Universities and medical schools: reflections on a half-century of Canadian medical education.

After 50 years of accelerated development, universities and medical schools have entered a period of uncertainty and instability. The Flexnerian paradigm of medical education, rooted in biomedical science and conducted under the aegis of a university, reached its apotheosis by the late 1960s and the early 1970s. Fuelled by the introduction of comprehensive, government-sponsored health care insurance and advances in technology, the demand for health care professionals and for access to facilities increased sharply. Medical education, research and advanced clinical services expanded dramatically aided by the emergence of academic health sciences centres and accompanied by a wave of medical curriculum reform. Now medical schools must strike a dynamic balance in responding to the continued expansion of knowledge and technology, the demand for social equity and the exigencies of prolonged fiscal constraint. They must also balance the biological and sociological approaches to medicine in establishing the foundations for the future development of Canadian medical education.     

Canadian medical schools before ACMC.

The earliest medical schools were established to supplement apprenticeship, the only route to practice available in colonial Canada. By 1885, eight medical schools were trying to accommodate the volume of new scientific information flowing from Europe. In 1910, when Flexner evaluated the schools against the Johns Hopkins model, some were woefully deficient, but by 1928 all had achieved Class A rating. The 1921 discovery of insulin in Toronto gave impetus to scientific research and, possibly, influenced the formation and funding of the National Research Council in 1934. Clinical specialization expanded, leading in 1929 to the establishment of the Royal College of Physicians and Surgeons of Canada to accredit training and certify graduates. The Association of Canadian Medical Colleges was formed at a meeting of deans to discuss a federal offer of funding and to accelerate the graduation of physicians for the war effort.     

Faculty development practices in Canadian medical schools.

Twelve Canadian medical schools that had an organized faculty development program were surveyed to evaluate the extent to which such programs were used and to estimate their effectiveness. Common practices included sabbaticals and programs designed to improve instructional skills. The main problems included underfunding, poor participation and inadequate instructor evaluation.     

An American's view of Canadian medical education.

Undergraduate medical education in Canada and the United States is remarkably similar, except for the fact that Canadian medical schools are supported by their provincial governments. However, the systems diverge sharply at the postgraduate level. In Canada, the number and specialty mix of residents are negotiated by medical schools in response to educational and social needs; in the United States, these factors are largely determined by hospital service needs. The Canadian systems of accreditation, certification and payment for medical education after graduation are much simpler than those of the United States, and the accreditation and certification systems are more objective. In addition, the US system promotes subspecialization and a costly specialty imbalance, whereas Canada''s system has achieved an appropriate balance of specialists and generalists. In general, Canadian medical education appears to be simpler, more accountable and more socially responsive.     

Career and training patterns of students entering Canadian medical schools in 1965.

This paper follows the careers of the 1128 students who entered Canadian medical schools in 1965, most of whom graduated in 1969. The type of career pursued (whether general or specialty practice or some combination thereof), the type of specialty undertaken, the place of internship and residency training and the 1973 practice location of the graduates are examined. The wide variation in careers followed by the 12 schools'' graduates provides the major focus of the paper.     

Pharmacogenetics education in British medical schools

Pharmacogenetic tests allow medications to be tailored to individual patients to improve efficacy and reduce drug toxicity. In 2005, the International Society of Pharmacogenomics (ISP) made recommendations for undergraduate medical teaching in pharmacogenetics. We aimed to establish the quantity and scope of this in British medical schools. An electronic survey was sent to all British medical schools. Nineteen out of 34 (56%) medical schools responded. Sixteen of the 19 (84%) respondents provided pharmacogenetics teaching, usually 1–2 h in total. Only four (21%) medical schools offered the four or more hours of teaching recommended by the ISP. However, 10 of 16 (63%) schools felt the amount of pharmacogenetic teaching offered was sufficient. The quantity of undergraduate teaching of pharmacogenetics is low. However, a majority of UK medical schools teach it, covering a broad scope of elements. It is encouraging that future clinicians are being provided with the knowledge to deliver pharmacogenetics into clinical practice.     

Canadian medical education: 50 years of innovation and leadership.

Over the past 50 years, many Canadian medical educators have pursued ideas and visions, as individuals in the 1950s and 1960s and later in partnership with various national bodies. Relations between universities and national medical organizations have been productive in dealing with issues of postgraduate education and clinical assessment, in particular. From 1970 to 1990, strong education offices and formally trained educators led to many successes in the areas of research in cognition, continuing medical education and clinical assessment. Canadian medical education has now achieved international recognition for its work in all aspects of the continuum of the physician''s education through vision, initiative and cooperation.