Medical education at the crossroads

Over the last 30 years, several changes have been introduced in medical education including the introduction of new contextualized approaches to instruction (e.g., problem-based learning [PBL]), the use of multimedia to enhance self-directed learning, the use of an integrated curriculum to address basic and clinical sciences, and the introduction of new formative and summative assessment tools that match with the curriculum changes. However, several challenges face medical education and need to be carefully researched. The list may be long and these challenges may vary depending on the needs of local and international health systems, the avaiability of resources, the vision of medical leaders and how they see these challenges and their impact. This paper discusses a number of challenges facing medical education including the selection of medical students and the validity of selection tools, students' learning skills, what makes a good medical curriculum, and the challenges facing a PBL curriculum.

"Medical education at the crossroads" was the title of an article published in the Proceedings of the Institute of Medicine of Chicago approximately 34 years ago by an American physician, Paul Rhoads. This challenging topic emerges every 20 or 30 years to stimulate leaders and educators to assess the direction of medical education, the current needs of the medical profession and what medical education can do to fulfill these needs. Medical education is conceptualized as the complex process by which a medical student is changed from a medical school applicant to a medical school graduate. In other words, from unknowing to knowing, from unskilled to skilled, from layman to professional, from medical student to physician. [2] Although these changes were described by Socrates more than 400 years before the Common Era, it is of interest to note that since the time Dr. Rhoads wrote his paper, several changes have taken place in most medical schools. For example, dissection of the whole cadaver used to be an essential component of every medical curriculum. Disciplinet based rather than an integrated teaching approach was used in most schools and teaching was mainly based on lectures. At that time, problemtbased learning (PBL) was only known in two or three medical schools and information technology and medical informatics were unknown. Furthermore, the importance of role models in medical schools was not clearly defined.Medical education comprises complex processes including faculty selection of students, learning and acquiring information by medical students, teaching by the faculty members and governance by the education unit. How these processes are interrelated to form medical education as we know it today warrants critical assessment.The aim of this article is to address key changes and critical issues facing medical education including: (1) the selection of medical students, (2) the art of learning, (3) what makes a good medical curriculum, and (4) challenges facing a PBL curriculum. A review of the medical literature shows that these issues are not adequately addressed. However, these issues should constitute a framework for medical educators and should stimulate researchers to target them.