Abstract
Medical education in the 19th and early 20th century was comprised of many reports detailing the individualized structure of lectures and topic areas including anatomy, biochemistry, physiology, microbiology, and pharmacology which were given to medical students. These lectures consisted largely of didactic format, in which students at various medical schools were given basic information in a lecture format, without emphasis on interactive learning or clinically based instruction. In the 19th and early 20th centuries, most medical schools operated independently, with little oversight and regulation from various governmental or local agencies. This resulted in a wide array of learning styles presented in each classroom setting, with no clear consistency either within a specific medical school or between medical schools with respect to curriculum. As a result, there was no uniformity or regulation in the medical education curriculum, nor were students from one medical school tested to be found equal to other students at various other schools.
In the early part of the 20th century, Abraham Flexner investigated the consistencies and variations found in curricula at many North American medical schools. In his now famous report published in 1910, he noted the discrepancies between almost every medical education format that was offered, and additionally, noted the wide variety of instruction found throughout established schools. His report ultimately challenge the existence of substandard medical schools and resulted in the closing of many of the medical schools for the next 30 years. Abraham Flexner was able to bring to light the need for a consistent format of teaching and testing as well as oversight of all North American medical schools. As a result, we now have a more unified approach to medical education and consistencies are now found across the many medical schools located throughout North America and around the world. In the 100 years since his initial report, medical schools have gone from individualized entities with little regard towards basic and clinical instruction, to a more uniform set of standards applied equally to all medical schools found throughout the United States. Many of these regulations and improvements in have been adopted by medical schools throughout the world to provide continuity and quality in medical education.
From the early 20th century to the later stages of the 20th century, medical education consisted of didactic lectures, with each individual course delivering information on a subset of individualized topics related to the specific department where the course was instructed. Instruction in core courses such as biochemistry, physiology, pharmacology, anatomy, microbiology, and pathology stood more alone as separate entities, rather than cooperative courses where material was taught in conjunction with each other. In the latter half of the 20th century and to the beginning part of the 21st century, a more clear understanding of teaching of medical students has become apparent, with more integration between basic and clinical science courses, and also a more broad-based understanding of the basic science courses. No longer are the basic science courses taught as separate entities, but they are taught in relationship to other basic science and clinically relevant courses with respect to the information presented. In addition, basic science better integrates clinical science perspective into the information taught, thus providing students with not only the basic information, but clinical perspectives by which they can take to their later years of their medical education. The integration of clinical correlations with basic science courses in medical school, and the interweaving of the basic science courses among the various disciplines, has provided a much clearer perspective of understanding for medical students as they prepare for residency and beyond. Relationships between drugs, specific diseases and their pathologies, affords students a broader knowledge with which they can more accurately diagnose and treat patients. The integration of anatomical skills with physiological understanding helps provide the student with a better understanding and insight into the biochemical basis of disease and clinical treatment. This clinical integration with basic science courses has served not only to improve the quality of medical education, but aids in the development of the quality of students that graduate from medical school and their aptitude in medicine.
As a component of increased clinical perspective and integration with basic science education, enhanced use of online teaching tools has become effective in guiding students through their education. Numerous texts are now found available in online format rather than hard copy, allowing students to have more free range of access to these materials via electronic devices, computers, and cellular phones. By having this information always available in electronic format, information is always at the student's fingertips for reference, and it affords the students more accurate diagnosis and more clear understanding of materials that are present. Libraries are acquiring online subscriptions to journals rather than the traditional hard copies. This not only saves cost in many venues, but affords individuals the opportunities to save documents on their computers for later referencing and cross reference. Programs such as RedMed, Blackboard, ExamSoft, among others, make it easier for the students to not only assess course documents, learning materials, as well as lecture notes, but make acquisition of information and learning of vital resources more effective. Accessibility of students to course related documentation is now easier than ever, with students being able to access course related handouts and materials at any time prior to the lecture. As a result, students are better prepared for the material that is presented in each didactic course, and have a clearer understanding of both the basic science and clinical correlations presented with each individual topic. As time progresses, there will be greater use of electronic media for dissemination of knowledge to the students whether it be in didactic instruction or in clinical correlations. Another increasing presence in medical education is both in problem-based learning and independent learning, with students having an even greater access to online materials, textbooks, and manuscripts with which to improve and strengthen their medical education.
