Medicine:Medical education

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Short description: Education related to the practice of being a medical practitioner
"Academic Medicine" redirects here. For the journal, see Academic Medicine (journal).
Medical student in a laboratory at Monterrey Institute of Technology and Higher Education, Mexico City
Medical Student taking blood pressure during awareness campaign event

Medical education is education related to the practice of being a medical practitioner, including the initial training to become a physician (i.e., medical school and internship) and additional training thereafter (e.g., residency, fellowship, and continuing medical education).

Medical education and training varies considerably across the world. Various teaching methodologies have been used in medical education, which is an active area of educational research.[1]

Medical education is also the subject-didactic academic field of educating medical doctors at all levels, including entry-level, post-graduate, and continuing medical education. Specific requirements such as entrustable professional activities must be met before moving on in stages of medical education.

Common techniques and evidence base

Medical education applies theories of pedagogy specifically in the context of medical education. Medical education has been a leader in the field of evidence-based education, through the development of evidence syntheses such as the Best Evidence Medical Education collection, formed in 1999, which aimed to "move from opinion-based education to evidence-based education".[2] Common evidence-based techniques include the Objective structured clinical examination (OSCE) [3] to assess clinical skills, and reliable checklist-based assessments to determine the development of soft skills such as professionalism.[4] However, there is a persistence of ineffective instructional methods in medical education, such as the matching of teaching to learning styles[5] and Edgar Dales' "Cone of Learning".[6]

Entry-level education

Faculty of Medicine (Comenius University in Bratislava) Slovakia

Entry-level medical education programs are tertiary-level courses undertaken at a medical school. Depending on jurisdiction and university, these may be either undergraduate-entry (most of Europe, Asia, South America and Oceania), or graduate-entry programs (mainly Australia, Philippines and North America). Some jurisdictions and universities provide both undergraduate entry programs and graduate entry programs (Australia, South Korea).

In general, initial training is taken at medical school. Traditionally entry-level medical education is divided between preclinical and clinical studies. The former consists of the basic sciences such as anatomy, physiology, biochemistry, pharmacology, pathology, microbiology. The latter consists of teaching in the various areas of clinical medicine such as internal medicine, pediatrics, obstetrics and gynecology, psychiatry, general practice and surgery. More recently, there have been significant efforts in the United States to integrate health systems science (HSS) as the "third pillar" of medical education, alongside preclinical and clinical studies.[7] HSS is a foundational platform and framework for the study and understanding of how care is delivered, how health professionals work together to deliver that care, and how the health system can improve patient care and health care delivery.[8]

The Liaison Committee on Medical Education (LMCE) is a committee of educational accreditation for schools of medicine leading to an MD in the United States and Canada. In order to maintain accreditation, medical schools are required to ensure that students meet a certain set of standards and competencies, defined by the accreditation committees. The "Function and Structure of a Medical School" article is a yearly published article from the LCME that defines 12 accreditation standards.[9]

The Association of American Medical Colleges (AAMC) has recommended thirteen Entrustable Professional Activities (EPAs) that medical students should be expected to accomplish prior to beginning a residency program.[10][11][12] EPAs are based on the integrated core competencies developed over the course of medical school training. Each EPA lists its key feature, associated competencies, and observed behaviors required for completion of that activity. The students progress through levels of understanding and capability, developing with decreasing need for direct supervision.[10][11][12] Eventually students should be able to perform each activity independently, only requiring assistance in situations of unique or uncommon complexity.[10][11][12]

The list of topics that EPAs address include:

  1. History and physical exam skills
  2. Differential diagnosis
  3. Diagnostic/screening tests
  4. Orders and prescriptions
  5. Patient encounter documentation
  6. Oral presentations of patient encounters
  7. Clinical questioning/using evidence
  8. Patient handovers/transitions of care
  9. Teamwork
  10. Urgent/Emergency care
  11. Informed consent
  12. Procedures
  13. Safety and improvement

Medical education has been criticized for limited innovation and for the length of schooling, which increases cost burden on students.[13] There has been a proliferation of programs that combine medical training with research (M.D./Ph.D.) or management programs (M.D./MBA), although this has been criticized because extended interruption to clinical study has been shown to have a detrimental effect on ultimate clinical knowledge.[14]

Postgraduate education

Dean's office at the First Faculty of Medicine, Charles University, Prague

Following completion of entry-level training, newly graduated doctors are often required to undertake a period of supervised practice before full registration is granted; this is most often of one-year duration and may be referred to as an "internship," "provisional registration," or "residency".

