Governments’ ability to identify, finance, and provide desirable medical services is under increasing pressure from aging populations, consumer expectations, and escalating health-related technological costs. In the US, health expenditure is nearly sixteen percent of the GDP with bureaucracy consuming about thirty-one percent of the expense (Gorman, 2008). In addition, up to forty-five million Americans lack adequate access to quality healthcare. However, the principle obstacle facing the healthcare system is the shortage of well-educated medical doctors who are adequately prepared to handle the various challenges encountered in the profession (Gorman, 2008). Thus, improvements in the education and certification of doctors are crucial to addressing most of the challenges in the healthcare system. Demographic trends show that the future doctors will be required to have adequate expertise in the treatment of the elderly and the chronically ill (Fernandez, 2014). Also, economic and political pressures on the current healthcare system continue to increase the need for primary care doctors and change the venues or practitioners associated with healthcare. Furthermore, the frequent updating of pedagogical, technological, and scientific knowledge is causing a shift in medical curriculum towards a framework that prioritizes skills in critical thinking and self-directed education (Fernandez, 2014). Doctors can apply such vital skills throughout their careers in the changing medical field.
In the US, the doctors’ education involves a lengthy process that comprises “undergraduate education, medical school and graduate medical education” (American Medical Association (AMA), 2016). After completing the three-stage education, trainees are still expected to acquire a practice license from a US’ jurisdiction where they plan to practice medicine. The doctors then apply for permanent licenses after passing various examinations and completing the required minimum years in a graduate school. In addition, most physicians also apply for board certification, although the process is optional and voluntary (AMA, 2016). The certification process ensures that doctors have been examined to evaluate their experience, skills, and knowledge in a particular specialty. It also ensures that physicians are qualified to offer quality medical services to their patients. Typically, the doctors are required to renew most of their certifications after practicing for a particular period. The learning process is not terminated after the completion of fellowship or residency training. Instead, physicians are required to complete annual coursework and achieve a particular “number of continuing medical education (CME) credits per year” (AMA, 2016). The requirement ensures that the doctor’s skills and knowledge remain current. Thus, the aim of the present literature review is to offer insight into emerging developments in the medical profession, and the key factors involved in shaping the twenty-first century’s medical education.
Current Healthcare Practice
Various political, economic, and social issues continue to influence the delivery of healthcare and the requirements imposed on medical practitioners. Consequently, medical educators confront evolving contexts, which will change the methods used to deliver healthcare in the future. Such changes include modifications in the patient-doctor interactions, increased demand for terminally-ill patients’ care, increased demand for aging societies’ care, increases in episodic and chronic illnesses’ cases, economic pressure to minimize healthcare costs, and increases in the need for community-centered medicine (Pugno, 2010; Keahey et. al., 2012). One particular trend associated with substantial implications for healthcare practitioners and medical educators is the prevailing shortage of qualified primary care doctors (Fernandez, 2014). Medical organization and schools are concerned with the misallocation of the specialties that medical students select (Fernandez, 2014). The ongoing compartmentalization of knowledge into a variety of specific medical fields has been shown to exacerbate such specialties’ misdistribution (Weatherall, 2011). Consequently, there has been an absence of an even distribution of education opportunities in medical practice, which hinders the ability of students to incorporate medical practice into the emerging “trends in integrative science” (Fernandez, 2014, p.1). A lack of qualified primary care physicians auspicates adverse consequences on the medical profession’s future, particularly due to the economic inducement for the medical field to play a significant role in the provision of healthcare. Therefore, medical schools should consider practical ways of enticing students to join the specialty (Pugno, 2010; Dezee et. al., 2012). Constant changes in the field have led medical schools to recognize the urgent need to produce competent physicians and give greater emphasis to the issues of professionalism, communication, and patient care (Pugno, 2010; Mann, 2011; Dezee et al., 2012). In addition, teamwork is becoming a valuable aspect in the education of medical practitioners because physicians increasingly coordinate the care of patients with other healthcare professionals like nurses and physician assistants (Keahey et. al., 2012). Moreover, the rapid advancement of science and technology requires medical students to acquire adequate skills in self-education and transform themselves into critical thinkers that can adapt and adjust easily to the shifts in customer demands (Yager, 2011).
