 |
|
Educational Programs in US Medical Schools, 2004-2005
Barbara Barzansky, PhD;
Sylvia I. Etzel
JAMA. 2005;294:1068-1074.
ABSTRACT
| |
Context The educational environment affects the outcomes of medical education, including the characteristics and distribution of medical school graduates.
Objective To report the status of variables related to medical education that represent areas that recently have been in flux or have potential impact on health care delivery.
Design, Setting, and Participants Descriptive survey study comparing selected results of the Liaison Committee on Medical Education Annual Medical School Questionnaire between 2004-2005 and 1994-1995. The questionnaire was sent to the deans of all 125 LCME-accredited medical schools. Response rate was 100% in both years.
Main Outcome Measures Overall trends between 1994-1995 and 2004-2005 in the size and composition of the medical school faculty, the numbers of medical school applicants and students, requirements for passage of the US Medical Licensing Examination, medical student work hours, the use of computers in the educational program, the geographic pipeline from entry to medical school to entry to graduate medical education, and the educational background of medical school deans.
Results The number of full-time faculty members increased from 90 016 in 1994-1995 to 119 025 in 2004-2005 (a 32% increase) while the number of medical students remained constant at about 67 000. In 2004-2005, 11% of medical school deans held MD and PhD degrees, 6% held MD and MBA degrees, 4% held MD and MPH degrees, and 2% held an MD and another degree (such as JD). In 2004-2005, 68% of all first-year medical students were residents of the state in which the medical school is located and a mean of 43% of 2005 graduates remained in the same state as the medical school for graduate medical education; results were similar in 1995. In 2004-2005, 58 schools (46%) required students to have their own computers and 35 (28%) to have their own personal digital assistants. In 2004-2005, night call was less common in the family medicine, internal medicine, pediatrics, and psychiatry clerkships compared with 1994-1995.
Conclusions Although most students remain in their home state for medical school, most students leave the medical school state for residency. Factors external to the medical school, such as funding mechanisms and regulations from the public and private sectors, may be having an impact on faculty size and composition, and on the geographic pipeline of students into medical school and residency training.
INTRODUCTION
In this comparison of data on medical schools from 2004-2005 and 1994-1995, we have chosen to consider several disparate variables related to medical education that were chosen primarily because they represent areas that have recently been in flux or because of their potential impact on medical education outcomes and health care delivery. The topics include the size and composition of the medical school faculty, the numbers of medical school applicants and students, requirements for passage of the US Medical Licensing Examination (USMLE), medical student duty hours, and the use of computers in the educational program. We also provide a preliminary analysis of the geographic origins of medical students and their retention in the state of their medical school for residency training, and on the changing educational background of medical school deans.
Factors affecting practice location are important in addressing physician workforce needs. The "geographic pipeline" for medical students, from premedical education through entry to residency training, is valuable to trace because there appears to be a link between site of residency training and initial practice location. For example, a national study published in 1996 showed that about half of physicians were practicing in the state where they completed graduate medical education.1 Other more limited studies from the 1990s confirmed this relationship.2-3 There is also suggestive evidence of an association between a student’s state of residence at entry to medical school or site of premedical education and the selection of location for residency training and practice. There was a statistically significant link between being a resident of Illinois at the time of medical school matriculation and the choice of an Illinois residency program.4 There is evidence from Minnesota that in-state practice retention is strongly associated with graduation from a state high school.5
Last year, we reported that compared with 10 years before, more individuals holding the position of dean had additional administrative titles, such as vice president or vice chancellor for health affairs.6 Deans now require a new set of skills to manage the complex medical school environment,7 which may not be supplied in the educational pathway leading to the MD degree. This year, we report on the additional training current deans have received that may assist them in meeting their expanding responsibilities.
METHODS
This is a descriptive survey study presenting data derived principally from the 2004-2005 Liaison Committee on Medical Education (LCME) Annual Medical School Questionnaire. This was sent to the deans of all 125 LCME-accredited US medical schools and had a 100% response rate, as did the responses to all individual items that we report. Each completed questionnaire was reviewed on receipt. Data that showed a major discordance from previous years were verified with the school. Comparisons were drawn with unpublished and published data from the 2003-20046 and 1994-19958 LCME annual medical school questionnaires, each of which had a 100% response rate. Data on medical school applicants and entrants were obtained from the Association of American Medical Colleges (AAMC) Section on Student Services. The AAMC Data Warehouse: Applicant Matriculant File contains complete data (updated during the fall of each year) on medical school applicants. Other sources of data are cited in the text.