Further training in a particular field of medicine may be undertaken. In the U.S., further specialized training, completed after residency is referred to as "fellowship". In some jurisdictions, this is commenced immediately following completion of entry-level training, while other jurisdictions require junior doctors to undertake generalist (non-specialty) training for a number of years before commencing specialization.

Each residency and fellowship program is accredited by the Accreditation Council for Graduate Medical Education (ACGME), a non-profit organization led by physicians with the goal of enhancing educational standards among physicians. The ACGME oversees all M.D. and D.O. residency programs in the United States. As of 2019, there were approximately 11,700 ACGME accredited residencies and fellowship programs in 181 specialties and subspecialties.[15]

Education theory itself is becoming an integral part of postgraduate medical training. Formal qualifications in education are also becoming the norm for medical educators, such that there has been a rapid increase in the number of available graduate programs in medical education.[16][17]

Continuing medical education

In most countries, continuing medical education (CME) courses are required for continued licensing.[18] CME requirements vary by state and by country. In the US, accreditation is overseen by the Accreditation Council for Continuing Medical Education (ACCME). Physicians often attend dedicated lectures, grand rounds, conferences, and performance improvement activities in order to fulfill their requirements. Additionally, physicians are increasingly opting to pursue further graduate-level training in the formal study of medical education as a pathway for continuing professional development.[19][20]

Online learning

Medical education is increasingly utilizing online teaching, usually within learning management systems (LMSs) or virtual learning environments (VLEs).[21][22] Additionally, several medical schools have incorporated the use of blended learning combining the use of video, asynchronous, and in-person exercises.[23][24] A landmark scoping review published in 2018 demonstrated that online teaching modalities are becoming increasingly prevalent in medical education, with associated high student satisfaction and improvement on knowledge tests. However, the use of evidence-based multimedia design principles in the development of online lectures was seldom reported, despite their known effectiveness in medical student contexts.[25] To enhance variety in an online delivery environment, the use of serious games, which have previously shown benefit in medical education,[26] can be incorporated to break the monotony of online-delivered lectures.[27]

Research areas into online medical education include practical applications, including simulated patients and virtual medical records (see also: telehealth).[28] When compared to no intervention, simulation in medical education training is associated with positive effects on knowledge, skills, and behaviors and moderate effects for patient outcomes.[29] However, data is inconsistent on the effectiveness of asynchronous online learning when compared to traditional in-person lectures.[30][31] Furthermore, studies utilizing modern visualization technology (i.e. virtual and augmented reality) have shown great promise as means to supplement lesson content in physiological and anatomical education.[32][33]

Telemedicine/telehealth education

With the advent of telemedicine (aka telehealth), students learn to interact with and treat patients online, an increasingly important skill in medical education.[34][35][36][37] In training, students and clinicians enter a "virtual patient room" in which they interact and share information with a simulated or real patient actors. Students are assessed based on professionalism, communication, medical history gathering, physical exam, and ability to make shared decisions with the patient actor.[38][39]

Medical education systems by country

Jackson Memorial Hospital in Miami, the primary teaching hospital for the Miller School of Medicine at the University of Miami, in July 2010

In the United Kingdom, a typical medicine course at university is five years, or four years if the student already holds a degree. Among some institutions and for some students, it may be six years (including the selection of an intercalated BSc—taking one year—at some point after the pre-clinical studies). All programs culminate in the Bachelor of Medicine and Surgery degree (abbreviated MBChB, MBBS, MBBCh, BM, etc.). This is followed by two clinical foundation years afterward, namely F1 and F2, similar to internship training. Students register with the UK General Medical Council at the end of F1. At the end of F2, they may pursue further years of study. The system in Australia is very similar, with registration by the Australian Medical Council (AMC).

