Macy Med School Report: A New Flexner?

[bth7]

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Interesting stuff:

Medical education today is rooted in the landmark work of Abraham Flexner, whose 1910 critique led to a greatly revised model of medical education, the broad outlines of which are still in evidence. Indeed, many features of that model—notably its commitment to the scientific foundations of medicine and its insistence on uniformly high standards— remain as valid as ever. However, the enormous changes that have transformed medicine over the past century have outstripped the ability of the Flexnerian model to prepare future physicians adequately for the challenges and expectations of the new century.

Regarding Standard-Setting Bodies
— The agencies responsible for accrediting allopathic and osteopathic medical education at both the undergraduate and graduate levels should promote innovation across the continuum.
The Liaison Committee on Medical Education (LCME), the Commission on Osteopathic College Accreditation (COCA), the Accreditation Council for Graduate Medical Education (ACGME), and the Council on Osteopathic Postdoctoral Training (COPT) should:

• begin promptly to share information with one another
• collaborate to assure maximal flexibility in designing and implementing accredited undergraduate and graduate education programs. This flexibility is particularly important for the LCME and COCA in fostering innovations in new, applicant schools, and schools undergoing significant
  expansion
• foster team training and the efficient use of faculty and clinician resources across the professions
• develop methods to disseminate information about innovative programs

Juicy. Discuss.

(Or just criticize those that want to discuss it, if that's your thing.)

Read full report here: http://www.josiahmacyfoundation.org/documents/Macy_MedSchoolMission_10_08.pdf

bth

 

[Bacchus]

.

 

[Fat Black Dude]

interesting articles.

 

[drusso]

The Josiah Macy foundation has a long history of fostering positive MD-DO relationships and held a series of conferences about a decade ago that were pivotal in bringing both sides to the table to discuss *SIMILARITIES* and not differences.

The emerging consensus is that both professions do certain things well and can learn from each other. What is lost among many in the debate about MD/DO professional identity issues is the fact that MD's have shaped the osteopathic profession probably more than the osteopathic medicine did itself! Imagine how different things would be if there had been no organized political attempt by MD's to subsume osteopathic medicine...since the MD's have capitulated that battle, the struggle for meaningful professional distinction has come from INSIDE of the osteopathic profession which is far more constructive. There is no more "allopathic Boogey-man" to blame your problems on any longer.

In my opinion, the growth of new DO schools and the development of for-profit and private ostoepathic medical education has not always been responsible (I would preferred the development of public-research univserity affiliated schools), but one positive aspect of that growth has been the demonstration of a certain "proof-of-concept." That is, by design or by accident, the osteopathic medical profession grows with a "McGeyver-esque" gumption: If you have a PhD anatomist, pharmacologist, and biochemist; a DO family practice doc, pathologist, OMM specialist, and OB/GYN or pediatrician you can pretty open up a DO school these days.

 

[drusso]

Where was the FMG representation? Who will recognize and accredit the Caribbean medical schools? Will AAMC, AACOM, LCME, and COCA share information with them? Currently, a sizable proportion of physicians training in ACGME-accredited residency programs are graduates of non-LCME/non-COCA accredited medical schools.

How long will this continue?

 

[DOinMS]

If you have a PhD anatomist, pharmacologist, and biochemist; a DO family practice doc, pathologist, OMM specialist, and OB/GYN or pediatrician you can pretty open up a DO school these days.

A travesty indeed. Look at the faculty profiles for some of the newer (<10 y/o) osteopathic schools. They are getting by with staffing the anatomy department with physical therapists (PhDs and DPTs). You would NEVER, NEVER, NEVER see this done in a respectable allopathic institution.

 

[scpod]

A travesty indeed. Look at the faculty profiles for some of the newer (<10 y/o) osteopathic schools. They are getting by with staffing the anatomy department with physical therapists (PhDs and DPTs). You would NEVER, NEVER, NEVER see this done in a respectable allopathic institution.

Care to give us some proof of this, or should we just accept your post as gospel? If it's true, I'd be interested in investigating further...Give me names!

 

[Peptoboy]

Interesting stuff:



Juicy. Discuss.

(Or just criticize those that want to discuss it, if that's your thing.)

