University of Missouri - Kansas City School of Medicine

Reform and innovation: a repeating pattern during a half century of medical education in the USA

INTRODUCTION

Medical education in the USA today is remarkably varied despite the shared mission of training doctors.

SIX MEDICAL SCHOOLS

A brief introduction to 6 institutions illustrates the variety of education available, while providing some specific details of how schools differ and how the mandate of any particular school may differ from that of another. Private schools include Dartmouth Medical School, Duke University School of Medicine, and Mount Sinai School of Medicine. State-supported schools include the University of Arizona College of Medicine, Oregon Health and Science University School of Medicine, and Southern Illinois University School of Medicine.

CHANGE

General remarks are made about changes over recent years in three separate areas of influence.

NEW SCHOOLS

Forty new medical schools were established between 1960 and 1980; a brief explanation is provided of the reasons for this and how it was achieved.

NEW DISCIPLINARY EMPHASES IN TRAINING DOCTORS

A few of the numerous new emphases that have been introduced into the medical school curriculum are discussed briefly.

CURRICULUM REFORM

A small sample is given of ways in which particular medical schools have reformed their curricula over the years. What went into the most influential curricular reform is presented, along with mention of what are perhaps the most unusual curricular paths today.

CONCLUSION

The paper concludes with an assessment of where reforms have brought US medical education by the beginning of the 21st century and what needs yet to be accomplished.

Promoting fundamental clinical skills: a competency-based college approach at the University of Washington

The focus on fundamental clinical skills in undergraduate medical education has declined over the last several decades. Dramatic growth in the number of faculty involved in teaching and increasing clinical and research commitments have contributed to depersonalization and declining individual attention to students. In contrast to the close teaching and mentoring relationship between faculty and students 50 years ago, today's medical students may interact with hundreds of faculty members without the benefit of a focused program of teaching and evaluating clinical skills to form the core of their four-year curriculum. Bedside teaching has also declined, which may negatively affect clinical skills development. In response to these and other concerns, the University of Washington School of Medicine has created an integrated developmental curriculum that emphasizes bedside teaching and role modeling, focuses on enhancing fundamental clinical skills and professionalism, and implements these goals via a new administrative structure, the College system, which consists of a core of clinical teachers who spend substantial time teaching and mentoring medical students. Each medical student is assigned a faculty mentor within a College for the duration of his or her medical school career. Mentors continuously teach and reflect with students on clinical skills development and professionalism and, during the second year, work intensively with them at the bedside. They also provide an ongoing personal faculty contact. Competency domains and benchmarks define skill areas in which deepening, progressive attention is focused throughout medical school. This educational model places primary focus on the student.