In the U.S. and Canada, a prospective medical student must first complete an undergraduate degree in any subject before applying to a graduate medical school to pursue an (M.D. or D.O.) program. U.S. medical schools are almost all four-year programs. Some students opt for the research-focused M.D./Ph.D. dual degree program, which is usually completed in 7–10 years. There are certain courses that are pre-requisite for being accepted to medical school, such as general chemistry, organic chemistry, physics, mathematics, biology, English, labwork, etc. The specific requirements vary by school.

In Australia, there are two pathways to a medical degree. Students can choose to take a five- or six-year undergraduate medical degree Bachelor of Medicine/Bachelor of Surgery (MBBS or BMed) as a first tertiary degree directly after secondary school graduation, or first complete a bachelor's degree (in general three years, usually in the medical sciences) and then apply for a four-year graduate entry Bachelor of Medicine/Bachelor of Surgery (MBBS) program.[40][41]

See:

North America
  • Medical education in Canada
  • Medical education in Panama
  • Medical education in the United States
Europe
  • Medical education in France
  • Medical education in Norway
  • Medical education in the United Kingdom
Asia/Middle East/Oceania
  • Medical education in Australia
  • Medical education in China
  • Medical education in Hong Kong
  • Medical education in India
  • Medical education in Jordan
  • Medical education in the Philippines
  • Medical education in South Korea
  • Medical education in Nepal
Africa
  • Medical education in South Africa
  • Medical education in Uganda

Norms and values

The aims of medical ethics training are to give medical doctors the ability to recognize ethical issues, reason about them morally and legally when making clinical decisions, and be able to interact to obtain the information necessary to do so.[42]

Along with training individuals in the practice of medicine, medical education influences the norms and values of its participants (patients, families, etc.) This either occurs through explicit training in medical ethics, or covertly through a hidden curriculum –– a body of norms and values that students encounter implicitly, but is not formally taught.[43][44][45] While formal ethics courses are a requirement at schools such as those accredited by the LCME, gaps between these courses and the hidden curriculum throughout medical education are frequently raised as issues contributing to the culture of medicine.[46][47][48][49]The hidden curriculum may include the use of unprofessional behaviors for efficiency[lower-alpha 1] or viewing the academic hierarchy as more important than the patient.[lower-alpha 2] In certain institutions, such as those with LCME accreditation, the requirement of professionalism may be additionally weaponized against trainees, with complaints about ethics and safety being labelled as unprofessional.[51][52][53][54] The hidden curriculum was recently shown to be a cause of reduction in medical student empathy as they progress throughout medical school.[55]

The politicization of medicine and health advocacy has been criticized.[56]

Integration with health policy

As medical professional stakeholders in the field of health care (i.e. entities integrally involved in the health care system and affected by reform), the practice of medicine (i.e. diagnosing, treating, and monitoring disease) is directly affected by the ongoing changes in both national and local health policy and economics.[57]

There is a growing call for health professional training programs to not only adopt more rigorous health policy education and leadership training,[58][59][60] but to apply a broader lens to the concept of teaching and implementing health policy through health equity and social disparities that largely affect health and patient outcomes.[61][62] Increased mortality and morbidity rates occur from birth to age 75, attributed to medical care (insurance access, quality of care), individual behavior (smoking, diet, exercise, drugs, risky behavior), socioeconomic and demographic factors (poverty, inequality, racial disparities, segregation), and physical environment (housing, education, transportation, urban planning).[62] A country's health care delivery system reflects its "underlying values, tolerances, expectations, and cultures of the societies they serve",[63] and medical professionals stand in a unique position to influence opinion and policy of patients, healthcare administrators, & lawmakers.[58][64]

