Department of Anesthesiology, University of Texas Medical Branch Galveston, Galveston, Texas, USA.
Acad Med. 2010 Feb;85(2):363-9. doi: 10.1097/ACM.0b013e3181c865b8.
One hundred years ago, Abraham Flexner wrote a report that profoundly influenced U.S. medical education. His conclusion-that medical degree (MD)-granting education programs should occur in not-for-profit universities and include hands-on laboratory and patient care experiences in teaching hospitals and clinics-led to the creation of the current model of U.S. MD education. Although this model has served the United States well, it is lengthy and costly. As the United States struggles to deal with a growing shortage of physicians, other models of medical education, including osteopathic medicine and offshore, MD-granting schools, have increased production of graduates. New private colleges of osteopathic medicine, including one accredited proprietary school, are nimble, cost-effective competitors for MD-granting schools. Do these schools portend the establishment of a U.S. for-profit medical education sector in the same way that proprietary universities have become well established in higher education? How should MD medicine respond? Can and should MD educators shorten the time needed to produce a fully trained MD-holding physician? How can MD educators make the training process shorter and less expensive to respond to the nation's physician shortage while maintaining the appeal of MD careers and without compromising educational quality? Models of shorter, less expensive pathways to earning an MD exist and have proven effective. Now is the time for MD educators to debate whether they should apply these pathways more widely. Six recommendations could help realize the goals of shortening and making less costly the training of MD physicians in the United States.
一百年前，亚伯拉罕·弗莱克斯纳（Abraham Flexner）撰写了一份报告，该报告深刻影响了美国的医学教育。他的结论是，授予医学博士（MD）学位的教育计划应该在非营利性大学中进行，并在教学医院和诊所中提供实践实验室和患者护理经验，这导致了当前美国 MD 教育模式的创建。尽管这种模式在美国表现良好，但它冗长且昂贵。随着美国努力应对医生短缺的问题，包括骨科医学和海外医学博士授予学校在内的其他医学教育模式已经增加了毕业生的数量。新的私立骨科医学院，包括一所经认可的私立学校，是具有竞争力的、成本效益高的 MD 授予学校的对手。这些学校是否预示着美国将建立一个营利性的医学教育部门，就像私立大学在高等教育中已经建立起来一样？MD 医学应该如何应对？MD 教育者能否并且应该缩短培养完全合格的 MD 医生所需的时间？MD 教育者如何在缩短培训过程并降低成本以应对国家医生短缺的同时，保持 MD 职业的吸引力而不影响教育质量？存在缩短获得 MD 所需时间和降低成本的途径，并且这些途径已经被证明是有效的。现在是 MD 教育者辩论他们是否应该更广泛地应用这些途径的时候了。有六项建议可以帮助实现缩短和降低美国 MD 医生培训成本的目标。
