American Medical Schools Research Articles

Advancements in Undergraduate Medical Education: Meeting the Challenges of an Evolving World of Education, Healthcare, and Technology.

Restructuring of undergraduate medical education (UGME) has occurred from time to time over the past century. Many influences, including the persuasive report of Abraham Flexner in 1910, acted to reorganize medical education in the early twentieth century [1, 2]. In his report, Flexner called on American medical schools to enact higher graduation standards and to stringently adhere to the protocols of mainstream science in their teaching. Prior to this report, UGME had changed little over the previous century but over the last several decades, reform within medical education has become routine. This increasing rate of change has been challenging for those within the realm of undergraduate medical education and can be frustrating to those outside this sphere. Today, the Association of American Medical Colleges (AAMC) and Liaison Committee on Medical Education (LCME) are typically the driving forces behind such changes, along with acceleration of advances in medical care and technology. The number of changes in the last decade is significant and warrants review by those interested or involved in education of medical students. This article aims to provide a summary of recent changes within UGME. Within the article, changes in both the pre-clerkship (1st and 2nd years) and clinical years (3rd and 4th) will be discussed. Finally, this review will attempt to clarify new terminology and concepts such as the recently released Core Entrustable Professional Activities (EPAs). The goal of these UGME changes, as with Flexner's reform, is to ensure future physicians are better prepared for patient care.

The Ethics of Physician Migration and Their Implications for the United States

Currently, the United States trains only three quarters of the physicians it requires to fill its entrylevel residency positions. The other quarter of residents employed by its hospitals is composed of immigrants who have been trained in other countries. This reliance of our healthcare system on foreign physicians puts a tremendous strain on the healthcare systems of developing nations. At the same time, by replacing American medical school graduates with graduates of foreign schools, the policy prevents a significant number of Americans who desire to practice medicine from doing so. An alarming shortage of physicians by the year 2020 has been forecasted. Discussion of how this shortage will be addressed is long overdue. The options are clear: either the United States can increase its dependence on foreign medical training programs or it can expand its own. It should choose the latter. 1 Daniel Bohl is a Biological Sciences major, Global Health Studies minor at Northwestern University in Evanston, IL. He will graduate in June of 2008 and subsequently begin a master’s program in International Health Policy at the London School of Economics. He can be contacted at dbohl@northwestern.edu.

‘Constrained collaboration’: Patient empowerment discourse as resource for countervailing power

Countervailing powers constrain the authority and autonomy of the medical profession. One countervailing power is patient consumerism, a movement with roots in health social movements. Patient empowerment discourses that emerge from health social movements suggest that active patienthood is a normative good, and that patients should inform themselves, claim their expertise, and participate in their care. Yet, little is known about how patient empowerment is understood by physicians. Drawing on ethnographic fieldwork in an American medical school, this article examines how physicians teach medical students to carry out patient encounters while adhering to American cultural expectations of a collaborative physician-patient relationship. Overt medical paternalism is characterised by professors as 'here's the orders' paternalism, and shown to be counterproductive to 'closing the deal' - achieving patient agreement to a course of treatment. To explain how physicians accomplish their therapeutic goals without violating cultural mandates of patient empowerment I develop the concept of 'constrained collaboration'. This analysis of constrained collaboration contrasts with structural-level narratives of diminishing professional authority and contributes to a theory of the micro-level reproduction of medical authority as a set of interactional practices.

The updated AMSA scorecard of conflict-of-interest policies: a survey of U.S. medical schools.