In order to truly integrate health policy matters into physician and medical education, training should begin as early as possible – ideally during medical school or premedical coursework – to build "foundational knowledge and analytical skills" continued during residency and reinforced throughout clinical practice, like any other core skill or competency.[60] This source further recommends adopting a national standardized core health policy curriculum for medical schools and residencies in order to introduce a core foundation in this much needed area, focusing on four main domains of health care: (1) systems and principles (e.g. financing; payment; models of management; information technology; physician workforce), (2) quality and safety (e.g. quality improvement indicators, measures, and outcomes; patient safety), (3) value and equity (e.g. medical economics, medical decision making, comparative effectiveness, health disparities), and (4) politics and law (e.g. history and consequences of major legislation; adverse events, medical errors, and malpractice).

However limitations to implementing these health policy courses mainly include perceived time constraints from scheduling conflicts, the need for an interdisciplinary faculty team, and lack of research / funding to determine what curriculum design may best suit the program goals.[60][61] Resistance in one pilot program was seen from program directors who did not see the relevance of the elective course and who were bounded by program training requirements limited by scheduling conflicts and inadequate time for non-clinical activities.[65] But for students in one medical school study,[66] those taught higher-intensity curriculum (vs lower-intensity) were "three to four times as likely to perceive themselves as appropriately trained in components of health care systems", and felt it did not take away from getting poorer training in other areas. Additionally, recruiting and retaining a diverse set of multidisciplinary instructors and policy or economic experts with sufficient knowledge and training may be limited at community-based programs or schools without health policy or public health departments or graduate programs. Remedies may include having online courses, off-site trips to the capitol or health foundations, or dedicated externships, but these have interactive, cost, and time constraints as well. Despite these limitations, several programs in both medical school and residency training have been pioneered.[61][65][67][68][69]

Lastly, more national support and research will be needed to not only establish these programs but to evaluate how to both standardize and innovate the curriculum in a way that is flexible with the changing health care and policy landscape. In the United States, this will involve coordination with the ACGME (Accreditation Council for Graduate Medical Education), a private non-profit organization (NPO) that sets educational and training standards[70] for U.S. residencies and fellowships that determines funding and ability to operate.

Medical education as a subject-didactic field

Medical education is also the subject-didactic field of educating medical doctors at all levels, applying theories of pedagogy in the medical context, with its own journals, such as Medical Education. Researchers and practitioners in this field are usually medical doctors or educationalists. Medical curricula vary between medical schools, and are constantly evolving in response to the need of medical students, as well as the resources available.[71] Medical schools have been documented to utilize various forms of problem-based learning, team-based learning, and simulation.[72][73][74][75] The Liaison Committee on Medical Education (LCME) publishes standard guidelines regarding goals of medical education, including curriculum design, implementation, and evaluation.[9]

Air National Guard Base training in medical simulation

The objective structured clinical examinations (OSCEs) are widely utilized as a way to assess health science students' clinical abilities in a controlled setting.[76][77] Although used in medical education programs throughout the world, the methodology for assessment may vary between programs and thus attempts to standardize the assessment have been made.[78][79]

Cadaver laboratory

Medical student describes anatomical landmarks of a donated human cadaver.

Medical schools and surgical residency programs may utilize cadavers to identify anatomy, study pathology, perform procedures, correlate radiology findings, and identify causes of death.[80][81][82][83][84] With the integration of technology, traditional cadaver dissection has been debated regarding its effectiveness in medical education, but remains a large component of medical curriculum around the world.[80][84] Didactic courses in cadaver dissection are commonly offered by certified anatomists, scientists, and physicians with a background in the subject.[80]

Medical curriculum and evidence-based medical education journals

Medical curriculum vary widely among medical schools and residency programs, but generally follow an evidence based medical education (EBME) approach.[85] These evidence based approaches are published in medical journals. The list of peer-reviewed medical education journals includes, but is not limited to:

