Medical Education and Societal Needs A Planning Report for Health Professions (1983) / Chapter Skim
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5. Innovative Models of Medical Education in the United States Today: An Overview with Implications for Curriculum and Program Evaluation
5. Innovative Models of Medical Education in the United States Today: An Overview with Implications for Curriculum and Program Evaluation
Pages 107-147
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From page 107... ...
Smith, and Allyn M Mortimer Thin critical review discusses some of the more innovative approaches to medical education found in United States medical schools today, and summarizes evaluative ef forte.
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From page 108... ...
, perhaps with the intention of selecting least costly means of achieving a particular goal or Ret of goals. To our knowledge, none of the evaluation activities noted in Part II have been undertaken explicitly for this purpose, although the cost of amounting innovative medical education programs has certainly been a consideration.
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From page 109... ...
outcomes for the larger community ~ see, for example, the School of Medicine of Ben Gurion University Center for Health Sciences ~ . The goals, as stated, will of course determine the focus of evaluation activities undertaken.o The curriculum or program goals must be specified in testable form.
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From page 110... ...
It Will be noted in Part II that the process of selecting students for participation in an innovative or nontraditional curriculum or program is never done by randomly assigning all students admitted to the medical school to one or the other of its medical education programs. In all cases, students select themselves for a program (by applying for it ~ or (perhaps)
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From page 111... ...
As Part II shows, the evaluation activities on innovative or nontraditional programs typically involve the use of one or more of the following types of instruments: (1) standardized tests -- e."., National Boards, licensure examinations-on which the performance of students or graduates of the program is compared with that of other students/graduates; (2)
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From page 112... ...
Some were evidently concerned with the learning process itself -- how it takes place most ef fecti~rely and with what kinds of students (see the McMaster University and Ben Gurion University programs in particular) , some more particularly with the relationship between the stage at which ce rtain concepts or experiences are introduced and reinforced and subsequent career choices (see, for example, all Community-Based/Primary Care programs)
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From page 113... ...
The authors suggest that "major innovations in medical education can develop more easily in new medical schools or in satellites remote from the parent institution," citing the McMaster program, Michigan State University' ~ Upper Peninsula Program, and the Biomedical Education Program at City College of New York. However, the creation of new medical schools is unlikely because of economic realities and the high cost of establishing them, and because existing schools are already reducing their entering class size in response to projections that the number of phys icians will exceed expected overall requirements in the next few decades.
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From page 114... ...
The very existence of the variants may, in fact, convey important messages to prospective physicians about what is valued in the medical community and by the community at large .2 A further suggestion is that more attention in medical education program evaluation be directed toward developing and specifying methods to evaluate . program impact on distant, societal goals (meeting the health care needs of the population, for example)
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From page 115... ...
The virtues of this approach at the time that it was instituted widely -- i.e., following publication of the Flexner reports and with the Johns Hopkins University School of Medicine serving as prototype -- were that the emphasis on basic science transformed medical schools that were "entirely vocational" ant reputedly of uneven ant in many cases very poor quality, into institutions that * Titles of models ant the exemplars selected to represent them are somewhat arbitrary, and leave room for honest disagreement.
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From page 116... ...
10 Organ System Model Origin ant Purposes An integrated organ system approach to medical education was pioneered by Case Western Reserve University School of Medicine in 1952, in a series of curriculum innovations that evolved over a ten-year period under special circu~stances -- the leadership of a new dean, many new department heads, and generous grants from The Commonweal eh Fund . The overall purpose of these innovations, which were f urther ref.
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S medical schools have adopted one or more of the innovations pioneered at Case Western Reserve .16 I ~ t'ts ~ ra tive Example: Case Western Reserve University School of M-licine*
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One such study, recently completed and prepared for The Commonwealth Fund, assesses the impact of the new curriculum on the first 10 classes of graduates (1956-1965~.16 This study was designed to facilitate comparison of results with an earlier study of Case Western Reserve medical graduates, which covered the period 1935-1945. Both studies examine physicians' careers ant career patterns and their sources of satisfaction and dissatisfaction with the ir professional lives.
