medical education

{{Short description|Education related to the practice of being a medical practitioner}}

{{Redirect|Academic Medicine|the journal|Academic Medicine (journal)}}

File:Medical student at the laboratories of ITESM CCM.jpg]]

Medical education is education related to the practice of being a medical practitioner, including the initial training to become a physician (i.e., medical school and internship) and additional training thereafter (e.g., residency, fellowship, and continuing medical education).

Medical education and training varies considerably across the world. Various teaching methodologies have been used in medical education, which is an active area of educational research.{{cite journal | vauthors = Flores-Mateo G, Argimon JM | title = Evidence based practice in postgraduate healthcare education: a systematic review | journal = BMC Health Services Research | volume = 7 | pages = 119 | date = July 2007 | pmid = 17655743 | pmc = 1995214 | doi = 10.1186/1472-6963-7-119 | doi-access = free }}

Medical education is also the subject-didactic academic field of educating medical doctors at all levels, including entry-level, post-graduate, and continuing medical education. Specific requirements such as entrustable professional activities must be met before moving on in stages of medical education.

Common techniques and evidence base

Medical education applies theories of pedagogy specifically in the context of medical education. Medical education has been a leader in the field of evidence-based education, through the development of evidence syntheses such as the Best Evidence Medical Education collection, formed in 1999, which aimed to "move from opinion-based education to evidence-based education".{{cite journal | vauthors = Harden RM, Grant J, Buckley G, Hart IR | title = BEME Guide No. 1: Best Evidence Medical Education | journal = Medical Teacher | volume = 21 | issue = 6 | pages = 553–62 | date = 1999-01-01 | pmid = 21281174 | doi = 10.1080/01421599978960 | s2cid = 7233599 }} Common evidence-based techniques include the Objective structured clinical examination (commonly known as the 'OSCE) {{cite journal | vauthors = Daniels VJ, Pugh D | title = Twelve tips for developing an OSCE that measures what you want | journal = Medical Teacher | volume = 40 | issue = 12 | pages = 1208–1213 | date = December 2018 | pmid = 29069965 | doi = 10.1080/0142159X.2017.1390214 | s2cid = 44971925 }} to assess clinical skills, and reliable checklist-based assessments to determine the development of soft skills such as professionalism.{{cite journal | vauthors = Wilkinson TJ, Wade WB, Knock LD | title = A blueprint to assess professionalism: results of a systematic review | journal = Academic Medicine | volume = 84 | issue = 5 | pages = 551–8 | date = May 2009 | pmid = 19704185 | doi = 10.1097/ACM.0b013e31819fbaa2 | s2cid = 44915975 | doi-access = free }} However, there is a persistence of ineffective instructional methods in medical education, such as the matching of teaching to learning styles{{cite journal | vauthors = Newton PM, Najabat-Lattif HF, Santiago G, Salvi A | title = The Learning Styles Neuromyth Is Still Thriving in Medical Education | journal = Frontiers in Human Neuroscience | volume = 15 | pages = 708540 | date = 2021 | pmid = 34456698 | pmc = 8385406 | doi = 10.3389/fnhum.2021.708540 | doi-access = free }} and Edgar Dales' "Cone of Learning".{{cite journal | vauthors = Masters K | title = Edgar Dale's Pyramid of Learning in medical education: Further expansion of the myth | journal = Medical Education | volume = 54 | issue = 1 | pages = 22–32 | date = January 2020 | pmid = 31576610 | doi = 10.1111/medu.13813 | s2cid = 203640807 | doi-access = free }}

Entry-level education

File:LF - Dekanat 1.jpg) Slovakia]]

Entry-level medical education programs are tertiary-level courses undertaken at a medical school. Depending on jurisdiction and university, these may be either undergraduate-entry (most of Europe, Asia, South America and Oceania), or graduate-entry programs (mainly Australia, Philippines and North America). Some jurisdictions and universities provide both undergraduate entry programs and graduate entry programs (Australia, South Korea).

In general, initial training is taken at medical school. Traditionally initial medical education is divided between preclinical and clinical studies. The former consists of the basic sciences such as anatomy, physiology, biochemistry, pharmacology, pathology, microbiology. The latter consists of teaching in the various areas of clinical medicine such as internal medicine, pediatrics, obstetrics and gynecology, psychiatry, general practice and surgery. More recently, there have been significant efforts in the United States to integrate health systems science (HSS) as the "third pillar" of medical education, alongside preclinical and clinical studies.{{Cite journal |last1=Fred |first1=Herbert L. |last2=Gonzalo |first2=Jed D. |date=2018-06-01 |title=Reframing Medical Education |url=https://meridian.allenpress.com/thij/article/45/3/123/85682/Reframing-Medical-Education |journal=Texas Heart Institute Journal |language=en |volume=45 |issue=3 |pages=123–125 |doi=10.14503/THIJ-18-6729 |issn=0730-2347 |pmc=6059511 |pmid=30072846}} HSS is a foundational platform and framework for the study and understanding of how care is delivered, how health professionals work together to deliver that care, and how the health system can improve patient care and health care delivery.{{Cite web |title=Health Systems Science - 9780323694629 |url=https://www.us.elsevierhealth.com/health-systems-science-9780323694629.html |access-date=2024-05-13 |website=US Elsevier Health |language=en}}

There has been a proliferation of programmes that combine medical training with research (M.D./Ph.D.) or management programmes (M.D./ MBA), although this has been criticised because extended interruption to clinical study has been shown to have a detrimental effect on ultimate clinical knowledge.{{cite journal | vauthors = Dyrbye LN, Thomas MR, Natt N, Rohren CH | title = Prolonged delays for research training in medical school are associated with poorer subsequent clinical knowledge | journal = Journal of General Internal Medicine | volume = 22 | issue = 8 | pages = 1101–6 | date = August 2007 | pmid = 17492473 | pmc = 2305740 | doi = 10.1007/s11606-007-0200-x }}

= The LCME and the "Function and Structure of a Medical School" =

The Liaison Committee on Medical Education (LCME) is a committee of educational accreditation for schools of medicine leading to an MD in the United States and Canada. In order to maintain accreditation, medical schools are required to ensure that students meet a certain set of standards and competencies, defined by the accreditation committees. The "Function and Structure of a Medical School" article is a yearly published article from the LCME that defines 12 accreditation standards.