  • Academic Medicine
  • Medical Education
  • Advances in Health Science Education
  • Medical Teacher

Open access medical education journals:

  • Perspectives on Medical Education
  • BMC Medical Education
  • MedEDPORTAL[86]
  • Journal of Medical Education and Curricular Development
  • MedConnect
  • MediUnite and MediUnite Journal

Graduate Medical Education and Continuing Medical Education focused journals:

  • Journal of Continuing Education in the Health Professions
  • Journal of Graduate Medical Education

This is not a complete list of medical education journals. Each medical journal in this list has a varying impact factor (mean number of citations) indicating how often it is used in scientific research and study.

See also

Explanatory notes

  1. ↑ "As in any crisis, the environment has evolved to accept substandard professional behavior in exchange for efficiency or productivity" [50]
  2. ↑ "In Coulehan's view, the hidden curriculum places the academic hierarchy—not the patient—at the center of medical education."[50]

References

  1. ↑ "Evidence based practice in postgraduate healthcare education: a systematic review". BMC Health Services Research 7. July 2007. doi:10.1186/1472-6963-7-119. PMID 17655743. 
  2. ↑ "BEME Guide No. 1: Best Evidence Medical Education". Medical Teacher 21 (6): 553–62. 1999-01-01. doi:10.1080/01421599978960. PMID 21281174. 
  3. ↑ "Twelve tips for developing an OSCE that measures what you want". Medical Teacher 40 (12): 1208–1213. December 2018. doi:10.1080/0142159X.2017.1390214. PMID 29069965. 
  4. ↑ "A blueprint to assess professionalism: results of a systematic review". Academic Medicine 84 (5): 551–8. May 2009. doi:10.1097/ACM.0b013e31819fbaa2. PMID 19704185. 
  5. ↑ "The Learning Styles Neuromyth Is Still Thriving in Medical Education". Frontiers in Human Neuroscience 15. 2021. doi:10.3389/fnhum.2021.708540. PMID 34456698. 
  6. ↑ "Edgar Dale's Pyramid of Learning in medical education: Further expansion of the myth". Medical Education 54 (1): 22–32. January 2020. doi:10.1111/medu.13813. PMID 31576610. 
  7. ↑ Fred, Herbert L.; Gonzalo, Jed D. (2018-06-01). "Reframing Medical Education" (in en). Texas Heart Institute Journal 45 (3): 123–125. doi:10.14503/THIJ-18-6729. ISSN 0730-2347. PMID 30072846. PMC 6059511. https://meridian.allenpress.com/thij/article/45/3/123/85682/Reframing-Medical-Education. 
  8. ↑ "Health Systems Science - 9780323694629" (in en). https://www.us.elsevierhealth.com/health-systems-science-9780323694629.html. 
  9. ↑ 9.0 9.1 "Standards, Publications, & Notification Forms". March 31, 2020. https://lcme.org/publications/. 
  10. ↑ 10.0 10.1 10.2 "Core Entrustable Professional Activities for Entering Residency". 2017. https://www.aamc.org/system/files/c/2/484778-epa13toolkit.pdf. 
  11. ↑ 11.0 11.1 11.2 "Nuts and bolts of entrustable professional activities". Journal of Graduate Medical Education 5 (1): 157–8. March 2013. doi:10.4300/JGME-D-12-00380.1. PMID 24404246. 
  12. ↑ 12.0 12.1 12.2 "A primer on entrustable professional activities". Korean Journal of Medical Education 30 (1): 1–10. March 2018. doi:10.3946/kjme.2018.76. PMID 29510603. 
  13. ↑ Alexander, Seth McKenzie; Gilleskie, Donna; Díaz-González de Ferris, Maria (2024-01-01). "Changing the Clock in Medical Education: Addressing Physician Shortages and Patient Outcomes" (in EN). Journal of Medical Education and Curricular Development 11. doi:10.1177/23821205241264692. ISSN 2382-1205. PMID 38894718. 
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  15. ↑ Data Resource Book. 19. Accreditation Council for Graduate Medical Education. 2019. pp. 13–19. https://www.acgme.org/About-Us/Publications-and-Resources/Graduate-Medical-Education-Data-Resource-Book. 
