Medical education for transformative times

100 years after the Flexner report on medical education, it's time to think about how to advance physician training for a new generation of students.

Posted Oct. 18, 2010.

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In 1910, educator Abraham Flexner presented an evaluation of American and Canadian medical schools that is widely credited for laying the groundwork for modern medical education. One hundred years later, the question is being asked: Has medical education evolved enough under the Flexner model to prepare the future generations of physicians?

To begin to answer that question, the American Medical Association and the Assn. of American Medical Colleges convened an event in September called "New Horizons in Medical Education: A Second Century of Achievement." The conference was concurrent with a special supplement to the September issue of Academic Medicine, the AAMC's journal, devoted to the past and future of medical education. Among meeting topics were standards for a medical curriculum, and how it should be taught, the same basis of the Flexner report.

Certainly, the 100-year anniversary of a report whose impact on medical education continues to resonate provides a marker for introspection. New Horizons also reflects a sense that we are living in times much like Flexner's, in which rapid scientific and technological change necessitates a closer look at how physicians are made.

In Flexner's time, greater knowledge of the body and how to treat it, such as the invention of the x-ray and the development of antimicrobials, created an environment that demanded more rigorous scientific training of physicians so they could be equipped with the knowledge and skill to handle the new advances. His report also made clear the obligation on society to help cover the cost of this education, saying that tuition alone was not enough to support medical education, from which all would benefit.

The Flexner report was written in a world transformed by the technological and social changes of the Industrial Revolution. Today we are in the midst of an information revolution. Physicians have access to more knowledge, more quickly than ever before.

At New Horizons, one discussion involved whether it is even possible to teach students almost everything they should know about medicine in the course of medical school, or if even a physician's lifetime was enough. In this scenario, a greater focus is placed on critical thinking, consultation skills and the ability to adapt to changing science.

What's also at issue are changing times. Health insurance was not an issue in Flexner's era, but now our complicated payer environment often dominates the discussion of what it is appropriate care. Another financial matter, paying for medical school, also is an issue. Students can graduate owing hundreds of thousands of dollars. That debt is driving the choice of what field of medicine they choose -- too often, not primary care -- if it does not keep them out of the profession altogether.

And for those who do go into medicine, they will be facing patients whose expectations also will be formed by technological and social changes. That includes their own access to online medical information, as well as the need for physicians to effectively provide care for a very diverse population of patients.

How medical education can meet these challenges is a major undertaking. What the conference -- as well as follow-up meetings and efforts like the AMA Center for Transforming Medical Education -- can do is jump-start a wide-ranging dialogue.

Like Flexner, the intent of today's efforts is to find ways for medical education to evolve, creating excellent physicians with the skills they need, scientific and otherwise, to serve patients in transformative times.

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