The Premedical Education of the First-Year Class in Canadian Medical Schools: 1965-66

The premedical academic records of the 1965-66 entering class of Canadian medical students were analysed. Ninety-six per cent of the class had taken their preparation in a Canadian institution, while 80% had taken it in the same university as the medical school in which they enrolled. Forty per cent entered without a degree, the remainder having at least a bachelor''s degree in arts or science.Thirty-six per cent of all courses taken by these students in their premedical education were in the physical sciences, 22% in the biological sciences and 41% in the social sciences and humanities. One-third of the students had taken no course in the behavioural sciences and another third had taken only one course.Analysis of the level of performance of the entering class showed that 10% had obtained an A average, 49% a B average, 41% a C average and 3% a D average. The grades of these students were higher generally in the natural sciences than in the social sciences or humanities.It was concluded that it could be questioned whether medical students received a premedical preparation which met the philosophy of a “broad, liberal education”.     

Sino-U.S. partnerships in research,education, and patient care: The experience of the University of Pittsburgh and UPMC

In 2011, the University of Pittsburgh School of Medicine (UPSOM) and Tsinghua University formed a partnership to further the education of Tsinghua medical students. These students come to UPSOM as visiting research scholars for two years of their eight-year MD curriculum. During this time, the students, who have completed four years at Tsinghua, work full-time in medical school laboratories and research programs of their choice, essentially functioning as graduate students. In their first two months in Pittsburgh, the scholars have a one-week orientation to biomedical research, followed by two-week rotations in four labs selected on the basis of the scholars’ scientific interests, after which they choose one of these labs for the remainder of the two years. Selected labs may be in basic science departments, basic science divisions of clinical departments, or specialized centers that focus on approaches like simulation and modeling. The Tsinghua students also have a brief exposure to clinical medicine. UPSOM has also formed a similar partnership with Central South University Xiangya School of Medicine in Changsha, Hunan Province. The Xiangya students come to UPSOM for two years of research training after their sixth year and, thus, unlike the Tsinghua students, have already completed their clinical rotations. UPSOM faculty members have also paved the way for UPMC (University of Pittsburgh Medical Center), UPSOM’s clinical partner, to engage with clinical centers in China. Major relationships involving advisory, training, managerial, and/or equity roles exist with Xiangya International Medical Center, KingMED Diagnostics, First Chengmei Medical Industry Group, and Macare Women’s Hospital. Both UPSOM and UPMC are actively exploring other clinical and academic opportunities in China.     

Medical School Graduates Who Leave California: A Study at the University of California,San Francisco

A follow-up survey of 1,087 physicians who had graduated from the University of California, San Francisco, School of Medicine from 1951 through 1971 was completed in 1977. A total of 307 (28.2 percent) of these persons were found to have left California. Comparison of the 307 who left with the 780 who remained showed only slight and statistically insignificant differences on most variables, such as sex, academic performance in premedical and medical education, educational level and social class of parents, age at entry into medical school, ratings by admissions interviewers, choice of specialty and a wide variety of personality inventory measures. Among the variables that did differentiate were place of birth, location and prestige of premedical college, preferences for subjects in the sciences and the humanities, and the Medical College Admission Test (MCAT) scores for quantitative ability and general information. However, attempts to combine these individual differentiators into clusters or equations from which to forecast emigration from California were unsuccessful.     

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.     

Flexner redux

Medical education in the 20th century has been vastly influenced by the Carnegie Foundation Flexner Report. The basic tenets of the modern four-year medical curriculum and the dominant role of the associated university teaching hospital were cemented into place and have remained the paradigm of the present-day medical educational process. The Flexner Report contributed importantly to the development of the modern health-care system. Despite enormous success, a number of current problems have been identified in today's medical educational curricula and have catalyzed the generation of a new Carnegie Foundation report that emphasizes the building of strong bridges across the artificial divide that separates the basic science and clinical years and lays the foundation for the growth and development of translational medicine. In addition, the report raises crucial issues regarding a national medical workforce policy.     

Medical education in an era of health-care reform

Medical educators are facing a challenge today that is quite analogous to that addressed by Abraham Flexner, namely how to transform a legacy system of education that is no longer preparing future physicians adequately to meet contemporary expectations and responsibilities. In facing up this challenge, however, today's educators not only must equip students to deal effectively with the rapidly changing paradigms in health care and medical practice, they also must adapt their curricula and pedagogical methods to the demanding new paradigms of medical education. Their success in addressing these dual imperatives will determine whether the educational transformations currently underway will have as momentous an effect on the public's health as did those stimulated by Flexner a century ago.     