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From page 119... ...
Impact of the Cased GO He most profound impaled at Case Western Reserve in the 1950s has been its influence on other medical schools, both in the IJnited States and abroad -- not so much as concerns particular curriculum features, but rather as an "inspiration," which liberated them from "the lockstep of conformity that dominated ~ United States schools] for forty years.
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From page 120... ...
* The Flexible or Elective Model Origin and Purposes A great many factors and pressures both within ant outside medical schools Led to major curriculum ant program innovation and experimentation that began in the 1950e with Case Western Reserve 's pioneering introduction of its totally interdi~ci;plinary prograel.3~5~9~12,l8~20 These factors included: (1)
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From page 121... ...
Evaluation Activities In conjunction with the overhaul of its medical education program in the 1960s, Duke designed and implemented mayor longitudinal curriculum evaluation activities. As of 1975, Duke had been evaluating the impact of its program changes for some 10 years.
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From page 122... ...
However, since that time there has been no rigorous analysis of the data, though program administrators express conf idence that analyses would conf ire their impressionistic view that the elective program has been highly successful. For example, they note that the postgraduate training programs that Duke graduates enter are "excellent, " and that Board certification rates are "high." Additionally, the point at which career choices are made tends to be earlier for Duke students than for students at other medical schools, which may be due to Duke students' earlier exposure to clinical experiences.22 Communi ty-Based/Primary Care Model Origin and Purposes A national physician shortage in comprehensive health care, especially for rural areas and economically poor population groups, became a major concern of the federal government and medical educators al ike beginning in the L9SOs.
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The network links these schools with each other and with other medical schools committed to an innovative approach or willing to collaborate with such sChooln.26 Both McMaster and Ben Gurion Uni~rersittes ~ discussed below, have medical schools belonging to the network. Illustrative Example: University of New Mexico (UNM)
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From page 124... ...
During this period, students also continue their basic and clinical science learning (centered around the problems of patients they encounter) , and study the social, political, and economic forces affecting the health of their communities; they also conduct community health assessments and develop community health projects on the basin of the needs they have identified.
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From page 125... ...
Description In 1977 the states of Alaska, Montana, and Idaho entered an agreement wi th the state of Washington to become full partners in medical education, with the University of Washington School of Medicine (Seattle) serving as the medical education, faculty, and tertiary-care resource.33~35 Students entering the program from the four WAMI states take their first year of medical education at one of four universities without medical schools (Washington State University, the University of Alaska, Montana State University, and the University of Idaho)
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From page 126... ...
Students typically complete the McMaster program in three years, with attendance for 11 months per year. However, in contrast to the typical three-year metical education program developed in the United States (and discusses later under Accelerated Models)
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, but also on the impact of biology, environment ~ and life-style on health. Students are exposed very early in the program to pat tents and their problems, in settings ranging from community health care practices to specialized hospital services (i.e., primary-, secondary-, and tertiary-care settings)
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From page 128... ...
, the goals of the McMaster program are to provide students with the capacity o to identify health problems and search for information to resolve or manage these problems; o to examine the underlying physical or behavioral mechanisms of the identif fed heal th problems; o to recognize, maintain, and develop personal characteristics and attitudes required for professional life; o to develop the clinical skills and learn the methods required to define and manage health problems of patients, including physical, emotional, and social aspects; o to become a self-directed learner, recognizing personal educat tonal needs, selecting appropriate learning resources, and evaluating progress; o to critically assess professional activity related to patient care, health delivery, and medical research; o to function as a productive member of a small group, engages in learning, research, or health care; and o to be aware of and to be able to work in a variety of health care set t ings . 37 Evaluation Activities Evaluation of student progress (called formative or diagnostic evaluations, in that they are fed back to the student)
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From page 129... ...
