An economist might add that there are substantial opportunity costs in pursuing this path. Instead of entering medical school, many of these students might
pursue careers in business, in which, instead of paying out $50,000 per year, they might earn such an amount, if not more. As a result, many
physicians-in-training postpone marriage and parenthood. By the time physicians complete their training, many of their college classmates already have
homes, families, and established careers.
The major investments of time, talent, and treasure and the many personal and family sacrifices involved in becoming a doctor make it even more important
to ensure that future physicians receive the best education possible. Traditionally, the 141 M.D. granting U.S. medical schools and their faculties have
focused their attention on three key educational ingredients: curriculum, instructional methods, and assessment techniques. Curriculum concerns what
knowledge and skills medical students are expected to learn, instructional methods address how they are taught, and assessment is used to determine how
well they have learned it.
But there is much more to educating medical students than these three elements. A school can provide the perfect curriculum, state-of-the-art
instructional methods, and unimpeachable testing, yet do a poor job of educating future physicians.
One ingredient missing from this account is the
creativity, commitment, and inspiration of medical educators. Education is not an industrial process, akin to pressing mounds of clay into a uniform
shape. Instead it is a human process. Students are not identical to one another. Each brings distinctive interests, abilities, and experiences. Like the
practice of medicine itself, great education means establishing a relationship between human beings.
To promote excellence in medical education means paying attention to two different sorts of
factors in the equation of educational excellence: those that tend to undermine the performance of medical educators, and those that tend to enhance it. One
factor that detracts from educational performance is a lack of respect. Medical schools are financed largely by revenues from patient care, and schools are often ranked according to research funding. Despite the fact that the institutions themselves are known as schools, some
may begin to see education as a loss.
This lack of respect for education can contribute to another problem, a dearth of resources. To educate future physicians, we need time, money, equipment, and personnel.
If medical school faculty members become too busy caring for patients or doing research, they may not have time to teach. Because tuition revenues tend to
be fixed, leaders may shift funding away from education to purposes that can generate additional revenue. Eventually, the size of teaching faculties may
decline, at least relative to the number of students. Faced with such challenges, we need to remember that medical schools exist to educate
physicians. All other responsibilities should flow from this.
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On the up side, there are several steps we can take to enhance the performance of medical educators. One is to make sure that educators remain engaged and
challenged by their work. There has been a trend toward increasing centralization in US medical education, with a central authority determining what gets
taught, how, when, where, why, and to whom. Here is the problem with that. Once educators become mere implementers of others' ideas, their level of engagement and
growth diminishes. Education at its best more closely resembles a relationship (e.g. friendship) than assembly-line mass production. The personal commitment of educators is a vital