Hiring Young Doctors: What Otolaryngologists Should Know About Changes in the Medical School Curriculum

For decades, the medical school curriculum remained “traditional.” Most of us received 2 years of basic science teaching followed by 2 years of clinical exposure. That model, which had been standard since about 1910, has changed in response to evolving needs in the health-care environment. In order to prepare young doctors to meet the demands of America’s rapidly changing health-care system, medical schools have made major adjustments. It is helpful for otolaryngologists to understand some of these changes so that we can have realistic understanding and expectations of young doctors whom we recruit for residencies or our practices.

One of the fundamental shortcomings of our traditional approach to medical education has been the narrow focus on treating the physical disease of an individual patient, with little or no attention to public health implications. The Association of American Medical Colleges (AAMC) has stressed the importance of this problem for a few years and encouraged medical schools to address it through curricular change. ¹ Many schools have responded. Students are being taught to view health problems not only focused on the individual but moreover at a population level. Obvious public health issues that should be at the front of our minds on a daily basis include prevention-related services, immunization, infection control, and other topics. During the last decade, many medical schools have introduced progressively more public health content into the required medical school curriculum, and some facilitate certificates or master’s degrees in public/population health for their medical students. For example, in Philadelphia, beginning with the class of 2014, the Sidney Kimmel Medical College of Thomas Jefferson University created a “college within the college” program to provide students with academic and research options in areas of population health, in association with Jefferson’s School of Population Health (as opposed to Public Health), founded in 2009 and the first of its kind. Many medical schools offer and encourage dual degree programs in medicine and public health. Students who graduate with such education bring a broader perspective on the implications of disease and medical care to our patients, departments, and practices.

Medical schools have instituted other major changes to the traditional curriculum. In an increasing number of medical schools, the initial basic science training has been condensed from 2 years to 1.5 years, or even 1 year. Most schools introduce clinical experience immediately, with student–patient contact starting within the first weeks of medical school. In some, additional basic science training is added to the curriculum in the latter years of medical school, after students have selected a specialty, so that they can concentrate their in-depth basic science studies in their areas of primary interest.

Some schools have introduced even more creative changes to help students gain a practical understanding of health care ² For example, at the Pennsylvania State College of Medicine in Hershey, students begin their medical training as patient navigators, helping patients and their families get through the medical system, and experiencing the confusions and frustrations of medical care firsthand, changing dramatically the students’ practical understanding of the patient experience. This process also gives them exceptional exposure (physical and bureaucratic) to the health system where they will train. At New York University, students track all hospital admissions and charges in the state. This leads to provocative discussions of the health-care system and discrepancies in the care of different populations, such as the US$3000, the cost for delivering a baby in rural New York compared with the US$22 000, cost for the same service in New York City. Students at Hofstra North Shore–Long Island Jewish School of Medicine do not spend their first 2 months in medical school lectures at all. Rather, they all become certified emergency medical technicians and experience firsthand the making of rapid, life-saving judgments through 911 calls. The Mayo Clinic medical school converted much of the material taught traditionally in didactic lecture classes to electronic format, allowing students to study it on their own time and to use class time for case studies and discussion. Mayo also added a 4-year course called The Science of Healthcare Delivery that teaches biomedical informatics, systems engineering, and health-care economics.

Even the admissions criteria for medical schools have changed. The medical college admission test is now 2 hours longer (6.5 hours) than the test most of us took. The added material includes questions on social and behavioral sciences, in addition to the standard information in chemistry, biology, and physics. Among other things, the redesigned test encourages prospective medical students to have a broader education and perspective than one might get from concentrating solely on the facts needed to be a biology major.

In addition, many medical schools are decreasing emphasis on memorizing material. This may be partly because of the rapidity with which medical facts are changing and partially because of the ubiquitous availability of electronic information. Rather, schools are teaching students to seek information efficiently and routinely and to utilize technology.

In addition, some schools are considering reducing the curriculum from 4 years to 3 years, allowing students to graduate and start residencies sooner. The AAMC is studying ways to use mastery of competencies as criteria for graduation rather than a specific number of years, allowing students to master information and skills at a pace of their choosing.

Like medical practice and health-care delivery systems, medical education is evolving. Recent medical school graduates are undoubtedly trained as well as most of us were, but differently. It is helpful for otolaryngologists to recognize these differences in training as we work with residents or hire young associates. Such understanding may do more than alter our expectations and the way we interact with new physicians; it also may highlight the many things we can learn from young doctors educated in the new paradigm.