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  19. ↑ "Health Professions Education Graduate Programs Are a Pathway to Strengthening Continuing Professional Development". The Journal of Continuing Education in the Health Professions 37 (2): 147–151. 2017. doi:10.1097/CEH.0000000000000155. PMID 28562504. 
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  21. ↑ "AMEE Guide 32: e-Learning in medical education Part 1: Learning, teaching and assessment". Medical Teacher 30 (5): 455–73. June 2008. doi:10.1080/01421590802108331. PMID 18576185. 
  22. ↑ "e-Learning in medical education Guide 32 Part 2: Technology, management and design". Medical Teacher 30 (5): 474–89. June 2008. doi:10.1080/01421590802108349. PMID 18576186. 
  23. ↑ "An Innovative Blended Preclinical Curriculum in Clinical Epidemiology and Biostatistics: Impact on Student Satisfaction and Performance". Academic Medicine 91 (5): 696–700. May 2016. doi:10.1097/ACM.0000000000001085. PMID 26796089. 
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  25. ↑ "Online Lectures in Undergraduate Medical Education: Scoping Review". JMIR Medical Education 4 (1): e11. April 2018. doi:10.2196/mededu.9091. PMID 29636322. 
  26. ↑ "Mobile Mixed Reality for Experiential Learning and Simulation in Medical and Health Sciences Education" (in en). Information 9 (2): 31. 2018-01-31. doi:10.3390/info9020031. ISSN 2078-2489. 
  27. ↑ "Enhancing variety through gamified, interactive learning experiences". Medical Education 54 (12): 1180–1181. December 2020. doi:10.1111/medu.14251. PMID 32438478. 
  28. ↑ "Minnesota Virtual Clinic Medical Education Software". Regents of the University of Minnesota. http://www.license.umn.edu/Products/Minnesota-Virtual-Clinic-Medical-Education-Software__Z05174.aspx. 
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  30. ↑ "Asynchronous vs didactic education: it's too early to throw in the towel on tradition". BMC Medical Education 13 (1). August 2013. doi:10.1186/1472-6920-13-105. PMID 23927420. 
  31. ↑ "Efficacy of an asynchronous electronic curriculum in emergency medicine education in the United States". Journal of Educational Evaluation for Health Professions 14: 29. 2017-12-11. doi:10.3352/jeehp.2017.14.29. PMID 29237247. 
  32. ↑ "The effectiveness of virtual and augmented reality in health sciences and medical anatomy". Anatomical Sciences Education 10 (6): 549–559. November 2017. doi:10.1002/ase.1696. PMID 28419750. https://research.bond.edu.au/en/publications/d761ced8-4406-4a5e-ae3f-01862a09a36e. 
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  35. ↑ "Impact of weekly case-based tele-education on quality of care in a limited resource medical intensive care unit". Critical Care 23 (1). June 2019. doi:10.1186/s13054-019-2494-6. PMID 31200761. 
  36. ↑ "Competencies required for nursing telehealth activities: A Delphi-study". Nurse Education Today 39: 50–62. April 2016. doi:10.1016/j.nedt.2015.12.025. PMID 27006033. 
  37. ↑ "Editorial". Indigenous Law Bulletin 7 (16). January–February 2010. doi:10.1163/2210-7975_hrd-1758-0046. http://www.ilc.unsw.edu.au/publications/ilb/january-february-2010-volume-7-issue-16. 
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  40. ↑ "Medicine - Find My Pathway" (in en-US). Find My Pathway. https://www.findmypathway.com/pathways/medicine/#registration. 
  41. ↑ "Pathways through specialty medical training" (in en). Royal Australasian College of Surgeons (RACS). https://www.surgeons.org/becoming-a-surgeon/surgery-as-a-career/pathways-through-specialty-medical-training/. 