BackgroundBest practices for conflict-of-interest (COI) policies in medical schools have evolved rapidly over the past decade, in part motivated by the American Medical Student Association (AMSA) scorecard that has publicly graded schools since 2007. This report describes the methodological update and impact of revisions to the scorecard in 2014.MethodsThe original AMSA scorecard (used annually from 2008 to 2013) was revised by a work group to improve its methodology and to increase the stringency of its criteria for scoring COI policies. All U.S. medical schools (both allopathic and osteopathic; n = 160) were invited to submit their COI policies to AMSA for scoring with the new scorecard; web site searches were used to acquire policy information for schools that did not submit. The authors developed a codebook and analyzed 14 distinct categories of COI policies, pertaining to activities such as industry-funded gifts, meals, educational events, site access for sales reps, and conflict-of-interest disclosure requirements. The analysis yielded four possible grades for each school: A, B, C, or I (incomplete). The authors compared 2014 grades with 2013 grades, and compared the distribution of grades of schools by type (allopathic vs. osteopathic) and geographical region.ResultsA total of 27 (16.9 %) medical schools scored A grades, indicating that their COI policies were strong, 81 (50.6 %) scored B, 25 (15.6 %) scored C and 26 (16.3 %) policies scored I. As compared to 2013, in 2014 fewer schools qualified for A grades (17.0 % vs. 26.0 %; p = 0.05). The grade distributions of allopathic and osteopathic schools were significantly different (p < 0.0001), with osteopathic schools more likely than allopathic schools to have incomplete policies. There were no significant grade differences by geographical region.ConclusionsThe revised 2014 AMSA scorecard, with its more stringent criteria for evaluating COI policies, assigned fewer As and more Bs and Cs than in years past. This was the first study to identify schools with COI policies stronger than those recommended in 2008 by the Association of American Medical Colleges. Developing more stringent COI policies should be helpful in reducing the influence of pharmaceutical and device industry marketing on both trainees and faculty in American medical schools.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0725-y) contains supplementary material, which is available to authorized users.

The (re)-introduction of semiotics into medical education: on the works of Thure von Uexküll

Thure von Uexküll's reputation as a pioneer in biosemiotics and also in psychosomatic medicine is well documented. It is easy to see these disciplines reflected in his notable publications, both...

Professionalism as a Social Construct: The Evolution of a Concept.

I n this issue of the Journal of Graduate Medical Education, the article entitled ‘‘Creating a framework for medical professionalism: an initial consensus statement from an Arab nation’’ by Abdel-Razig and colleagues provides another enlightening contribution to our understanding of professionalism in global terms and adds to the literature on professionalism in the Muslim world. Our comments will be directed to 2 areas of interest: (1) the evolution of our understanding of professionalism, and (2) a brief analysis of the consensus definition developed for the United Arab Emirates as compared to definitions in contemporary use within Western cultures. The independent and self-regulating professions, as we in Western society understand them, have their origins in Hellenic Greece, are derived from the guilds and universities of medieval Europe and England, and emerged in approximately their present form in the middle of the 19th century. Their moral foundations are deeply rooted in Judeo-Christian traditions of morality. The Anglo-American world has exerted significant influence on the concept of the medical professional, although the role of individual physicians and the medical profession is very similar throughout Western culture. It is significant that if one consults dictionaries in non-English speaking countries, the references to professions and professionalism almost uniformly relate to differentiating amateurs from professionals. The autonomous and self-regulating professions are largely absent. Definitions of professionalism from dictionaries of the English language stress service and the fact that the professions are granted monopolies over the use of specialized knowledge, with the understanding that they will deliver certain services and behave in prescribed ways. We, and others, have termed this a social contract. There is little question that, until recently, there was an assumption within the English-speaking world that this concept of professionalism was truly universal and applicable to all nations and all cultures. Indeed, the intent of the committee that created the International Charter on Medical Professionalism, to which the authors refer in their article, was to provide a document that would be universally relevant. We can attest to this, as we participated in the creation of the charter. It is difficult to know when social scientists arrived at the conclusion that there were major differences in the interpretation of professionalism in different contexts. Most sociologists believe that society uses the professions as a means of organizing work—in the case of the professions, work of a specialized and essential nature. Thus it is logical to believe that even early sociologists would find it natural for different countries and cultures to choose different means of organizing this work. What is certain is that, for at least the last 2 decades, social scientists have recorded that each country expresses professionalism in a slightly different fashion. In 1993, contributors to a volume edited by Hafferty and McKinley compared professionalism in 15 Western countries and China, and in 1996 Krause studied 5 professions in 5 Western nations. Both seminal works noted, along with many commonalities, significant differences in the nature of professionalism across national boundaries. The contributors to this literature stressed the differences imposed in patterns of medical practice by different health care systems, but did not probe into the impact of culture. The consensus was that professionalism was used to organize the services of the healer, and that there were differences in national organizational approaches imposed by different health care systems. Many assumptions long held by the medical profession in the Western world have been questioned in the course of an ongoing critical appraisal of professionalism in society that has taken place over the past half-century. These include the motivation of the medical profession to pursue its own selfinterest, the profession’s failure to self-regulate with rigor, its neglect of some issues of importance to society, and, of course, the relevance of the concept of the professions to countries with their own histories, cultures, and concepts of morality. Ho and colleagues systematically studied the differences between Western concepts of professionDOI: http://dx.doi.org/10.4300/JGME-D-16-00102.1