= Entrustable Professional Activities for entering residency =

The Association of American Medical Colleges (AAMC) has recommended thirteen Entrustable Professional Activities (EPAs) that medical students should be expected to accomplish prior to beginning a residency program.{{Cite web|title=Core Entrustable Professional Activities for Entering Residency |url=https://www.aamc.org/system/files/c/2/484778-epa13toolkit.pdf | vauthors = Obeso V |date=2017|access-date=29 April 2020}}{{cite journal | vauthors = Ten Cate O | title = Nuts and bolts of entrustable professional activities | journal = Journal of Graduate Medical Education | volume = 5 | issue = 1 | pages = 157–8 | date = March 2013 | pmid = 24404246 | pmc = 3613304 | doi = 10.4300/JGME-D-12-00380.1 }}{{cite journal | vauthors = Cate OT | title = A primer on entrustable professional activities | journal = Korean Journal of Medical Education | volume = 30 | issue = 1 | pages = 1–10 | date = March 2018 | pmid = 29510603 | pmc = 5840559 | doi = 10.3946/kjme.2018.76 }} EPAs are based on the integrated core competencies developed over the course of medical school training. Each EPA lists its key feature, associated competencies, and observed behaviors required for completion of that activity. The students progress through levels of understanding and capability, developing with decreasing need for direct supervision. Eventually students should be able to perform each activity independently, only requiring assistance in situations of unique or uncommon complexity.

The list of topics that EPAs address include:

History and physical exam skills
Differential diagnosis
Diagnostic/screening tests
Orders and prescriptions
Patient encounter documentation
Oral presentations of patient encounters
Clinical questioning/using evidence
Patient handovers/transitions of care
Teamwork
Urgent/Emergency care
Informed consent
Procedures
Safety and improvement

Postgraduate education

File:Děkanát 1.LF UK.jpg, Charles University, Prague]]

Following completion of entry-level training, newly graduated doctors are often required to undertake a period of supervised practice before full registration is granted; this is most often of one-year duration and may be referred to as an "internship" or "provisional registration" or "residency".

Further training in a particular field of medicine may be undertaken. In the U.S., further specialized training, completed after residency is referred to as "fellowship". In some jurisdictions, this is commenced immediately following completion of entry-level training, while other jurisdictions require junior doctors to undertake generalist (unstreamed) training for a number of years before commencing specialization.

Each residency and fellowship program is accredited by the Accreditation Council for Graduate Medical Education (ACGME), a non-profit organization led by physicians with the goal of enhancing educational standards among physicians. The ACGME oversees all MD and DO residency programs in the United States. As of 2019, there were approximately 11,700 ACGME accredited residencies and fellowship programs in 181 specialties and subspecialties.{{Cite book|date=2019|title=Data Resource Book|url=https://www.acgme.org/About-Us/Publications-and-Resources/Graduate-Medical-Education-Data-Resource-Book|publisher=Accreditation Council for Graduate Medical Education |volume=19|pages=13–19}}

Education theory itself is becoming an integral part of postgraduate medical training. Formal qualifications in education are also becoming the norm for medical educators, such that there has been a rapid increase in the number of available graduate programs in medical education.{{cite journal | vauthors = Tekian A, Artino AR | title = AM last page: master's degree in health professions education programs | journal = Academic Medicine | volume = 88 | issue = 9 | pages = 1399 | date = September 2013 | pmid = 23982511 | doi = 10.1097/ACM.0b013e31829decf6 | doi-access = free }}{{cite journal | vauthors = Tekian A, Artino AR | title = AM last page. Overview of doctoral programs in health professions education | journal = Academic Medicine | volume = 89 | issue = 9 | pages = 1309 | date = September 2014 | pmid = 25006714 | doi = 10.1097/ACM.0000000000000421 | doi-access = free }}

Continuing medical education

In most countries, continuing medical education (CME) courses are required for continued licensing.{{cite journal | vauthors = Ahmed K, Ashrafian H, Hanna GB, Darzi A, Athanasiou T | title = Assessment of specialists in cardiovascular practice | journal = Nature Reviews. Cardiology | volume = 6 | issue = 10 | pages = 659–67 | date = October 2009 | pmid = 19724254 | doi = 10.1038/nrcardio.2009.155 | s2cid = 21452983 }} CME requirements vary by state and by country. In the US, accreditation is overseen by the Accreditation Council for Continuing Medical Education (ACCME). Physicians often attend dedicated lectures, grand rounds, conferences, and performance improvement activities in order to fulfill their requirements. Additionally, physicians are increasingly opting to pursue further graduate-level training in the formal study of medical education as a pathway for continuing professional development.{{cite journal | vauthors = Cervero RM, Artino AR, Daley BJ, Durning SJ | title = Health Professions Education Graduate Programs Are a Pathway to Strengthening Continuing Professional Development | journal = The Journal of Continuing Education in the Health Professions | volume = 37 | issue = 2 | pages = 147–151 | date = 2017 | pmid = 28562504 | doi = 10.1097/CEH.0000000000000155 | s2cid = 13954832 }}{{cite journal | vauthors = Artino AR, Cervero RM, DeZee KJ, Holmboe E, Durning SJ | title = Graduate Programs in Health Professions Education: Preparing Academic Leaders for Future Challenges | journal = Journal of Graduate Medical Education | volume = 10 | issue = 2 | pages = 119–122 | date = April 2018 | pmid = 29686748 | pmc = 5901787 | doi = 10.4300/JGME-D-18-00082.1 }}

