Repeal and Replace? A Note of Caution for Medical School Curriculum Reformers

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The sudden, dramatic collapse of the seven-year struggle in Congress to repeal and replace the Affordable Care Act holds important lessons for all would-be reformers, including those advocating fundamental changes in medical education. In this Invited Commentary, the author draws parallels between reform initiatives in health policy and those in medical education, highlighting that, in both settings, stakeholders rarely support “repeal” in the absence of a superior replacement, even when they view the status quo as deeply flawed.For more than three decades, reformers have worked to overhaul the preclerkship medical school curriculum. The author compares two broad categories of these reform initiatives. First, pedagogical reforms largely preserve existing curricular content, instead seeking to maximize active learning principles from educational psychology. By contrast, content reformers attribute the traditional curriculum’s shortcomings mainly to what students are taught, rather than how they learn, and seek to swap out significant portions of the existing basic science curriculum to make room for more clinically relevant material. While pedagogical innovations currently dominate reform efforts, few medical education research studies have rigorously proved the impact of different teaching strategies on the outcome of greatest interest to future patients and the public at large: Do new teaching methods yield better doctors?The persistent reliance of residency programs on United States Medical Licensing Examination Step 1 scores in the resident selection process constitutes the single greatest barrier to fundamental paradigm shifts in undergraduate medical education. The author concludes by proposing a solution to overcome this barrier.

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