Match Results Show Psychiatry Remains on Upward Trend

Back to table of contents Previous article Next article Education and TrainingFull AccessMatch Results Show Psychiatry Remains on Upward TrendMark MoranMark MoranSearch for more papers by this authorPublished Online:7 Apr 2016https://doi.org/10.1176/appi.pn.2016.4b20AbstractNew developments in neuroscience may be attracting students to the field, but it is also likely that increasing competition for residency slots is causing many students to opt for multiple specialties, a trend that is likely helping psychiatry.The number of U.S. senior allopathic medical students entering psychiatry through the National Resident Matching Program increased by 10 percent from 2015 to 2016, to a total of 850. This is the fourth consecutive year that psychiatry has seen an increase. Psychiatry’s number and percentage increases exceeded those of family medicine and emergency medicine, and the percentage increase was greater than those of all other large specialties in the match. APA Director of Education Tristan Gorrindo, M.D., welcomed the news. “We are seeing a growing interest in pursuing careers in psychiatry among medical students,” he told Psychiatric News. “Anecdotally, students starting psychiatry residencies tell us that they are drawn toward the combination of exciting new frontiers in neuroscience and the continued focus on the most humanistic parts of medicine. These elements together align with the reasons that many medical students chose careers in medicine.”The annual match, in which the program choices of graduating medical students are paired with those of residency programs seeking trainees, is typically watched as an indicator of workforce size and makeup of the various medical specialties for the coming years.Sidney Weissman, M.D., a former APA Trustee and past president of the American Association of Directors of Psychiatric Residency Programs (AADPRT), said increasing competition for residency slots is causing medical school students to interview for residencies in multiple specialties—a trend that he believes is helping to fuel psychiatry’s growing numbers. “The pressure on students to find a residency position helps us,” he said. “Psychiatry did well in this year’s match as senior medical students aware of the limited number of residency positions in sought-after specialties are considering more options as they plan their medical careers. This response from an expanding pool of U.S. graduates will continue to the end of the decade and into the 20s. If we combine the number of osteopathic and allopathic graduates entering psychiatry this year, the number of U.S. graduates will approach 1,000.”The Association of American Medical Colleges (AAMC) has predicted a shortage of up to 90,000 physicians in the future and called for an expansion of federal funding for residency slots. In a statement released after this year’s match results, AAMC President and CEO Darrell G. Kirch, M.D., said American medical schools have increased their enrollments by nearly 30 percent to address the coming shortage. “The nation’s medical schools and teaching hospitals have been doing all that they can to prepare for these expected shortages by expanding enrollments, creating innovative programs to make care more efficient, and training new M.D.s in teams with other health care professionals in a wide variety of settings to improve the health of their communities,” he said. “However, residency growth has not been able to keep up with expanding patient needs because of a 20-year cap on federal support.”Medicare-funded residency positions have been capped since 1997. Nonetheless, an Institute of Medicine report in 2014 argues against the idea of a coming physician shortage and noted that a 17.5 percent increase in training slots in the last 10 years financed by other sources has not eased geographic shortages or improved the specialist mix. That report, written by a 21-member committee co-chaired by former CMS administrators Donald Berwick and Gail Wilensky, says that shortages are created by poor geographic distribution of physicians and lopsided ratios of primary care and specialty physicians and that recent research suggests the answers lie in new technology and innovations in health care delivery. ■Data from the National Resident Matching Program can be accessed here. ISSUES NewArchived

Medical school websites out of compliance with ADA

Only one‐third of American medical schools' websites state outright that they would be open to accommodating disabled students, according to a new study published by American Medicine. Half of all medical school websites have vague information about which students would be accepted.

Student Evaluation of Faculty Physicians: Gender Differences in Teaching Evaluations.