Online learning

Medical education is increasingly utilizing online teaching, usually within learning management systems (LMSs) or virtual learning environments (VLEs).{{cite journal | vauthors = Ellaway R, Masters K | title = AMEE Guide 32: e-Learning in medical education Part 1: Learning, teaching and assessment | journal = Medical Teacher | volume = 30 | issue = 5 | pages = 455–73 | date = June 2008 | pmid = 18576185 | doi = 10.1080/01421590802108331 | citeseerx = 10.1.1.475.1660 | s2cid = 13793264 }}{{cite journal | vauthors = Masters K, Ellaway R | title = e-Learning in medical education Guide 32 Part 2: Technology, management and design | journal = Medical Teacher | volume = 30 | issue = 5 | pages = 474–89 | date = June 2008 | pmid = 18576186 | doi = 10.1080/01421590802108349 | s2cid = 43473920 }} Additionally, several medical schools have incorporated the use of blended learning combining the use of video, asynchronous, and in-person exercises.{{cite journal | vauthors = Evans KH, Thompson AC, O'Brien C, Bryant M, Basaviah P, Prober C, Popat RA | title = An Innovative Blended Preclinical Curriculum in Clinical Epidemiology and Biostatistics: Impact on Student Satisfaction and Performance | journal = Academic Medicine | volume = 91 | issue = 5 | pages = 696–700 | date = May 2016 | pmid = 26796089 | doi = 10.1097/ACM.0000000000001085 | doi-access = free }}{{cite journal | vauthors = Villatoro T, Lackritz K, Chan JS | title = Case-Based Asynchronous Interactive Modules in Undergraduate Medical Education | journal = Academic Pathology | volume = 6 | pages = 2374289519884715 | date = 2019-01-01 | pmid = 31700991 | pmc = 6823976 | doi = 10.1177/2374289519884715 }} A landmark scoping review published in 2018 demonstrated that online teaching modalities are becoming increasingly prevalent in medical education, with associated high student satisfaction and improvement on knowledge tests. However, the use of evidence-based multimedia design principles in the development of online lectures was seldom reported, despite their known effectiveness in medical student contexts.{{cite journal | vauthors = Tang B, Coret A, Qureshi A, Barron H, Ayala AP, Law M | title = Online Lectures in Undergraduate Medical Education: Scoping Review | journal = JMIR Medical Education | volume = 4 | issue = 1 | pages = e11 | date = April 2018 | pmid = 29636322 | pmc = 5915670 | doi = 10.2196/mededu.9091 | doi-access = free }} To enhance variety in an online delivery environment, the use of serious games, which have previously shown benefit in medical education,{{Cite journal| vauthors = Birt J, Stromberga Z, Cowling M, Moro C |date=2018-01-31|title=Mobile Mixed Reality for Experiential Learning and Simulation in Medical and Health Sciences Education |journal=Information |language=en |volume=9 |issue=2|pages=31 |doi=10.3390/info9020031 |issn=2078-2489|doi-access=free}} can be incorporated to break the monotony of online-delivered lectures.{{cite journal | vauthors = Moro C, Stromberga Z | title = Enhancing variety through gamified, interactive learning experiences | journal = Medical Education | volume = 54 | issue = 12 | pages = 1180–1181 | date = December 2020 | pmid = 32438478 | doi = 10.1111/medu.14251 | doi-access = free }}

Research areas into online medical education include practical applications, including simulated patients and virtual medical records (see also: telehealth).{{cite web | vauthors = Favreau A | title=Minnesota Virtual Clinic Medical Education Software|url=http://www.license.umn.edu/Products/Minnesota-Virtual-Clinic-Medical-Education-Software__Z05174.aspx|publisher=Regents of the University of Minnesota|access-date=2011-09-13|url-status=dead|archive-url=https://web.archive.org/web/20120324152337/http://www.license.umn.edu/Products/Minnesota-Virtual-Clinic-Medical-Education-Software__Z05174.aspx|archive-date=2012-03-24}} When compared to no intervention, simulation in medical education

training is associated with positive effects on knowledge, skills, and behaviors and moderate effects for patient outcomes.{{cite journal | vauthors = Cook DA, Hatala R, Brydges R, Zendejas B, Szostek JH, Wang AT, Erwin PJ, Hamstra SJ | display-authors = 6 | title = Technology-enhanced simulation for health professions education: a systematic review and meta-analysis | journal = JAMA | volume = 306 | issue = 9 | pages = 978–88 | date = September 2011 | pmid = 21900138 | doi = 10.1001/jama.2011.1234 }} However, data is inconsistent on the effectiveness of asynchronous online learning when compared to traditional in-person lectures.{{cite journal | vauthors = Jordan J, Jalali A, Clarke S, Dyne P, Spector T, Coates W | title = Asynchronous vs didactic education: it's too early to throw in the towel on tradition | journal = BMC Medical Education | volume = 13 | issue = 1 | pages = 105 | date = August 2013 | pmid = 23927420 | pmc = 3750828 | doi = 10.1186/1472-6920-13-105 | doi-access = free }}{{cite journal | vauthors = Wray A, Bennett K, Boysen-Osborn M, Wiechmann W, Toohey S | title = Efficacy of an asynchronous electronic curriculum in emergency medicine education in the United States | journal = Journal of Educational Evaluation for Health Professions | volume = 14 | pages = 29 | date = 2017-12-11 | pmid = 29237247 | pmc = 5801323 | doi = 10.3352/jeehp.2017.14.29 }} Furthermore, studies utilizing modern visualization technology (i.e. virtual and augmented reality) have shown great promise as means to supplement lesson content in physiological and anatomical education.{{cite journal | vauthors = Moro C, Štromberga Z, Raikos A, Stirling A | title = The effectiveness of virtual and augmented reality in health sciences and medical anatomy | journal = Anatomical Sciences Education | volume = 10 | issue = 6 | pages = 549–559 | date = November 2017 | pmid = 28419750 | doi = 10.1002/ase.1696 | url = https://research.bond.edu.au/en/publications/d761ced8-4406-4a5e-ae3f-01862a09a36e | s2cid = 25961448 }}{{Cite journal| vauthors = Moro C, Štromberga Z, Stirling A |date=2017-11-29|title=Virtualisation devices for student learning: Comparison between desktop-based (Oculus Rift) and mobile-based (Gear VR) virtual reality in medical and health science education|url=https://ajet.org.au/index.php/AJET/article/view/3840|journal=Australasian Journal of Educational Technology|volume=33|issue=6|doi=10.14742/ajet.3840|issn=1449-5554|doi-access=free}}

