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Medical education is education related to the practice of being a medical practitioner; either the initial training to become a physician (i.e., medical school and internship), or additional training thereafter (e.g., residency, fellowship and continuing medical education).
Medical education and training varies considerably across the world. Various teaching methodologies have been utilised in medical education, which is an active area of educational research.
Medical education is also the subject-didactic academic field of educating medical doctors at all levels, including entry-level, post-graduate, and continuing medical education. Medical education applies theories of pedagogy specifically in the context of medical education. Specific requirements such as entrustable professional activities must be met before moving on in stages of medical education.
Entry-level medical education programs are tertiary-level courses undertaken at a medical school. Depending on jurisdiction and university, these may be either undergraduate-entry (most of Europe, Asia, South America and Oceania), or graduate-entry programs (mainly Australia, Philippines and North America). Some jurisdictions and universities provide both undergraduate entry programs and graduate entry programs (Australia, South Korea).
In general, initial training is taken at medical school. Traditionally initial medical education is divided between preclinical and clinical studies. The former consists of the basic sciences such as anatomy, physiology, biochemistry, pharmacology, pathology. The latter consists of teaching in the various areas of clinical medicine such as internal medicine, pediatrics, obstetrics and gynecology, psychiatry, general practice and surgery.
There has been a proliferation of programmes that combine medical training with research (M.D./Ph.D.) or management programmes (M.D./ MBA), although this has been criticised because extended interruption to clinical study has been shown to have a detrimental effect on ultimate clinical knowledge.
The Liaison Committee on Medical Education ( LCME ) is a committee of educational accreditation for schools of medicine leading to an MD in the United States and Canada. In order to maintain accreditation, medical schools are required to ensure that students meet a certain set of standards and competencies, defined by the accreditation committees. The "Function and Structure of a Medical School" article is a yearly published article from the LCME that defines 12 accreditation standards.
The Association of American Medical Colleges (AAMC) has recommended 13 Entrustable Professional Activities (EPAs) that medical students should be expected to accomplish prior to beginning a residency program.EPAs are based on the integrated core competencies developed over the course of medical school training. Each EPA lists it's key feature, associated competencies, and observed behaviors required for completion of that activity. The students progress through levels of understanding and capability, developing with decreasing need for direct supervision. Eventually students should be able to perform each activity independently, only requiring assistance in situations of unique or uncommon complexity .
The list of topics that EPAs address include:
Following completion of entry-level training, newly graduated doctors are often required to undertake a period of supervised practice before full registration is granted; this is most often of one-year duration and may be referred to as an "internship" or "provisional registration" or "residency".
Further training in a particular field of medicine may be undertaken. In the U.S., further specialized training, completed after residency is referred to as "fellowship". In some jurisdictions, this is commenced immediately following completion of entry-level training, while other jurisdictions require junior doctors to undertake generalist (unstreamed) training for a number of years before commencing specialization.
Each residency and fellowship program is accredited by the Accreditation Council for Graduate Medical Education (ACGME), a non-profit organization led by physicians with the goal of enhancing educational standards among physicians. The ACGME oversees all MD and DO residency programs in the United States. As of 2019, there were approximately 11,700 ACGME accredited residencies and fellowship programs in 181 specialties and subspecialties.
Education theory itself is becoming an integral part of postgraduate medical training. Formal qualifications in education are also becoming the norm for medical educators, such that there has been a rapid increase in the number of available graduate programs in medical education.
In most countries, continuing medical education (CME) courses are required for continued licensing.CME requirements vary by state and by country. In the USA, accreditation is overseen by the Accreditation Council for Continuing Medical Education (ACCME). Physicians often attend dedicated lectures, grand rounds, conferences, and performance improvement activities in order to fulfill their requirements. Additionally, physicians are increasingly opting to pursue further graduate-level training in the formal study of medical education as a pathway for continuing professional development.
Medical education is increasingly utilizing online teaching, usually within learning management systems (LMSs) or virtual learning environments (VLEs).Additionally, several medical schools have incorporated the use of blended learning combining the use of video, asynchronous, and in-person exercises. A landmark scoping review published in 2018 demonstrated that online teaching modalities are becoming increasingly prevalent in medical education, with associated high student satisfaction and improvement on knowledge tests. However, the use of evidence-based multimedia design principles in the development of online lectures was seldom reported, despite their known effectiveness in medical student contexts. To enhance variety in an online delivery environment, the use of serious games, which have previously shown benefit in medical education , can be incorporated to break the monotony of online-delivered lectures.
