Research Paper on Medical Education in the US
Abstract
This paper presents a historical description of medical education in America, the changes that have occurred in the system in the twentieth and twenty first century. The United States is privileged to have an outstanding system of education having 150 medical schools, many GMEs, standardized examinations and many educational research programs. America has experienced a changing environment since the start of the twentieth century up to date in order to enhance its medical system of education. Such changes include curriculum reforms by revising some important health care instructions, improved process of admission, reporting of innovation approaches, and restriction on working hours. These changes have granted opportunity for trainees to attain a hands-on experience as soon as possible. The other likely changes need to focus on the strategies of education that can produce better physicians ever and how this system can be funded. All these are likely to occur in this 21st century.
Introduction
Medical education comprises of activities involved in studies by physicians. There are a number of reforms that have always been put in place a year after the other and these reforms have led to a discovery of significant changes in medical education. Thus, this research paper will present the overview of history in medical education, including the details of the reforms that have been experienced along the centuries.
The history of medical education
Pain and suffering resulting to death have devastated people from the beginning of time. America went through the same kind of life during colonial era. The life expectancy for all human beings was twenty-five years. The inhabitants of colonial America sought medical care from traditional practitioners. In the eighteenth century, medicine had become common; however, a few practitioners obtained qualifications through studying (Bliss, 1999). The dominant system of medical education by then was known as apprenticeship, and its preceptorial period lasted in three years.
Another system of medical education known as proprietary emerged in the early nineteenth century which became dominant by then. Four medical schools existed as per 1800 and twenty-six other schools were established between 1810 and 1840 (Elam and Johnson, 1997). By the nineteenth century, many other medical schools had sprouted and these were intended to replace the apprenticeship system.
Previously before the twentieth century, America’s medical setting and quality was diverse. Many universities such as Harvard University, University of Pennsylvania and many others had medical schools. Johns Hopkins being one of the Universities, through the influence of Sir William Osler, a Canadian physician came up with the innovation of clinical clerkship and in the 1890s Johns Hopkins had become the most key medical facility for physicians in America. Most medical schools by then were still small with diverse and non-standardized curricula. However, America completely changed its medical education system in 1910 after the Report by Flexner. Flexner conducted a study on the medical education system and discovered that Osler’s model of medical education was suitable to bring a change in the medical setting (Flexner, 1910). When Flexner’s report was released, many non-university affiliated schools were terminated. This report also led to the implementation of a model of curriculum which required a trainee to go for two year scientific training followed by two other years of clinical medicine training.
Following World War 1, internship was introduced which involved supervised patient care and it became a usual practice as medical education continued to expand. Furthermore, in 1930s, Graduate Medical Education expanded and thereby introduced hospital-based residencies. After the Second World War, National Institutes of Health were established and this demanded for a large government funding hence increasing postgraduate. By the end of the 19th century, there was a shortfall of physicians because over 2000 medical schools had been put in place and 12 allopathic schools were in plan (Ludmerer and Johns, 2005).
Essentially, allopathic is known as the main form of medical education in America with around 125 schools, and this is according to the GME’s report of 2007. According to that report, 85% of medical graduates were from allopathic schools and the remaining representing osteopathic medicine. These two forms of medical education have similar requirements and training, but a slight difference is the teaching of manipulation which is exercised in osteopathic schools. Osteopathic schools have also been expanding rapidly and currently comprising of 28 schools. With this, it can be able to produce 25% of medical graduates by 2019 (Bonaminio et al, 2008).
Changes in America’s medical education between the 20th and 21st century
Many changes in medical education have occurred in the 20th century and many others are being anticipated to take place in this 21st century. These changes came in after the study conducted by Flexner in 1910, because, before then medical education was in its childhood. The higher education curriculum did not compliment medicine because sciences were not recognized at all. There were very low standards for one to be admitted and many medical schools; a high school diploma was not a requirement. Compared to other categories of schools, medical schools had the lowest preliminary education requirement. In those times, many hospitals were not suitable for proper treatment and dispensaries were more preferable forms of medical treatment (Pace and Glass, 2000). Many students preferred to go to dispensaries because they hosted more patients. Dispensaries catered for students’ needs compared to hospitals.
Medicine started changing slowly by slowly as the government started to put its focus on public health. The purpose of Flexner’s report emphasized on the quality of facilities, requirement for entry, and the number of faculty members qualified for at medical schools (Flexner, 1910). The report instigated a need for transformation in medical education and it was to strictly stick on to the practice of mainstream science teaching. When surgery was introduced, and a need for specialization on it, an internship and residency program was created with a purpose to grant hands-on experience for the aspirants and this has become an important part of medical education.