To investigate whether there is a difference in medical student teaching evaluations for male and female clinical physician faculty. The authors examined all teaching evaluations completed by clinical students at one North American medical school in the surgery, obstetrics and gynecology, pediatrics, and internal medicine clinical rotations from 2008 to 2012. The authors focused on how students rated physician faculty on their "overall quality of teaching" using a 5-point response scale (1 = Poor to 5 = Excellent). Linear mixed-effects models provided estimated mean differences in evaluation outcomes by faculty gender. There were 14,107 teaching evaluations of 965 physician faculty. Of these evaluations, 7688 (54%) were for male physician faculty and 6419 (46%) were for female physician faculty. Female physicians received significantly lower mean evaluation scores in all four rotations. The discrepancy was largest in the surgery rotation (males = 4.23, females = 4.01, p = 0.003). Pediatrics showed the next greatest difference (males = 4.44, females = 4.29, p = 0.009), followed by obstetrics and gynecology (males = 4.38, females = 4.26, p = 0.026), and internal medicine (males = 4.35, females = 4.27, p = 0.043). Female physicians received lower teaching evaluations in all four core clinical rotations. This comprehensive examination adds to the medical literature by illuminating subtle differences in evaluations based on physician gender, and provides further evidence of disparities for women in academic medicine.

Creating the Modern Physician: The Architecture of American Medical Schools in the Era of Medical Education Reform

In the late nineteenth century, the American system of medical education underwent a complete transformation. Medical colleges shifted from commercial schools where instruction was based almost exclusively on classroom lectures to university-affiliated programs providing hands-on training in both laboratory and clinical work. Medical educators recognized that successfully enacting the new pedagogy required new buildings. By the 1930s, almost every medical college in the United States had rebuilt or significantly renovated its facilities. In Creating the Modern Physician: The Architecture of American Medical Schools in the Era of Medical Education Reform, Katherine L. Carroll analyzes the first wave of schools constructed to house the new medical training. She examines the three dominant types of American medical school buildings, which she argues did more than supply spaces for teaching and research—they defined specific conceptions of modern medicine and helped to shape the modern physician.

The comparison of integrated neurology curriculum among Chinese and North American medical schools

Taking the application of integration teaching in neurology curriculum as an example, by analyzing the Harvard Medical School, the University of Toronto School of Medicine and the Shanghai Jiaotong University School of Medicine on the course curriculum, the issues related to neurology curriculum integration has been explored. The results show that the integration of teaching mode reflects the two major characteristics of multi discipline integration, clinical and basic integration, and it emphasizes the organ system as the center, the problem based learning (problem-based learning, PBL), Problem-Based Learning, Case-based Learning and other teaching methods will play an important role in the medical education reform in the important position. Key words: Integrated curriculum; Neurology; Curriculum reform

The association between Myers-Briggs Type Indicator and Psychiatry as the specialty choice.

ObjectivesThe purpose of this pilot study is to examine the association between Myers-Briggs Type Indicator (MBTI) and prospective psychiatry residents. MethodsForty-six American medical schools were contacted and asked to participate in this study. Data were collected and an aggregated list was compiled that included the following information: date of MBTI administration, academic year, MBTI form/version, residency match information and student demographic information. The data includes 835 American medical students who completed the MBTI survey and matched into a residency training program in the United States. All analyses were performed using R 3.1.2. ResultsThe probability of an introvert matching to a psychiatry residency is no different than that of an extravert (p= 0.30). The probability of an intuitive individual matching to a psychiatry residency is no different than that of a sensing type (p=0.20). The probability of a feeling type matching to a psychiatry residency is no different than that of a thinking type (p= 0.50). The probability of a perceiving type matching to a psychiatry residency is no different than that of a judging type (p= 0.60). ConclusionsFurther analyses may elicit more accurate information regarding the personality profile of prospective psychiatry residents. The improvement in communication, team dynamics, mentor-mentee relationships and reduction in workplace conflicts are possible with the awareness of MBTI personality profiles.

Why Educators Should Apply Theories and Models of Health Education and Health Promotion to Teach Communication Skills to Nursing and Medical Students.

