Medical education is education related to the practice of being a medical practitioner, including the initial training to become a physician (i.e., medical school and internship) and additional training thereafter (e.g., residency, fellowship, and continuing medical education).
Medical education and training varies considerably across the world. Various teaching methodologies have been used in medical education, which is an active area of educational research.
Medical education is also the subject-didactic academic field of educating medical doctors at all levels, including entry-level, post-graduate, and continuing medical education. Specific requirements such as entrustable professional activities must be met before moving on in stages of medical education.
Common techniques and evidence base Medical education applies theories of pedagogy specifically in the context of medical education. Medical education has been a leader in the field of evidence-based education, through the development of evidence syntheses such as the Best Evidence Medical Education collection, formed in 1999, which aimed to "move from opinion-based education to evidence-based education". Common evidence-based techniques include the Objective structured clinical examination (OSCE) to assess clinical skills, and reliable checklist-based assessments to determine the development of soft skills such as professionalism. However, there is a persistence of ineffective instructional methods in medical education, such as the matching of teaching to learning styles and Edgar Dales' "Cone of Learning".
Entry-level education
Entry-level medical education programs are tertiary-level courses undertaken at a medical school. Depending on jurisdiction and university, these may be either undergraduate-entry (most of Europe, Asia, South America and Oceania), or graduate-entry programs (mainly Australia, Philippines and North America). Some jurisdictions and universities provide both undergraduate entry programs and graduate entry programs (Australia, South Korea).
In general, initial training is taken at medical school. Traditionally entry-level medical education is divided between preclinical and clinical studies. The former consists of the basic sciences such as anatomy, physiology, biochemistry, pharmacology, pathology, microbiology. The latter consists of teaching in the various areas of clinical medicine such as internal medicine, pediatrics, obstetrics and gynecology, psychiatry, general practice and surgery. More recently, there have been significant efforts in the United States to integrate health systems science (HSS) as the "third pillar" of medical education, alongside preclinical and clinical studies. HSS is a foundational platform and framework for the study and understanding of how care is delivered, how health professionals work together to deliver that care, and how the health system can improve patient care and health care delivery.
The Liaison Committee on Medical Education (LMCE) is a committee of educational accreditation for schools of medicine leading to an MD in the United States and Canada. In order to maintain accreditation, medical schools are required to ensure that students meet a certain set of standards and competencies, defined by the accreditation committees. The "Function and Structure of a Medical School" article is a yearly published article from the LCME that defines 12 accreditation standards.
The Association of American Medical Colleges (AAMC) has recommended thirteen Entrustable Professional Activities (EPAs) that medical students should be expected to accomplish prior to beginning a residency program. EPAs are based on the integrated core competencies developed over the course of medical school training. Each EPA lists its key feature, associated competencies, and observed behaviors required for completion of that activity. The students progress through levels of understanding and capability, developing with decreasing need for direct supervision. Eventually students should be able to perform each activity independently, only requiring assistance in situations of unique or uncommon complexity.
The list of topics that EPAs address include:
History and physical exam skills Differential diagnosis Diagnostic/screening tests Orders and prescriptions Patient encounter documentation Oral presentations of patient encounters Clinical questioning/using evidence Patient handovers/transitions of care Teamwork Urgent/Emergency care Informed consent Procedures Safety and improvement
Medical education has been criticized for limited innovation and for the length of schooling, which increases cost burden on students. There has been a proliferation of programs that combine medical training with research (M.D./Ph.D.) or management programs (M.D./MBA), although this has been criticized because extended interruption to clinical study has been shown to have a detrimental effect on ultimate clinical knowledge.
Medical student
A medical student is an individual enrolled at a medical school with the eventual goal of becoming a medical doctor. Medical students are exposed to both preclinical and clinical studies throughout their professional education, and are generally conferred a medical degree upon successful completion of the required curriculum. Further training through a residency program in addition to board certification is required in many jurisdictions prior to individuals becoming eligible to obtain a medical license and practice as a physician.