To accommodate these students, more f legibility in scheduling is presently being developed .41 Impact of the McMaster Program Information about McMaster's medical education program has been widely disseminated in the United States ant elsewhere. Several new medical schools' including the medical school founded in Maastricht, Holland, in 1974 and the Suez Canal University in Egypt, have based their medical education programs on the McMaster program.
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S medical schools.
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Evaluation Activities Assessment of the Ben Gurion medical education program is carried out by both students and faculty. While only two classes have been graduated (as of December 1982)
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D Programs Origin and Purposes Fueled by the f inancial incentives of the 1971 federal health legislation to meet a physician shortage by increasing the product ion of physicians, many Medical schools increased their medical school enrollments and shortened the length of time needed to complete the medical education program, without substantively changing the curriculum.
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From page 133... ...
Description and Goals Southern Illinois University began its three-year medical education program in 1973, simultaneously with the opening of its medical sChool.46 She three-year curriculum attempted to accomplish a traditional program in 36 months. Basic science content was covered over 67 weeks, there were 48 clerkship weeks, and 18 weeks of electives.
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D programs available in United States medical schools.
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From page 135... ...
Combining baccalaureate and medical education also may help eliminate redundancies and discontinuities in course work, permit more clinical training time during the medical education phase, and make better use of facilities and human resources, according to proponents of such combined degree programs. Interface programs were established in 1975 at the seven institutions cited above, with assistance from the Commonwealth Fund, to (1)
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From page 136... ...
experience. Evaluation Activities Findings from its own self-evaluation efforts are viewed internally as so favorable that its proponents recommend the MMEDEC program as a model for other schools of medicine.49 For instance, the first two cohorts of students admitted to the program took a larger proportion of conscience courses during their last two years of college than did a "similar group of premedical students who were still concerned with admission to medical school.
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From page 137... ...
Small numbers, furthermore, create an additional problem of making it virtually impossible to "draw any conclusions" as to program impact.4d With respect to the medical schools involved, the study also notes that the universities have failed to challenge medical school admissions policies, which continue to require a high grade point average , high grades in premedical science courses, and satisfactory to good performance on the Medical College Aptitude Tests.48 Illustrative Example: University of Michigan Medical School Integrated Premedical-Medical (Inteflex) Program program: Description and Goals Begun in 1972, the six-year Inteflex program, like the Interface programs described above, is a combined baccalaureate-M.D.
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From page 138... ...
The Inteflex program is also especially concerned with women, particularly the program's impact on female students and graduates. Evaluation Activities Since its inception, extensive program monitoring and evaluation activities have been under way.
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Evaluation Activities Student monitoring and performance evaluation are both continuous and extensive. For example, multiple choice examinations are given every three months, and students are required to pass Parts I and II of the National Boards by graduation date.
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Some 94 medical schools in the United States offer M.D.-Ph.D. programs.
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Special Needs: A Medical Education Program for Minority Students Illustrative Example: Meharry Medical College School of Medicine* Established in 1876, Meharry Medical College School of Medicine is one of four predominantly black medical colleges that address the special needs of black medical students and the black community in the United States.
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In terms of achieving program goals or objectives (apart from student achievement) , administrators note that, over the past ten years, some 75 percent of Meharry graduates have located their practices in medically underserved areas (inner cities and rural areas)
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V Medical Schools and the Changing Times: Nine Case Reports on Experimentation in Medical Education, 1950-1960.
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H Medical education at Western Reserve University: a progress report for the sixteen years, 1946-1962.
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452-54. In Proceedings of the Seventeenth Annual Conference on Research in Medical Educatione Sponsored by the AAMC Division of Educational Measurement and Research in conjunction with the 89th Annual Meeting, October 1978.
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F., eds. New Medical Schools at Home and Abroad.
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David Etcher, President, Meharry Medical College (see Appendix D)
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