Undergraduate medical education
H. S. Jonas, S. I. Etzel and B. Barzansky
American Medical Association, Division of Undergraduate Medical Education.
The number of applicants to US medical schools, which declined steadily
between 1985 and 1988, increased slightly for the class entering in 1989.
The profile of entering students showed a small decline from last year in
the percentage of students with grade point averages categorized as "A"
(3.5 or above on a 4-point scale) and slight declines in four of the six
MCAT subtest scores. The percentage of both women and minority students in
the entering class increased from the previous year. An interesting
observation is the large percentage increase this year in students
transferring to LCME medical schools from graduate and professional degree
programs and from osteopathic medical schools. While the number of
full-time faculty members in medical schools continues to increase,
significant vacancy rates exist in some departments. More than 5% of
full-time faculty positions are vacant in genetics, pathology, dermatology,
family medicine, neurology, obstetrics-gynecology, orthopedics,
otolaryngology, pediatrics, and surgery departments. Along with faculty
vacancies, there has been a considerable turnover of medical school deans.
The curriculum in most medical schools includes some innovative
instructional formats, such as problem-based learning and computer-assisted
instruction. However, current data do not allow a generalization about the
extent to which these are being utilized. It seems that, at least in some
institutions, multiple methods are being used to assess the clinical
competence of medical students (observation by faculty members and
residents, written and oral examinations, and multiple station
examinations), including the use of standardized patients. About half of
the medical schools require students to pass the NBME Part I examination
and about one third require passage of Part II. The subject examinations
provided by the NBME seem to be used widely, at least in the clinical
disciplines. Within the past year, about 14% of medical schools have
reported the presence of students or residents who have been diagnosed with
human immunodeficiency virus infection, and 12% have had students or
residents diagnosed with hepatitis B virus infection. It is critical that
medical schools teach students how to prevent occupational exposure to
these infections, as well as ensuring that adequate health insurance
coverage be provided for these conditions.