Why medical and nursing students need education in communication skills? And how these skills should be thought? These are two important questions in medical education. Effective communication between health care providers and their clients is a crucial factor in patient-centered care. Identifying clients’ needs and taking appropriate actions to overcome these problems need appropriate communication skills (1). Providing effective communication skills to nursing and midwifery students and helping them to reflect this on both work and personal lives is one of the main goals of education (2). According to Simonson (3), 25 years ago, formal writing courses were not offered at about 86 of 101 (85%) responding American medical schools. Furthermore, regarding his professional commitment, he hoped that his residents as well as other medical students would benefit from “formal professional written and verbal communication” programs soon. After 25 years, thanks to very admirable efforts of educational policy makers, the number of medical schools that offer formal communication skills has been significantly increased; however, the number of patient complaints about physicians and nurses communication skills has been dramatically increased. For instance, in content analysis of 1216 complaints of patients by Montini et al., “poor provider-patient communication” contributed to 17% of complaints (4). In a study in Turkey, nursing students’ mean score of communication skills scale was 165.27, which showed a moderate level of these skills (2). Benbassat found that teaching interviewing skills to medical students had serious problems. First the students were faced with wide variability in interviewing styles and different role models, second clinical teachers were not usually specialists in patient interviewing and third there was no valid method for assessment of interviewing skills (5). It seems that the efficacy of our communication skills programs is still under question and as Simonson has recommended, it needs something more than theoretical teaching (3). For instance, role modeling, critical reflections and formative and summative evaluations should be integrated in teaching programs. The role of theories in designing and conducting medical and nursing education is well defined. Learning theories are popular within nursing education and many important notions such as self-monitoring and simulation design have been derived from these theories. Sociocultural theories have been largely overlooked in medical and nursing education (6). It is believed that theories and models in health education and health promotion (HEHP) should be used in planning, implementing and evaluation of any educational programs about communication skills to enhance the success rate of educational programs (7). In “effective training strategies for teaching communication skills to physicians: an overview of systematic reviews” (8), the methodological errors of studies were reported as one of the limitations of overview. Reporting such an error in many studies supports the idea of using theories and models of HEHP in teaching communication skills. Indeed, applying theories and models would decrease methodological errors of studies, which in turn, would allow instructional designers to access many valid and reliable educational strategies. Applying theories and models of HEHP in instructional designs regarding communication skills should be a crucial concern of educators; otherwise, their blind attempts to improve medical students’ communication skills would usually fail to succeed. Moreover, using different constructs of theories and models of HEHP lets educators recognize constructs which are the most important predictors of physicians’ successful communication behaviors. Consequently, designing educational programs based on highly predictive constructs would be the key to their success. Based on social, epidemiological, educational and administrative and policy assessment, performed in a recent Ph.D. dissertation in Tarbiat Modarres University, Precede–Proceed model was the effective model for planning interns’ physician-patient communication skills and for the most part, the items from interviews with 14 faculty members and 7 medical interns were matched with the constructs of Social Cognitive Theory. Based on confirmatory factor analysis (CFA), the most important predictors of successful communication behavior among interns were recognized and used to write lesson plans to train participants in the intervention group of the educational quasi-experimental study (IRCT2013021812511N1). Having a good grasp of theories and models of HEHP and practicing theories and models of HEHP in formal communication courses by educators and health leaders would improve the outcome measures of communication skills programs. For this reason, educators should appreciate that theories and models are for all health care administers, not just for students.

The Creation of a Model Pediatric Ward for African American Children in 1920s Kansas City.

* Abbreviations: CMH — : Children’s Mercy Hospital WPH — : Wheatley-Provident Hospital The summer of 1919 is remembered for some of the worst race riots in American history. Dubbed the Red Summer by James Weldon Johnson, at least 25 major riots rocked American cities, and more than 52 African Americans were lynched.1 Although provocations varied, a root cause of the racial tension was the disappointment felt by African American World War I veterans. They had hoped that their military service would earn them equality at home. Instead they returned to a society where the majority of American states enforced Jim Crow racial segregation laws. As in many American cities, Kansas City hospitals, including Children’s Mercy Hospital (CMH), were racially segregated in the early 20th century. African Americans went to the “Negro hospitals,” where facilities were substandard and overcrowded.2 The mortality rate for Kansas City’s black population was nearly double that of the country’s.3 Children fared no better: the black infant mortality rate was close to double that of whites. Common causes of child death were prematurity, diarrhea, and pneumonia.4,5 Conditions were worsened by limited numbers of black physicians. The 1910 Flexner report prompted the closure of all but 2 African American medical schools, Howard University and Meharry Medical College. Although Flexner recommended coeducation for men and women, he accepted racial segregation in medical schools. Furthermore, education gaps between black and white physicians were widened when he recommended that black physicians be trained differently at a more basic level as “sanitarians” with an emphasis on “serving” their people.6,7 The overall effect was to reinforce segregated and unequal medical training, thereby limiting education and practice opportunities for African Americans.7 It was in this climate that physicians Katharine Berry Richardson and John Edward Perry … Address correspondence to Jane F. Knapp, MD, Children’s Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108. E-mail: jknapp{at}cmh.edu

Nutrition education in the medical school curriculum: a review of the course content at the Royal College of Surgeons in Ireland-Bahrain.

