Educational programs in US medical schools
H. S. Jonas, S. I. Etzel and B. Barzansky
Division of Undergraduate Medical Education, American Medical Association, Chicago, IL 60610.
Trends of the past few years indicate that the 1990s will be a time of
intense activity in medical education reform. A number of areas described
in this annual review of medical education are grounds for optimism,
tempered, however, by caution. The applicant pool has been increasing
rapidly over the past 2 years and has reached the levels of the early
1980s. The average proportion of women and some minorities also has been
rising. While these are positive signs, efforts to ensure diversity in the
student population should not be abandoned. The number of faculty members
continues to rise, especially in the clinical disciplines. The increases,
occurring in the context of stable medical student enrollments, raise
questions about the various roles and responsibilities of medical school
faculty. Many medical schools are in the process of curriculum review and
revision; while these changes respond to identified problems, they may have
implications for faculty and other resources. External financial support
fueled previous waves of curriculum innovation, and some of these gains
could not be maintained when that support was withdrawn. The revisions in
the examinations of the NBME are being well received, and the single
pathway to licensure through USMLE has been initiated. This system does,
however, affect graduates' options for licensure. Finally, the increased
interest in program evaluation, especially the definition of goals and the
measurement of educational outcomes to assess their attainment,
demonstrates that medical schools are serious about educational
accountability. Some schools also are being asked to address externally
imposed objectives, related specifically to specialty choice, creating a
potential for conflict between the objectives that the medical school sets
for itself and those mandated by its external constituencies. While this
analysis may imply that medical education is now in a "good news/bad news"
situation, the message is that planning and careful assessment of options
are perhaps even more important today than they were in the past. Change
has its costs and its implications, but it must nonetheless be undertaken.