Research areas into online medical education include practical applications, including simulated patients and virtual medical records (see also: telehealth).When compared to no intervention, simulation in medical education training is associated with positive effects on knowledge, skills, and behaviors and moderate effects for patient outcomes. However, data is inconsistent on the effectiveness of asynchronous online learning when compared to traditional in-person lectures. Furthermore, studies utilizing modern visualization technology (i.e. virtual and augmented reality) have shown great promise as means to supplement lesson content in physiological and anatomical education.
With the advent of telemedicine (aka telehealth), students learn to interact with and treat patients online, an increasingly important skill in medical education.In training, students and clinicians enter a "virtual patient room" in which they interact and share information with a simulated or real patient actors. Students are assessed based on professionalism, communication, medical history gathering, physical exam, and ability to make shared decisions with the patient actor.
At present, in the United Kingdom, a typical medicine course at university is 5 years or 4 years if the student already holds a degree. Among some institutions and for some students, it may be 6 years (including the selection of an intercalated BSc—taking one year—at some point after the pre-clinical studies). All programs culminate in the Bachelor of Medicine and Surgery degree (abbreviated MBChB, MBBS, MBBCh, BM, etc.). This is followed by 2 clinical foundation years afterward, namely F1 and F2, similar to internship training. Students register with the UK General Medical Council at the end of F1. At the end of F2, they may pursue further years of study. The system in Australia is very similar, with registration by the Australian Medical Council (AMC).
In the US and Canada, a potential medical student must first complete an undergraduate degree in any subject before applying to a graduate medical school to pursue an (M.D. or D.O.) program. U.S. medical schools are almost all four-year programs. Some students opt for the research-focused M.D./Ph.D. dual degree program, which is usually completed in 7–10 years. There are certain courses that are pre-requisite for being accepted to medical school, such as general chemistry, organic chemistry, physics, mathematics, biology, English, labwork, etc. The specific requirements vary by school.
In Australia, there are two pathways to a medical degree. Students can choose to take a five- or six-year undergraduate medical degree Bachelor of Medicine/Bachelor of Surgery (MBBS or BMed) as a first tertiary degree directly after secondary school graduation, or first complete a bachelor's degree (in general three years, usually in the medical sciences) and then apply for a four-year graduate entry Bachelor of Medicine/Bachelor of Surgery (MBBS) program.
Along with training individuals in the practice of medicine, medical education will influence the norms and values of those people who pass through it. This occur through explicit training in medical ethics, or implicitly through "hidden curriculum" a body of norms and values that students will come to understand implicitly but is not formally taught.The hidden curriculim and formal ethics curriculum will often contradict one another.
The aims of medical ethics training are to give medical doctors the ability to recognise ethical issues, reason about them morally and legally when making clinical decisions, and be able to interact to obtain the information necessary to do so.
The hidden curriculum may include the use of unprofessional behaviours for efficiency.Or view the academic hierarchy as more important than the patient. The concept of "professionalism" may be used as a device to ensure obedience, with complaints about ethics and safety being labelled as unprofessional.
As medical professional stakeholders in the field of health care (i.e. entities integrally involved in the health care system and affected by reform), the practice of medicine (i.e. diagnosing, treating, and monitoring disease) is directly affected by the ongoing changes in both national and local health policy and economics.
There is a growing call for health professional training programs to not only adopt more rigorous health policy education and leadership training,but to apply a broader lens to the concept of teaching and implementing health policy through health equity and social disparities that largely affect health and patient outcomes. Increased mortality and morbidity rates occur from birth to age 75, attributed to medical care (insurance access, quality of care), individual behavior (smoking, diet, exercise, drugs, risky behavior), socioeconomic and demographic factors (poverty, inequality, racial disparities, segregation), and physical environment (housing, education, transportation, urban planning). A country’s health care delivery system reflects its “underlying values, tolerances, expectations, and cultures of the societies they serve”, and medical professionals stand in a unique position to influence opinion and policy of patients, healthcare administrators, & lawmakers.