  42. ↑ "Standards, Publications, & Notification Forms" (in en-US). https://lcme.org/publications/. 
  43. ↑ "Navigating the hidden curriculum in medical school" (in en). https://www.aamc.org/news/navigating-hidden-curriculum-medical-school. 
  44. ↑ "Analyzing the interaction of main components of hidden curriculum in medical education using interpretive structural modeling method". BMC Medical Education 20 (1). June 2020. doi:10.1186/s12909-020-02094-5. PMID 32487128. 
  45. ↑ "The hidden curriculum in undergraduate medical education: qualitative study of medical students' perceptions of teaching". BMJ 329 (7469): 770–773. October 2004. doi:10.1136/bmj.329.7469.770. PMID 15459051. 
  46. ↑ "Decoding the learning environment of medical education: a hidden curriculum perspective for faculty development". Academic Medicine 86 (4): 440–444. April 2011. doi:10.1097/ACM.0b013e31820df8e2. PMID 21346498. 
  47. ↑ "Confronting the Hidden Curriculum: A Four-Year Integrated Course in Ethics and Professionalism Grounded in Virtue Ethics" (in en). The Medical/Health Humanities-Politics, Programs, and Pedagogies. Cham: Springer International Publishing. 2022. pp. 177–191. doi:10.1007/978-3-031-19227-2_12. ISBN 978-3-031-19227-2. 
  48. ↑ "Learning professionalism through hidden curriculum: Iranian medical students' perspective". Journal of Medical Ethics and History of Medicine 11: 10. 2018. PMID 31346387. 
  49. ↑ "The role of hidden curriculum in the formation of professional ethics in Iranian medical students: A qualitative study". Journal of Education and Health Promotion 9: 180. 2020. doi:10.4103/jehp.jehp_172_20. PMID 32953908. 
  50. ↑ 50.0 50.1 "Viewpoint: learning professionalism: a view from the trenches". Academic Medicine (Ovid Technologies (Wolters Kluwer Health)) 82 (11): 1010–1014. November 2007. doi:10.1097/01.acm.0000285343.95826.94. PMID 17971682. 
  51. ↑ "Professionalism Framings Across Medical Schools". Journal of General Internal Medicine 33 (5): 610–611. May 2018. doi:10.1007/s11606-018-4314-0. PMID 29435728. 
  52. ↑ "Do looks matter? The role of the Electronic Residency Application Service photograph in dermatology residency selection". Dermatology Online Journal 24 (4): 13030/qt5qc988jz. April 2018. doi:10.5070/D3244039354. PMID 29906000. 
  53. ↑ "Differences in words used to describe racial and gender groups in Medical Student Performance Evaluations". PLOS ONE 12 (8). 2017. doi:10.1371/journal.pone.0181659. PMID 28792940. Bibcode: 2017PLoSO..1281659R. 
  54. ↑ "Resculpting Professionalism for Equity and Accountability". Annals of Family Medicine 20 (6): 573–577. 2022. doi:10.1370/afm.2892. PMID 36443090. 
  55. ↑ "Why might medical student empathy change throughout medical school? a systematic review and thematic synthesis of qualitative studies". BMC Medical Education 23 (270). April 2023. doi:10.1186/s12909-023-04165-9. PMID 37088814. 
  56. ↑ Goldberg, Daniel S. (January 2012). "Against the Very Idea of the Politicization of Public Health Policy". American Journal of Public Health 102 (1): 44–49. doi:10.2105/AJPH.2011.300325. ISSN 0090-0036. PMC 3490541. https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2011.300325. 
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  61. ↑ 61.0 61.1 61.2 "Health Policy Training: A Review of the Literature". International Journal of Environmental Research and Public Health 13 (1). December 2015. doi:10.3390/ijerph13010020. PMID 26703657. 
  62. ↑ 62.0 62.1 "Why do Americans have shorter life expectancy and worse health than do people in other high-income countries?". Annual Review of Public Health 35: 307–25. 2014-01-01. doi:10.1146/annurev-publhealth-032013-182411. PMID 24422560. 
