Undergrad medical education — research

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See also Accreditation | Evidence-based health care | Health libraries | Medical education in Canada | Problem-based learning

Undergraduate medical education is a topic of some importance given all of the demands on the health care system, and on physicians themselves. For decades, North American medical schools have approached the education of doctors in a primarily didactic fashion with preclinical work followed by two years of clinically-oriented practical experiences. Traditionally, medical education was divided between preclinical and clinical studies. The former consisted of the basic sciences such as anatomy, physiology, biochemistry, pharmacology, pathology. The latter consisted of clinical medicine topics such as internal medicine, pediatrics, obstetrics and gynecology, psychiatry, and surgery.

This tradition is attributed to Abraham Flexner, a teacher of a private high school in Kentucky, who visited all 155 medical schools in the United States & Canada in 1909. With the rise of evidence-based practice, there is a movement to change the outmoded biomedical model that pervades the medical curriculum. Additionally, there is some recognition that medical education should change to keep up with the medical practice and the expanding understanding of how people learn.

Best Evidence Medical Education (BEME)

Best Evidence Medical Education (BEME) is an international group of individuals, universities and professional organisations committed to the development of evidence informed education in the medical and health professions through:

  • dissemination of information which allows teachers and stakeholders in the medical and health professions to make decisions on the basis of the best evidence available;
  • production of systematic reviews which present the best available evidence and meet the needs of the user; and
  • creation of a culture of best evidence education amongst individuals, institutions and national bodies.

Centre for Health Education Scholarship (CHES)

UBC's Centre for Health Education Scholarship (CHES) aims to enhance health education scholarship by building capacity across the Faculty of Medicine through collaboration, team-building, mentorship of new faculty, successful funding applications, and other activities. It is linked strongly to undergraduate activities and serves as a resource to help support best practice in terms of the delivery of the Faculty’s educational programs including assessment.

Problems & cases

Problem-based learning (PBL) is an educational format that is centred around biomedical research questions as they might arise in the clinic or as medical students might engage with patients. Its simulation of the cognitive, emotional and psychological factors that arise in decision-making in the clinic is a very powerful learning tool, and prepares medical students for their actual work on the wards with patients. It helps that PBL provides students with a lot of practice (what might be called cognitive apprenticeship) in finding answers, defining gaps in their knowledge and arriving at suitable solutions for the clinical problem at hand. It is a widely-held view that PBL encourages deeper understanding of medicine than either listening to lectures or engaging in rote memorization would ever afford. The McMaster model of PBL has been incorporated into curricula in medical schools around the world. Many schools in the United States and Canada use it, or a variation of it. The evidence clearly shows that PBL is just as effective as conventional didactic learning. Small PBL groups encourage inquisitive and detailed examination of clinical issues, concepts and principles around patient-oriented problems. Further, the time spent outside of groups in PBL facilitates the development of skills such as information and literature retrieval, critical appraisal of medical information and the exchange of opinions with peers and experienced clinicians. PBL encourages students to become more involved in their own learning; the research says that students and faculty feel that PBL is a highly enjoyable way to learn and teach.

Medical programs

Most of Canada's medical schools offer four-year medical degree (MD) programs but McMaster University and University of Calgary offer three-year programs without interruption. In years I and II of medical school, students focus on basic science and subjects such as anatomy, physiology, pharmacology, genetics, microbiology, bioethics and epidemiology. The blocks within years I and II are often organized by disciplines, or organ systems. The learning activities in medicine often comprise a combination of problem-based learning, traditional lecture, laboratory, simulated patients and clinical experience. Most of the clinical experience comes during years III and IV of the MD program. Clerks participate in day-to-day management of patients during these formative years. Clerks are always supervised and mentored through their clinical experiences by senior residents, faculty and fully-licensed physicians. Typical rotations include internal medicine, family medicine, psychiatry, surgery, emergency medicine, obstetrics and gynecology, and pediatrics. Elective rotations are also available. A few medical schools offer joint degree programs such as the combined MD and PhD programs. These programs are rigorous, and combine research with clinical activities and can least anywhere from 7-9 years.

During year IV, medical students complete the Medical Council of Canada] qualifying examinations which are multiple choice, short answer computer-based tests. Part II, called the Objective Structured Clinical Examination (OSCE), is taken after one year of medical residency training. For information about the future of medical education in Canada, see the AFMC Reports. The Canadian Association for Medical Education (CAME) is a grassroots organization of medical educators who are dedicated to the success and improvement of medical education in Canada. See the many publications and learning objects on their website.

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