In order to truly integrate health policy matters into physician and medical education, training should begin as early as possible – ideally during medical school or premedical coursework – to build “foundational knowledge and analytical skills” continued during residency and reinforced throughout clinical practice, like any other core skill or competency.This source further recommends adopting a national standardized core health policy curriculum for medical schools and residencies in order to introduce a core foundation in this much needed area, focusing on four main domains of health care: (1) systems and principles (e.g. financing; payment; models of management; information technology; physician workforce), (2) quality and safety (e.g. quality improvement indicators, measures, and outcomes; patient safety), (3) value and equity (e.g. medical economics, medical decision making, comparative effectiveness, health disparities), and (4) politics and law (e.g. history and consequences of major legislations; adverse events, medical errors, and malpractice).
However limitations to implementing these health policy courses mainly include perceived time constraints from scheduling conflicts, the need for an interdisciplinary faculty team, and lack of research / funding to determine what curriculum design may best suit the program goals.Resistance in one pilot program was seen from program directors who did not see the relevance of the elective course and who were bounded by program training requirements limited by scheduling conflicts and inadequate time for non-clinical activities. But for students in one medical school study, those taught higher-intensity curriculum (vs lower-intensity) were “three to four times as likely to perceive themselves as appropriately trained in components of health care systems”, and felt it did not take away from getting poorer training in other areas. Additionally, recruiting and retaining a diverse set of multidisciplinary instructors and policy or economic experts with sufficient knowledge and training may be limited at community-based programs or schools without health policy or public health departments or graduate programs. Remedies may include having online courses, off-site trips to the capitol or health foundations, or dedicated externships, but these have interactive, cost, and time constraints as well. Despite these limitations, several programs in both medical school and residency training have been pioneered.
Lastly, more national support and research will be needed to not only establish these programs but to evaluate how to both standardize and innovate the curriculum in a way that is flexible with the changing health care and policy landscape. In the United States, this will involve coordination with the ACGME (Accrediting Council for Graduate Medical Education), a private NPO that sets educational and training standardsfor U.S. residencies and fellowships that determines funding and ability to operate.
Medical education is also the subject-didactic field of educating medical doctors at all levels, applying theories of pedagogy in the medical context, with its own journals, such as Medical Education . Researchers and practitioners in this field are usually medical doctors or educationalists. Medical curricula vary between medical schools, and are constantly evolving in response to the need of medical students, as well as the resources available.Medical schools have been documented to utilize various forms of problem-based learning, team-based learning, and simulation. The Liaison Committee on Medical Education (LCME) publishes standard guidelines regarding goals of medical education, including curriculum design, implementation, and evaluation.
The Objective Structure Clinical Examinations (OSCEs) are widely utilized as a way to assess health science students' clinical abilities in a controlled setting.Although used in medical education programs throughout the world, the methodology for assessment may vary between programs and thus attempts to standardize the assessment have been made.
Medical schools and surgical residency programs may utilize cadavers to identify anatomy, study pathology, perform procedures, correlate radiology findings, and identify causes of death.With the integration of technology, traditional cadaver dissection has been debated regarding it's effectiveness in medical education, but remains a large component of medical curriculum around the world. Didactic courses in cadaver dissection are commonly offered by certified anatomists, scientists, and physicians with a background in the subject.
Medical curriculum vary widely among medical schools and residency programs, but generally follow an evidence based medical education (EBME) approach.These evidence based approaches are published in medical journals. The list of peer-reviewed medical education journals includes, but is not limited to:
Open access medical education journals:
Graduate Medical Education and Continuing Medical Education focused journals:
This is not a complete list of medical education journals. Each medical journal in this list has a varying impact factor, or mean number of citations indicating how often it is used in scientific research and study.
Emergency medicine, also known as accident and emergency medicine, is the medical specialty concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians care for unscheduled and undifferentiated patients of all ages. As first-line providers, their primary responsibility is to initiate resuscitation and stabilization and to start investigations and interventions to diagnose and treat illnesses in the acute phase. Emergency physicians generally practise in hospital emergency departments, pre-hospital settings via emergency medical services, and intensive care units, but may also work in primary care settings such as urgent care clinics. Sub-specializations of emergency medicine include disaster medicine, medical toxicology, ultrasonography, critical care medicine, hyperbaric medicine, sports medicine, palliative care, or aerospace medicine.
Osteopathic medicine is a branch of the medical profession in the United States. Osteopathic physicians (DOs) are licensed to practice medicine and surgery in all 50 states and are recognized to varying degrees in 85 other countries.