Challenges Stress in medical students is a widely recognized problem, causing both short- and long-lasting physical and psychological effects that are detrimental to the well-being of medical students. The demands of medical school curriculum can differ significantly from academic expectations students have previously been exposed to, which can lead to uncertainty in personal study behavior and progress, in addition to concerns regarding the availability of study materials. Stress has been observed to differ across student demographics and stage of training; students have often cited academic pressure and financial burden as significant stressors. A higher prevalence of depression and anxiety has been noted among trainees in comparison to the general population, likely due to the constant exposure to clinical environments as well as high demands of medical training. Excessive levels of stress at the medical student level may serve as a precursor to physician burnout, a well-documented psychological syndrome of fatigue due to chronic exposure to occupational stressors.
In addition to acting as a stressor, the financial burden of attending medical school can be significant and may serve as a barrier for individuals seeking access to professional training. The average cost of tuition, fees and health insurance for medical schools in the United States for the 2021-2022 academic year was US$62,539 for private institutions; students reported that these high costs, in addition to further unexpected additional expenses associated with attendance, significantly impacted their mental health and well-being.
Bullying in medicine has been noted to disproportionately affect medical students. A 1990 JAMA study reported that 46.4% of students at one medical school have reported being abused at some point during their education; despite increased public awareness, Association of American Medical Colleges graduation questionnaires from 2012 and 2013 reported mistreatment rates of 47.1% and 42.1%, respectively. Medical students have also cited abuse in academic research settings, ranging from bullying and harassment to denial of recognition and authorship manipulation.
Postgraduate education
Following completion of entry-level training, newly graduated doctors are often required to undertake a period of supervised practice before full registration is granted; this is most often of one-year duration and may be referred to as an "internship," "provisional registration," or "residency".
Further training in a particular field of medicine may be undertaken. In the U.S., further specialized training, completed after residency is referred to as "fellowship". In some jurisdictions, this is commenced immediately following completion of entry-level training, while other jurisdictions require junior doctors to undertake generalist (non-specialty) training for a number of years before commencing specialization.
Each residency and fellowship program is accredited by the Accreditation Council for Graduate Medical Education (ACGME), a non-profit organization led by physicians with the goal of enhancing educational standards among physicians. The ACGME oversees all M.D. and D.O. residency programs in the United States. As of 2019, there were approximately 11,700 ACGME accredited residencies and fellowship programs in 181 specialties and subspecialties.
Education theory itself is becoming an integral part of postgraduate medical training. Formal qualifications in education are also becoming the norm for medical educators, such that there has been a rapid increase in the number of available graduate programs in medical education.
Continuing medical education In most countries, continuing medical education (CME) courses are required for continued licensing. CME requirements vary by state and by country. In the US, accreditation is overseen by the Accreditation Council for Continuing Medical Education (ACCME). Physicians often attend dedicated lectures, grand rounds, conferences, and performance improvement activities in order to fulfill their requirements. Additionally, physicians are increasingly opting to pursue further graduate-level training in the formal study of medical education as a pathway for continuing professional development.
Online learning Medical education is increasingly utilizing online teaching, usually within learning management systems (LMSs) or virtual learning environments (VLEs). Additionally, several medical schools have incorporated the use of blended learning combining the use of video, asynchronous, and in-person exercises. A landmark scoping review published in 2018 demonstrated that online teaching modalities are becoming increasingly prevalent in medical education, with associated high student satisfaction and improvement on knowledge tests. However, the use of evidence-based multimedia design principles in the development of online lectures was seldom reported, despite their known effectiveness in medical student contexts. To enhance variety in an online delivery environment, the use of serious games, which have previously shown benefit in medical education, can be incorporated to break the monotony of online-delivered lectures.
Research areas into online medical education include practical applications, including simulated patients and virtual medical records (see also: telehealth). When compared to no intervention, simulation in medical education training is associated with positive effects on knowledge, skills, and behaviors and moderate effects for patient outcomes. However, data is inconsistent on the effectiveness of asynchronous online learning when compared to traditional in-person lectures. Furthermore, studies utilizing modern visualization technology (i.e. virtual and augmented reality) have shown great promise as means to supplement lesson content in physiological and anatomical education.
Telemedicine/telehealth education With the advent of telemedicine (aka telehealth), students learn to interact with and treat patients online, an increasingly important skill in medical education. In training, students and clinicians enter a "virtual patient room" in which they interact and share information with a simulated or real patient actors. Students are assessed based on professionalism, communication, medical history gathering, physical exam, and ability to make shared decisions with the patient actor.