= Telemedicine/telehealth education =

With the advent of telemedicine (aka telehealth), students learn to interact with and treat patients online, an increasingly important skill in medical education.{{cite journal | vauthors = Kononowicz AA, Woodham LA, Edelbring S, Stathakarou N, Davies D, Saxena N, Tudor Car L, Carlstedt-Duke J, Car J, Zary N | display-authors = 6 | title = Virtual Patient Simulations in Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration | journal = Journal of Medical Internet Research | volume = 21 | issue = 7 | pages = e14676 | date = July 2019 | pmid = 31267981 | pmc = 6632099 | doi = 10.2196/14676 | doi-access = free }}{{cite journal | vauthors = Kovacevic P, Dragic S, Kovacevic T, Momcicevic D, Festic E, Kashyap R, Niven AS, Dong Y, Gajic O | display-authors = 6 | title = Impact of weekly case-based tele-education on quality of care in a limited resource medical intensive care unit | journal = Critical Care | volume = 23 | issue = 1 | pages = 220 | date = June 2019 | pmid = 31200761 | pmc = 6567671 | doi = 10.1186/s13054-019-2494-6 | doi-access = free }}{{cite journal | vauthors = van Houwelingen CT, Moerman AH, Ettema RG, Kort HS, Ten Cate O | title = Competencies required for nursing telehealth activities: A Delphi-study | journal = Nurse Education Today | volume = 39 | pages = 50–62 | date = April 2016 | pmid = 27006033 | doi = 10.1016/j.nedt.2015.12.025 | doi-access = free }}{{Cite journal |title=Editorial |url=http://www.ilc.unsw.edu.au/publications/ilb/january-february-2010-volume-7-issue-16 |date=January–February 2010 |journal=Indigenous Law Bulletin |volume=7 |issue=16 |doi=10.1163/2210-7975_hrd-1758-0046}} In training, students and clinicians enter a "virtual patient room" in which they interact and share information with a simulated or real patient actors. Students are assessed based on professionalism, communication, medical history gathering, physical exam, and ability to make shared decisions with the patient actor.{{cite journal | vauthors = Cantone RE, Palmer R, Dodson LG, Biagioli FE | title = Insomnia Telemedicine OSCE (TeleOSCE): A Simulated Standardized Patient Video-Visit Case for Clerkship Students | journal = MedEdPORTAL | volume = 15 | issue = 1 | pages = 10867 | date = December 2019 | pmid = 32051850 | pmc = 7012306 | doi = 10.15766/mep_2374-8265.10867 }}{{cite journal | vauthors = Shortridge A, Steinheider B, Ciro C, Randall K, Costner-Lark A, Loving G | title = Simulating Interprofessional Geriatric Patient Care Using Telehealth: A Team-Based Learning Activity | journal = MedEdPORTAL | volume = 12 | issue = 1 | pages = 10415 | date = June 2016 | pmid = 31008195 | pmc = 6464453 | doi = 10.15766/mep_2374-8265.10415 }}

Medical education systems by country

File:Aerial-Picture-of-Jackson-e1445995779731.jpg in Miami, the primary teaching hospital for the Miller School of Medicine at the University of Miami, in July 2010]]

In the United Kingdom, a typical medicine course at university is five years, or four years if the student already holds a degree. Among some institutions and for some students, it may be six years (including the selection of an intercalated BSc—taking one year—at some point after the pre-clinical studies). All programs culminate in the Bachelor of Medicine and Surgery degree (abbreviated MBChB, MBBS, MBBCh, BM, etc.). This is followed by two clinical foundation years afterward, namely F1 and F2, similar to internship training. Students register with the UK General Medical Council at the end of F1. At the end of F2, they may pursue further years of study. The system in Australia is very similar, with registration by the Australian Medical Council (AMC).

In the U.S. and Canada, a potential medical student must first complete an undergraduate degree in any subject before applying to a graduate medical school to pursue an (M.D. or D.O.) program. U.S. medical schools are almost all four-year programs. Some students opt for the research-focused M.D./Ph.D. dual degree program, which is usually completed in 7–10 years. There are certain courses that are pre-requisite for being accepted to medical school, such as general chemistry, organic chemistry, physics, mathematics, biology, English, labwork, etc. The specific requirements vary by school.

In Australia, there are two pathways to a medical degree. Students can choose to take a five- or six-year undergraduate medical degree Bachelor of Medicine/Bachelor of Surgery (MBBS or BMed) as a first tertiary degree directly after secondary school graduation, or first complete a bachelor's degree (in general three years, usually in the medical sciences) and then apply for a four-year graduate entry Bachelor of Medicine/Bachelor of Surgery (MBBS) program.{{Cite news|url=https://www.findmypathway.com/pathways/medicine/#registration|title=Medicine - Find My Pathway|work=Find My Pathway|access-date=2018-10-26|language=en-US}}{{Cite web|url=https://www.surgeons.org/becoming-a-surgeon/surgery-as-a-career/pathways-through-specialty-medical-training/|title=Pathways through specialty medical training| publisher = Royal Australasian College of Surgeons (RACS) |language=en|access-date=2018-10-26}}

See:

