A fresh start for medical education

In 1910, the year that Abraham Flexner issued his landmark report on the state of medical education in the United States, another report was in the works. The Committee on Revision of the United States Pharmacopeia was evaluating the effectiveness of the handful of medicines available at the time. That year also marked the 15th anniversary of the opening of the world’s first pharmaceutical lab. And only 15 years had passed since the first clinical application of the X-ray. The deciphering of the structure of DNA was decades away.

More than a hundred years on, doctors have upwards of 3,300 medicines available to them. Genome sequencing for individual patients has become routine. In a nod to the importance of the effects of our social and physical environments on our health, physicians pay as much attention to patients’ zip codes as to their genetic codes. Yet despite advances in what we know about disease and the human body, the social and economic factors that affect health, and the ways in which we provide medical care, a century-old model of medical education has prevailed. To be sure, recent years have seen efforts around the country to teach the underlying science of health in the context of disease and other insults to the human body.

Last fall the School of Medicine embarked on its own effort to devise a curriculum that reflects the changes, not just in medicine, but in society’s expectations of its physicians. Among the features of the new curriculum are the merging of basic science and clinical training, with clinical experiences starting in the first year. Third-year students have a chance to revisit key clinical concepts at the start of each clerkship. And medical students also train with the nursing and physician associate students who will become their colleagues on the wards.

In this issue of Yale Medicine, we look at this changing landscape and how the School of Medicine has responded with new approaches to training the next generation of leaders in medicine.