Read full report here: http://www.josiahmacyfoundation.org/documents/Macy_MedSchoolMission_10_08.pdf

bth

Very interesting article, I liked it! Anything that encourages unity between Allo-/Osteo- Schools is definitely in the best interests of Medicine as a whole. Medicine has come a long way and there is still much more to be done. Our patients and future patients deserve the best and hopefully we can continue to come together for their best outcome. The future holds great things!🙂

 

[DOinMS]

Care to give us some proof of this, or should we just accept your post as gospel? If it's true, I'd be interested in investigating further...Give me names!

Proof of what? Physical therapists teaching in departments of anatomy at osteopathic medical schools? Check out VCOM and PNWCOM websites.

 

[Toohotinvegas33]

Proof of what? Physical therapists teaching in departments of anatomy at osteopathic medical schools? Check out VCOM and PNWCOM websites.

The person at VCOM also has a PhD and is dept chair, but a PT teaching MSK anatomy doesnt sound like such a bad idea

 

[DOinMS]

The person at VCOM also has a PhD and is dept chair, but a PT teaching MSK anatomy doesnt sound like such a bad idea

A PhD in physical therapy.

I have to respectfully disagree that it is a "good" idea. The reason is because the standard DPT or PhD (physical therapy) curriculum has one course in gross anatomy, and the emphasis is very different from that of medical gross anatomy. A PhD or DSc in anatomy requires years of coursework, dissertation based on original research on a topic relevant to anatomy, and oftentimes a post-doc.

The only reason I brought this up was to agree with the statement I quoted from drusso. Just because the school is a DO school, doesn't mean that the standards for faculty should fall below what you find in the average MD school.

 

[beastmaster]

Proof of what? Physical therapists teaching in departments of anatomy at osteopathic medical schools? Check out VCOM and PNWCOM websites.

That doesn't make them inferior educators. The NYCOM anatomy department is run by paleontologists. One was on the Discovery channel recently talking about dinosaur anatomy and evolution. And they are excellent teachers of human anatomy, even if they sometimes draw unusual comparison to lizard and shark anatomy..... who cares what courses they took in graduate school if they have 15 yrs of experience teaching anatomy to medical students?

 

[facetguy]

... but a PT teaching MSK anatomy doesnt sound like such a bad idea

Would you have said the same about a DC, who gets considerably more anatomy training than a PT? Just curious.

 

[Hernandez]

Read full report here: http://www.josiahmacyfoundation.org/documents/Macy_MedSchoolMission_10_08.pdf

bth

Am I the only one who the link isn't working for?

 

[DrMidlife]

Am I the only one who the link isn't working for?

Works for me - you're probably missing Acrobat Reader. Go to http://www.josiahmacyfoundation.org/ and work from there.

 

[Toohotinvegas33]

A PhD in physical therapy.

I have to respectfully disagree that it is a "good" idea. The reason is because the standard DPT or PhD (physical therapy) curriculum has one course in gross anatomy, and the emphasis is very different from that of medical gross anatomy. A PhD or DSc in anatomy requires years of coursework, dissertation based on original research on a topic relevant to anatomy, and oftentimes a post-doc.

The only reason I brought this up was to agree with the statement I quoted from drusso. Just because the school is a DO school, doesn't mean that the standards for faculty should fall below what you find in the average MD school.

I said a PT teaching msk (muscular skeletal) anatomy wouldnt be bad because they could incorporate biomechanics, and besides its anatomy aka "name that part", its tough because theres a lot to memorize in a short period of time, but 2nd year courses are way more important

 

[stonewall22]

From what I know, it would seem that DO schools are one step ahead in one area addressed by the report..."place less emphasis on hospital venues and more on community settings as “classrooms” for educating future physicians..." I know there are allopathic schools that do this too, but not very many. This was actually one of the reasons I became interested in osteopathic medical schools.

 

[stonewall22]

Okay, one last point I'd like to comment on and I'd be curious to hear other's opinions. The report talked about the alarming disparity of adequate representation of minorities in medical school. I'm not sure of reasons, and it's not likely one reason and probably no simple remedy exists, but shouldn't the most qualified person be accepted regardless of gender or ethnic background? When I go to see the doctor I want to see someone that got into medical school because they were one of the best candidates, and I couldn't care less about gender or ethnic background. When I was a child my pediatrician was an Indian and later as a teenager I saw a hispanic woman, and there were awesome. However, wouldn't accepting applicants that are less qualified to meet goals of increasing diversity hurt the profession overall?

