Focus on Medical Education

Substantial reforms in American medical education have been recommended by a national panel put together by the New York Academy of Medicine. The study deserves close attention.

Medical education in the United States “retains its primacy today,” the panel concluded. “But now there is abundant and increasing evidence that American medical education is not keeping pace with the swift changes in the way medical care is organized and delivered and with the technologies that have so revolutionized medical practice. It is a worrisome paradox that, although remarkable recent achievements in biomedical science have vastly increased physicians’ ability to better the lot of the sick, medicine is waning in its attractiveness to the young.”

Clinical medical education “is in danger of preparing doctors for medicine of the past,” the study concluded.

The reforms proposed by the group focus both on medical schools and on government bodies that license physicians. More clinical training should be moved to ambulatory-care settings, matching the trend to do more procedures outside traditional acute-care hospital facilities. Community service should become part of the required training. And comprehensive, performance-based clinical examinations should be added to the traditional examinations now in place.

Much of the medical-education reform is intended to “introduce a better blend of humanism and science into our health-care institutions and the students they graduate,” to encourage more emphasis on health promotion and disease prevention and to reverse the trend that has made medical education “an increasingly fragmented, technically oriented training program for specialists” rather than “a broad preparation of the undifferentiated doctor.”

The study is the first in a series to be funded by the Josiah Macy Jr. Foundation. The panel was under the chairmanship of Dr. David E. Rogers of the Cornell Medical College, formerly the president of the Robert Wood Johnson Foundation.