Chronicle of Higher Education Article Regarding Medical Admissions and Training Models
Medical Schools Should Re-Examine Admissions and Training Methods, Experts Say
By KATHERINE MANGAN
Medical schools should take advantage of the first major expansion in 30 years to update an outmoded physician-training model that has resulted in the wrong mix of people being trained in the wrong settings at too high a cost, according to a report released on Thursday by the Josiah Macy Jr. Foundation.
The report, “Revisiting the Medical School Educational Mission at a Time of Expansion,” calls on medical schools to adopt sweeping changes in order to attract students of more diverse economic and ethnic backgrounds, train them in community settings as well as hospitals, and, in some cases, compress the time it takes to become a physician. (A summary of the report is available on the Macy foundation’s Web site.)
The report is based on the work of 36 educators who met at a three-day brainstorming session in October and a series of commissioned studies. Jordan J. Cohen, who was president of the Association of American Medical Colleges from 1994 to 2006, led the panel of educators.
Amid warnings of a looming shortage of physicians in the United States, nine new schools for training medical doctors are being built or planned, and 108 of the nation’s 126 traditional medical schools are expanding their class sizes. Some are also opening new branches (The Chronicle, January 12, 2007).
In addition, the number of osteopathic schools, which tend to graduate larger proportions of primary-care doctors than traditional medical schools do, has grown from 19 in 2000 to 28 today, with more in the works.
“We feel this is a unique moment in time—the first expansion of medical schools and medical-school enrollments in 30 years in this country, combined with the need and real possibility of health-care reform” under the Obama administration, said George E. Thibault, president of the foundation, which is in New York.
Dr. Cohen concurred. “The overarching message is that medical schools must accelerate the pace of change in order to meet the rapidly evolving needs of society.”
The staggering debt loads that doctors in training incur are scaring away many potential students, including minority-group members, and discouraging graduates from considering careers in primary-care medicine. The report notes that 80 percent of new physicians owe $130,000or more in student loans. One strategy the panel suggests is to follow the lead of some Canadian medical schools and examine ways to compress four years of medical education into three, possibly by combining the fourth year of medical school with the first year of residency training.
De-emphasizing standardized-test scores and looking at applicants more holistically could enable medical schools to diversify what is too often a predominantly white and affluent student body, the report notes.
Medical students and residents should also spend more time in a variety of practice settings, it says.
“Increasingly … much more medicine is being practiced outside the hospital, in clinics, doctors’ offices, and even in the home,” Dr. Cohen said. “We need to provide more opportunities for our students to practice in the real world, as well as the hospital.”
