A century after Flexner: the need for reform in medical education from college and medical school through residency training

The last major change in medical education occurred almost 100 years ago following an independent investigation conducted by Dr. Abraham Flexner in 1910. Although individual institutions have implemented drastic changes in their own curriculum and the accrediting agencies have mandated other initiatives intended to maintain medical education at the cutting edge of science and technology, many facets of medical education, from the premedical requirements through medical school and residency training, have not changed in nearly half a century. There are areas that are completely lacking in the process of training physicians, and perhaps the assumption was that physicians were intelligent enough to figure this out on their own. While that may have been true in the past when things were less complicated, this approach offers too many opportunities for misadventure, ultimately to the detriment of physicians and patients. Perhaps what is needed is a more rigorous, didactic training program and more thought put into areas where judgment, morality and ethics converge to create potential hazards that can defeat the finest training, equipment and intent. Although American residency programs produce physicians fully capable of independent practice after their prescribed periods of training, there are elements of these training programs that are outdated, costly and perhaps not the best way to get to the desired endpoint. Perhaps these can be revised to more accurately reflect the changing times. This manuscript addresses some of these issues at all levels of training with recommendations for corrective action.