Additional areas that have seen tremendous growth over the past 20 years of medical education are the advent of both problem-based learning and team-based learning in medical education. Problem-based learning, is key to presenting the student with information that he or she needs to solve a specific clinical diagnosis. Students are either assessed individually, or in teams, where they actively discuss the specific case at hand. Students are required to work together in small groups to identify the specific problem at hand, and utilize all resources available to them to come up with diagnosis and treatment modalities of the specific cases. Enhanced use of problem-based learning affords the student more of a hands-on approach to medical education, where they can clearly identify the critical needs of each clinical scenario, and identify the methods by which they should approach the problem toward its eventual conclusion. While problem-based learning and team-based learning are vital components of a medical education, they should not be regarded as total substitutes towards didactic instruction. They should, however, be regarded as integral components that are closely linked the complete education process of the student. Both problem-based learning and team-based learning allow the students to think more critically to resolve issues of medical importance, and to refine their clinical skills at both diagnosis, treatment, and most importantly knowing where to find critical information needed to diagnose a specific case.
As we progress through the 21st century and beyond, independent learning exercises are also finding their way into medical education. Independent learning exercises are frequently found in all basic science courses, and are designed to allow the student to effectively investigate a specific topic area individually prior to coming up with the appropriate solution. Topics can be quite varied through independent learning exercises, and for many courses, this lecture format serves as a companion to didactic lectures. In the ideal independent learning scenario, students are presented with specific topical information with which to expand their educational experience, and are required to use a variety of online resources with which to fully understand the topic. Students are regularly asked either multiple-choice questions, or essay format questions that test the students grasp of the information that they have previously investigated in this exercise. This learning exercise provides the student with the motivation to successfully achieve the answer to the questions that are presented in each independent learning exercise, and allows the student the resources with which to find the specific answers. Both problem-based learning and independent learning exercises can be accomplished individually, or with groups of students. Each of these exercises provides a venue in which the students can expand upon their knowledge of basic science curriculum, and forge links towards the clinical years of their medical education.
One of the key features that is arising in medical education is also the field of active learning in medical education. Active learning is simply defined as presenting the students with problems with which they can seek out specific answers. Active learning has similarity between problem-based learning and independent learning exercises. Active learning, translates into a format where each individual student, whether alone or in groups, vigorously engages upon the learning materials that are presented in the context of each course. These skills include self-assessment on learning needs, the independent identification, analysis, and synthesis of relevant information, and the appraisal of the credibility of information sources. As we progress in medical education, more and more didactic lectures will be replaced with active learning, team-based learning and problem-based learning exercises. In addition, didactic lectures will be replaced with independent learning exercises in which the students must actively learn materials on their own, culminating in a correct answering of a variety of question formats. Whether these be in team-based learning exercises, problem-based learning, or individualized learning, more and more students will be forced to actively engage themselves in the learning of the basic medical curriculum.
Another area of importance in medical education is the evaluation of students as they progress in the medical curriculum. All students learn at different rates, and each method of instruction, whether didactic learning, independent learning, or team-based learning, works differently for certain subsets of students. The only way to effectively monitor success of any individualized teaching methods is to apply longitudinal learning assessments in the medical curriculum. To effectively conduct longitudinal learning assessments, specific subsets of faculty need to be assigned with individual students and follow their progress through each individual basic and clinical science courses and ultimately throughout their career in medical school. Longitudinal assessments of students learning habits can be accomplished in any of the classic basic science courses, whether it be anatomy, physiology, microbiology, biochemistry, pharmacology, or pathology. Gaps in student knowledge can be assessed as the student progresses throughout the curriculum. Longitudinal assessment of student learning also helps catch those students that are falling behind early in each individual courses, so that remediation can be obtained early rather than later to allow the students to progress successfully through each individual course of instruction.
As we progress into the 21st century, there will be less formalized didactic lectures that are presented in each of the core basic science curriculum, and the development of a more seamless education in the first two years of medical school. This integration of medical science curriculum allows the student to more carefully understand materials that are presented in a relationship to the various topics at hand. In addition, the seamless curriculum will allow the students to be better prepared for their clinical years of medical school so that they can effectively comprehend, diagnose, and treat those patients with which they are presented.
In summary, medical education is just a shadow of its former self as was taught in the 19th and early part of the 20th century. Changes in the way that lectures are delivered, increasing use of independent learning, and increasing use of online teaching tools have provided the student with a wide array of information sources with which to supplement and expand their education. Individualized courses only delivering information in the specific subset area of medicine, are now a thing of the past, and more correlations, both clinical and nonclinical between the various courses are presented students to aid their education. As we progress into the future, there will be a seamless basic science curriculum, where courses are identified based more on topic areas across basic and clinical perspectives, rather than the individual basic science as taught as in years past.
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We have assembled a truly outstanding editorial board of individuals in medical schools throughout North America and Europe, Africa, Australia, New Zealand, and Asia with which to guide us in the initial stages and future success of our Journal. We look forward to making this one of the leaders in medical education, with high visibility, and high impact, not only on basic science medical education, but also on clinical education for many years to come.