for the Advancement of Teaching. Medicine had advanced rapidly in the preceding decades; bacteria had been identified as a cause of infectious diseases, for example, and scopes and other instruments had allowed more precise diagnoses. But Flexner found that many medical schools were poorly equipped, second-rate institutions and few were adequately preparing students for this brave new world.
The impact of the Flexner Report was immediate and immense. Within a decade, about one third of the country's medical schools had closed, and many of those remaining had radically changed their admissions and academic requirements. The modern medical school, attached to a teaching hospital and emphasizing hands-on, scientifically based training, was born.
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Last year, 100 years after publication of that report and in the throes of another massive healthcare transformation, the Carnegie Foundation again threw a spotlight on the training of doctors-to-be and called for an overhaul. The authors of "Educating Physicians: A Call for Reform of Medical School and Residency," released last summer, did find much to applaud. But they also saw vast room for improvement.
For example, they criticized the lack of connection between book learning and clinical experience (students read about diseased hearts and broken bones for a full two years before ever seeing a patient with such conditions); students' inability to observe patients over a full course of illness and recovery; and the implied acceptance of current systems of healthcare delivery, rather than an emphasis on reimagining them.
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Moreover, they were dismayed to find that schools don't put a premium on lifelong learning. "The commitment to making patients' health and healthcare better requires a continuous reinvestment of energy, rather than only a certain amount of schooling and then you're launched," says Molly Cooke, professor of medicine at the University of California-San Francisco and a coauthor of the report.
Cooke and the other authors recommended significant reform, including earlier and more frequent clinical experiences, more emphasis on quality of care, and a shift away from a set four-year course of study toward students' mastery of the materials at their own pace. It's too soon to tell whether their prescription will have the force of Flexner's—but today's med school applicants may find out.
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