Integrated future?

Medical education of the early 20th century was strongly influenced by Abraham Flexner, who began directing money from North American philanthropic endowments towards reforming medical education.1 His influence upon education was so informed that most medical courses followed his pattern of preclinical science preceding clinical exposure.

However, this has recently been changing, with teaching in ethical, attitudinal, and interpersonal aspects of medical practice,2 and the realisation that early clinical exposure improves motivation and reinforces learning. In 1993 the UK General Medical Council recommended new medical curriculums that integrate preclinical and clinical courses more and devote more time to communication skills,34 problem based learning (PBL), and practical clinical tasks, which most medical schools have introduced.5

As to which system is better is still in debate. Some people say that integrated courses allow students to put knowledge in context and that they prepare students better for clinical problems in the first years of practice.14 Supporters of the traditional method, however, say longer preclinical components give students a more comprehensive foundation of scientific knowledge on which to build an understanding of clinical medicine.