Only 14% of American physicians report that they feel adequately trained to provide nutritional counselling. The average number of nutrition teaching hours in American medical schools is falling below recommendations by the National Academy of Sciences and nutritional education in the medical school curriculum is currently an important discussion topic. This study aimed to review the teaching hours delivered during a 6-year medical programme at The Royal College of Surgeons in Ireland-Bahrain (RCSI-B) and define the importance of nutritional education for medical students. Lecture time regarding the topic of nutrition was quantified by studying the contents of the 6-year course materials on the Moodle® platform virtual learning environment used by RCSI-B. Students are exposed to approximately 15h of education in nutrition during their medical studies at RCSI-B. The 15h spent educating RCSI-B medical students on nutrition is inadequate according to international recommendations. However, RCSI-B is one of many medical schools that do not reach the minimum required hours (25-44) as set by the National Academy of Sciences and the American Society for Nutrition. We recommend that more teaching hours on nutrition be introduced into the curriculum. These extra teaching hours may greatly benefit RCSI-B students, patients and public health in Bahrain.

A National Assessment on Patient Safety Curricula in Undergraduate Medical Education: Results From the 2012 Clerkship Directors in Internal Medicine Survey.

Patient safety is a cornerstone of quality patient care, and educating medical students about patient safety is of growing importance. This investigation was a follow-up to a 2006 study to assess the current status of patient safety curricula within undergraduate medical education in North America with the additional goals of identifying areas for improvement and barriers to implementation. Thirteen items regarding patient safety were part of the 2012 Clerkship Directors in Internal Medicine annual survey. Questions addressed curriculum content, delivery, and barriers to implementation. Ninety-nine clerkship directors (82%) responded. Forty-one (45.6%) reported that their medical school had a patient safety curriculum taught during medical school as compared with 25% in a 2006 survey. Fifteen (20%) reported satisfaction with students' level of safety competency at the end of the clerkship. Barriers to implementation included lack of faculty time (n = 57, 78.1%), lack of trained faculty (n = 47, 65.3%), and lack of a mandate from school's dean's office (n = 27, 38.0%). Our study found that less than half of North American medical schools have a formal patient safety curriculum; although this is higher than in 2006, it still exemplifies a major gap in undergraduate medical education.

Analysis on the differences of medical education between America and China from observing the teaching of Utah University

United States is the world's Medical Center, and American medical education is also a typical representative of the western medical education. This study takes the Medical School of Utah University and Tongji Medical College of Huazhong University of Science and Technology as an example to analyze and compare the similarities and differences between Chinese and American medi-cal schools in the aspects of subject setting, curriculum planning, teaching method and auxiliary teaching means. The result shows that both are basically the same in the setting of the course of clini-cal medicine, adopt integration module and PBL teaching, but there are fewer subjects of basic course at the school of medicine of Utah university, and online teaching and studying are more commonly used as an auxiliary teaching means. Key words: Medical education; Teaching observation; Utah University

The Biopsychosocial Model: "Reports of My Death Have Been Greatly Exaggerated".

In 1952, The British psychologist, H. J. Eysenck published a landmark study essentially concluding that psychotherapy was ineffective. Coincidently, at the time that Eysenck announced his findings, the number of psychologists providing psychotherapy was increasing dramatically (Norcross et al. 2011). Eysenck’s (1952) study was an obvious threat to a rapidly growing profession. The next 25 years were characterized by multiple studies refuting Eysenck’s claim culminating in one of the earliest published meta-analyses which concluded that the average person receiving psychotherapy was better off than 75 % of untreated individuals (Smith and Glass 1977) To date, The Rise and Fall of the Biopsychosocial Model has not incited a scholarly response comparable to that provoked by Eysenck. However, in the 5 years since the book appeared, Ghamei’s (2010) work has been widely cited by both advocates and critics of the biopsychosocial (BPS) model. As the book’s title suggests, Ghaemi devotes over 200 pages to challenging and systematically dismantling a theory that has become a mainstay of North American medical school curricula and postgraduate psychiatric education. Yet, it appears that the BPS may still be alive and well with recently published applications to orthopedics (Ayers et al. 2013), cardiology (Kirian et al. 2012), obstetrics and gynecology (Edozien 2015), as well as pediatrics and internal medicine (Crosby et al. 2015). While the psychiatrist, Roy Grinker used the term ‘‘biopsychosocial’’ in 1952, Engel (1977) is typically credited with describing the current version of the BPS in a 1977 Science article, ‘The need for a new medical model: A challenge to biomedicine.’ Engel argued that the prevailing biomedical worldview was outdated

Musculoskeletal Medicine Is Underrepresented in the American Medical School Clinical Curriculum.

