A Century after Flexner: Recommendations for Change in Undergraduate College Curriculum
Recommendations for Change in Undergraduate College Curriculum
A revisionist premedical college curriculum might include at least a semester and possibly a year of medical business economics specifically tailored for premedical students. This would include the evolution of medical insurance companies in this country; a thorough review of Medicare and Medicaid or CMS; how insurance companies, including HMOs, work; and the essentials of billing and coding. Keyboarding should be a requirement, although proficiency could be demonstrated in lieu of a formal classroom environment. Physics and organic chemistry should be revisited. Physics could be changed to one semester of medically relevant material with a laboratory component. Organic chemistry could possibly be restructured to a one-semester course with a laboratory component or a year-long course with one semester of laboratory. At most institutions, premedical students and chemistry majors take the same course, and it is possible that there is a point of divergence here where the specifics of the specialty for the chemistry students are not essential to the study of medicine. Finally, at least a semester of medical biostatistics should be required, even at the expense of an existing requirement in mathematics.
Medical School
Many schools have decreased gross anatomy to something less than a full year with less actual dissection being done by the students. Biochemistry is now a one-semester course at some schools with no laboratory experience at others. Faculty in the first two years of medical school are very territorial about their contact time with students as their livelihood depends upon this. This leaves a very crowded curriculum with little room for substantive changes. Therefore, some new initiatives could be moved into the fourth year. If students were required to take Part II of the USMLE series no later than mid-December of their senior year, it would facilitate subsequent changes in the second semester of this year as the students would not be detracted by the need to study for this examination. The entire match process needs to be retooled, but again, a lot of livelihoods are dependent on the long version of this process and resistance will be encountered. Currently, this process lingers on through January when travel is very unpredictable across the northern latitudes. The interview/travel portion of this process could be completed before Christmas. The second semester of the senior year could be restructured as presented in Table 4. Make your pharmacy dollar go further and buy Viagra Super Active online
Residency Training
Perhaps specialties should be required to justify the need for a preliminary year, especially if it is largely unstructured. Eliminating the preliminary residency year as it is currently structured could add significantly more patient contact time for a physician over the course of a career, and could lower the overall cost of GME by millions of dollars a year with no loss in physician competency. Residents who complete a preliminary year rarely remain up-to-date in the specialty afterwards because of the expanding knowledge base in their chosen field and no responsibility for managing that aspect of a patient’s care related to their internship experience. viagra jelly
Of course, all of this would require the blessing of the Liaison Committee on Medical Education (LCME), possibly the ACGME and CMS for final approval under a novel program similar to other joint ventures crossing multiple lines of jurisdiction. Also, there are other areas that deserve equal attention, such as diversity issues, professionalism, sexual harassment training and time management, to name a few. Finally, it is highly unlikely that the current senior leadership in medical education today can effect these changes because radical change is difficult to accept. It will certainly take more than a generation to put these changes in place, and the best place to begin is with the college curriculum, which can then drive subsequent changes in medical school and residency training.