Impact of Technology on Medical Education
In recent decades, technology has increasingly affected the exercise of medical teaching and has gained significant prominence in medical practice. Novel technological advancements, such as iPads, have been incorporated into the clinical training of doctors (Pappas, 2012). Pugno (2010) suggested that medical doctors should have proficiency in the current technology to compete successfully in the specialty. The introduction of new technological equipment continues to influence the classroom’s potential. As such, medical educators should capitalize on the potential of opening classroom sessions to online participants and the relatively easy accessibility of various online curricular materials (Yager, 2011).
Medical Education’s Practice and Theory
Current studies on medical education concentrate on the content and practice of instructing medical trainees. Several methods employed in the teaching process have been criticized for their failure to promote the development of curiosity in the trainees. The critiqued methods include techniques that demand increased efficiency and foster the culture of overconfidence and objectivity. The top-down approach that lecturers employ in colleges and universities also discourages medical trainees from questioning knowledge or integrating emotional judgments into their education (Dyche & Epstein, 2011). New hypotheses are also emerging frequently in the medical field. For example, “Evidence Based Medicine” is one of the major theoretical techniques that have gained popularity in recent years (Fernandez, 2014, p. 2). However, the application of the hypothesis in medical pedagogy has been criticized due to its inability to explain complex maladies and their interactions (Jones et al., 2009). The approach has also been associated with the incorporation of unconventional treatment methods (Cohen & Ziv, 2009).
At present, the typical pedagogical method has deviated from the common “top-down, hierarchical lecture” and employed an instructional approach that fosters self-directed education (Fernandez, 2014, p. 2). The new method of medical education relies on learning techniques that emphasize case studies and relatively smaller groups (Weatherall, 2011; McMillin, 2012). The changing practices have often resulted in changes in assessment styles (McMillin 2012). Also, medical colleges and universities have been forced to alter the scientific and clinical curriculum in order “to reflect the changing emphasis on integrating clinical education earlier in the medical school curriculum” (Fernandez, 2014, p. 2). As a result, modern medical pedagogy has evolved past the Flexner report’s standard that strictly separated clinical education from science education (Weatherall, 2011; Deezee et al., 2012; McMillin 2012).
Inculcation of Professionalism
Historians used social structures in medicine to define professionalism; however, the term evolved to represent practitioners’ expected attributes and behaviors (Wearn et al., 2010). Well-publicized incidents of misconduct involving medical doctors and the emergence of ethics as a medical discipline, as well as the development of more patient-centered approaches, have led educators to emphasize professionalism in medicine. Modeling by senior medical doctors has been suggested as a critical factor in the trainees’ development of professionalism “as students move from peripheral observers to legitimate participants” (Wearn et al., 2010). Nevertheless, several challenges often arise as educators inculcate professionalism. For instance, presenting trainees with cases involving professionalism can be a daunting task. Additionally, the media frequently presents students with “negative role models” (Kirk, 2007). Physician characters in shows like Scrubs, M.D., House, and Grey’s Anatomy often exemplify unprofessional behavior. Thus, educators have started to use segments of such television shows in class discussions, where they ask students to present their views regarding particular scenes (Kirk, 2007). Typically, such discussions help students to identify unprofessional behaviors. Professionalism, therefore, forms a significant “component of medicine’s contract with society” (Kirk, 2007). In addition to making well-informed decisions for the patients, doctors should apply such decisions in professional ways. Nonetheless, adequate experience and frequent training allow physicians to improve their professional conduct.
