Medical education

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Medical student in a laboratory at Monterrey Institute of Technology and Higher Education, Mexico City. Medical student at the laboratories of ITESM CCM.jpg
Medical student in a laboratory at Monterrey Institute of Technology and Higher Education, Mexico City.
Medical Student taking blood pressure during awareness campaign event MMSA Checking Blood Pressure.JPG
Medical Student taking blood pressure during awareness campaign event

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).

Physician professional who practices medicine

A physician, medical practitioner, medical doctor, or simply doctor, is a professional who practises medicine, which is concerned with promoting, maintaining, or restoring health through the study, diagnosis, prognosis and treatment of disease, injury, and other physical and mental impairments. Physicians may focus their practice on certain disease categories, types of patients, and methods of treatment—known as specialities—or they may assume responsibility for the provision of continuing and comprehensive medical care to individuals, families, and communities—known as general practice. Medical practice properly requires both a detailed knowledge of the academic disciplines, such as anatomy and physiology, underlying diseases and their treatment—the science of medicine—and also a decent competence in its applied practice—the art or craft of medicine.

A medical school is a tertiary educational institution, or part of such an institution, that teaches medicine, and awards a professional degree for physicians and surgeons. Such medical degrees include the Bachelor of Medicine, Bachelor of Surgery, Doctor of Medicine (MD), or Doctor of Osteopathic Medicine (DO). Many medical schools offer additional degrees, such as a Doctor of Philosophy (Ph.D), Master's degree (M.Sc), a physician assistant program, or other post-secondary education.

Residency (medicine) type of early-career medical practitioner

Residency or postgraduate training is a stage of graduate medical education. It refers to a qualified physician, podiatrist, or dentist who practices medicine, usually in a hospital or clinic, under the direct or indirect supervision of a senior 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, house officer, registrar or trainee depending on the jurisdiction. Residency training may be followed by fellowship or sub-specialty training.

Contents

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. [1]

Entry-level education

Faculty of Medicine (Comenius University in Bratislava) Slovakia LF - Dekanat 1.jpg
Faculty of Medicine (Comenius University in Bratislava) Slovakia

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, 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. However, medical programs are using systems-based curricula in which learning is integrated, and several institutions do this. In the United States, until quite recently,[ when? ] the requirements for the M.D. degree did not include even one course in human nutrition. Today, this omission has been rectified, [2] at least to the extent that one such course is required. [3]

Anatomy The study of the structure of organisms and their parts

Anatomy is the branch of biology concerned with the study of the structure of organisms and their parts. Anatomy is a branch of natural science which deals with the structural organization of living things. It is an old science, having its beginnings in prehistoric times. Anatomy is inherently tied to developmental biology, embryology, comparative anatomy, evolutionary biology, and phylogeny, as these are the processes by which anatomy is generated over immediate (embryology) and long (evolution) timescales. Anatomy and physiology, which study (respectively) the structure and function of organisms and their parts, make a natural pair of related disciplines, and they are often studied together. Human anatomy is one of the essential basic sciences that are applied in medicine.

Physiology science of the function of living systems

Physiology is the scientific study of the functions and mechanisms which work within a living system.

Biochemistry study of chemical processes in living organisms

Biochemistry, sometimes called biological chemistry, is the study of chemical processes within and relating to living organisms. Biochemical processes give rise to the complexity of life.

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. [4]

Postgraduate education

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".

Dean's office at the First Faculty of Medicine, Charles University, Prague Dekanat 1.LF UK.jpg
Dean's office at the First Faculty of Medicine, Charles University, Prague

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 specialisation.

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. [5] [6]

Continuing medical education

In most countries, continuing medical education (CME) courses are required for continued licensing. [7] 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. [8] [9]

Online learning

Medical education is increasingly utilizing online teaching, usually within learning management systems (LMSs) or virtual learning environments (VLEs). [10] [11] Additionally, several medical schools have incorporated the use of blended learning combining the use of video and in-person exercises. [12] 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. [13]

Research areas into online medical education include practical applications, including simulated patients and virtual medical records. [14] 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. [15]

Example of medical education systems

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. [16] [17]


See:

Integration with health policy

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. [18]

There is a growing call for health professional training programs to not only adopt more rigorous health policy education and leadership training, [19] [20] [21] 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. [22] [23] 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). [23] A country’s health care delivery system reflects its “underlying values, tolerances, expectations, and cultures of the societies they serve”, [24] and medical professionals stand in a unique position to influence opinion and policy of patients, healthcare administrators, & lawmakers. [19] [25]

One 2010 survey of U.S. medical school deans of education regarding health policy education initiatives [26] found that of the 160 accredited M.D. and D.O schools surveyed, 58% responded to report that while 94% of them had "some form" of policy education, 74% required that education and only 24% had courses directly on the topic of health policy. 58% reported room for improvement, while 52% were currently in the processing of adapting their policy curriculums. Still, the average amount of time spent with health policy instruction was only 14 hours (SD 12 hours) over the four years of medical school training.

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. [21] 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. [21] [22] 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. [27] But for students in one medical school study, [28] 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. [22] [27] [29] [30] [31]

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 standards [32] for U.S. residencies and fellowships that determines funding and ability to operate.

See also

Related Research Articles

Evidence-based medicine (EBM) is an approach to medical practice intended to optimize decision-making by emphasizing the use of evidence from well-designed and well-conducted research. Although all medicine based on science has some degree of empirical support, EBM goes further, classifying evidence by its epistemologic strength and requiring that only the strongest types can yield strong recommendations; weaker types can yield only weak recommendations. The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians about individual patients. Use of the term rapidly expanded to include a previously described approach that emphasized the use of evidence in the design of guidelines and policies that apply to groups of patients and populations. It has subsequently spread to describe an approach to decision-making that is used at virtually every level of health care as well as other fields.