Musculoskeletal (MSK) conditions are common, and their burden on the healthcare system is increasing as the general population ages. It is essential that medical students be well prepared to evaluate and treat MSK disorders in a confident manner as they enter the workforce. Recent studies and the American Association of Medical Colleges have raised concern that medical schools may not give sufficient instruction on this topic. Other authors have shown that preclinical instruction has increased over the past decade; however, it is unclear if required clinical instruction also has followed that trend. The purposes of this study were: (1) to assess the presence and duration of required or selective instruction in a MSK medicine specialty within the clinical years of undergraduate medical education; and (2) to assess the current state of requirements of clinical clerkships or rotations in other surgical and nonsurgical fields for comparison with the initial findings. The web sites of all 141 US medical schools were assessed to determine the content of their clinical curricula for the 2014-2015 academic year; five were excluded because they had not yet had a graduating class by the conclusion of the 2014-2015 academic year. Complete information on required rotations was obtained through the schools' web sites for all 136 (100%) medical schools. For selective experience during the surgery clerkships, complete information was available for 130 of the remaining 136 (96%) web sites. Mean (in weeks, ± SD) duration of core clerkships were as follows: internal medicine (10 ± 2), surgery (8 ± 2), pediatrics (7 ± 1), obstetrics/gynecology (6 ± 1), and psychiatry (5 ± 1). Other common required clerkships were: family medicine (required in 96% [131 of 136] of schools, mean duration of 6 ± 2 weeks), neurology (81% [110], 4 ± 1), and emergency medicine (55% [75], 3 ± 1). Required MSK instruction, at a mean of 2 ± 1 weeks, was only present in 15% (20 of 136) of medical schools. In addition, clinical MSK instruction was offered as a selective (eg, students pick from a selection of subspecialties such as orthopaedics, plastics, or urology during a general surgery clerkship) in 34% (44 of 130) of all medical schools. This is less than other non-core specialties: geriatrics/ambulatory care (required in 40% [54 of 136] of schools, mean duration of 3 ± 1 weeks), critical care (30% [41], mean of 3 ± 1 weeks), radiology (26% [35], mean of 3 ± 1 weeks), anesthesiology (23% [31], mean of 2 ± 1 weeks), and other surgical subspecialties (19% [26], mean of 3 ± 1weeks). Traditional core clerkships continue to be well represented in the clinical years, whereas three newer specialties have gained a larger presence: family medicine, neurology, and emergency medicine; these comprise the "big eight" of clinical clerkships. Given the high prevalence and burden of MSK disorders, required experience in MSK medicine continues to be underrepresented. Further discussion at a national level is needed to determine appropriate representation of MSK medicine specialties during the clinical years.

Student Research Programs in U.S. Medical Schools and Institutions

The majority of medical educators agree that scientific education is critical to the development of physician-scientists. However, the proportion of physicians interested or engaged in research has been decreasing. To overcome this deficit of research oriented physicians, many medical schools in the United States have introduced scholarly concentration (SC) programs into their medical curricula since 2000. In contrast, Korea has very few medical schools with such programs. Research programs at American medical schools were surveyed and investigated in order to better design and develop SC programs appropriate for Korean medical schools. Information on SC programs was gathered by reviewing medical school web sites and related articles. The SC programs of Brown Alpert Medical School, University of Pittsburgh School of Medicine, Duke University School of Medicine, and Stanford University School of Medicine are discussed in depth. The characteristics of each program were organized into seven parts: program description, administrative structure, orientation, curricular content, mentors and mentoring, student evaluation, and challenges. For a successful SC program in Korea we must consider providing guaranteed time for SC programs with necessary modifications in the core medical curriculum, educating and training of mentors, providing orientation and motivating students to pursue research, developing curricula for SC programs, and evaluating the progress of SC projects.