Institutional review board approval was not required for this study since the responses for each questionnaire item represented aggregate data that were derived from institutions, not from individuals. No responses could be traced to an individual faculty member or medical student. The 125 LCME-accredited US schools are listed in Appendix IA and the 17 Canadian accredited medical schools are listed in Appendix IB.
RESULTS
Medical School Faculty
In 2004-2005, there were 119 025 full-time faculty members in US medical schools, a 32% increase from the 90 016 full-time faculty in 1994-1995 (Table 1). Between 1994-1995 and 2004-2005, the number of full-time basic science faculty members increased from 16 597 to 20 679 (a 25% increase) and the number of full-time clinical faculty increased from 73 419 to 98 256 (a 34% increase).8
|
|
|
|
Table 1. Trends in Numbers of Faculty, Applicants, and Enrolled Students*
|
|
|
The distribution of faculty by rank showed little change between 1994-1995 and 2004-2005. In 2004-2005 in basic science departments, 35% of full-time faculty held the rank of professor (compared with 36% in 1994-1995), 22% held the rank of associate professor (26% in 1994-1995), 30% held the rank of assistant professor (28% in 1994-1995), and 12% held the rank of instructor/other (10% in 1994-1995; Table 2). In clinical departments in 2004-2005, 21% of full-time faculty were at the rank of professor (21% in 1994-1995), 21% at the rank of associate professor (22% in 1994-1995), 43% at the rank of assistant professor (42% in 1994-1995), and 16% at the rank of instructor/other (15% in 1994-1995).
|
|
|
|
Table 2. Number of Full-time Faculty by Discipline and Academic Rank in US Medical Schools, 2004-2005
|
|
|
The percentage of full-time faculty who are women has increased. In 1994-1995, 21% of full-time basic science faculty and 24% of clinical faculty were women, compared with 30% of basic science faculty and 32% of clinical faculty in 2004-2005.9(p39)
In addition to full-time faculty, in 2004-2005 there were 1738 part-time and 7501 volunteer faculty members in basic science departments and 18 174 part-time and 142 395 volunteer faculty in clinical departments. In total, 288 833 individuals held faculty appointments in US medical schools during 2004-2005. This is approximately 33% of all US physicians,10 and represents a 17% increase from 1994-1995.
Educational Preparation of Medical School Deans
In 1994-1995, 86% of deans (including acting and interim deans) held the MD degree only, 6% had both MD and PhD degrees, and 8% held a PhD degree only. In contrast, in 2004-2005, 75% of deans held the MD degree only, 11% had both the MD and PhD degrees, 6% held an MD and an MBA degree, 4% held an MD and an MPH degree, 2% held an MD and some other degree (such as JD), and 2% held the PhD degree or an equivalent alone.
Medical Students
Applicants and Accepted Applicants. For the class entering in 2004, there were 35 735 applicants, a 2.7% increase from 2003 (Table 1). There were 18 018 women applicants in 2004, 50.4% of the total. In 1994-1995, there were 45 365 applicants, of whom 18 968 (41.8%) were women.
Enrolled Students. First-year enrollment during 2004-2005 was 17 109, similar to the number of students enrolled in 2003-2004 (17 118) and 1994-1995 (17 048; Table 1). Of first-year students in 2004-2005, 8463 (49.5% of the total) were women. In 1994-1995, the 7191 women in the entering class represented 42.2% of the total. In 2004-2005, 109 schools (87%) had 40% to 60% women in the entering class, 7 schools (6%) had less than 40% women, and 9 schools (7%) had more than 60% women. In 1994-1995, 83 schools (66%) had 40% to 60% women in the first-year class, 41 schools (32%) had less than 40% women, and 1 school (1%) had more than 60% women.
Students entering in 2004 had a mean premedical grade point average of 3.62 (range, 3.00-3.83 among individual schools), compared with 3.46 in 1994-1995 (range, 3.11-3.75). In 2004, the mean Medical College Admission Test (MCAT) scores for the entering class were 10.3 (Biological Sciences), 9.9 (Physical Sciences), and 9.7 (Verbal Reasoning).9(p32) For the 1994 entering class, mean MCAT scores were 9.7 (Biological Sciences), 9.4 (Physical Sciences), and 9.4 (Verbal Reasoning).8
Of the 16 066 graduates in 2005, 316 (2%) were not planning to enter residency training during 2005-2006. The reasons given for postponement were research or study for an additional degree (45%), family responsibilities (12%), inability to find a residency position (11%), career change (7%), and other reasons (25%).