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  64. ↑ "The role of physicians and medical organizations in the development, analysis, and implementation of health care policy". Seminars in Radiation Oncology 18 (3): 186–93. July 2008. doi:10.1016/j.semradonc.2008.01.006. PMID 18513628. 
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  66. ↑ "Medical student perceptions of education in health care systems". Academic Medicine 84 (9): 1301–6. September 2009. doi:10.1097/acm.0b013e3181b17e3e. PMID 19707077. 
  67. ↑ "A pilot curriculum to integrate community health into internal medicine residency training" (in EN). Journal of Graduate Medical Education 5 (4): 674–7. December 2013. doi:10.4300/jgme-d-12-00354.1. PMID 24455022. 
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  69. ↑ "Systems-Based Training in Graduate Medical Education for Service Learning in the State Legislature in the United States: Pilot Study". JMIR Medical Education 3 (2): e18. October 2017. doi:10.2196/mededu.7730. PMID 29042343. 
  70. ↑ "ACGME Core Competencies.". The Accreditation Council for Graduate Medical Education. The Educational Commission for Foreign Medical Graduates.. July 5, 2012. http://www.ecfmg.org/echo/acgme-core-competencies.html. 
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  72. ↑ "Problem-Based Learning: An Overview of its Process and Impact on Learning". Health Professions Education 2 (2): 75–79. 2016-12-01. doi:10.1016/j.hpe.2016.01.004. 
  73. ↑ "Team-based learning (TBL): a community of practice". BMC Medical Education 19 (1). October 2019. doi:10.1186/s12909-019-1795-4. PMID 31615507. 
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  76. ↑ "An evaluative study of objective structured clinical examination (OSCE): students and examiners perspectives" (in en). Advances in Medical Education and Practice 10: 387–397. 2019-06-05. doi:10.2147/amep.s197275. PMID 31239801. 
  77. ↑ "Osce: Design, Development and Deployment". Journal of the West African College of Surgeons 8 (1): 1–22. 2018. PMID 30899701. 
  78. ↑ "Assessing Communication Skills of Medical Students in Objective Structured Clinical Examinations (OSCE)--A Systematic Review of Rating Scales". PLOS ONE 11 (3). 2016-03-31. doi:10.1371/journal.pone.0152717. PMID 27031506. Bibcode: 2016PLoSO..1152717C. 
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  82. ↑ "Outcomes and satisfaction of two optional cadaveric dissection courses: A 3-year prospective study". Anatomical Sciences Education 10 (2): 127–136. March 2017. doi:10.1002/ase.1638. PMID 27483443. http://orca.cf.ac.uk/94661/1/Outcomes%20and%20satisfaction%20of%20two%20optional%20cadaveric%20%20dissection%20courses%20%28BJM%29.pdf. 
  83. ↑ "Computer-based sessions in radiological anatomy: one year's experience in clinical anatomy". Surgical and Radiologic Anatomy 22 (1): 29–34. 1 May 2000. doi:10.1007/s00276-000-0029-z. PMID 10863744. 
  84. ↑ 84.0 84.1 "The dissection course - necessary and indispensable for teaching anatomy to medical students". Annals of Anatomy - Anatomischer Anzeiger 190 (1): 16–22. 1 February 2008. doi:10.1016/j.aanat.2007.10.001. PMID 18342138. 
  85. ↑ "BEME Guide No. 1: Best Evidence Medical Education". Medical Teacher 21 (6): 553–62. 1 January 1999. doi:10.1080/01421599978960. PMID 21281174. 
  86. ↑ "MedEDPORTAL Author Handbook". Association of American Medical Colleges (AAMC). 2009. pp. 2–4. https://wiki.library.ucsf.edu/download/attachments/321128482/mededportal%20author%20handbook%20KHS.pdf?api=v2. 

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