현재 전 세계 의학교육 시스템(J Med Dent Sci 2011)

현재 전 세계 의학교육 시스템(J Med Dent Sci 2011)

The Current Medical Education System in the World

Nobuo Nara1), Toshiya Suzuki1) and Shuji Tohda2)

Introduction

세계 의과대학의 교육시스템

Education system in the overseas medical schools

세 그룹으로 구분가능

We can divide the overseas medical education system into 3 groups.

• 고등학교 졸업생만 선발
  Type 1 system accepts high school leavers and the education period is 5 ~7 years. Germany, the Netherlands, Belgium, Spain, Scotland, and Malaysia belong to this group. Japan also takes this system, while 36 medical schools also accept 5-40 (mostly 5) college-graduates at the 2nd or 3rd year class. This system is merely limited term college graduate-entry system and we include Japanese medical education in this group.

• 국가단위 시험을 통해서 선발하며, 일본에서는 각 의과대학별 시험은 거의 없다. 네덜란드, 벨기에, 말레이시아에서는 정부가 입학생을 결정한다.
  Type 1 medical schools (or called medical colleges in Korea) accept usually 18-19 years old high school leavers (Figure 2a). For admission the grades at high school and the results of the nation-wide common achievement tests are evaluated. Entrance examination in each medical school as in Japan is rare. Moreover, in some countries such as the Netherlands, Belgium and Malaysia, the government determines the medical school to which each applicant admits. 

• The education periods are 5 ~7 years; 

• 5 years in Scotland, and Malaysia: 

• 6 years in Japan, Germany, the Netherlands, and Spain; 

• 7 years in Belgium. 

• The main aim of type 1 medical school is to create clinical physicians. At graduation the students get the degree of medical doctor or medical bachelor.

• 대학교 졸업생만 선발
  Type 2 system accepts only college graduates with baccalaureate and educate them for4 years. USA and Canada belong to this group.

• MCAT을 보며 면접이 중요하다. 일부 MD-PhD 과정도 있다.
  Type 2 medical schools accept only bachelors graduated from colleges of other than medicine (Figure 2b). Normally applicants are 22 ~24 years old. For admission, scores of medical college admission tests (MCAT) and performance of college are evaluated in USA. Personal interview is also important for evaluation to confirm the motivation for learning medicine. Students take four years education at medical school and get the degree of medical doctor at graduation. Some schools have MD-PhD course to encourage students to be physician scientists.

• 두 가지 혼합
  Type 3 system is the mixture of both type 1 and type 2. Namely, it accepts both high school leavers and college graduates. Australia, England, Ireland, Korea and Singapore belong to this group.

• Type 3 medical schools accept both high school leavers and college graduates (Figure 2c). 

세 유형을 모두 시행하는 나라도 있다.

In the countries that accept type 3 medical schools, there are three kinds of schools. Some schools exclusively accept either high school leavers or college graduates. Other schools accept both of them; double track education courses are carried out in the same school.

Curriculum

의예과학, 기초의학, 임상의학 으로 구분된다.

The curriculum of medical school is composed of premedical science, basic medicine and clinical medicine. 

In type 1 medical school, 

• students learn liberal arts including philosophy, ethics, mathematics, physics, chemistry, biology, foreign language, etc. in premedical course for 0.5 ~2 years. 
• After the premedical course, students learn basic medicine such as anatomy, histology, biophysics, biochemistry, bacteriology/virology, pathology, hygiene, public health, physiology, pharmacology, etc. for 1.5 ~2 years. 
• Finally they learn clinical medicine such as internal medicine, pediatrics, surgery, obstetrics, gynecology, orthopedics, urology, otorhinolaryngology, ophthalmology etc. for 2 ~3 years including clinical clerkship.

type 2에서는 premedical course는 불필요.

It is not necessary for students in type 2 medical schools to take premedical course because they have already learned before admission. In 4 years education, students learn basic medicine for two years and clinical medicine for two years.

Education methods

Formally, the knowledge of medicine has been taught by teachers through lectures in a large theater.

Clinical clerkship system is reasonable to master clinical skills. Students belong to the medical team as a staff and do medical practice under the supervision of attendants. This clinical clerkship system is most advanced in USA and Canada.

Medical schools of the other countries have also introduced actively this system. Before entering clinical clerkship, students usually take simulation-based learning using standardized patients and/or models7.

Although clinical training is the principal role of medical school, it is also of importance to create physician scientists for the advance of medical science. For this purpose some medical schools have introduced elective course such as MD-PhD course. Approximately 40% of students in Stanford university entered to this elective course and got both MD and PhD degrees at graduation.

Furthermore exchange program is active especially in Australia and Europe to promote globalization in medicine. In fact some medical students from the overseas medical schools such as Australia and Germany visited our university to study medicine with Japanese students.

Innovation and its effect of medical education in Germany

독일의 Charité University 의 실험. 매년 603명의 입학생. 540명과 63명으로 나누어 교육과정 다르게 진행함.

Very attractive and important pilot study is under way in Charité University in Berlin, Germany. It accepts approximately 603 students per year. Students are divided into two classes by lot; 540 students for regular course and 63 students for reformed course. Informed consents are obtained from students of both groups. Students of either group can take appropriate education to be medical physicians; they do not think unfair even if they belong either class.

• The first five years of the reformed course are divided into two phases.
• At the first phase, the students l earn organ- based medi ci ne
• At the second phase, they learn basic medicine and clinical medicine chronologicallysuch as pregnancy, new born, baby, infant, schoolchild, adolescent and adult. Clinical clerkship is also included in this phase
• The last 6th year is a clinical clerkship year where students rotate internal medicine for 4 months, surgery for 4 months and elective department for 4 months.

6. Thompson BM, Schneider VF, Haidet P, et al. Team-based learning at ten medical schools: two years later. Med Educ 41: 250-257, 2007.

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J Med Dent Sci. 2011 Jul 4;58(2):79-83.

The current medical education system in the world.

Nara N1, Suzuki T, Tohda S.

Author information

• 1Center for Education Research in Medicine and Dentistry.

Abstract

To contribute to the innovation of the medical education system in Japan, we visited 35 medical schools and 5 institutes in 12 countries of North America, Europe, Australia and Asia in 2008-2010 and observed the education system. We met the deans, medical education committee and administration affairs and discussed about the desirable education system. We also observed the facilities of medical schools.Medical education system shows marked diversity in the world. There are three types of education course; non-graduate-entry program(non-GEP), graduate-entry program(GEP) and mixed program of non-GEP and GEP. Even in the same country, several types of medical schools coexist. Although the education methods are also various among medical schools, most of the medical schools have introduced tutorial system based on PBL or TBL and simulation-based learning to create excellent medical physicians. The medical education system is variable among countries depending on the social environment. Although the change in education program may not be necessary in Japan, we have to innovate education methods; clinical training by clinical clerkship must be made more developed to foster the training of the excellent clinical physicians, and tutorial education by PBL or TBL and simulation-based learning should be introduced more actively.

PMID:

 

23896789

 

[PubMed - indexed for MEDLINE]