Evaluating Sex and Gender Competencies in the Medical Curriculum: A Case Study

BackgroundSex and gender differences exist in the manifestation and prevalence of many conditions and diseases. Yet many clinician training programs neglect to integrate this information across their curricula.ObjectiveThis study aimed to measure the sex and gender medical knowledge of medical students enrolled in a program without an explicit directive to integrate sex and gender differences across a block system of core subjects.MethodsA forced-choice instrument consisting of 35 multiple-choice and true or false questions was adapted from an evaluation tool used in the European Curriculum in Gender Medicine held at Charité Hospital, Berlin, in September 2010.ResultsFourth-year (response rate 93%) and second-year (response rate 70%) students enrolled in Mayo Medical School completed the instrument. More than 50% of students in both classes indicated that topics related to sex and gender were covered in gynecology, cardiology, and pediatrics, and <20% of students indicated inclusion of such topics in nephrology, neurology, and orthopedics. More than twice as many second-year students indicated that topics dealing with sex and gender were included in immunology course material compared with fourth-year students. A consensus of written comments indicated that concepts of sex and gender-based medicine need to be embedded into existing curriculum, with an emphasis on clinically relevant information.ConclusionsAlthough this study represents only one medical school in the United States, information regarding sex and gender aspects of medicine is not consistently included in this curriculum without an explicit directive. These results can provide guidance for curriculum improvement to train future physicians.     

Demand-side medical education: educating future physicians for Ontario.

Initiated by Associated Medical Services (AMS), Educating Future Physicians for Ontario is a 5-year collaborative project whose overall goal is to make medical education in Ontario more responsive to that province''s evolving health needs. It is supported by AMS, the five universities with medical schools or academic health sciences centres and the Ontario Ministry of Health. The project''s five objectives are to (a) define the health needs and expectations of the public as they relate to the training of physicians, (b) prepare the educators of future physicians, (c) assess medical students'' competencies, (d) support related curricular innovations and (e) develop ongoing leadership in medical education. There are several distinctive features: a focus on "demand-side" considerations in the design of curricula, collaboration within a geopolitical jurisdiction (Ontario), implementation rather than recommendation, a systematic project-evaluation plan and agreement as to defined project outcomes, in particular the development of institutional mechanisms of curriculum renewal as health needs and expectations evolve.     

A Simple Curriculum Content Change Increased Medical Student Comfort with Transgender Medicine

ObjectiveA barrier to safe therapy for transgender patients is lack of access to care. Because transgender medicine is rarely taught in medical curricula, few physicians are comfortable with the treatment of transgender conditions. Our objective was to demonstrate that a simple content change in a medical school curriculum would increase students' willingness to care for transgender patients.MethodsCurriculum content was added to the endocrinology unit of the Boston University second-year pathophysiology course regarding rigidity of gender identity, treatment regimens, and monitoring requirements. All medical students received an online, anonymous questionnaire 1 month prior to and 1 month after receiving the transgender teaching. The questionnaire asked about predicted comfort using hormones to treat transgender individuals. Shifts in the views of the second-year students were compared with views of students not exposed to the curriculum change.ResultsPrior to the unit, 38% of students self-reported anticipated discomfort with caring for transgender patients. In addition, 5% of students reported that the treatment was not a part of conventional medicine. Students in the second-year class were no different than other students. Subsequent to the teaching unit, the second-year students reported a 67% drop in discomfort with providing transgender care (P<.001), and no second-year students reported the opinion that treatment was not a part of conventional medicine.ConclusionA simple change in the content of the second-year medical school curriculum significantly increased students' self-reported willingness to care for transgender patients.(Endocr Pract. 2013;19:633-637)     

构建融合医学人文教育的新型医学遗传学教学模式

医学遗传学是广泛涉及基础与临床学科的综合性课程,对于医学生是至关重要的必修课程。现代医学已由传统的生物-医学模式向生物-心理-社会医学模式转化,医学诊疗模式从最初的以"疾病为中心"到"以病人为中心"的方式转变,医生不仅精通医术,更要理解患者的心理,与其进行良好的沟通,因此现代医学成为了一门具有自然科学、人文社会科学双重属性的综合性科学体系。长期以来,我国医学院校的教学仍然是生物医学知识和技能占据主导地位,人文课程不受重视。因此,必须加强医学人文知识的学习和技能培训,只有这样才能在未来的医疗工作中掌握良好的医患沟通技巧,建立和谐的医患关系,对处理好日渐增多的医疗纠纷、维护医患双方的共同利益具有重要意义。     

“Markings” of a Class: The Statistical Trail Left by the First Graduating Class in Medicine,University of British Columbia

In 1954 the first class in medicine graduated from the University of British Columbia. This class of 57 men and three women left a statistical trail behind them which began before they entered medical school, and which now has extended 10 years into their professional postgraduate careers. This first class was made up largely of British Columbians of older age than subsequent classes. The overall achievement and aptitude of the class was high, as measured by premedical grades, intelligence tests and Medical College Admission Test scores. Interest tests at the time of admission indicated that the members of the class had major interest levels in the fields of science and social service or humanitarianism. The subsequent medical school performance of the class was exceptional. Of the class, 63.4% interned in teaching hospitals. By 1964 only 53.4% of the graduates were engaged in general practice. Most of the graduates are now practising in British Columbia.     

