New Developments in Medical Student Education: Opportunities for Child and Adolescent Psychiatrists

Abstract

TRANSLATIONS New Developments in Medical Student Education: Opportunities for Child and Adolescent Psychiatrists Margaret L. Stuber, I n 1910 the Carnegie Foundation for the Ad- vancement of Teaching published what is known as the Flexner Report. This assessment of medical education in the United States changed the structure of U.S. medical education to the form in which it is today: a focused study of the basic sciences that are the foundation of medicine, followed by a series of supervised clinical apprenticeships. In recognition of the centennial of the Flexner Report, many docu- ments have been published over the past 2 years that present thoughtful recommendations for medical education in the 21st century. This article highlights five documents that present child and adolescent psychiatrists (CAPs) with specific op- portunities and challenges, because the recom- mendations are in areas in which we have signif- icant interest and expertise. The first of these reports was published in 2010, when the Carnegie Foundation published Educating Physicians: A Call for Reform of Medical School and Residency. 1 In this book, Irby et al. made the case that medical education must do a better job of standardizing learning outcomes and individualizing the learning process, pro- moting multiple forms of integration, incorporat- ing habits of inquiry and improvement, and focusing on the progressive formation of the phy- sician’s professional identity. Although many of these principles had been adopted by schools across the United States and Canada, this report marked a change in the expectations of all medical schools by the Liaison Committee for Medication Education, the body jointly authorized by the American Medical Association and the Association of American Medical Colleges (AAMC) to accredit medical schools. An interview with the author is available by podcast at www.jaacap.org. M.D. The implications of these new expectations for CAPs became clearer in a series of documents published in 2011. Two came from the AAMC. The first was the Behavioral and Social Science Foundations for Future Physicians, based on the premise that, “A complete medical education must include, alongside physical and biological sciences, the perspective and findings that flow from the behavioral and social sciences” (p. 5). 2 The report emphasized the need for future phy- sicians to develop self-knowledge, effective ther- apeutic relationships with patients, respectful alliances with colleagues, and responses to the health needs of populations. The key themes highlighted in this document were the need for a “developmental, life span perspective” and a focus on the social and biological contexts of behavior (p. 10). This 2011 report was commis- sioned as a complement to a report from the AAMC and the Howard Hughes Medical Insti- tute in 2009, the Scientific Foundations for Future Physicians. 3 The second AAMC document in 2011 was MR5: The 5th Comprehensive Update of the Medical College Admissions Test (MCAT). 4 As of 2015, the MCAT will be lengthened and the content areas changed. There will be four sec- tions, of roughly equal length: biological and biochemical foundation of living systems; chem- ical and physical foundation of biological sys- tems; psychological, social, and biological foun- dations of behavior; and critical analysis and reasoning skills. This last section (a version of which has existed before) will ask students to analyze passages from social and behavioral sciences and humanities, including ethics, philo- sophy, cross-cultural studies, and population health. The section on social and biological foun- dations of behavior is new for the MCAT. It is described as covering what would be taught in one-semester introductory courses in psychology J OURNAL OF THE A MERICAN A CADEMY OF C HILD & A DOLESCENT P SYCHIATRY VOLUME 51 NUMBER 8 AUGUST 2012 www.jaacap.org