; North America

; Europe

; Asia/Middle East/Oceania

; Africa

Norms and values

Along with training individuals in the practice of medicine, medical education influences the norms and values of its participants (patients, families, etc.) This either occurs through explicit training in medical ethics, or covertly through a "hidden curriculum" –– a body of norms and values that students encounter implicitly, but is not formally taught.{{Cite web |title=Navigating the hidden curriculum in medical school |url=https://www.aamc.org/news/navigating-hidden-curriculum-medical-school |access-date=2023-09-24 |website=AAMC |language=en}}{{cite journal | vauthors = Sarikhani Y, Shojaei P, Rafiee M, Delavari S | title = Analyzing the interaction of main components of hidden curriculum in medical education using interpretive structural modeling method | journal = BMC Medical Education | volume = 20 | issue = 1 | pages = 176 | date = June 2020 | pmid = 32487128 | pmc = 7269001 | doi = 10.1186/s12909-020-02094-5 | doi-access = free }}{{cite journal | vauthors = Lempp H, Seale C | title = The hidden curriculum in undergraduate medical education: qualitative study of medical students' perceptions of teaching | journal = BMJ | volume = 329 | issue = 7469 | pages = 770–773 | date = October 2004 | pmid = 15459051 | pmc = 520997 | doi = 10.1136/bmj.329.7469.770 }} While formal ethics courses are a requirement at schools such as those accredited by the LCME, gaps between these courses and the "hidden curriculum" throughout medical education are frequently raised as issues contributing to the culture of medicine.{{cite journal | vauthors = Hafler JP, Ownby AR, Thompson BM, Fasser CE, Grigsby K, Haidet P, Kahn MJ, Hafferty FW | display-authors = 6 | title = Decoding the learning environment of medical education: a hidden curriculum perspective for faculty development | journal = Academic Medicine | volume = 86 | issue = 4 | pages = 440–444 | date = April 2011 | pmid = 21346498 | doi = 10.1097/ACM.0b013e31820df8e2 | doi-access = free }}{{cite book | vauthors = Shelton W, Campo-Engelstein L | chapter = Confronting the Hidden Curriculum: A Four-Year Integrated Course in Ethics and Professionalism Grounded in Virtue Ethics |date=2022 |title =The Medical/Health Humanities-Politics, Programs, and Pedagogies |pages=177–191 | veditors = Jones T, Pachucki K |place=Cham |publisher=Springer International Publishing |language=en |doi=10.1007/978-3-031-19227-2_12 |isbn=978-3-031-19227-2 }}{{cite journal | vauthors = Azmand S, Ebrahimi S, Iman M, Asemani O | title = Learning professionalism through hidden curriculum: Iranian medical students' perspective | journal = Journal of Medical Ethics and History of Medicine | volume = 11 | pages = 10 | date = 2018 | pmid = 31346387 | pmc = 6642446 }}{{cite journal | vauthors = Safari Y, Khatony A, Khodamoradi E, Rezaei M | title = The role of hidden curriculum in the formation of professional ethics in Iranian medical students: A qualitative study | journal = Journal of Education and Health Promotion | volume = 9 | pages = 180 | date = 2020 | pmid = 32953908 | pmc = 7482700 | doi = 10.4103/jehp.jehp_172_20 | doi-access = free }}

The aims of medical ethics training are to give medical doctors the ability to recognise ethical issues, reason about them morally and legally when making clinical decisions, and be able to interact to obtain the information necessary to do so.{{Cite web |title=Standards, Publications, & Notification Forms |url=https://lcme.org/publications/ |access-date=2023-09-24 |website=LCME |language=en-US}}

The hidden curriculum may include the use of unprofessional behaviours for efficiency{{efn|name=efficiency|"As in any crisis, the environment has evolved to accept substandard professional behavior in exchange for efficiency or productivity" {{cite journal | vauthors = Brainard AH, Brislen HC | title = Viewpoint: learning professionalism: a view from the trenches | journal = Academic Medicine | volume = 82 | issue = 11 | pages = 1010–1014 | date = November 2007 | pmid = 17971682 | doi = 10.1097/01.acm.0000285343.95826.94 | publisher = Ovid Technologies (Wolters Kluwer Health) | doi-access = free }}|group=}} or viewing the academic hierarchy as more important than the patient.{{efn|name=hierarchy|"In Coulehan's view, the hidden curriculum places the academic hierarchy—not the patient—at the center of medical education." }} In certain institutions, such as those with LCME accreditation, the requirement of "professionalism" may be additionally weaponized against trainees, with complaints about ethics and safety being labelled as unprofessional.{{cite journal | vauthors = DeLoughery EP | title = Professionalism Framings Across Medical Schools | journal = Journal of General Internal Medicine | volume = 33 | issue = 5 | pages = 610–611 | date = May 2018 | pmid = 29435728 | pmc = 5910349 | doi = 10.1007/s11606-018-4314-0 }}{{cite journal | vauthors = Corcimaru A, Morrell MC, Morrell DS | title = Do looks matter? The role of the Electronic Residency Application Service photograph in dermatology residency selection | journal = Dermatology Online Journal | volume = 24 | issue = 4 | pages = 13030/qt5qc988jz | date = April 2018 | doi = 10.5070/D3244039354 | pmid = 29906000 | doi-access = free }}{{cite journal | vauthors = Ross DA, Boatright D, Nunez-Smith M, Jordan A, Chekroud A, Moore EZ | title = Differences in words used to describe racial and gender groups in Medical Student Performance Evaluations | journal = PLOS ONE | volume = 12 | issue = 8 | pages = e0181659 | date = 2017 | pmid = 28792940 | pmc = 5549898 | doi = 10.1371/journal.pone.0181659 | bibcode = 2017PLoSO..1281659R | doi-access = free }}{{cite journal | vauthors = Cerdeña JP, Asabor EN, Rendell S, Okolo T, Lett E | title = Resculpting Professionalism for Equity and Accountability | journal = Annals of Family Medicine | volume = 20 | issue = 6 | pages = 573–577 | date = 2022 | pmid = 36443090 | pmc = 9705046 | doi = 10.1370/afm.2892 }}

