Editor's Note: Many schools of medicine in the United States are currently revising or just recently completed major revisions of their medical school curricula.This commentary incorporates the perspectives of a recent future-oriented Surgeon General, the Dean of the Uniformed Services University of the Health Sciences' School of Medicine, a nationally renowned educational scholar, and a senior physician who were charged with coordinating the design and implementation of the first major revision of the University's medical school curriculum in over 30 years.
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The longstanding approach to North American medical school education (also known as Undergraduate Medical Education or UME) with 2 years of primarily didactic, preclinical work followed by 2 years of clinically oriented experiences is based on a 100-year-old tradition.
This tradition is attributed to the work of Abraham Flexner, a former headmaster of a private high school in Kentucky, who in 1909 visited all 155 medical schools in the United States & Canada.
A year later, the Carnegie Foundation for the Advancement of Teaching published his findings, the impact of which reverberated throughout North America, and resulted in the closure and/or merger of nearly one-third of those 155 schools.Another key element of the new curriculum involves the deliberate and consistent intertwining of clinical medicine and basic sciences—not just during the traditional pre-clerkship period, but throughout all 4 years of undergraduate medical training.As such, the new curriculum has been completely revised with virtually none of the preexisting components being unchanged. A major change affecting the pre-clerkship period involved the shift from a traditional, discipline-based form of preclinical instruction to one that is fully integrated and divided into seven different, organ system–based modules. of the heart and lungs are now all combined in one module.The challenge is to learn more about the various systems in medical education ...The last century has witnessed tremendous changes in the education and training system of medical students, as well as medical and surgical residents, in short, our future physicians.This includes consideration of the clinical microsystem associated with the Patient-Centered Medical Home, as well as the military unique considerations that often arise in theater and/or in garrison.In the civilian sector, consideration of the external milieu would involve analysis of pertinent policies/procedures established by a given hospital/HMO, by the associated community/state medical system(s), and/or those policies/procedures associated with Medicare, Medicaid, and other second party payers.The report also heralded a major cultural reform with regard to the manner in which medical students were taught and trained.This landmark report has come to be known as the “Flexner Report” and provided the foundation for the traditional, 2 × 2 approach to undergraduate medical education.This approach has served as the educational underpinning for UME at the Uniformed Services University of the Health Sciences (USU), starting with the graduation of the Charter Class in 1980.As USU celebrates its fortieth anniversary this year, it seems especially fitting not only to reflect on past traditions, but also to highlight some of the curricular innovations that are currently taking place within the University.