Return to Front PageVOLUME 6, NUMBER 4
 

In a recent round of public opinion research commissioned by the AAMC, we learned that 22 percent of parents want their children to grow up to be physicians - a slight increase over the 18 percent of parents who expressed the same desire for their children in 1965. Today, as it did 35 years ago, "physician" tops the list of parental aspirations.

This finding is particularly gratifying in view of the recent decline in applicants to medical school. Although the falloff is far from worrisome, given that more than two applicants still vie for every available first-year slot, the reminder that parents continue to regard medicine so highly as a career choice is reassuring for the future of our profession.

Equally reassuring for the future of medicine is the continued evolution of medical education itself. Students choosing medicine today are not only making a wise decision about their future (and pleasing their parents, to boot!), they are embarking on a much different - and much improved - educational experience from that of their predecessors.

As medical science bursts forth with dramatic new tools for relieving human suffering, as the need for cost containment transforms the health care delivery system, and as patients express a longing for more culturally competent, caring physicians, medical educators across the country have been busily modifying their curricula to accommodate new expectations - all the while sustaining the time-honored virtues that have made American medical education the envy of the world.

On Sept. 21, the AAMC, the Milbank Memorial Fund, and Academic Medicine, the AAMC's scholarly journal, hosted a special event in Washington, D.C., to celebrate medical education's accomplishments over the past 100 years. Titled "A Century of Reform - Medical Education's Quiet Revolution to Meet America's Health Care Needs," the event brought together many leaders from inside and outside academic medicine both to pay tribute to the inventive and exciting curricular reforms already adopted by our schools and to discuss future opportunities and challenges.

The celebration was scheduled to coincide with the release of two exceptional reports charting the evolution of medical education in North America. The first, a report sponsored by the Milbank Memorial Fund, takes an in-depth look at the curricular innovations and reforms implemented by 10 medical schools in the United States. The second, a supplement to the September issue of Academic Medicine, compiles "snapshots" of the similarly remarkable advances evident in the curriculum of 130 of the 141 medical schools in the U.S. and Canada. The supplement provides a mosaic of medical students' education at the beginning of the 21st century - information that has never before been collected in a single place.

By documenting not only what medical schools are now teaching, but also where and how they are teaching it, these reports illustrate vividly just how successfully medical education has adapted to changing times. More education is now taking place in community settings where so many of today's medical problems are found; both real and "standardized" patients have taken on new roles as "teachers" of vital clinical skills; and computers and mannequins are now as commonplace as textbooks and film clips in assisting students to achieve requisite competencies and to gain confidence in their abilities before encountering their own patients.

But not all is rosy. Medical education is - and has always been - a work in progress. Many challenges remain. The Milbank Report warns, for example, of the erosion of the learning environment and of the need to develop tools to evaluate curricular reform. It also cautions that a growing divide separates clinical research from clinical teaching and that today's students may not be adequately prepared to care for patients with chronic diseases.

Still another challenge is to ensure that students wed their knowledge of modern science and technology with a commitment to compassionate care and professionalism. Students need not only the knowledge to comprehend molecular genetics; they need the skills and attitudes to deal effectively with end-of-life issues and the competencies to care for an ethnically and racially diverse population.

The myriad improvements in medical education adopted in the 20th century and chronicled in the new Milbank Report and in the Academic Medicine supplement have positioned us well to meet our students' needs for the 21st century. But we cannot rest on our past accomplishments. If parents are to continue to encourage their sons and daughters to become doctors, the education we provide must continually adapt to merit their high regard.

 Jordan J. Cohen, M.D.
AAMC President

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