the behavioral and social sciences into their curricula. Other agencies and organizations concerned about ensuring that appropriate behavioral and social science information is being adequately taught to all U.S. medical students would also find this database useful. Based on the finding that existing national databases provide inadequate information on behavioral and social science content, teaching techniques, and assessment methodologies, the committee recommends the development of a comprehensive database that is updated on a regular basis.

The current structure of American medical education was adopted in the early 1900s and has not varied greatly since that time (Ludmerer, 1985). The basic sciences—anatomy, physiology, biochemistry, and microbiology—were introduced as a scientific foundation on which clinical practice knowledge and skills were built. In addition, the introduction of clinical science in the context of a university constituted a significant shift from a community practice–based, apprenticeship model of preparation for careers in medicine to one in which clinical medicine was taught by full-time faculty in a university-owned or university-affiliated teaching hospital. The Carnegie Foundation was instrumental in this reform of medical education, sponsoring a study by Abraham Flexner that became a blueprint for the transformation of medical schools nationally (Flexner, 1910). Over the years, however, shifts have occurred within the basic structure of medical education, including those related to learning techniques. An example is the movement from a focus on passive learning through lectures to active learning through the use of small-group exercises focused on cases and exercises that help integrate biological, psychological, and sociological perspectives, as well as clinical and basic science knowledge (Irby and Hekelman, 1997).

These new directions have coincided with significant changes in the practice of medicine and important developments in medicine itself. For example, medical schools have become only one element of academic health centers, which combine schools of various health professions, medical centers and hospitals, major clinical practice facilities, and research facilities. The practice of medicine itself has become highly organized and has generally moved from solo, private practices to practices in large groups and institutions. In addition, dramatic improvements have occurred in medical therapeutics, especially compared with the therapeutic modalities available a century ago, when it has been asserted that no more than six useful drugs were available (Osler and Harvey, 1976).

Another change is one that complicates attempts to identify and assess specific content taught in medical school courses. In the early 1900s, it was relatively easy to identify the science content (at least by subject area) of medical school courses because the courses were often given titles derived from the science being taught. Today, however, although the science content is still present, it is diffused across courses and is difficult to identify from outside the classroom and from a course title alone. For example, gross anatomy, which was classically



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement