BHA-FPX4002 Assessment 2-1 PDF

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Running head: CHANGES IN MEDICAL EDUCATION

Changes in Medical Education Capella University History of United States Healthcare System Changes in Medical Education January, 2019

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Introduction The field of medicine has been changing rapidly. Patients expect Doctors to adapt and be equipped with the knowledge they need to perform the growing volume of tasks expected of them. Through this paper, I plan to expound on the changes that have occurred in medical education from the 1800s to today. Secondly, describe, compare, and contrast the apprenticeship versus the academic models of medical training, and how it progressed. And lastly, evaluate the significance of understanding the history of medical education, and its benefits to educating prospective medical graduates now and in the future. The Changing Scope of Medical Education Medicine has made dynamic changes throughout history, to what it has become today. Through these changes, the way we educate physicians has contributed to medicine’s evolution. While we marvel on the wealth of information medical students are required to absorb, let’s review how medical education has evolved from the 1800s, to what it is today. The first medical school in the United States was founded by John Morgan in 1765. Originally named the Philadelphia College of Medicine; it was soon changed to the University of Pennsylvania (Slawson, 2012). Medical universities during the 1800s were comprised of Preceptors, who lectured students with little to no oversight or structure. To obtain a degree in the field of Medicine during the 1800s, prospective medical students had to meet the following requirements; be at least 21 years of age, complete two years of schooling, and three years of apprenticeship training (Slawson, 2012). Terms for classes during each semester consisted of sixteen week sessions, with no grading applied. Schools required no formal college prerequisite degree or pre entrance testing (Slawson, 2012).

CHANGES IN MEDICAL EDUCATION Medical schools today are structured differently than those in the 1800s. Before a student can be accepted into a medical school program, this candidate must precure a four-year bachelor’s degree before being considered. The Candidate must then apply for and pass the Medical College Admission Test (MCAT), and gain admission into a university that is accredited by the Liaison Committee of Medical Education (LCME). When the candidate receives acceptance into a medical program; requirements includes intensive academic courses, followed by a rigorous clinical residency apprenticeship, including rotations through various medical specialties, After successfully completing these requirements, the Candidate must sit for and successfully pass the United States Medical Licensing Examination (USMLE) examination (DeZee, et al., 2012). If one desires to become a doctor today, a commitment of eleven years of post-secondary school education will be required (DeZee, et al., 2012). Compared to Medical School training in the 1800s, today’s program is very rigorous, and dynamic is nature. It requires the Candidate to not only be dedicated, but disciplined, often sacrificing work-life balance, to achieve success. Apprenticeship verses Academic Models The cornerstones that shaped medical education standards today comprise of an apprenticeship and academic approaches. Both models in its own manner formed an infrastructure for professional enrichment, through advancement and learning opportunities for potential medical students. The apprenticeship model provides medical students direct involvement within a clinical atmosphere. This model emphasizes a hands-on approach of learning for students, which promotes problem-solving skills, establishes an understanding of common medical challenges, which can aid medical students in executing problem solving independently. For guidance; senior practicing physician would oversee each student during

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rotations. A fierce advocate for bedside learning was William Osler. Osler believed, medical students should step away from the classroom and immerse themselves into clinical settings. Early engagement with patients provides students with an advantage they will not achieve if they remain in a classroom (Swanson, 2012). Through this approach, Osler formed the first residency program in Johns Hopkins School of Medicine (Buja, 2019).

The academic model emphasizes structural education with tasks driven assessments and lectured learning (DeZee, et al., 2012). In 1910, Abraham Flexner published a report entitled the Flexner Report, which galvanized the revamping of medical school qualifications and curriculums within United States and Canada (Barzansky, 2010). Flexner proposed medical schools should have minimal admission qualifications, apply a rigorous curriculum with practical lab and a clinical science content, with faculty engaging in research (Barzansky, 2010). This report led to reforms of standard acceptance practices by medical schools on how the preadmission format and educating of medical students should be constructed.

The apprenticeship and academic model, when used cohesively creates a well-rounded physician. Osler and Flexner believed practicing physicians should be educated, scientifically grounded and possess clinical skills to become successful in the field of medicine. Overtime both concepts combined and morphed into what is common practice today for medical schools. The creation of four year learning paired with a residency programs provides both a classroom and hand on understanding of learning.

Involving Medical Education by Understanding History Revisiting the history of medicine provides medical students the ability to learn the origination of medical theory, how scientific intervention aided the processes of care, and why it

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is important to be evidence based when choosing avenues of treatments for patients. The building blocks for modern medical education where students learn the history, theory and science of a problem cohesively, as they encounter that issue in life (Caelleigh, 2002).

Understanding healthcare history to its relation today, helps the medical community not to repeat mistakes of the past. Take for example, surgical sterile practices by surgeons; during the 1800s, Surgeons did not understand the importance of proper hand washing methods that are standard practice today (Newsom, 2003). Surgeries performed during 1800s were ramped with infections. Surgeons seldomly wash their hands, and often just rinse them with water if it was available and proceed to operate on another patient with no forms of protective barriers such as gloves or gown. Florence Nightingale advocated for the reform of surgical practices, introducing surgical safety and hand washing hygiene guidelines, due to infections and cross contamination that persisted during the 1800s until 1858 (Newsom, 2003).

Conclusion Throughout history medicine has made tremendous advancements and improvements. Integration with scientific techniques and innovative breakthroughs elevated medicine to the cutting edge of modern technology (DeZee, et al., 2012). For medicine to be where it is today, educating these innovators equally played an integral role in medicine’s progression. Learning models such as the apprenticeship and academic methods separately enabled educators with diverse approaches on how to deliver suitable skills to medical students. When these models are cohesively applied as we observe today by medical schools, students obtain and reap the benefits of learning.

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Reference Barzansky, B. (2010). Abraham Flexner and the Era of Medical Education Reform. Academic Medicine, 85(9), S19-S25. doi: 10.1097/ACM.0b013e3181f12bd1. Buja, L. M. (2019). Medical education today: All that glitters is not gold. BMC Medical Education, 19 doi: http://dx.doi.org.library.capella.edu/10.1186/s12909-019-1535-9

Caelleigh, A. (2002). Time to heal: American medical education from the turn of the century to the era of managed care. Education for Health, 15(1), 95-96. http://library.capella.edu/login? qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview%2F2258169883%3Faccountid %3D27965

DeZee, K. J., Artino, A. R., Elnicki, D. M., Hemmer, P. A., & Durning, S. J. (2012). Medical education in the United States of America. Medical Teacher, 34(7), 521–525. https://doiorg.library.capella.edu/10.3109/0142159X.2012.668248 Newsom, S. (2003). The history of infection control: Florence nightingale part 1: 1820-1856. British Journal of Infection Control, 4(2), 22-25. doi:10.1177/175717740300400208 Rassie, K. (2017). The apprenticeship model of clinical medical education: Time for structural change. The New Zealand Medical Journal (Online), 130(1461), 66-72. Retrieved from http://library.capella.edu/login?qurl=https%3A%2F%2Fsearch.proquest.com%2Fdocview %2F1938125570%3Faccountid%3D27965

Slawson, R. G. (2012). Medical Training in the United States Prior to the Civil War*. Journal of Evidence-Based Complementary & Alternative Medicine, 17(1), 11–27. https://doi.org/10.1177/2156587211427404...