Medical education today: all that glitters is not gold

Abstract

Background The medical education system based on principles advocated by Flexner and Osler has produced generations of scientifically grounded and clinically skilled physicians whose collective experiences and contributions have served medicine and patients well. Yet sweeping changes launched around the turn of the millennium have constituted a revolution in medical education. In this article, a critique is presented of the new undergraduate medical education (UME) curricula in relationship to graduate medical education (GME) and clinical practice. Discussion Medical education has changed and will continue to change in response to scientific advances and societal needs. However, enthusiasm for reform needs to be tempered by a more measured approach to avoid unintended consequences. Movement from novice to master in medicine cannot be rushed. An argument is made for a shoring up of biomedical science in revised curricula with the beneficiaries being nascent practitioners, developing physician-scientists --and the public. Conclusion Unless there is further modification, the new integrated curricula are at risk of produce graduates deficient in the characteristics that have set physicians apart from other healthcare professionals, namely high-level clinical expertise based on a deep grounding in biomedical science and understanding of the pathologic basis of disease. The challenges for education of the best possible physicians are great but the benefits to medicine and society are enormous.

“It Is This Very Knowledge That Makes Us Doctors”: An Applied Thematic Analysis of How Medical Students Perceive the Relevance of Biomedical Science Knowledge to Clinical Medicine

“…As the goal of medical education is to equip physicians with the requisite biomedical science knowledge to make clinical decisions and practice evidence-based medicine, and the skills and knowledge to effectively communicate with patients and engage them in shared decision-making, the findings herein suggest caution when revising curricula. Our study supports the notion of others that the loss of clinical expertise deeply grounded in biomedical science and an understanding of the pathologic basis of disease may negatively impact the development of adaptive expertise and professional identity formation (51,52). Finally, we recommend that future studies identify the contextual factors of the learning environment, including both explicit and tacit elements of the formal, informal, and hidden curriculum, that enable biomedical science knowledge to contribute to these developmental processes so that they can be leveraged rather than lost during curricular reform (53).…”

Challenges and Opportunities of Preclinical Medical Education: COVID-19 Crisis and Beyond

“…The British model of MBBS curriculum is spilt into preclinical and clinical phases; the initial 3 years are preclinical years dealing with basic science subjects, i.e., anatomy, physiology, biochemistry, pharmacology, microbiology, and pathology. Preclinical phase plays a very crucial role in shaping up scientifically grounded and clinically competent physicians [ 5 , 6 ].…”

Biomedical Science Knowledge Contributes to the Development of Adaptive Expertise and Formation of a Professional Identity: An Applied Thematic Analysis of Medical Students' Essays

“…As the goal of medical education is to equip physicians with the requisite biomedical science knowledge to make clinical decisions and practice evidence-based medicine, and the skills and knowledge to effectively communicate with patients and engage them in shared decision-making, the findings herein suggest caution when revising curricula to truncate training in the biomedical sciences. As cautioned by others, the loss of clinical expertise deeply grounded in biomedical science and an understanding of the pathologic basis of disease may negatively impact the development of adaptive expertise and professional identity formation (50,51). Finally, we recommend that future studies seek to identify and study the contextual factors of the learning environment, including both explicit and tacit elements of the formal, informal, and hidden curriculum, that enable biomedical science knowledge to contribute to these developmental processes so that they can be leveraged rather than lost during curricular reform (52).…”