Viewpoint: Medical Education:
Time to Reevaluate the Status Quo

John L. Gollan, M.D., Ph.D.; Dean, College of Medicine University of Nebraska Medical Center

As an 18-year-old at Adelaide University in South Australia, I frequently thought about the wonderful surfing weather that I was missing by sitting in gross anatomy lab. Fortunately, this state of mind passed when I became a fourth-year medical student and finally began to interact with patients. This was a sixth-year course clearly divided into pre-med and clinical years.

Reflecting on subsequent phases of my career, most of which have been spent in London, San Francisco and Boston, it is evident that major differences exist in the traditional British and U.S. medical education systems. Despite these differences, however, it is difficult to argue the merits of one model versus the other in terms of superior graduates. For certain, in order to adequately train young U.S. doctors and prepare them for the world that will confront them beyond this decade, profound changes in our current system will be required.

Simply stated, I am concerned about how our medical students are being educated. Although I do not have all of the answers, I have reached one undeniable conclusion: As medical educators in the United States, we can do better. It is time to address our shortcomings and begin to talk about real reform in medical education.

We all recognize that the practice of medicine is changing, and that education must keep pace. To achieve this, we must look at many factors, including, but not limited to: the escalating cost of education, the "knowledge explosion," changing demographics of the population, the "fiscal health" of academic health centers, the differing needs of patients, inefficiencies in our current educational process and the use of new teaching modalities, particularly involving information technology.

For many years we have expected students to accumulate a vast array of facts, retaining all of the information that is useful for the treatment of patients. Along these lines, we have emphasized the tripartite roles of clinician, researcher and educator. It is time to reevaluate the balance between these areas as we review our current medical curriculum and move to consider a more modular system that provides flexibility and accelerated focus or specialization.

As knowledge at all levels of medicine grows, it is impractical to expect physicians to stay abreast in all areas. Physicians of the future must carry an approach to medicine rather than all of the facts relating to diseases. By serving in a role similar to a team manager the physician of tomorrow will make obligatory use of pharmacists, physician assistants, nurses, social workers and allied health care providers to deliver routine care. Physicians of tomorrow should spend less time on routine encounters and more on complex problem-solving. They must be experts in the use of information technology in order to handle the knowledge explosion that is underway. We must stress this role in education.

That is not to say that medical education should be devoid of traditional subjects and learning. For sure, basic science knowledge is critical to the physician, but the depth of coverage might not need to be as comprehensive. Should we identify and teach basic concepts in less detail in order to free up more specialized educational opportunities in all years of medical school? In freeing this time, we would allow students who are interested in specific areas, such as primary care, surgery, interventional medicine and clinical or basic research to specialize in specific channels of coursework throughout their years in medical school. When combined with residency training, this approach might decrease the total time in the educational system for specific students, thus decreasing their debt load.

One way to achieve this goal is by combining residency training programs with the final year of medical school. These programs have been most successful in allowing students the opportunity to cut a year from their formal education, thus lowering their debt burden. However, we think that much more can be done, and that is why we continue to vigorously reevaluate our curriculum.

Making changes on these levels will be a monumental task. Certainly, the easiest path is to continue to tweak our current system just enough to implement the latest pedagogical trend or to incorporate the latest breakthrough. We cannot let logistical concerns block pertinent discussion and real action. We must take steps now to ensure the best health of our patients and our profession in the coming century.

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