The ability of nations to provide adequate medical services is under increasing pressure from aging populations, consumer expectations, and escalating health-related technological costs. Nevertheless, the principle obstacle facing the healthcare system is the shortage of well-educated medical doctors who are adequately prepared to handle the various challenges encountered in the specialty (Gorman, 2008). Therefore, there is a need to ameliorate the education and certification of doctors in order to address the various challenges in the healthcare system. Concurrently, the frequent updating of pedagogical, technological, and scientific knowledge is causing a shift in medical curriculum towards a framework that prioritizes skills in critical thinking and self-directed education. Therefore, educators should emphasize the need for students to incorporate current technology, life-long training, and professionalism in their medical careers.
American Medical Association (AMA, 2016). Requirements for becoming a physician. Retrieved from http://www.ama-assn.org/ama/pub/education-careers/becoming-physician.page?
Cohen, I.R. & Ziv, A. (2009). Medical education in the 21st century: The new medical school in the Galilee: New paradigms, innovations and challenges. Retrieved from http://www.israelhpr.org.il/h/1/&mod=download&me_id=1346
Dezee, K.J., Artino, A.R., Elnicki, D.M., Hemmer, P.A., & Durning, S.J. (2012). Medical education in the United States of America. Medical Teacher, 34 (7), 521-525. doi: 10.3109/0142159X.2012.668248.
Dyche, L. & Epstein, R. M. (2011). Curiosity and medical education. Medical Education, 45(7), 663-668. doi: 10.1111/j.1365-2923.2011.03944.x
Fernandez, C. M. (2014). Literature review: trends in 21st century medical education. Retrieved from https://gse.touro.edu/media/schools-and-colleges/graduate-school-of-education/eac/literature-reviews/FernandezInstructionInMedicalEducation.pdf
Gorman, D. (2008). Medical practice in the twenty-first century: what, if anything, will doctors be doing? Sultan Qaboos University Medical Journal, 8(3), 261-265. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074853/
Jones, D.S., Hofmann, L. & Quinn, S. (2009). 21st century medicine: A new model for medical education and practice. Retrieved from http://www.marthaherbert.org/library/IFM-White-paper-21stCenturyMedicine.pdf
Keahey, D., Dickinson, P., Hills, K., Kaprielian, V., Lohenry, K., Marion, G., Statler, M., Nolte, T., & Walsh, A. (2012). Educating primary care teams for the future: Family medicine and physician assistant interprofessional education. The Journal of Physician Assistant Education, 23(3), 33-41.
Kirk, l. M. (2007). Professionalism in medicine: definitions and considerations for teaching. Proceedings (Baylor University. Medical Center), 20(1), 13–16. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769526/?report=classic
Mann, K.V. (2011). Theoretical perspectives in medical education: Past experience and future possibilities. Medical Education, 45(1), 60-68. doi: 10.1111/j.1365-2923.2010.03757.x
McMillin, A. (2012). Training physicians for the 21st century. Retrieved from http://medicine.nevada.edu/synapse/fall-2012/training-physicians-for-the-21st-century
Pappas, C. (2012). Chapter 4: Medical librarian rounding with an iPad. Retrieved from https://journals.ala.org/ltr/article/view/4284/4912
Pugno, P.A. (2010). One giant leap for family medicine: Preparing the 21st-century physician to practice patient-centered high-performance family medicine. Journal of the American Board of Family Medicine, 23(Supplement), S23-S27. doi: 10.3122/jabfm.2010.S1.090291
Wearn, A., Wilson, H., Hawken, S. J., Child, S., & Mitchell, C. J. (2010). In search of professionalism: implications for medical education [Abstract]. New Zealand Medical Journal, 123(1314), 123-132. Retrieved from http://europepmc.org/abstract/MED/20581922
Weatherall, D. (2011). Science and medical education: Is it time to revisit Flexner? Medical Education, 45(1), 44-50. doi: 10.1111/j.1365-2923.2010.03761.x.
Yager, J. (2011). The practice of psychiatry in the 21st century: Challenges for psychiatric education. Academic Psychiatry, 35(5), 283-292. doi: 10.1176/appi.ap.35.5.283