 

[DannMann99]

Medical schools must reduce their reliance on
standardized tests, college grade point aver-
ages, and traditional undergraduate course
requirements in selecting applicants for admis-
sion. Although these factors can predict success
during the first two years of the traditional medical
school curriculum, they fail to assess the full
range of attributes required of fully competent
physicians. Medical schools must employ a more
balanced, comprehensive set of admission cri-
teria in order to attract, matriculate, and support
students who, in addition to the requisite intel-
lectual skills, have the maturity, judgment, and
commitment to serving others required to meet
public expectations and needs.

Okay 1, DO schools have been doing this for years.

and 2, I would rate the MCAT as being only slightly more stressful then any run of the mill medical school exam (the new 4hr one... 8hr was a beast. But my M1 exams are 3 so...)

3, If a student CANT get a good GPA that means they don't know their basic sciences. Medicine is built quite a bit on basic sciences.

It's fine if you want a broader scope of physicians... But in reality if you are just going to scrape the bottom of the pool you're going to turn up **** candidates who will never make it, and become FPs...

I guess that's the ultimate goal of this review? If we wanted to get sub-par medical help we can just let nurses prescribe Rx's

 

[DannMann99]

Regarding Medical School Faculty
— Medical schools should recruit and support
men and women faculty members who reflect
the ethnic and racial diversity of the American
population.

Why.

Is anyone else sick and tired of this racial diversity bull crap?

I am.

Medical schools should hire the BEST CANDIDATE that is available to them to teach their students. INDEPENDENT of race... 👎

 

[cleoscat3]

Okay 1, DO schools have been doing this for years.

and 2, I would rate the MCAT as being only slightly more stressful then any run of the mill medical school exam (the new 4hr one... 8hr was a beast. But my M1 exams are 3 so...)

3, If a student CANT get a good GPA that means they don't know their basic sciences. Medicine is built quite a bit on basic sciences.

It's fine if you want a broader scope of physicians... But in reality if you are just going to scrape the bottom of the pool you're going to turn up **** candidates who will never make it, and become FPs...

I guess that's the ultimate goal of this review? If we wanted to get sub-par medical help we can just let nurses prescribe Rx's

I wish you wouldn't knock family practice docs. Many extraordinary doctors i have encountered are fp. Besides, if what you say is true than those who get a low gpa or low mcat will flunk out of med school because they can't handle the tests or the basic science. Therefore these students won't make it to any kind of practice and your point is moot.

 

[DannMann99]

not at all knocking FOS but its those residencies that have little competition. I'm afraid if we install Mentally handicapped people into primary care, healthcare will suck that much more.

Now with this I'm also afraid for do schools, as they traditionally have brought in candidates with less stats then md. So increasing allo enrollment by 5k a year how will this affect dos. I don't believe negatively, but it will undeniably slow do awareness campaigns

 

[theraball]

Okay 1, DO schools have been doing this for years.

and 2, I would rate the MCAT as being only slightly more stressful then any run of the mill medical school exam (the new 4hr one... 8hr was a beast. But my M1 exams are 3 so...)

The MCAT is a pretty formidable exam. I wouldn't try to compare it to medical school since after all it's aimed at premedical students.

3, If a student CANT get a good GPA that means they don't know their basic sciences. Medicine is built quite a bit on basic sciences.

I've spoken with scientists who told me they flunked organic chem first time around. I agree with you that the basic sciences are important, but you can't judge solely on grades. Some really bright people happen to be not-so-great test takers (and vice versa). There is some correlation between grades and ultimate success as a physician, but not a lot.

It's fine if you want a broader scope of physicians... But in reality if you are just going to scrape the bottom of the pool you're going to turn up **** candidates who will never make it, and become FPs...

You didn't really mean to say that, did you? Some of us here are planning to go into family practice and we don't view ourselves as "bottom of the pool". Maybe you need to rephrase that.... 😕

 

[DannMann99]

people tend to default into primary care.

You don't see many people who aced all of medical school, and their boards, have loads of research go into FP.

I'm sure you can show me evidence of SOME and I wont deny those, but I would go to far to say that ~90% of FPs went there because they had to. (Realizing they weren't competitive for other residencies).

Now if you want to go into FP that's fine, i'm not insulting FPs by any means... There are plenty of great FPs out there. But what I AM saying is that if they bring in students who aren't any good. Some might fail out, others will scrape by and be pushed into Primary care which is fine, and others still will do phenomenal (as was eluded to... lol).

