April 29, 2015
Medical school education has traditionally thrived on exposure to basic and clinical research, but as programs shift their focus to practitioner-based training, medical leaders in Philadelphia now warn that a two-tiered system will arise unless research is preserved as an essential part of the curriculum.
In “American Medical Education at a Crossroads,” a new position paper published by 'Science Translational Medicine,' the authors argue that the United States is in danger of decreasing the physician-scientist pipeline and diminishing the application of scientific advances to patient care.
The paper was co-authored by Arthur Feldman, M.D., Ph.D., Executive Dean of Temple University School of Medicine and Chief Academic Officer for the Temple University Health System, Arthur H. Rubenstein, MBBCh, Professor of Medicine at the Perelman School of Medicine at the University of Pennsylvania, and colleagues.
Specifically, the paper considers the reasons why research is being deemphasized. The authors point to newer U.S. medical schools that lack affiliations with major research institutions and often do not have a significant basic science faculty. Their students in turn take clerkships in community hospitals rather than research-oriented quaternary care hospitals.
“Research at our nation’s medical schools has led to discoveries that have changed the face of American medicine,” says Dr. Feldman. “Unfortunately, many of the nation’s newer medical schools do not prioritize research or are unable to compete for scarce research funding. The result is an increased proportion of U.S. medical school graduates matriculating from programs where the faculty members pursue little to no clinical or translational research.”
Proponents of the newer model argue that medical students who plan to pursue a career in primary care do not need hands-on exposure to lab-based translational research, to clinical research applied at hospitals with a complex array of disease, or to research focused on outcomes, comparative effectiveness and investigations of healthcare delivery systems.
The authors of the paper suggest that it is little surprise to see this change in focus, as newer medical schools struggle support basic or clinical research. Among several other factors that have dried up investment in research education, 2013 funding from the National Institutes of Health fell 21.9 percent below its 2003 level when adjusted for inflation.
“Without question, omitting research improves the finances of a school of medicine,” write the authors. “Indeed, a 2011 report from the Association of American Osteopathic Colleges demonstrated that a medical school achieves a positive margin when it does not have to support basic or translational research or a research-oriented clinical program."
With budgetary goals in mind, medical schools could further cut the size of their faculty and divest their research-oriented hospitals.
To counter the current trend and avoid unintended consequences, the authors of the study suggest that academic organizations and regulatory bodies conduct an objective evaluation of the new models of medical education. They also urge a commitment from universities to maintain basic science faculty and say that public education will help reinforce the value of a scientifically based education. Finally, the authors call for increased NIH funding for new physician-scientists to ensure that the next generation has an adequate supply of instructors and mentors.
“We need to continue to educate highly competent physicians and assiduously avoid the creation of a group of physicians who will be unable to apply the scientific advances of medicine for the benefit of their patients,” the authors say.