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American Medical Schools and the Practice of MedicineA History$
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William G. Rothstein

Print publication date: 1987

Print ISBN-13: 9780195041866

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780195041866.001.0001

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PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use. date: 04 December 2021

Undergraduate Medical Education

Undergraduate Medical Education

(p.294) 16 Undergraduate Medical Education
American Medical Schools and the Practice of Medicine

William G. Rothstein

Oxford University Press

Undergraduate medical education has changed markedly in the decades after mid-century. The basic medical sciences have been de-emphasized; clinical training in the specialties has replaced that in general medicine; and both types of training have been compressed to permit much of the fourth year to be used for electives. The patients used for teaching in the major teaching hospitals have become less typical of those found in community practice. Innovations in medical education have been successful only when they have been compatible with other interests of the faculty. As medicine and medical schools have changed, major differences of opinion have developed over the goals of undergraduate medical education. Practicing physicians have continued to believe that the fundamentals of clinical medicine should be emphasized. A survey in the 1970s of 903 physicians found that over 97 percent of them believed that each of the following was “a proper goal of medical school training:” “knowing enough medical facts;” “being skillful in medical diagnosis;” “making good treatment plans;” “understanding the doctor-patient relationship;” “understanding the extent to which emotional factors can affect physical illness;” “being able to keep up with new developments in medicine;” and being able to use and evaluate sources of medical information. Only 52 percent felt that “being able to carry out research” was a proper goal of medical school training. Medical students have also believed that undergraduate medical education should emphasize clinical training. Bloom asked students at one medical school in the early 1960s whether they would prefer to “work at some interesting research problem that does not involve any contact with patients,” or to “work directly with patients, even though tasks are relatively routine.” About 25 percent of the students in all four classes chose research, while 58 percent of the freshmen and 70 percent of the juniors and seniors chose patient care. The same study also asked students their criteria for ranking classmates “as medical students.” Clinical skills were the predominant criteria used by students, with “ability to carry out research” ranking far down on the list. Faculty members, on the other hand, have emphasized the basic and preliminary nature of undergraduate medical education.

Keywords:   Community-based medical schools, Comprehensive care teaching, Cornell University medical school, Duke University medical school, Preceptors, Western Reserve University medical school

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