The Geographic Pipeline. To explore retention of state residents for medical school and residency training, we examined the percentage of state residents in the applicant pool of each medical school; the percentage of state residents in the entering class, by individual medical school and by state; and the percentage of medical students who remained in the same state as the medical school for residency training, by individual medical school and by state. These analyses were performed for 2004-2005 and, for comparison, for 1994-1995. The analysis did not include the 3 medical schools in the District of Columbia and the federal Uniformed Services University of the Health Sciences. Of the 44 states and Puerto Rico with medical schools in 2004-2005, 19 had 1 medical school, 10 had 2 medical schools, and 16 had 3 or more medical schools (Table 3).
|
|
|
|
Table 3. Retention in State for Medical School and Residency Training*
|
|
|
For the class entering in 2004-2005, a mean of 36% of total applications came from residents of the state in which the school is located (range across schools, 1%-100%). By school ownership, a mean of 47% of applications to public schools (range, 1%-93%) and 20% of applications to private schools (range, 1%-100%) came from in-state residents. Results were similar in 1994-1995, with 34% of total applications (range, 1%-100%), 42% of applications to public schools (range, 1%-100%), and 23% of applications to private schools (range, 5%-84%) coming from in-state applicants. We did not perform this analysis at the state level since many residents in states with multiple medical schools apply to more than 1 medical school in their home state.
By medical school, a mean of 68% of first-year students in 2004-2005 were residents of the state in which their medical school is located (range, 4%-100%). For public schools, a mean of 86% of first-year students were state residents (range, 31%-100%) and for private schools a mean of 39% of first-year students were from the same state as the medical school (range, 4%-100%). Among medical schools in 1994-1995, 71% of all first-year students were residents of the state in which the school is located (range, 3%-100%). Ninety percent of first-year students in public schools (range, 37%-100%) and 44% of first-year students in private schools (range, 3%-100%) were state residents. An analysis by state shows similar results (Table 3).
We also examined the percentage of graduates who remained in the same state as the medical school for residency training, by individual medical school and by state. Across all individual schools, in 2004-2005 the mean in-state retention of graduates was 43% (range, 4%-80%); for public schools the mean retention was 45% (range, 18%-77%) and for private schools retention was 40% (range, 4%-80%). The mean retention rates for graduates in 1994-1995 were identical to the 2004-2005 figures. In general, the percentage of medical school graduates who remain in the same state as their medical school for residency training is lower than the percentage of students who enter medical school in their home state (Table 3). Overall, by state, the mean percentage of medical school graduates who remained in the state for residency training was 39% in 2004-2005 and in 1994-1995.
USMLE Requirements. During 2004-2005, the Step 2 Clinical Skills examination was added to the USMLE sequence of Step 1 and Step 2 Clinical Knowledge; this sequence must be passed for licensure. We asked schools whether they required students to take and pass each of these examinations. There were 123 schools (98%) that required students to take USMLE Step 1, 122 (98%) that required taking Step 2 Clinical Knowledge, and 120 (96%) that required taking Step 2 Clinical Skills. For advancement or graduation, a passing score was required in Step 1 in 108 schools (86%), in Step 2 Clinical Knowledge in 83 schools (66%), and in Step 2 Clinical Skills in 44 schools (35%). Across schools, 44 (35%) required a passing grade in all 3 examinations, 39 (31%) required passing Step 1 and Step 2 Clinical Knowledge, 25 (20%) required passing only Step 1, and 17 (14%) did not require students to pass any of the examinations. In comparison, in 1994-1995 a passing score was required for Step 1 in 87 schools (70%) and for Step 2 in 58 schools (46%). There were 53 schools (42%) that required a passing score in both examinations.
Computer Use in the Educational Program
In 1994-1995, the great majority of medical schools were making use of computer applications to support instruction. There were 121 schools (97%) that used computer-based instructional programs as study aids and 102 schools (82%) where computer-based instructional programs were a required part of 1 or more courses. Computer-based simulations were used in 73 schools (58%) to teach or test diagnostic or therapeutic decision-making.
