BHA FPX 4002 Assessment 2 Changes in Medical Education

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Capella University

BHA-FPX4002 History of the United States Health Care System

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Introduction

The field of medicine has been changing rapidly. Patients expect doctors to adapt and be equipped with the knowledge they need to perform the growing volume of tasks expected of them. Through this paper, I plan to expound on the changes that have occurred in medical education from the 1800s to today. Secondly, I will describe, compare, and contrast the apprenticeship versus the academic models of medical training, and how they have progressed. Lastly, I will evaluate the significance of understanding the history of medical education and its benefits for educating prospective medical graduates now and in the future.

The Changing Scope of Medical Education

Medicine has made dynamic changes throughout history, evolving into what it is today. Through these changes, the way we educate physicians has contributed to the evolution of medicine. While we marvel at the wealth of information medical students are required to absorb, let’s review how medical education has evolved from the 1800s to what it is today.

The first medical school in the United States was founded by John Morgan in 1765. Originally named the Philadelphia College of Medicine, it was soon changed to the University of Pennsylvania (Slawson, 2012). Medical universities during the 1800s were comprised of preceptors who lectured students with little to no oversight or structure. To obtain a degree in medicine during the 1800s, prospective medical students had to meet the following requirements: be at least 21 years of age, complete two years of schooling, and three years of apprenticeship training (Slawson, 2012). Terms for classes during each semester consisted of sixteen-week sessions, with no grading applied. Schools required no formal college prerequisite degree or pre-entrance testing (Slawson, 2012).

Medical schools today are structured differently than those in the 1800s. Before a student can be accepted into a medical school program, this candidate must procure a four-year bachelor’s degree. The candidate must then apply for and pass the Medical College Admission Test (MCAT) and gain admission into a university accredited by the Liaison Committee of Medical Education (LCME). When the candidate receives acceptance into a medical program, requirements include intensive academic courses followed by a rigorous clinical residency apprenticeship, including rotations through various medical specialties. After successfully completing these requirements, the candidate must sit for and successfully pass the United States Medical Licensing Examination (USMLE) (DeZee et al., 2012).

If one desires to become a doctor today, a commitment of eleven years of post-secondary school education is required (DeZee et al., 2012). Compared to medical school training in the 1800s, today’s program is very rigorous and dynamic in nature. It requires the candidate to be dedicated and disciplined, often sacrificing work-life balance to achieve success.

Apprenticeship Versus Academic Models

The cornerstones that shaped medical education standards today comprise of an apprenticeship and academic approaches. Both models, in their own manner, formed an infrastructure for professional enrichment through advancement and learning opportunities for potential medical students. The apprenticeship model provides medical students with direct involvement within a clinical atmosphere. This model emphasizes a hands-on approach to learning for students, which promotes problem-solving skills and establishes an understanding of common medical challenges, aiding medical students in executing problem-solving independently. For guidance, senior practicing physicians oversee each student during rotations. A fierce advocate for bedside learning was William Osler, who believed medical students should step away from the classroom and immerse themselves into clinical settings. Early engagement with patients provides students with an advantage they will not achieve if they remain in a classroom (Swanson, 2012). Through this approach, Osler formed the first residency program at Johns Hopkins School of Medicine (Buja, 2019).

The academic model emphasizes structured education with task-driven assessments and lecture-based learning (DeZee et al., 2012). In 1910, Abraham Flexner published a report entitled the Flexner Report, which galvanized the revamping of medical school qualifications and curricula in the United States and Canada (Barzansky, 2010). Flexner proposed that medical schools should have minimal admission qualifications, apply a rigorous curriculum with practical lab and clinical science content, and engage faculty in research (Barzansky, 2010). This report led to reforms in standard acceptance practices by medical schools on how the preadmission format and education of medical students should be constructed.

The apprenticeship and academic models, when used cohesively, create a well-rounded physician. Osler and Flexner believed practicing physicians should be educated, scientifically grounded, and possess clinical skills to become successful in the field of medicine. Over time, both concepts combined and morphed into what is common practice today for medical schools. The creation of four-year learning paired with residency programs provides both a classroom and hands-on understanding of learning.

Involving Medical Education by Understanding History

Revisiting the history of medicine provides medical students the ability to learn the origination of medical theory, how scientific intervention aided the processes of care, and why it is important to be evidence-based when choosing avenues of treatment for patients. The building blocks for modern medical education involve students learning the history, theory, and science of a problem cohesively as they encounter that issue in life (Caelleigh, 2002). Understanding healthcare history in relation to today helps the medical community avoid repeating mistakes of the past. For example, surgical sterile practices by surgeons during the 1800s were not understood, leading to rampant infections. Surgeons seldom washed their hands, often just rinsing them with water if available, and proceeded to operate on another patient with no protective barriers such as gloves or gowns. Florence Nightingale advocated for the reform of surgical practices, introducing surgical safety and hand-washing hygiene guidelines due to infections and cross-contamination that persisted until 1858 (Newsom, 2003).

Conclusion

Throughout history, medicine has made tremendous advancements and improvements. Integration with scientific techniques and innovative breakthroughs has elevated medicine to the cutting edge of modern technology (DeZee et al., 2012). For medicine to be where it is today, educating these innovators has equally played an integral role in medicine’s progression. Learning models such as the apprenticeship and academic methods separately enabled educators with diverse approaches to delivering suitable skills to medical students. When these models are cohesively applied, as observed today by medical schools, students obtain and reap the benefits of learning.

References

Barzansky, B. (2010). Abraham Flexner and the era of medical education reform. Academic Medicine, 85(9), S19-S25. https://doi.org/10.1097/ACM.0b013e3181f12bd1

Buja, L. M. (2019). Medical education today: All that glitters is not gold. BMC Medical Education, 19. https://doi.org/10.1186/s12909-019-1535-9

Caelleigh, A. (2002). Time to heal: American medical education from the turn of the century to the era of managed care. Education for Health, 15(1), 95-96. Retrieved from http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F2258169883%3Faccountid%3D27965

DeZee, K. J., Artino, A. R., Elnicki, D. M., Hemmer, P. A., & Durning, S. J. (2012). Medical education in the United States of America. Medical Teacher, 34(7), 521–525. https://doi.org/10.3109/0142159X.2012.668248

Newsom, S. (2003). The history of infection control: Florence Nightingale part 1: 1820-1856. British Journal of Infection Control, 4(2), 22-25. https://doi.org/10.1177/175717740300400208