In the first article I wrote for the Differential, I wrote about how physicians of today will be solving the problems of tomorrow. One of the ways doctors will tackle healthcare issues is through an interdisciplinary education. However, the current approach to medical education is lacking an interdisciplinary focus in its modern structure. Medical education is divided into three separate phases, the first of which is 4 years of undergraduate studies that consists of a basic science education with little room for other interests. Although students are free to major in any topic they desire, this approach is typically unrealistic for most students. I previously wrote that nearly 60% of incoming medical students majored in the biological sciences alone [1]. The time required for lectures, labs, and course difficulty leaves students little freedom to explore other academic interests.
The next phases of medical education are medical school and residency, another 7 to 11 years -depending on chosen specialty- that is and should be dedicated to learning medicine and its practice. I believe these phases are not the best place for an interdisciplinary education to take place, largely due to time constraints. Medical knowledge is rapidly expanding in 2020. In 1950, the doubling time of medical knowledge was 50 years. In 2020, that doubling time is 73 days [2]. Being able to learn and keep up with medical knowledge as well as interdisciplinary topics is unrealistic. Another factor to consider is the debt load taken on by future doctors. The AAMC lists the average debt for a medical student graduate is $201,500. The only graduate education with a larger debt load is dental graduates at $292,000 [3]. Doctors graduate later and with substantially more debt than other professions and previous generations, stifling their ability to explore topics outside of medicine. It is time we adjust to a new age of medicine.
In order to address these issues, I believe it is important to analyze how we arrived at this point. Modern medical education began with the Flexner Report published in 1910 [4]. In essence, the paper concludes that medical education should have a foundation in biological sciences, chemistry, mathematics, and physics. The report stated that medicine should be defined by a scientific education. Back then this made sense. It was nearly 30 years later, in 1943, that Oswald Avery proved that DNA was the genetic material of the chromosome. It would then take another 60 years to map the entire human genome (at a cost of nearly $2.7 billion, which today costs less than $1,000)[5]. The Flexner Report was designed for an age of discovery and advancement in medicine when science was moving at a slower pace. In 2020, the task of learning science and medicine in the traditional format is increasingly difficult. Remember, the doubling time of medical knowledge is 73 days. A new approach is needed for medical education that factors in the technological changes we have seen over the past few decades.
The World Wide Web was created in the mid 1980s, and really exploded into common use in the early 2000s. Up until this point, knowledge could only be obtained by going to higher education. The only way to earn an education was by attending a university or graduate school, which is no longer the case. With the advent of thousands of online resources and outlets of knowledge, becoming educated is as simple as having access to the internet. Students from anywhere in the world can now watch a lecture on organic chemistry, quantum physics, or any advanced subject by simply Googling their topic of interest. The value of higher education has shifted: colleges and universities used to be repositories of exclusive knowledge but this knowledge is now free and accessible. The benefit of college used to be both access to knowledge and social capital, but in 2020 the balance has shifted significantly towards social capital.
I believe the solution lies in a personalized, interdisciplinary medical education. The model of linear medical education progression (college to medical school to residency) is outdated and too expensive. Early exposure to diverse topics in undergraduate education is necessary. Admission to medical school should not be based on obtaining a bachelor’s degree. If a student achieves a high MCAT score, this should demonstrate a sufficient knowledge base for medical school. If a student can achieve that score after one or two years in college, then that should be rewarded. Premedical education should include topics such as health care systems, finance, technological literacy, and bioethics. Students need the freedom to explore topics outside of the hard sciences and medicine early on when they have the time to learn. Of course, the basic sciences will always be necessary, but the overemphasis on these subjects at the expense of equally important topics should change in the coming years.
In the future, access to medical school should be available earlier and at a cheaper cost (easier said than done). Additionally, there needs to be room for a diverse curriculum in undergraduate education. The path forward is abandoning the rigid structure we have had in medicine for the past 100 years. Medical education should be centered around building the skills necessary to educate oneself independently. It needs an interdisciplinary update for the 21st Century.
- “MCAT and GPAs for Applicants and Matriculants to US Medical Schools by Primary Undergraduate Major, 2019-2020.” 2019 Facts: Applicants and Matriculants Data. AAMC. Retrieved from: https://www.aamc.org/data-reports/students-residents/interactive-data/2019-facts-applicants-and-matriculants-data.
- Densen P. Challenges and opportunities facing medical education. Trans Am Clin Climatol Assoc. 2011;122:48-58.
- Solana, Kimber. “Erasing Dental Debt.” Erasing Dental Debt: From $200K to Zero in Less than Three Years, Mar. 2020, www.ada.org/en/publications/new-dentist-news/2020-archive/march/from-200k-to-zero-in-less-than-three-years.
- Duffy TP. The Flexner Report—100 years later. Yale J Biol Med. 2011;84(3):269-276.
- Megtirrell, Meg. “Unlocking My Genome: Was It Worth It?” CNBC, CNBC, 14 Dec. 2015, www.cnbc.com/2015/12/10/unlocking-my-genome-was-it-worth-it.html.
Aaron Dowell is a member of the University of Arizona College of Medicine-Phoenix Class of 2024. He graduated from the University of Evansville in 2020 with a degree in Neuroscience. He plans on obtaining his MD/MBA dual degree and is interested in reducing physician burnout, leadership, and healthcare-market trends. In his free time he enjoys hiking with his wife, weightlifting, training Brazilian Jiu-Jitsu, and bowhunting. Contact information: aarondowell@email.arizona.edu