Emergency medicine medical specialty concerned with care for patients who require immediate medical attention

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 practice 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 doctors (DOs) can be licensed to practice medicine and surgery in all 50 states and are recognized to varying degrees in 65 other countries.

A Doctor of Medicine is a medical degree, the meaning of which varies between different jurisdictions. In the United States, Canada and some other countries, the MD denotes a professional graduate degree awarded upon graduation from medical school. In the United Kingdom, Ireland and other countries, the MD is a research doctorate, higher doctorate, honorary doctorate or applied clinical degree restricted to those who already hold a professional degree in medicine; in those countries, the equivalent professional degree is typically titled Bachelor of Medicine, Bachelor of Surgery (MBBS).

Physician assistant profession

A physician assistant (PA) is a professional who practices medicine in collaboration or under indirect supervision of a physician, depending on state laws. Physicians do not need to be on-site with PAs and collaboration or supervision often occurs via electronic means when consults are necessary. Their scope of practice varies by jurisdiction and healthcare setting.

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 emphasises 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 Doctorate of Medicine and of Philosophy (MD–PhD) is a dual doctoral degree for physician–scientists, combining the vocational training of the Doctor of Medicine degree with the research expertise of the Doctor of Philosophy degree. The degree is granted by medical schools often through the Medical Scientist Training Program or other non-MSTP MD–PhD programs. The National Institutes of Health currently provides 43 medical schools with Medical Scientist Training Program grants that support the training of students in MD–PhD programs at these institutions through tuition and stipend allowances. These programs are often competitive, with some admitting as few as two students per academic year. The MCAT score and GPA of MD–PhD matriculants are often higher than MD only matriculants.

The Accreditation Council for Graduate Medical Education (ACGME) is the body responsible for accrediting the majority of 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 the majority of DO physicians in the United States. Plans call for the ACGME to oversee the Unified Accreditation System for all MDs and DOs in 2015.

The Mayo Clinic College of Medicine and Science (MCCMS), formerly known as Mayo Clinic College of Medicine (MCCM), is a private graduate-only research university based in Rochester, Minnesota that trains physicians, scientists, and allied health professionals. The college is part of the Mayo Clinic academic medical center and is accredited by the Higher Learning Commission (HLC). MCCMS consists of five schools that offer M.D., Ph.D., and other degrees, as well as residencies, fellowships, and continuing medical education.

The University of Cincinnati Academic Health Center (AHC) is a collection of health colleges and institutions of the University of Cincinnati, Cincinnati, Ohio. It trains health care professionals and provides research and patient care. AHC has strong ties to UC Health, which includes the University of Cincinnati Medical Center and West Chester Hospital.

Lake Erie College of Osteopathic Medicine

The Lake Erie College of Osteopathic Medicine (LECOM) is a private graduate school of medicine, dentistry, and pharmacy with a main campus in Erie, Pennsylvania, and branch campuses located in Greensburg, Pennsylvania and Bradenton, Florida. Founded in 1992, LECOM confers degrees in osteopathic medicine (D.O.), pharmacy (PharmD), and dentistry (DMD), as well as master's degrees in Health Services Administration, Biomedical Sciences, and Medical Education. LECOM operates one of the few accelerated three-year pharmacy programs in the country, and is one of 2 pharmacy schools in the country with a distance education program.

Medical school in the United States is most commonly a four-year 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 bachelors 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.

In the United States, physicians may hold either the Doctor of Medicine degree (MD) or the Doctor of Osteopathic Medicine degree (DO). MD and DO physicians complete similar residency programs in hospitals, can be licensed in all 50 states, and have rights and responsibilities common to physicians.

Doctor of Osteopathic Medicine is a professional doctoral degree for physicians and surgeons offered by medical schools in the United States. A DO graduate may become licensed as an osteopathic physician, having equivalent rights, privileges, and responsibilities as a physician who has earned the Doctor of Medicine (MD) degree. DO physicians are licensed to practice the full scope of medicine and surgery in 65 countries, and in all 50 US states. They constitute 11% of all US physicians. As of 2018, there were more than 145,000 osteopathic medical physicians and osteopathic medical students in the United States.

Marshall B. Ketchum University is a private university focused on graduate programs in healthcare and located in Fullerton, California. MBKU expanded from the Southern California College of Optometry which was founded in 1904. The university was officially established as a multidisciplinary university with the addition of School of PA Studies in 2011 and College of Pharmacy in 2013.

The OU School of Community Medicine (OUSCM) located in Tulsa, OK is a branch of the University of Oklahoma College of Medicine. It is the first medical school of its kind in the nation. The OU School of Community Medicine is designed to serve the healthcare needs of entire communities, especially vulnerable and underserved populations. OUSCM is guided by the growing need for more physicians focused on serving vulnerable populations, the growing number of people without access to quality health care, and the relatively poor health status of Oklahomans.

Physical therapy education

Physical therapy education varies greatly from country to country. Worldwide, physical therapy training ranges from basic work site education in hospitals and outpatient clinics to professional doctoral degree and masters programs.

College of Osteopathic Medicine of the Pacific

The College of Osteopathic Medicine of the Pacific (COMP) is a private, non-profit medical school for osteopathic medicine located in downtown Pomona, in the U.S. state of California. The college opened in 1977 as the only osteopathic medical school west of the Rocky Mountains. COMP was the founding program of Western University of Health Sciences (WesternU), which now has 8 colleges in addition to COMP, each offering professional degrees in various fields of healthcare. COMP has a single 4-year program, conferring the Doctor of Osteopathic Medicine (D.O.) degree. Graduates are eligible to practice medicine in all 50 states and more than 60 countries.

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