Editor's Note
Making Change
Education is all about change. Elementary school teachers change nonspellers into spellers, nonreaders into readers, and non-subtractors into subtractors. Colleges take unprocessed high school graduates, refine them with doses of reading and lecture, and produce thinking, informed citizens. And medical schools accept collegians who know more about Lost than lungs and graduate M.D.s who can recognize rhonchi and treat pneumonia. Transformation is the goal of education at all levels.
The transformers seem to be in a constant state of transformation themselves. Public education has hopscotched from theory to theory—from Dewey’s Theory of Knowledge to Bush’s No Child Left Behind.
Medical education has moved more slowly and less frequently. Since Abraham Flexner penned his foundational report in 1910, most medical schools have offered a four-year curriculum with two years of basic science and two of clinical exposure. Some schools have dabbled in experimentation such as my alma mater, Northwestern University, which in 1961 started the combined baccalaureate/M.D. program, simultaneously accepting high school seniors into the undergraduate program and medical school and then granting an M.D. six years later. Since the advent of medical specialties in the 1930s and ’40s, most medical school graduates have gone on to postgraduate training. Although residency requirements have lengthened and subspecialties have popped up, the fundamentals of training neophyte physicians have remained much the same for the past 60 years.
But recent shifts in the profile of those neophytes have forced medical education to adapt. No longer is the crop of medical school applicants uniformly fresh college graduates who are predominantly male and determined to race through medical school in four years. Current first-year students are former engineers who switched careers at age 30 or mothers of three who are juggling doctor-training with child-rearing. So medical educators have had to create a curriculum flexible enough to accept students with diverse life situations yet teach them medicine and help them reach the commencement platform four, maybe six, years later.
The medical world that those newly minted M.D.s enter has also changed. Managed care dictates reimbursement and, frequently, treatment. As hospitalists proliferate, primary care is evolving into an outpatient-only profession. Technology increasingly dominates daily practice. And the income gap between specialties seems to be widening. Choosing a specialty and a practice setting is no longer a simple matter of liking a field and “hanging up a shingle” after residency. Medical school graduates walk off that platform with their diploma in one hand and a $150,000 reminder from their banker in the other, so income potential is bound to drive their decision about where they land in today’s medical universe.
Is anything unchangeable in medical education? Certainly, the medical student will always need to learn the basics of anatomy, biochemistry, and physiology. But in the future, diseases likely will be understood at the chromosomal level and diagnosed with blood samples using microchips in the office, relegating stethoscopes to museum cases and reflex hammers to dusty drawers. Regardless of any future technological marvels, however, what won’t change in doctoring and in educating future doctors is the living, feeling human who walks through the clinic door looking for help.
Charles R. Meyer, M.D., editor in chief
Dr. Meyer can be reached at
cmeyer1@fairview.org