The hidden curriculum was recently shown to be a cause of reduction in medical student empathy as they progress throughout medical school.{{cite journal | vauthors = Howick J, Dudko M, Feng SN, Ahmed A, Alluri N, Nockels K, Winter R, Holland R | title = Why might medical student empathy change throughout medical school? a systematic review and thematic synthesis of qualitative studies | journal = BMC Medical Education | volume = 23 | issue = 270 | date = April 2023 | page = 270 | pmid = 37088814 | doi = 10.1186/s12909-023-04165-9 | pmc = 10124056 | doi-access = free }}

Integration with health policy

As medical professional stakeholders in the field of health care (i.e. entities integrally involved in the health care system and affected by reform), the practice of medicine (i.e. diagnosing, treating, and monitoring disease) is directly affected by the ongoing changes in both national and local health policy and economics.{{cite journal | vauthors = Steinberg ML | title = Introduction: health policy and health care economics observed | journal = Seminars in Radiation Oncology | volume = 18 | issue = 3 | pages = 149–51 | date = July 2008 | pmid = 18513623 | doi = 10.1016/j.semradonc.2008.01.001 }}

There is a growing call for health professional training programs to not only adopt more rigorous health policy education and leadership training,{{cite journal | vauthors = Schwartz RW, Pogge C | title = Physician leadership: essential skills in a changing environment | journal = American Journal of Surgery | volume = 180 | issue = 3 | pages = 187–92 | date = September 2000 | pmid = 11084127 | doi = 10.1016/s0002-9610(00)00481-5 | citeseerx = 10.1.1.579.8091 }}{{cite journal | vauthors = Gee RE, Lockwood CJ | title = Medical education and health policy: what is important for me to know, how do I learn it, and what are the gaps? | journal = Obstetrics and Gynecology | volume = 121 | issue = 1 | pages = 9–13 | date = January 2013 | pmid = 23262923 | doi = 10.1097/AOG.0b013e31827a099d | s2cid = 35826385 }}{{cite journal | vauthors = Patel MS, Davis MM, Lypson ML | title = Advancing medical education by teaching health policy | journal = The New England Journal of Medicine | volume = 364 | issue = 8 | pages = 695–7 | date = February 2011 | pmid = 21345098 | doi = 10.1056/NEJMp1009202 }} but to apply a broader lens to the concept of teaching and implementing health policy through health equity and social disparities that largely affect health and patient outcomes.{{cite journal | vauthors = Heiman HJ, Smith LL, McKool M, Mitchell DN, Roth Bayer C | title = Health Policy Training: A Review of the Literature | journal = International Journal of Environmental Research and Public Health | volume = 13 | issue = 1 | pages = ijerph13010020 | date = December 2015 | pmid = 26703657 | pmc = 4730411 | doi = 10.3390/ijerph13010020 | doi-access = free }}{{cite journal | vauthors = Avendano M, Kawachi I | title = Why do Americans have shorter life expectancy and worse health than do people in other high-income countries? | journal = Annual Review of Public Health | volume = 35 | pages = 307–25 | date = 2014-01-01 | pmid = 24422560 | pmc = 4112220 | doi = 10.1146/annurev-publhealth-032013-182411|doi-access=free }} Increased mortality and morbidity rates occur from birth to age 75, attributed to medical care (insurance access, quality of care), individual behavior (smoking, diet, exercise, drugs, risky behavior), socioeconomic and demographic factors (poverty, inequality, racial disparities, segregation), and physical environment (housing, education, transportation, urban planning). A country's health care delivery system reflects its "underlying values, tolerances, expectations, and cultures of the societies they serve",{{cite journal | vauthors = Williams TR | title = A cultural and global perspective of United States health care economics | journal = Seminars in Radiation Oncology | volume = 18 | issue = 3 | pages = 175–85 | date = July 2008 | pmid = 18513627 | doi = 10.1016/j.semradonc.2008.01.005 }} and medical professionals stand in a unique position to influence opinion and policy of patients, healthcare administrators, & lawmakers.{{cite journal | vauthors = Beyer DC, Mohideen N | title = The role of physicians and medical organizations in the development, analysis, and implementation of health care policy | journal = Seminars in Radiation Oncology | volume = 18 | issue = 3 | pages = 186–93 | date = July 2008 | pmid = 18513628 | doi = 10.1016/j.semradonc.2008.01.006 }}

In order to truly integrate health policy matters into physician and medical education, training should begin as early as possible – ideally during medical school or premedical coursework – to build "foundational knowledge and analytical skills" continued during residency and reinforced throughout clinical practice, like any other core skill or competency. This source further recommends adopting a national standardized core health policy curriculum for medical schools and residencies in order to introduce a core foundation in this much needed area, focusing on four main domains of health care: (1) systems and principles (e.g. financing; payment; models of management; information technology; physician workforce), (2) quality and safety (e.g. quality improvement indicators, measures, and outcomes; patient safety), (3) value and equity (e.g. medical economics, medical decision making, comparative effectiveness, health disparities), and (4) politics and law (e.g. history and consequences of major legislations; adverse events, medical errors, and malpractice).