Internal medicine or general internal medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of internal diseases. Physicians specializing in internal medicine are called internists, or physicians in Commonwealth nations. Internists are skilled in the management of patients who have undifferentiated or multi-system disease processes. Internists care for hospitalized and ambulatory patients and may play a major role in teaching and research. Of note is that internal medicine and family medicine are often confused as equal in the Commonwealth nations.
Anesthesiology, anaesthesiology, anaesthesia or anaesthetics is the medical speciality concerned with the total perioperative care of patients before, during and after surgery. It encompasses anesthesia, intensive care medicine, critical emergency medicine, and pain medicine. A physician specialised in this field of medicine is called an anesthesiologist, anaesthesiologist or anaesthetist, depending on the country.
A teaching hospital is a hospital or medical center that provides medical education and training to future and current health professionals. Teaching hospitals are often affiliated with medical schools and work closely with medical students throughout their period of matriculation, and especially during their clerkship (internship) years. In most cases, teaching hospitals also offer graduate medical education (GME)/physician residency programs, where medical school graduates train under a supervising (attending) physician to assist with the coordination of care.
Residency or postgraduate training is specifically a stage of graduate medical education. It refers to a qualified physician, podiatrist, dentist, or veterinarian who practices medicine, usually in a hospital or clinic, under the direct or indirect supervision of a senior medical clinician registered in that specialty such as an attending physician or consultant. In many jurisdictions, successful completion of such training is a requirement in order to obtain an unrestricted license to practice medicine, and in particular a license to practice a chosen specialty. An individual engaged in such training may be referred to as a resident, registrar or trainee depending on the jurisdiction. Residency training may be followed by fellowship or sub-specialty training.
Family medicine (FM), formerly family practice (FP), is a medical specialty devoted to comprehensive health care for people of all ages. The specialist is named a family physician or family doctor. In Europe, the discipline is often referred to as general practice and a practitioner as a general practice doctor or GP. This name emphasizes the holistic nature of this speciality, as well as its roots in the family. Family practice is a division of primary care that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body. Family physicians are often primary care physicians. It is based on knowledge of the patient in the context of the family and the community, emphasizing disease prevention and health promotion. According to the World Organization of Family Doctors (WONCA), the aim of family medicine is to provide personal, comprehensive, and continuing care for the individual in the context of the family and the community. The issues of values underlying this practice are usually known as primary care ethics.
The University of Pittsburgh School of Medicine is the medical school of the University of Pittsburgh, located in Pittsburgh, Pennsylvania. The School of Medicine, also known as Pitt Med, is consistently ranked as a "Top Medical School" by U.S. News & World Report in both research and primary care. It is ranked 13th in the category of research and 14th in primary care by U.S. News for 2020, and is separately ranked 17th in the Academic Ranking of World Universities list of best medical schools in the world. The school encompasses both a medical program, offering the doctor of medicine, and graduate programs, offering doctor of philosophy and master's degrees in several areas of biomedical science, clinical research, medical education, and medical informatics.
The American Osteopathic Association (AOA) is the representative member organization for the more than 145,000 osteopathic medical doctors (D.O.s) and osteopathic medical students in the United States. The AOA is headquartered in Chicago, Illinois, and is involved in post-graduate training for osteopathic physicians. Beginning in 2015, it began accrediting post-graduate education as a committee within ACGME, creating a unified accreditation system for all DOs and MDs in the United States. The organization promotes public health, encourages academic scientific research, serves as the primary certifying body for D.O.s overseeing 18 certifying boards, and is the accrediting agency for osteopathic medical schools through its Commission on Osteopathic College Accreditation. As of October 2015, the AOA no longer owns the Healthcare Facilities Accreditation Program (HFAP), which accredited hospitals and other health care facilities.
The Accreditation Council for Graduate Medical Education (ACGME) is the body responsible for accrediting all graduate medical training programs for physicians in the United States. It is a non-profit private council that evaluates and accredits medical residency and internship programs. The ACGME was founded in 1981 and was preceded by the Liaison Committee for Graduate Medical Education, which was established in 1972. The ACGME currently oversees the post-graduate education and training for all MD and DO physicians in the United States.
Medical resident work hours refers to the shifts worked by medical interns and residents during their medical residency.
