Competencies in premedical and medical education: the AAMC-HHMI report

One hundred years ago, Flexner emphasized the importance of science in medicine and medical education. Over the subsequent years, science education in the premedical and medical curricula has changed little, in spite of the vast changes in the biomedical sciences. The National Research Council, in their report Bio 2010, noted that the premedical curriculum caused many students to lose interest in medicine and in the biological sciences in general. Many medical students and physicians have come to view the premedical curriculum as of limited relevance to medicine and designed more as a screening mechanism for medical school admission. To address this, the Association of American Medical Colleges and the Howard Hughes Medical Institute formed a committee to evaluate the premedical and medical school science curricula. The committee made a number of recommendations that are summarized in this essay. Most important were that competencies replace course requirements and that the physical sciences and mathematics be better integrated with the biological sciences and medicine. The goal is that all physicians possess a strong scientific knowledge base and come to appreciate the importance of this to the practice of medicine. While science education needs to evolve, Flexner's vision is as relevant today as it was 100 years ago.     

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.     

Medical Student Enrolment in Canadian Universities

Statistical returns from the 12 Canadian medical schools revealed in 1962, for the fourth consecutive year, a larger first-year enrolment (946, 970, 1006 and 1057). This is attributed to an increase in qualified applicants and expansion in size of the first-year class in the face of a physician shortage. The proportion of women graduates increased from 5.2% in 1958 to 10.1% in 1962 (U.S.A., 5.6%). The academic calibre of entering students showed little change over five years, 1957-61. Recent impressions indicate an upward swing. Loss from withdrawals and dismissals was chiefly in first year (9.1%, 7.6% and 9.0%: 1959-60 to 1961-62), 40% being attributed to “nonacademic” causes. Foreign students now comprise 12.6% of the medical student body. A decrease in American and an increase in Commonwealth student numbers was noted. Recommendations include attention to drop-outs before and after registration and provision for stand-by applicants; the general adoption of some objective measure of qualification, e.g. the Medical College Admission Test; an on-going registry of applicants to Canadian medical schools for later retrospective studies and re-examination of admission policies for non-residents.     

Teaching medical physics to general audiences.

By judiciously selecting topics and reading materials, one can teach a full semester course on medical physics appropriate for college students not majoring in the natural sciences. This interdisciplinary field offers an opportunity to teach a great deal of basic physics at the freshman level in the context of explaining modern medical technologies such as ultrasound imaging, laser surgery, and positron emission tomography. This article describes one such course which combines lectures, outside visitors, varied readings, and laboratories to convey a select subset of physical principles and quantitative problem-solving skills. These resources are also valuable for enriching the standard freshman physics sequence for premedical students.     

Medical Students in Canadian Universities: Report of Statistics, 1966-67

Enrolment in the 13 Canadian medical schools in 1966-67 reached a new high of 4230, an increase of 5.1% over 1965-66. The percentage of women among medical students (12.1%) was close to that of the preceding three years. There has been a levelling off in the decline of students from outside Canada in 1966-67, when 9.5% of medical students were non-Canadian. The decline had been primarily in the number of American students, which continues. The number of students from Commonwealth countries has shown a steady increase during the eight-year period under review; in 1966-67, they make up nearly one-half of all non-Canadian students. It was noted that 18.5% of overseas students came to Canada under governmental or intergovernmental sponsorship. Of the Canadian students, 94% came from the “home” provinces of the medical schools.     

Council on Medical Services says medical rehabilitation must be under MD direction

The 1976-77 statistical study of medical school enrollment by the Association of Canadian Medical Colleges shows that total enrollment in Canadian medical schools had increased 103.8% since 1960-61, although the rate of increase had decreased to almost zero by 1976-77. Women accounted for 30.3% of the total enrollment in 1976-77 (for all years of the course), which represents an increase of more than 550% in the 17-year period; for the 16 schools the proportion ranged between 23.9% and 43.8%. Enrollment of foreign students had decreased from 340 in 1966-67 to 90 (1.2%) in 1976-77; 71 of the 90 students were American. For the entire nation the mean number of medical students per 10 000 population was 3.1, but in British Columbia the figure was only 1.5. Of the Canadian and landed immigrant students 94.5% were attending medical school in their home province.     

Preventive medicine and family medicine in the medical school.

The normal variations in the paper electrophoretic lipoprotein patterns in 240 healthy Canadian males and females, aged 10 to 59 years, have been described and compared with serum cholesterol and triglyceride levels.The incidence of abnormal chylomicra, beta and pre-beta lipoproteins was similar in both sexes and increased with age in both sexes.Chylomicron bands and/or pre-beta trails from the origin occurred in 4% of subjects, pre-beta bands in 27% and “abnormally” dense beta bands in 28%.Five per cent of subjects were considered to have definite hyperlipoproteinemia, another 19% had slight and 21% had questionable hyperlipoproteinemia. Fifty-five per cent were normal.     