However limitations to implementing these health policy courses mainly include perceived time constraints from scheduling conflicts, the need for an interdisciplinary faculty team, and lack of research / funding to determine what curriculum design may best suit the program goals. Resistance in one pilot program was seen from program directors who did not see the relevance of the elective course and who were bounded by program training requirements limited by scheduling conflicts and inadequate time for non-clinical activities.{{cite journal | vauthors = Greysen SR, Wassermann T, Payne P, Mullan F | title = Teaching health policy to residents--three-year experience with a multi-specialty curriculum | journal = Journal of General Internal Medicine | volume = 24 | issue = 12 | pages = 1322–6 | date = December 2009 | pmid = 19862580 | pmc = 2787946 | doi = 10.1007/s11606-009-1143-1 }} But for students in one medical school study,{{cite journal | vauthors = Patel MS, Lypson ML, Davis MM | title = Medical student perceptions of education in health care systems | journal = Academic Medicine | volume = 84 | issue = 9 | pages = 1301–6 | date = September 2009 | pmid = 19707077 | doi = 10.1097/acm.0b013e3181b17e3e | doi-access = free }} those taught higher-intensity curriculum (vs lower-intensity) were "three to four times as likely to perceive themselves as appropriately trained in components of health care systems", and felt it did not take away from getting poorer training in other areas. Additionally, recruiting and retaining a diverse set of multidisciplinary instructors and policy or economic experts with sufficient knowledge and training may be limited at community-based programs or schools without health policy or public health departments or graduate programs. Remedies may include having online courses, off-site trips to the capitol or health foundations, or dedicated externships, but these have interactive, cost, and time constraints as well. Despite these limitations, several programs in both medical school and residency training have been pioneered.{{cite journal | vauthors = Catalanotti J, Popiel D, Johansson P, Talib Z | title = A pilot curriculum to integrate community health into internal medicine residency training | language = EN | journal = Journal of Graduate Medical Education | volume = 5 | issue = 4 | pages = 674–7 | date = December 2013 | pmid = 24455022 | pmc = 3886472 | doi = 10.4300/jgme-d-12-00354.1 |doi-access=free }}{{Cite news|url=https://www.npr.org/sections/health-shots/2016/06/09/481206602/this-med-school-teaches-health-policy-along-with-the-pills|title=This Med School Teaches Health Policy Along With The Pills.| vauthors = Rovner J |newspaper=NPR | name-list-style = vanc |date=June 9, 2016|access-date=December 13, 2016|via= Kaiser Health News }}{{cite journal | vauthors = Shah SH, Clark MD, Hu K, Shoener JA, Fogel J, Kling WC, Ronayne J | title = Systems-Based Training in Graduate Medical Education for Service Learning in the State Legislature in the United States: Pilot Study | journal = JMIR Medical Education | volume = 3 | issue = 2 | pages = e18 | date = October 2017 | pmid = 29042343 | pmc = 5663953 | doi = 10.2196/mededu.7730 | doi-access = free }}

Lastly, more national support and research will be needed to not only establish these programs but to evaluate how to both standardize and innovate the curriculum in a way that is flexible with the changing health care and policy landscape. In the United States, this will involve coordination with the ACGME (Accreditation Council for Graduate Medical Education), a private NPO that sets educational and training standards{{Cite web|url=http://www.ecfmg.org/echo/acgme-core-competencies.html|archive-url=https://web.archive.org/web/20120728011931/http://www.ecfmg.org/echo/acgme-core-competencies.html|url-status=live|archive-date=July 28, 2012|title=ACGME Core Competencies.| work = The Accreditation Council for Graduate Medical Education |date=July 5, 2012 |publisher=The Educational Commission for Foreign Medical Graduates.|access-date=December 13, 2016}} for U.S. residencies and fellowships that determines funding and ability to operate.

=Medical education as a subject-didactic field=

Medical education is also the subject-didactic field of educating medical doctors at all levels, applying theories of pedagogy in the medical context, with its own journals, such as Medical Education. Researchers and practitioners in this field are usually medical doctors or educationalists. Medical curricula vary between medical schools, and are constantly evolving in response to the need of medical students, as well as the resources available.{{Cite book| vauthors = Thomas P |title=Curriculum Development for Medical Education-A Six Step Approach|publisher=Johns Hopkins University Press|year=2016|isbn=978-1421418520|pages=9}} Medical schools have been documented to utilize various forms of problem-based learning, team-based learning, and simulation.{{cite journal | vauthors = Yew EH, Goh K |date=2016-12-01|title=Problem-Based Learning: An Overview of its Process and Impact on Learning |journal=Health Professions Education |volume=2 |issue=2 |pages=75–79 |doi= 10.1016/j.hpe.2016.01.004 |doi-access=free }}{{cite journal | vauthors = Burgess A, Haq I, Bleasel J, Roberts C, Garsia R, Randal N, Mellis C | title = Team-based learning (TBL): a community of practice | journal = BMC Medical Education | volume = 19 | issue = 1 | pages = 369 | date = October 2019 | pmid = 31615507 | pmc = 6792232 | doi = 10.1186/s12909-019-1795-4 | doi-access = free }}{{cite journal | vauthors = Scalese RJ, Obeso VT, Issenberg SB | title = Simulation technology for skills training and competency assessment in medical education | journal = Journal of General Internal Medicine | volume = 23 | issue = 1 | pages = 46–9 | date = January 2008 | pmid = 18095044 | pmc = 2150630 | doi = 10.1007/s11606-007-0283-4 }}{{Cite journal| vauthors = Kilkie S, Harris P |date=2019-11-01 |title=P25 Using simulation to assess the effectiveness of undergraduate education |journal=BMJ Simulation and Technology Enhanced Learning |volume=5 |issue=Suppl 2 |doi= 10.1136/bmjstel-2019-aspihconf.130 |doi-broken-date=1 November 2024 |doi-access=free }} The Liaison Committee on Medical Education (LCME) publishes standard guidelines regarding goals of medical education, including curriculum design, implementation, and evaluation.{{Cite web|url=https://lcme.org/publications/|title=Standards, Publications, & Notification Forms|date=March 31, 2020|website=LCME |access-date=April 17, 2020}}File:North Dakota Air National Guard Base medical training 140603-Z-WA217-178.jpg