Medical school in the United States is graduate program with the purpose of educating physicians in the field of medicine. Such schools provide a major part of the medical education in the United States. Most medical schools in the US confer upon graduates a Doctor of Medicine (MD) degree, although some confer a Doctor of Osteopathic Medicine (DO) degree, and a few offer combined programs where graduates earn both a bachelor's degree and an MD or DO. Most schools follow a similar pattern of education, with two years of classroom and laboratory based education, followed by two years of clinical rotations in a teaching hospital where students see patients in a variety of specialties. After completion, graduates must complete a residency before becoming licensed to practice medicine.
Physicians in the United States hold either the Doctor of Medicine degree (MD) or the Doctor of Osteopathic Medicine degree (DO). Institutions awarding the MD are accredited by the Liaison Committee on Medical Education (LCME) or Educational Commission for Foreign Medical Graduates (ECFMG). Institutions awarding the DO are accredited by the Commission on Osteopathic College Accreditation (COCA). The MD degree is obtained at either domestic or international schools. The DO degree is obtained at domestic schools only. Foreign-trained osteopaths are not recognized as physicians in the United States.
The Michigan State University College of Osteopathic Medicine (MSUCOM) is the osteopathic medical school of Michigan State University located in East Lansing, Michigan. The college grants the Doctor of Osteopathic Medicine (D.O.) degree, as well as a DO-PhD combined degree for students interested in training as physician-scientists. MSUCOM operates two satellite campuses in Clinton Township and Detroit. The college is accredited by the American Osteopathic Association's Commission on Osteopathic College Accreditation (COCA) and by the Higher Learning Commission of the North Central Association of Colleges and Schools.
The Alliance of Independent Academic Medical Centers (AIAMC) is an American national membership organization of approximately 70 major academic medical centers and health systems committed to quality patient care, medical education and research. AIAMC members regard medical education and research as strategic assets in providing patient-centered care; operate independently of medical school ownership or governance while maintaining major medical school affiliations; care for a patient population that mirrors their local communities; and provide teaching and research that is innovative, applicable to practice and community responsive.
Mercer University School of Medicine (MUSM) is the graduate medical school of Mercer University and a component of the Mercer University Health Sciences Center. It was founded in 1982 in Macon, Georgia, United States, and in 2008 opened a second campus in Savannah, Georgia with either site allowing students to complete all four requisite years of medical training. In 2012 MUSM developed a third site in Columbus, Georgia at which students may elect to complete their third and fourth years of training.
The Surgical Council on Resident Education (SCORE®) is a nonprofit consortium founded in 2004 by seven organizations involved in U.S. surgical education.
Obesity medicine is a field of medicine dedicated to the comprehensive treatment of patients with obesity. Obesity medicine takes into account the multi-factorial etiology of obesity in which behavior, development, environment, epigenetic, genetic, nutrition, physiology, and psychosocial contributors all play a role. As time progresses, we become more knowledgeable about the complexity of obesity, and we have ascertained that there is a certain skill set and knowledge base that is required to treat this patient population. Clinicians in the field should understand how a myriad of factors contribute to obesity including: gut microbiota diversity, regulation of food intake and energy balance through enteroendocrine and neuroregulation, and adipokine physiology. Obesity medicine physicians should be skilled in identifying factors which have contributed to obesity and know how to employ methods to treat obesity. No two people with obesity are alike, and it is important to approach each patient as an individual to determine which factors contributed to their obesity in order to effectively treat each patient.
The Elson S. Floyd College of Medicine is a public medical school headquartered in Spokane, Washington. Founded in 2015, it is part of Washington State University, and is the second public medical school in the state of Washington. It welcomed its inaugural class in the fall of 2017, joining the University of Washington and Pacific Northwest University of Health Sciences as one of three medical schools in the state.
The Mayo Clinic Alix School of Medicine (MCASOM), formerly known as Mayo Medical School (MMS), is a research-oriented medical school based in Rochester, Minnesota, with additional campuses in Arizona and Florida. MCASOM is a school within the Mayo Clinic College of Medicine and Science (MCCMS), the education division of the Mayo Clinic. It grants the Doctor of Medicine (M.D.) degree, accredited by the Higher Learning Commission (HLC) and the Liaison Committee on Medical Education (LCME). In November 2018, the school was renamed in honor of a $200 million donation from businessman Jay Alix.
|Wikisource has the text of the 1911 Encyclopædia Britannica article Medical Education .|