Use of computer-based resources continues to be widespread in medical schools. In addition to using computer-based applications as learning aids, they now are being used as part of course-management systems, such as an addition to or replacement for a paper syllabus, or as a medium for student and program evaluation. In general, more schools use such electronic resources during basic science courses than in clinical clerkships. In 2004-2005, in 1 or more basic science courses, computer-based methods were used to distribute course objectives or the syllabus in 112 schools (90%), instructor lecture notes in 120 schools (96%), course tests in 58 schools (46%), and course evaluations in 102 schools (82%). During clinical clerkships, 100 schools (80%) used electronic means to distribute course objectives or the syllabus, 77 (62%) to distribute instructor lecture notes, 29 (23%) to distribute course tests, and 91 (73%) to distribute course evaluations. Sixty-two medical schools (50%) use computer case simulations to test clinical knowledge in 1 or more required clerkships.
Use of computers for distance learning, where the teacher and some or all students are at different locations for all teaching sessions in a given course or clerkship, appears to be uncommon in US medical schools. In 2004-2005, of all 125 US medical schools, 2 schools (2%) reported using computer-based distance learning for the complete delivery of basic science content in 1 or more courses, 2 schools (2%) reported using online distance learning for the delivery of all didactic sessions in 1 or more clerkships, and 1 school (1%) reported using online distance learning for the complete delivery of content in 1 or more basic science and clinical courses. We did not ask if schools used online instruction to replace all other teaching sessions when students and faculty were in the same location.
Medical schools were first asked in 1996-1997 whether students were required to own or obtain access to an individual personal computer. In that year, 24 schools (19%) required students to have their own computers.11 In 2004-2005, 58 schools (46%) required students to own or have access to a personal computer, and 35 (28%) required students to have a personal digital assistant. There were 20 schools (16%) that required students to have both a personal computer and a personal digital assistant.
During 1994-1995, 82 schools (66%) reported including the subject of medical informatics as part of a required course. There are no data from that year on the amount of curricular time schools devoted to the subject. In 2004-2005, 104 schools (83%) included medical informatics in 1 or more required courses. In the 99 schools that supplied information about required curricular hours devoted to medical informatics teaching, the mean amount of time spent on the subject was 8.7 hours (range, 1-52).
Joint-Degree Programs
Many medical schools are providing opportunities for students to acquire an additional degree in conjunction with pursuing their medical studies. During 2004-2005, 107 schools (86%) had MD-PhD programs, 64 (51%) had MD-MPH programs, 42 (34%) had MD-MBA programs, and 20 (16%) had MD-JD programs. In comparison, during 1994-1995, 116 (93%) reported having a combined MD-PhD program, 35 (28%) had an MD-MPH program, 13 (10%) had an MD-MBA program, and 10 (8%) had an MD-JD program.
Monitoring Medical Student Hours
The implementation of revised duty hours standards for residents by the Accreditation Council for Graduate Medical Education in 2003 has led to increased interest in the hours that medical students spend during required clerkships. We collected information on requirements for night call and policies that schools have adopted related to medical student hours. During 2004-2005, night call was required in the family medicine clerkship in 16 schools (13%), in the internal medicine clerkship in 93 schools (74%), in the obstetrics-gynecology clerkship in 119 schools (95%), in the pediatrics clerkship in 99 schools (79%), in the psychiatry clerkship in 62 schools (50%), and in the surgery clerkship in 114 schools (91%). There was only 1 medical school that did not require night call in any of the listed clerkships. In 1994-1995, night call was required in family medicine in 30 schools (24%); internal medicine, 108 schools (86%); obstetrics-gynecology, 114 schools (91%); pediatrics, 107 schools (86%); psychiatry, 69 schools (55%); and surgery, 100 schools (80%).
In 2004-2005, schools were asked to select the modal frequency for night call across all clerkships. The frequency was every fourth night in 69 schools (55%), every third night in 5 schools (4%), and some other frequency (typically once per week) in 50 schools (40%). We did not collect information from schools on the frequency of night call in each specialty.
Fifty schools (40%) reported having a formal policy on the hours that students are expected to be present in the clinical setting. The policies addressed a specific hour limit in 29 schools (58% of schools with policies), contained a general statement about hour limitations without a numerical limit in 30 schools (60%), included a general statement about preserving time for education in 13 schools (26%), and contained a mechanism for reporting violations in 13 schools (26%). No information was collected on what specific hour limits were included in school policies.
Schools were asked which individuals or groups have responsibility for monitoring medical student hours, including receiving information. The clerkship director has responsibility or receives information in 96 schools (77%), the dean’s office in 50 schools (40%), the curriculum committee in 33 schools (26%), attending faculty in 22 schools (18%), and residents in 14 schools (11%).