Academic family medicine in Canada.

Fifty years ago family practice in Canada had no academic presence. Stimulated by a number of general practitioners and with the support of the Canadian Medical Association, the College of General Practitioners of Canada (CGPC) was founded in 1954. In 1962, conferences on education for general practice attended by the Association of Canadian Medical Colleges and the CGPC led to pilot postgraduate residencies in family practice supported by Department of National Health and Welfare. The first certification examination was held in 1969 and, by 1974, all Canadian medical schools had a family medicine residency program. Today departments of family medicine contribute substantially to undergraduate education in all 16 schools. In Canada, the medical profession, governments and the medical schools have demonstrated the importance they place on appropriate education for family physicians.     

Awareness and Acceptance of Evolution and Evolutionary Medicine Among Medical Students in Pakistan

Evolutionary medicine is a perspective on medical sciences derived through application of theory of evolution to aid in therapeutics. This study sought to determine the level of knowledge and acceptance of evolutionary theory in medical students along with their attitude toward teaching evolutionary medicine as a part of their undergraduate course. Factors that are likely to cause difficulty in teaching evolutionary medicine were also identified. A cross-sectional study was carried out at Army Medical College, National University of Sciences and Technology, Pakistan in which 299 medical students were selected by nonprobability convenient sampling technique to participate in the study. Participants’ views were obtained by a structured questionnaire comprised of three sections: appreciation of evolutionary medicine, acceptance of evolutionary theory, knowledge of evolutionary theory. Medical students had a low acceptance [mean measure of acceptance of theory of evolution (MATE) = 58.32] and a low knowledge (mean score of 5.20 out of a total ten marks). Students believed that religious beliefs, lack of resources, and an existent extensive medical curriculum would cause difficulty in imparting such an education despite its potential to improve medical research and clinical practice. Only 37.2% agreed that the subject should be taught in medical schools as an individual subject.     

Workshop summaries from the 2015 Sex and Gender Medical Education Summit: utilization of sex and gender based medical education resources and creating student competencies

Background

Despite overwhelming evidence that sex and gender are critical factors in the delivery and practice of medicine, there is no unified sex- and gender-based medicine (SGBM) undergraduate medical education curriculum. Two Workshops within the 2015 Sex and Gender Medical Education Summit: a Roadmap to Curricular Innovation sought to lay the framework for such a curriculum.

Methods

Attendees to the Sex and Gender Educational Summit self-selected attendance for one of two Workshops: (A) Utilization of SGBM Resources in U.S. Medical Schools or (B) Creating SGBM Student Competencies.

Results

Workshop A identified gaps in existing curricula as well as strategies for incorporating available SGBM content into existing educational activities or curricular threads. Focus was given to the use of advisory committees to nurture collaboration and sharing of resources. Workshop B created a framework for national SGBM competencies by adapting existing materials from women’s health curricula such as Brown University’s SGBM Emergency Medicine subspecialty. The importance of student engagement, assessment, and faculty development were stressed as well as engaging the Liaison Committee on Medical Education (LCME) in awareness of the vital nature of including SGBM content into all medical school curricula.

Conclusion

These Workshops provided a forum for national and international institutional representatives to lay a foundation for integration of SGBM into medical school curricula and the development of national SGBM Student Competencies.

     

A New School of Medicine Is Born in Quebec

The new Faculty of Medicine at the University of Sherbrooke accepted its first 32 students in September 1966. The four major objectives of the school are: (1) medical education with emphasis on learning rather than teaching; (2) research in three major fields of endeavour: basic, clinical and medico-social sciences; (3) optimum patient care; and (4) service to society. A new Health Sciences Centre houses the Medical School, 1 420-bed hospital and multidisciplinary laboratories, and eventually will contain the paramedical schools, including a School of Nursing Sciences. The three major divisions of the Faculty are basic, clinical and medico-social sciences. The curriculum of the first two years is correlated and integrated within the “block” system, with participation from all three divisions.     

A century of premedical education

The Flexner Report established guidelines for medical education and made the university the obligate home for medical education. Flexner mandated specific elements necessary for university-based premedical education. With the exception of the MCAT, much less attention has been paid to premedical education and its integration into the scope of medical education than to education within the confines of the medical school. This article reviews the history of premedical education, describes some recent critiques of premedical education, discusses a newer program for premedical education evolving at the University of Illinois at Chicago, and offers some suggestions for the future.