But a majority will be students who did poorly, and again to my above statement, if we wanted a bunch of people who couldn't do (or could barely cut) med school. We'd just let nurses be PCPs.

 

[theraball]

people tend to default into primary care.

...blah blah blah deleted...

I see that you are a premed, so your arguments are likely based on hearsay, things you read on this website or what you have heard from your classmates, and not on experience. In any event, you have not cited any evidence for your rather extraordinary claims and I don't have any more time to debate with you. I'll just leave you with this: once you are in medical school you will quickly learn that people are there for a variety of reasons, not all of them prestige and money. Furthermore you will learn that you are not the sharpest knife in the drawer; everyone in medical school is smart. You do need to lose the condescending attitude toward primary care, or you will have a truly miserable time during your clinical years (and for the rest of your career). Words to the wise.

 

[DannMann99]

I see that you are a premed, so your arguments are likely based on hearsay, things you read on this website or what you have heard from your classmates, and not on experience. In any event, you have not cited any evidence for your rather extraordinary claims and I don't have any more time to debate with you. I'll just leave you with this: once you are in medical school you will quickly learn that people are there for a variety of reasons, not all of them prestige and money. Furthermore you will learn that you are not the sharpest knife in the drawer; everyone in medical school is smart. You do need to lose the condescending attitude toward primary care, or you will have a truly miserable time during your clinical years (and for the rest of your career). Words to the wise.

1) LoL

2) Evidence = surgical/roade residencies don't go unfilled... Primary care does. What more do you want?

3) Never had a condescending attitude towards PC. I had a condescending attitude towards people who couldn't match anywhere and even though they may not have liked it, went PC. Ugh, I ****ing hate medical students.

***edited by DrMom to remove offensive content***

 

[Jamers]

1) LoL

2) Evidence = surgical/roade residencies don't go unfilled... Primary care does. What more do you want?

3) Never had a condescending attitude towards PC. I had a condescending attitude towards people who couldn't match anywhere and even though they may not have liked it, went PC. Ugh, I ****ing hate medical students.

***edited by DrMom to remove offensive content***

You have to admit your posts all come off as negative towards family practice. Now while I may have no desire to go into that field I don't like when people just assume that every family doctor was the bottom of their class. These are the individuals that really are the front line. They will be seeing the patients and referring them onto the specialists. I know this is more hearsay but the two most intelligent physicians I have ever known are family doctors.

 

[pianoman511]

You have to admit your posts all come off as negative towards family practice. Now while I may have no desire to go into that field I don't like when people just assume that every family doctor was the bottom of their class. These are the individuals that really are the front line. They will be seeing the patients and referring them onto the specialists. I know this is more hearsay but the two most intelligent physicians I have ever known are family doctors.

I would have to agree. Family physicians have to be some of the most broadly educated physicians I know. Specialists may have to know a lot about one organ system, but a family physician needs to know a lot about everything. The same would be true of internal medicine.

 

[Lokhtar]

In an ideal scenario, DO schools would grow and increase in number, but they would be attached to actual universities, and not free standing, and certainly not for-profit.

 

[bioman2006]

A PhD in physical therapy.

I have to respectfully disagree that it is a "good" idea. The reason is because the standard DPT or PhD (physical therapy) curriculum has one course in gross anatomy, and the emphasis is very different from that of medical gross anatomy. A PhD or DSc in anatomy requires years of coursework, dissertation based on original research on a topic relevant to anatomy, and oftentimes a post-doc.

The only reason I brought this up was to agree with the statement I quoted from drusso. Just because the school is a DO school, doesn't mean that the standards for faculty should fall below what you find in the average MD school.

VCOM also has two MDs, a PhD, and an MD/PhD teaching anatomy. I think they've got it covered.

 

[DOinMS]

VCOM also has two MDs, a PhD, and an MD/PhD teaching anatomy. I think they've got it covered.

You missed my point. My original post was in response to a statement made regarding what is needed to start a DO school. The fact of the matter is that the standards for DO faculty appear, in some cases, to be lower than that of the average allopathic school. Is that fair to DO students? I would have to say that it is not.

All of this boils down to perception - if DO schools cannot meet the standards of the average allopathic school with its admission standards, teaching of evidenced-based treatment modalities, and, yes, faculty qualifications, then we should not expect to enjoy equal recognition.