COMMENT
The total number of faculty rose substantially between 1994-1995 and 2004-2005 in both basic science and clinical departments. The increase in faculty size occurred in the context of stable medical school enrollment. A number of factors may have contributed to this increase. Some disciplines, such as genetics and emergency medicine, increased well beyond the average, perhaps indicating a newly defined need for this expertise for patient care or research. In addition, during 2002-2003 medical schools derived 35.9% of their total revenue from faculty practice and 32.6% from grants and contracts (including direct and facilities/administrative costs).9(p42) Maintaining these revenue streams requires considerable faculty effort and has provided some of the impetus to increase the size of the faculty.
The increasing proportion of deans with MBA, MPH, and JD degrees may reflect the needs of the expanding role of the dean. This change in the academic profile of deans may be a function of the characteristics of the applicant pool for dean positions or the perspectives of search committees about the needed qualifications. Medical schools are increasingly offering students the opportunity to obtain such additional degrees (MBA, MPH, JD), and it would be valuable to know whether academic physicians who anticipate a leadership career path in academic medicine prepare themselves by pursuing such additional degrees.
The "geographic pipeline" from entry to medical school through entry to residency training is influenced by a number of factors. Our data show that, on average, public medical schools draw a higher percentage of their applications and a higher percentage of their first-year students from the state in which the school is located. This is due at least in part to admissions policies in public medical schools that favor state residents, which, in turn, may be based on state mandates.12 Many states with 1 or several public medical schools (such as Arizona, Arkansas, Mississippi, New Jersey) tend to have a high proportion total first-year medical school positions filled by state residents (Table 3). Private medical schools tend to draw and accept from a national pool, so the percentage of state residents in the entering class tends to be lower. States with a single private school, such as Rhode Island, or with multiple private schools (even if mixed with public schools), such as New York and Pennsylvania, have a lower proportion of state residents in the entering class. Some private medical schools have received financial incentives from the state for admitting state residents, so that their overall percentage of first-year medical students who are state residents is high.12
Retention of medical school graduates in the state is much lower than in-state enrollment in medical schools, even for states with a high proportion of in-state entrants. In most states, there are more residency positions than medical school graduates (see Appendix IA; State-level Data for Accredited Graduate Medical Education Programs in the United States: 2004-2005 is available on request), so the reasons for out-migration remain to be determined. This examination of the geographic pipeline was carried out using school-level data so that the path of individuals cannot be traced from entry into medical school, to graduate medical education, and then into practice. Another limitation is that causes and patterns related to physician maldistribution often occur locally, varying within a given state, and would require more precise analyses to gain additional insights.
Medical schools are making extensive use of computer applications, not only for the delivery of instruction but also for course management. Although online education is common, there is little use of computers for true distance education in which students are separated geographically from their teachers and all didactic teaching is carried out in an online format. Most "e-learning" for undergraduate medical education has been directed to enhancing individualized learning, with little attention to the synchronous, real-time delivery of lecture, laboratory, or tutorial sessions13 that might be used in a distance learning situation in which faculty and students are never in the same location.
Night call is less common across schools in the nonsurgical clinical clerkships (family medicine, internal medicine, pediatrics, psychiatry) than 10 years ago, but in the surgery and obstetrics-gynecology clerkships, the number of schools requiring night call has increased. These changes had begun by at least 2001-2002. In that year, night call was required in family medicine (25 schools), internal medicine (101 schools), obstetrics-gynecology (116 schools), pediatrics (103 schools), psychiatry (68 schools), and surgery (111 schools) clerkships.14 These results are intermediate between those of 1994-1995 and 2004-2005. It is unclear what stimulated these changes, which began before the introduction of the revisions to the Accreditation Council for Graduate Medical Education duty hours standards in 2003. The trends in night call could have arisen from individual decisions at the clerkship or medical school level or have been tied to changes in the structure of residency training and delivery of hospital care that preceded the 2003 requirements. For example, in internal medicine the use of night float systems for residents had begun by the early 1990s15 and increases in the use of this approach are anticipated.16 The presence of a night float system might discourage clerkship directors from implementing call for medical students.
Although our study has important strengths of a 100% response from all US medical schools to the questionnaire and to all individual reported items in both 2004-2005 and 1994-1995, limitations need to be considered. Although instructions were provided to schools to assist them in understanding the meaning of each question, it is possible that the interpretation of questions was not consistent across schools, or between the 2 study years in any given school. Also, some questions were not completely parallel between 2004-2005 and 1994-1995, so the ability to draw comparisons was limited.
