Research Article: Putting students at the center: moving beyond time-variable one-size-fits-all medical education to true individualization

Date Published: February 28, 2019

Publisher: Dove Medical Press

Author(s): Debra A Schwinn, Christopher S Cooper, Jean E Robillard.


Medical education has undergone a wave of creative innovation over the last decade, with new curricular structures, pedagogy, content, and team-based approaches. Augmenting these changes, integration of clinical and scientific principles increasingly occurs across all years of training. Given success in innovation and integration, as well as recent interest and national pilots in time-variable (competency-based) education, we propose the next important step in medical education evolution is individualization.

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Nudged by accreditation bodies, national organizations, education consortia, a new generation of education leaders, and increased recognition of the science of adult learning, medical education has undergone unprecedented innovation over the last decade.1,2 Today’s medical students mature in a digital era where they routinely explore and answer self-generated questions with information literally at their fingertips. Such students enthusiastically embrace innovative computer-based learning such as cyber/holographic anatomy to augment cadaveric dissection. The “flipped classroom” is beginning to be the new normal, with self-directed reading/assignments completed before class so that classroom time can be devoted to interactive small group learning.3,4 New academic subjects (eg, healthcare delivery science, eHealth/telehealth, quality/safety science, clinical informatics, population health) have been introduced to various degrees across the US to prepare medical students for adequate practice into the 21st century.1 Emphasis on evidence-based informatics in guiding patient management, while discerning (and documenting) when “standard of care” may not be appropriate for a given patient, are crucial concepts for future physicians. Personal and professional wellness concepts and practice during medical school are also emphasized so that students can begin to foster sustainable engagement with their careers, while preserving family and personal vitality.

Adding to innovative approaches, clinical and foundational science learning is also increasingly integrated across all years.1 For example, clinical experience often now starts in the first week of medical school, building toward longitudinal clerkships in students’ later years. Many institutions integrate foundations of bioscience and medical information along organ system, or physiologic mechanisms, in a more efficient 18-month format concentrated at the beginning of medical school. Science concepts are readdressed on clinical rotations in more formal ways than in the past, allowing re-engagement with foundational basic science principles underpinning health and disease in the most clinically relevant context possible. Core clinical rotations are more often completed earlier in medical school, giving students enhanced opportunity to explore various disciplines before determining their career specialty. These changes also allow time for inter-professional education to be transformed into longitudinal inter-professional practice opportunities with patients/families in specific local communities, ambulatory venues, and/or through health systems partnerships.

We believe that given today’s robust and ongoing curricular innovation and integration, the next natural evolutionary step in medical education is individualization. Individualization is crucial in an era of ongoing major healthcare transformation (eg, exemplified by the recent entry of retail partners into healthcare).5 Yet, despite new knowledge needed for healthcare transformation, for more than a century medical education has focused on teaching similar material at a similar rate to all students. Although it is self-evident that individual students master material at different rates, to date logistical challenges associated with self-paced courses have limited this option in almost all medical schools. With recent technological advancements and self-directed computer-based modules to deliver some curriculum elements, as well as improved assessments of competency, some logistical challenges are being reduced; ultimately these changes offer promise of a self-paced medical education. However, with almost all residency programs routinely beginning at the same time once a year, practical flexibility of time-variable medical education remains relatively fixed (at least presently) at annual or semi-annual increments.




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