Article review: Carnegie’s vision for medical education

In 2010, the Carnegie Foundation for the Advancement of Teaching published recommendations for the future reform of medical education. This same Carnegie Foundation had also commissioned and published the landmark 1910 Flexner report ¹  on medical education, exactly 100 hears prior.

Here is a summary of the four major recommendations:

1. Standardization and individualization

Competency-based education is the future. Students enter medical school with a diverse background of knowledge and experiences. The focus should be towards achieving goals within the competency framework, rather than finishing four set years of medical school. Once you achieve each competency, you can move on. For instance, why does a medical student with a PhD in Statistics have to enroll in the mandatory first-year course on “Introduction to Statistics”? That person should just be able to “test out” and spend that time learning more about anatomy, for instance. Curricula should be individualized and tailored to the learner. The same case could be made for residency education, as well.

2. Integration

Clinical medicine needs to be part of medical school education from day 1, instead of just the second-half of medical school. It also needs to be integrated with the basic and social sciences. Innovative programs include longitudinal integrated clerkships which do away with the traditional block rotations and instead have students follow a set group of patients over the year. A few schools actually start with clinical education and then incorporate basic science courses later.

3. Habits of inquiry and improvement

Learning doesn’t stop after you graduate from medical school and residency. Learners should be encouraged to constantly ask questions, learn, and innovate.

4. Identity formation

Learners should be encouraged to take responsibility as a physician with high standards for knowledge, skill, and professionalism. This can be done through various rituals (eg. white coat ceremony), self-reflection, mentoring, and feedback. Occasionally, unprofessional behavior by medical providers occurs in reality and undermines this mission. It is critical that the medical community maintain a culture of respect, collaboration, and professionalism because impressionable eyes are watching.

Author information

Michelle Lin, MD

ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco

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