Many of the variables that we have examined, including faculty size and the geographic pipeline into medical school and residency training, may be affected by factors external to the medical school. Understanding these interrelationships will be critical in addressing important issues in medical education and health care today and in the future.
AUTHOR INFORMATION
Corresponding Author: Barbara Barzansky, PhD, Division of Undergraduate Medical Education Policy and Standards, American Medical Association, 515 N State St, Chicago, IL 60610 (barbara.barzansky{at}ama-assn.org).
Author Contributions: Dr Barzansky had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Barzansky.
Acquisition of data: Barzansky, Etzel.
Analysis and interpretation of data: Barzansky.
Drafting of the manuscript: Barzansky.
Critical revision of the manuscript for important intellectual content: Etzel.
Statistical analysis: Barzansky, Etzel.
Administrative, technical, or material support: Etzel.
Financial Disclosures: None reported.
Funding/Support: This research was funded solely by the American Medical Association, which employs Dr Barzansky and Ms Etzel.
Role of the Sponsor: Other than Dr Barzansky and Ms Etzel, no employee of the American Medical Association had any involvement in the design and conduct of the study; in the collection, management, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript.
Author Affiliations: Division of Undergraduate Medical Education Policy and Standards and the Division of Graduate Medical Education, American Medical Association, Chicago, Ill.
REFERENCES
| |
1. Seifer SD, Vranizan MA, Grumbach K. Graduate medical education and physician practice location. JAMA. 1995;274:685-691.
ABSTRACT
2. Dorner FH, Burr RM, Tucker SM. The geographic relationship between physicians’ residency site and the locations of their first practices. Acad Med. 1991;66:540-544.
ISI
| PUBMED
3. Steele MT, Schwab RA, McNamara RM, et al. Emergency medicine resident choice of a practice location. Ann Emerg Med. 1998;31:351-357.
FULL TEXT
|
ISI
| PUBMED
4. Cooksey JA, Harman CP. Dissecting the medical training-to-practice continuum: factors associated with choosing in-state graduate medical education. Acad Med. 1999;74(10 suppl):S114-S117.
ISI
5. Rydrych D. New findings from the 2002 Minnesota Resident Physician Exit Survey. Minn Med. 2003;86:34-38.
PUBMED
6. Barzansky B, Etzel S. Educational programs in US medical schools, 2003-2004. JAMA. 2004;292:1025-1031.
FREE FULL TEXT
7. Daugherty RM Jr. Leading among leaders: the dean in today’s medical school. Acad Med. 1998;73:649-653.
ISI
| PUBMED
8. Barzansky B, Jonas HS, Etzel S. Educational programs in US medical schools, 1994-1995. JAMA. 1995;274:716-722.
ABSTRACT
9. AAMC Data Book: Statistical Information Related to Medical Education. Washington, DC: Association of American Medical Colleges; January 2005.
10. Pasko T, Smart D. Physician Characteristics and Distribution in the US: 2005 Edition. Chicago, Ill: American Medical Association Press; 2004:29.
11. Barzansky B, Jonas HS, Etzel S. Educational programs in US medical schools, 1996-1997. JAMA. 1997;278:744-749.
ABSTRACT
12. Medical School Admission Requirements: United States and Canada—1999-2000. Washington, DC: Association of American Medical Colleges; 1998.
13. Lau F, Bates J. A review of e-learning practices for undergraduate medical education. J Med Syst. 2004;28:71-87.
FULL TEXT
|
ISI
| PUBMED
14. Barzansky B, Etzel S. Educational programs in US medical schools, 2001-2002. JAMA. 2002;288:1067-1072.
FREE FULL TEXT
15. Trontell MC, Carson JL, Taragin MI, et al. The impact of a night float system on internal medicine residency programs. J Gen Intern Med. 1991;6:445-449.
ISI
| PUBMED
16. Lieberman JD, Olenwine JA, Finley W, et al. Residency reform: anticipated effects of ACGME guidelines on general surgery and internal medicine residency programs. Curr Surg. 2005;62:231-236.
FULL TEXT
| PUBMED
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Does gender influence learning style preferences of first-year medical students?
Slater et al.
Adv. Physiol. Educ. 2007;31:336-342.
ABSTRACT
| FULL TEXT
Committing to Medical Student Education
Roberts et al.
Acad. Psychiatry 2006;30:93-94.
FULL TEXT
|
