Are the Didactic Years an Artifact of Ancestral Medicine? Updating the Curriculum to Meet Modern Needs

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Excerpt

Despite course-level revisions and reform, the broad architecture of a medical education has remained largely unaltered for more than a century.1 Although it is possible this persistence is a testament to its efficacy, one must also consider the presence of a strong institutional inertia that anchors medical education as one constant in a field that continues to change rapidly and drastically.
The facts are changing. As clinician scientists continue to refine protocols for analyzing and sharing data, breakthroughs in clinical and biomedical research will increasingly become the norm. While clinical training provides an adaptive illustrative approach to teaching new concepts in medicine, didactic course work is often sluggish to evolve, requiring the collaborative effort of teaching faculty, administrators, and students.2
Therapies are changing. Groundbreaking work in genomics, molecular medicine, and tissue regeneration will continue to enable us to administer target therapies. The administration of such therapies is more likely to require the effective application of information than it is to rely on a superior ability to memorize the minutia pertaining to the underlying disease process.
Patients are changing. Broad patterns in our patients’ clinical profiles are likely to evolve over the next few decades, but more important within the context of medical education reform is how they are already different. Efforts to integrate cultural competency training into didactic-style course work have largely fallen short.3 Among the roughly 24 million Americans who are considered underserved, access to care and trust in the medical profession are gravely lacking.4 While strategies have been implemented to address this critical gap in care, the wound of distrust and disuse among members of underserved communities must be healed.
A conceptual foundation in the clinical sciences is an important part of physician training, but the predominating construct of a medical education may overemphasize didactic course work in the basic sciences. First, steps should be taken to better integrate undergraduate and medical course work to minimize redundancies. Second, a refocusing of didactic curricula should emphasize medical data analysis and application. Finally, attempts to facilitate cultural competence through didactic course work should be replaced by course-directed community outreach and service.
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