The result was the establishment of two key components or pillars of medical education, namely, the basic or foundational sciences and the clinical sciences. Osler championed bedside teaching, bringing medical students into direct contact with patients, and learning medicine from these direct experiences under the guidance of faculty clinicians. Flexner recommended that medical schools should be university based, have minimum admission requirements, implement a rigorous curriculum with applied laboratory and clinical science content, and have faculty actively engaged in research. Early in the twentieth century, medical education became guided by principles articulated by Abraham Flexner and William Osler.
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This education provides the basis for a professional career enhanced by continuing medical education and life-long learning. The education of a physician has developed to encompass pre-medical preparation, a course of study in a medical school which is typically a major component of an academic medical center (AHC), and medical specialty training in residency and fellowship programs, UME and GME, respectively. The purpose of this article is to offer a critique and express a major concern by a physician-scientist, pathologist and medical educator that the contemporary medical education system is being subject to the downside of disruptive innovation with unintended and potentially detrimental long-term outcomes for academic medicine and clinical practice. While continual assessment leading to measured adaptation is essential for the enduring value of a system, simultaneous and multifaceted change such as that occurring in the traditional medical education system qualifies as disruptive innovation. Yet sweeping changes launched around the turn of the millennium have constituted a revolution in undergraduate medical education (UME) and graduate medical education (GME). The traditional medical education system widely adopted throughout most of the twentieth century has produced generations of scientifically grounded and clinically skilled physicians who have served medicine and society well. The challenges for education of the best possible physicians are great but the benefits to medicine and society are enormous.
Unless there is further modification, the new integrated curricula are at risk of produce graduates deficient in the characteristics that have set physicians apart from other healthcare professionals, namely high-level clinical expertise based on a deep grounding in biomedical science and understanding of the pathologic basis of disease. An argument is made for a shoring up of biomedical science in revised curricula with the beneficiaries being nascent practitioners, developing physician-scientists -and the public. Movement from novice to master in medicine cannot be rushed.
However, enthusiasm for reform needs to be tempered by a more measured approach to avoid unintended consequences. Medical education has changed and will continue to change in response to scientific advances and societal needs. In this article, a critique is presented of the new undergraduate medical education (UME) curricula in relationship to graduate medical education (GME) and clinical practice. Yet sweeping changes launched around the turn of the millennium have constituted a revolution in medical education. The medical education system based on principles advocated by Flexner and Osler has produced generations of scientifically grounded and clinically skilled physicians whose collective experiences and contributions have served medicine and patients well.