Characteristics of medical students who choose primary care as a career: the McMaster experience.

We examined the relation between demographic characteristics and the career choices of medical students who entered McMaster University medical school between 1969 and 1975. In contrast to earlier work, this study found no significant differences in sex, age, marital status at the time of entry into medical school, undergraduate major, whether prerequisite premedical courses had been taken, undergraduate grade point average and academic performance between the graduates who chose primary care and those who chose a specialty. This suggests that many medical school graduates in the 1970s entered primary care by choice rather than by default.     

Medical Students in Canadian Universities: Report of Statistics, 1965-66

Enrolment in the 12 Canadian medical schools in 1965-66 reached a new high of 4023, an increase of 3.8% over 1964-65. The percentage of women among medical students (11.4%) was close to that for the preceding two years. The decline in the numbers of students from outside Canada continued into the present year; in 1965-66, 9.1% of medical students were non-Canadian. This decline has been primarily in the number of students from the U.S.A. The number of students from Commonwealth countries has shown a steady increase over the seven-year period under review; in 1965-66 they make up nearly one-half of all non-Canadian students. It was noted that 27% of overseas students came to Canada under governmental or intergovernmental sponsorship. Of the Canadian students, 95% came from the “home” provinces of the medical schools.     

Canadian and Landed Immigrant Applicants to Canadian Medical Schools for 1968-69

There were 2337 Canadian and Landed Immigrant applicants for the fall 1968 entering classes at Canadian medical schools. These applicants filed a total of 4579 applications.The results of this study show that there are regional differences in the quantity and quality of the applicant pool for Canadian medical schools. The study also shows that despite the fact that Canadian and landed immigrant applicants are filing more applications than they have in the past two years, there has been no appreciable change in the ratio of applicants to available places. A further point to be noted is that the participation of women both as applicants to and as medical students in the entering class of 1968-69 at Canadian medical schools was higher than in previous years.     

Exploring Health Literacy in Medical University Students of Chongqing,China: A Cross-Sectional Study

Health literacy is important in public health and healthcare, particularly in effective communication between patients and health professionals. Although most medical students will eventually work as health professionals after graduation, research on health literacy of medical students is scarce. This study aimed to assess the health literacy level of medical students in Chongqing, China, and its influencing factors. A cross-sectional study was conducted and 1,275 participants (250 males and 1,022 females) who majored in five different disciplines were involved. The Health Literacy Questionnaire was used as the survey tool. The junior students obtained the highest scores, whereas the freshman students had the lowest scores on each scale. The average score of males was higher than that of females except in “feeling understood and supported by healthcare providers,” and the average score of students who reside in urban areas was higher than that of students in rural areas. Moreover, the average score of engineering students was higher than that of medical or health sciences students. Multiple linear regression models (R_adj² = 0.435, P = 0.000) showed that the grade, socioeconomic status, and parent’s highest level of education were positively correlated with health literacy. In conclusion, the health literacy levels of the medical students are insufficient and need improvement.     

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。     

GERIATRIC PATIENTS IN A MENTAL HOSPITAL

An intensive study was made of men 55 years of age and over admitted to Napa State Hospital with either senile or arteriosclerotic brain disease. A ward treatment program, combining both the medical and psychiatric approaches, was applied to one-half of such patients admitted to a state hospital, with the aim of determining what, if any, effect this program would have on the course of the illnesses.Special laboratory studies showed: (a) Serial electroencephalograms and hospital adjustment ratings appeared to be positively correlated with the patients'' clinical course; (b) In 35 per cent of cases the electrocardiographic tracings at the time of admittance were within normal limits; (c) A “pathological level” of blood bromides was found in only one of 340 consecutive admissions in this age group.Sociopsychiatric study of 100 consecutively admitted patients revealed that: (a) 35 per cent of the patients were from the middle, and 65 per cent from the lower classes of society; (b) Only 59 per cent were admitted because of activities specifically psychotic. (c) 63 per cent needed admittance to this state hospital for observation and diagnosis, but only 44 per cent needed to stay for care and treatment; (d) In 88 per cent, specific emotional stresses were present just preceding and coincident with the clinical appearance of the organic brain syndrome.     

Lack of impact of undergraduate genetic courses on the teaching of medical genetics.