Since then, the quality of health has kept on improving significantly. This also marked the closing of most dispensaries as many hospitals were being opened. Many other programs such as clinical specialty were put in place and this allowed interns to pick a specialty to focus on prior the completion of their training. As medicine has continued to expand, we find specialization on what kind of medicine one can practice. For example, we have the audiologists, pathologists and anesthesiologists.
Many shifts in science, demographics and federal policies have placed a significant change of the health care system. Many initiatives are also underway to improve admission processes and practices to better the selection of future doctors in the health care system. Medical education still undergoes refinement as a result of improvement in medicine, public health challenges, and the improvement of the learning and teaching process.
Some of the changes realized in this century include selective admission process; medical education has been divided in two three segments and these are: medical school, residency training and continuing medical education. Admission committees use broad-based criteria for selection, prior academic achievements for assessments and evidence of values necessary for one to qualify as a compassionate and an excellent physician (Gevitz, 2009). Medical schools are also testing new ways to evaluate personal characteristics for instance, how applicants can properly work in teams, their interaction with diverse people and their resilience ability. In addition to that, applicants are also being assessed on physical sciences and verbal reasoning and all these are being put in place to improve the quality of medical education. Additionally, other institutions are recruiting initiatives to address the emerging needs in the national and local health care system. In a survey conducted in 2015, medical schools deans suggested suitable admission policies for recruiting many students in the health care network. These policies included those geared toward minorities such as students from disadvantaged families and those from rural and undeserved communities (Irby et al, 2010). This is to ensure equality in the delivery of health care. Medical schools have also centralized the management of the curriculum with an oversight responsibility. Previously, students received introduction to clinical skills in the first two years, and required hands-on patient interaction via clerkship in their two years of completion.
Medical education is being revised continually to reflect scientific advancements, changes in the delivery system, medical breakthroughs and social issues. For example, the emphasis put in medical care has broadened from treating only acute conditions to also managing more chronic diseases and now physicians are able to treat problems associated with aging (Pace and Glass, 2000). While maintaining an elementary clinical curriculum, educators have modeled instruction to include management of chronic illnesses and have also integrated in curriculum themes such as geriatrics, palliative care and pain management.
Schools have also emphasized on improving the instructions on certain topics for instance, disease prevention, health of the people, health promotion, communication skills, addiction, and determinants of health, medical informatics, and emergence preparedness, among others. There is also a change in the structure of medical schools with themes such as earlier clinical experiences, curricular structures incorporating the basic sciences (Ludmerer and Johns, 2005). Learners are being exposed to a broad variety of health care settings and instructional modalities based on new advanced technologies. Learners are also expected to achieve a specified target in the realm of competency.
Schools have also reported approaches for innovation in order to advance their missions, for instance, referring students to undergo a nonmedical community service in the locality as a way to establish dedicated tracks in rural health and primary care and this promotes research experiences in the medical field (Bonaminio et al, 2008). Graduates need to seek a medical licensure by entering GME. These programs vary in length depending on the specialty. Health educational experts are designing programs to respond to the health community needs. They are also looking at how to optimize the GME duration, for instance, by shortening the period of education (Gevitz, 2009). After completing a course in a medical school, it is a duty of a physician to continue with professional development in the course of the career. A physician may do this by participating in their educational activities or by finishing the continuing medical education. With such continued experience, physicians are able to reinforce the content they studied earlier on, and also remain competent in the field of medicine, while providing quality health care to patients and communities. Furthermore, there is restriction of working hours and this has caused a significant change (Horowitz et al, 2004). Previously, there were no working restrictions and practitioners worked for so many hours. This was redesigned such that a trainee works for lesser hours compared to historical hours so that they don’t become tired as a result of having lengthy hours of duty. This can also help to improve their quality of life.
Conclusion
America like any other country suffered poor medical care. The Inhabitants of colonial searched for medical care from herbal practitioners, and Indian medicine. However, America has experienced significant expansion of the medical education system since the nineteenth century. Until today, America‘s medical education is a large enterprise and it is still reinventing itself on various levels. Many changes have taken place to enhance America’s medical education system, for instance, the undergraduate years have been emphasized that the students are in well being with the trainer. Training is also being linked to various meaningful outcomes that are beneficial to the trainee and the neighborhood. Such changes in medical education have resulted in to improved health care practice and delivery in the United States. The changes in medical education were also aimed to improve trainee’s quality of life and this is currently true in the US. Additionally, the selective admission process allows only qualified students to be admitted for the medical schools hence producing excellent medical care givers.
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