The objective structured clinical examinations (OSCEs) are widely utilized as a way to assess health science students' clinical abilities in a controlled setting.{{cite journal | vauthors = Majumder MA, Kumar A, Krishnamurthy K, Ojeh N, Adams OP, Sa B | title = An evaluative study of objective structured clinical examination (OSCE): students and examiners perspectives | language = en | journal = Advances in Medical Education and Practice | volume = 10 | pages = 387–397 | date = 2019-06-05 | pmid = 31239801 | pmc = 6556562 | doi = 10.2147/amep.s197275 | doi-access = free }}{{cite journal | vauthors = Onwudiegwu U | title = Osce: Design, Development and Deployment | journal = Journal of the West African College of Surgeons | volume = 8 | issue = 1 | pages = 1–22 | date = 2018 | pmid = 30899701 | pmc = 6398515 }} Although used in medical education programs throughout the world, the methodology for assessment may vary between programs and thus attempts to standardize the assessment have been made.{{cite journal | vauthors = Cömert M, Zill JM, Christalle E, Dirmaier J, Härter M, Scholl I | title = Assessing Communication Skills of Medical Students in Objective Structured Clinical Examinations (OSCE)--A Systematic Review of Rating Scales | journal = PLOS ONE | volume = 11 | issue = 3 | pages = e0152717 | date = 2016-03-31 | pmid = 27031506 | pmc = 4816391 | doi = 10.1371/journal.pone.0152717 | bibcode = 2016PLoSO..1152717C | veditors = Hills RK | doi-access = free }}{{cite journal | vauthors = Yazbeck Karam V, Park YS, Tekian A, Youssef N | title = Evaluating the validity evidence of an OSCE: results from a new medical school | journal = BMC Medical Education | volume = 18 | issue = 1 | pages = 313 | date = December 2018 | pmid = 30572876 | pmc = 6302424 | doi = 10.1186/s12909-018-1421-x | doi-access = free }}

= Cadaver laboratory =

File:024 Anatomy Laboratory.jpg

Medical schools and surgical residency programs may utilize cadavers to identify anatomy, study pathology, perform procedures, correlate radiology findings, and identify causes of death.{{cite journal | vauthors = Memon I | title = Cadaver Dissection Is Obsolete in Medical Training! A Misinterpreted Notion | journal = Medical Principles and Practice | volume = 27 | issue = 3 | pages = 201–210 | date = 2018 | pmid = 29529601 | pmc = 6062726 | doi = 10.1159/000488320 }}{{cite journal | vauthors = Tabas JA, Rosenson J, Price DD, Rohde D, Baird CH, Dhillon N | title = A comprehensive, unembalmed cadaver-based course in advanced emergency procedures for medical students | journal = Academic Emergency Medicine | volume = 12 | issue = 8 | pages = 782–5 | date = August 2005 | pmid = 16079434 | doi = 10.1197/j.aem.2005.04.004 | doi-access = free }}{{cite journal | vauthors = Pais D, Casal D, Mascarenhas-Lemos L, Barata P, Moxham BJ, Goyri-O'Neill J | title = Outcomes and satisfaction of two optional cadaveric dissection courses: A 3-year prospective study | journal = Anatomical Sciences Education | volume = 10 | issue = 2 | pages = 127–136 | date = March 2017 | pmid = 27483443 | doi = 10.1002/ase.1638 | s2cid = 24795098 | url = http://orca.cf.ac.uk/94661/1/Outcomes%20and%20satisfaction%20of%20two%20optional%20cadaveric%20%20dissection%20courses%20%28BJM%29.pdf | hdl = 10400.17/3529 | hdl-access = free }}{{cite journal | vauthors = Tavares MA, Dinis-Machado J, Silva MC | title = Computer-based sessions in radiological anatomy: one year's experience in clinical anatomy | journal = Surgical and Radiologic Anatomy | volume = 22 | issue = 1 | pages = 29–34 | date = 1 May 2000 | pmid = 10863744 | doi = 10.1007/s00276-000-0029-z | s2cid = 24564960 }}{{cite journal | vauthors = Korf HW, Wicht H, Snipes RL, Timmermans JP, Paulsen F, Rune G, Baumgart-Vogt E | title = The dissection course - necessary and indispensable for teaching anatomy to medical students | journal = Annals of Anatomy - Anatomischer Anzeiger | volume = 190 | issue = 1 | pages = 16–22 | date = 1 February 2008 | pmid = 18342138 | doi = 10.1016/j.aanat.2007.10.001 }} With the integration of technology, traditional cadaver dissection has been debated regarding its effectiveness in medical education, but remains a large component of medical curriculum around the world. Didactic courses in cadaver dissection are commonly offered by certified anatomists, scientists, and physicians with a background in the subject.

= Medical curriculum and evidence-based medical education journals =

Medical curriculum vary widely among medical schools and residency programs, but generally follow an evidence based medical education (EBME) approach.{{cite journal | vauthors = Harden RM, Grant J, Buckley G, Hart IR | title = BEME Guide No. 1: Best Evidence Medical Education | journal = Medical Teacher | volume = 21 | issue = 6 | pages = 553–62 | date = 1 January 1999 | pmid = 21281174 | doi = 10.1080/01421599978960 | s2cid = 7233599 }} These evidence based approaches are published in medical journals. The list of peer-reviewed medical education journals includes, but is not limited to:

Academic Medicine
Medical Education
Advances in Health Science Education
Medical Teacher

Open access medical education journals:

Perspectives on Medical Education
BMC Medical Education
MedEDPORTAL{{cite web | publisher = Association of American Medical Colleges (AAMC) | date = 2009 | url = https://wiki.library.ucsf.edu/download/attachments/321128482/mededportal%20author%20handbook%20KHS.pdf?api=v2 | title = MedEDPORTAL Author Handbook | pages = 2–4 | access-date = 2020-04-30 | archive-date = 2020-08-03 | archive-url = https://web.archive.org/web/20200803223338/https://wiki.library.ucsf.edu/download/attachments/321128482/mededportal%20author%20handbook%20KHS.pdf?api=v2 | url-status = dead }}
Journal of Medical Education and Curricular Development
MedConnect
MediUnite and MediUnite Journal

Graduate Medical Education and Continuing Medical Education focused journals:

Journal of Continuing Education in the Health Professions
Journal of Graduate Medical Education

This is not a complete list of medical education journals. Each medical journal in this list has a varying impact factor, or mean number of citations indicating how often it is used in scientific research and study.

Explanatory notes

References

External links

{{official website|http://www.medicaleducators.org}} of the Academy of Medical Educators