The impact of undergraduate genetic courses on the academic performance of first-year medical students in the medical genetics course at the University of Pittsburgh School of Medicine was evaluated over a period of 9 years. Comparisons were made between medical students who had taken a formal undergraduate course in genetics and those who had not. Little if any differences were found in the academic performance in the medical genetics course between these two groups of students. Perhaps the design of undergraduate courses in genetics should be re-evaluated to give more depth to the medical student's preparation for appreciating the significance of genetics in normal and abnormal human variation.     

RHEUMATIC FEVER IN COLLEGE STUDENTS

The results of three independent surveys concerned with rheumatic fever and heart disease in students at the University of California were assembled and found to be in close agreement. A full 2 per cent of all students believed they had had rheumatic fever; and several times that proportion gave a history of one of the rheumatic manifestations. Only 0.25 per cent had demonstrable rheumatic heart disease and 0.1 per cent had congenital heart disease.Physiologic murmurs may occur in 3 per cent or more of students entering college.Penicillin prophylaxis is important in persons with rheumatic heart disease, but it is important not to put a label of rheumatic heart disease on persons who think they have had rheumatic fever but who have no demonstrable heart disease. Long term penicillin prophylaxis or other long term prophylactic procedures directed against rheumatic fever are not indicated unless the diagnostic criteria for rheumatic fever are clearly met or unless rheumatic heart involvement is definitely present.     

L'enseignement des sciences morphologiques dans 13 facultés de médecine canadiennes

A survey of teaching of morphologic sciences in Canadian medical schools has shown that few radical changes have taken place in most schools. The survey has also shown the following: (a) department chairmen have a major influence on teaching of morphologic sciences; (b) they are worried about the diminishing time alloted to them; (c) students, by their choice of electives, do not seem to share that worry; (d) lectures remain popular, as does disection in most schools; and (e) audiovisual methods, especially rediology, are becoming more popular but are not yet used on a very large scale.     

Physicians' Use of Relative Value Studies,Report of Bureau of Research and Planning

Data tabulated from the Study of the Characteristics of Physicians in California, conducted by the C.M.A. Bureau of Research and Planning, show that over 70 per cent of all physicians in active private practice utilize the Relative Value Studies, with over 41 per cent stating that they use it “all or most of the time.” Use figures range from almost 78 per cent of physicians who participate in some form of prepayment program to under 53 per cent of physicians who do not participate in any such program.Eighty per cent of all physicians in private practice who use the RVS expressed general satisfaction, with 11.8 per cent dissatisfied and 8.2 per cent stating no opinion as to their satisfaction. Of the 80 per cent who expressed satisfaction, two out of three use the RVS all or most of the time.     

Applications and Enrolments at the Western Medical Schools: A Study of Medical Matriculants for 1964

All applicants and those who subsequently enrolled for the 1964-65 session in the Western medical schools were studied with the hope that it would encourage a national registration of applicants. Seven hundred and sixty-four applicants completed 865 applications for 288 places in four schools. Although the principal factor in selecting medical students in all Western schools is pre-medical performance, 49 “good-quality” (academically of good standing and under 30 years of age) resident applicants were not accepted in their own provincial school, and 49 places were filled with “poor-quality” students.The loss of good applicants to the Western medical schools and the 20% overlap of each school''s applicant pool with that of other schools suggests that objective standards of quality must be developed, and that a regular annual national assessment of applicants should be conducted by the Association of Canadian Medical Colleges.     

Ecole d'été de l'A.C.E.M.I.—Ha?ti

Six Canadian medical students record their experience at a summer school of tropical medicine in Haiti, sponsored by the Canadian Association of Medical Students and Internes. The social, economic and medical background is described, including “Voodoo” practices, language and Haitian art. Attention is directed to the occurrence of umbilical tetanus, diarrhea and malnutrition. From even a brief stay in a country such as Haiti one comes to appreciate that a public health program in an underdeveloped nation is not strictly a medical undertaking but must be seen in its social and economic contexts.     

A Decade of Experience with Medical School Applicants at the University of British Columbia

During the decade 1952-1961, 2060 students applied for admission to the University of B.C. medical school. Only 1664 fulfilled the pre-medical requirements. This cluster of eligible applicants changed in size and characteristics as the medical school grew older; in general, the academic calibre of applicant cohorts improved as mean age fell and length of pre-medical training increased. A decline in the number of British Columbia applicants was to some extent balanced by an increase in other applicants.Forty-three per cent of eligible applicants were accepted by the screening committee. In contrast to the applicant cluster, freshman classes contained a disproportionate number of B.C. residents. Acceptance, however, was strongly correlated with good pre-medical academic performance and all M.C.A.T. scores except those for “Understanding Modern Society”. Unfortunately, one-quarter of all accepted students withdrew before registration and had to be replaced.These observations are interpreted in terms of student recruitment and the efficiency of the screening committee.