2010년의 미국과 캐나다 의학교육(Acad Med, 2010)

미국과 캐나다의 의학교육(Acad Med, 2010)

Medical Education in the United States and Canada, 2010
M. Brownell Anderson and Steven L. Kanter, MD

 

 

 

이 솔루션은 현재와 가까운 미래, 즉 기껏해야 한 세대에 대해서만 다룹니다. 향후 30년 동안, 필요성은 우리가 고려하지 않는 것으로 발전될 것이다.1(p143) 
This solution deals only with the present and the near future—a generation, at most. In the course of the next thirty years, needs will develop of which we here take no account.1(p143) 

2000년 9월, 많은 의대 교수진의 기여와 AAMC의 지원 덕분에, 학술 의학에 대한 부록인 "21세기 초 의대 교육의 스냅숏"이 출판되었다.
In September 2000, thanks to the contributions of many medical school faculty and the support of the AAMC, a supplement to Academic Medicine was published, “Snapshots of Medical Education at the Beginning of the 21st Century.”

2000년 부록은 확실히 그 주장을 잠재웠고 또한 유용한 참고 자료로 작용했다. 하지만 2000년 이후 의대생 교육에 지속적인 변화가 있었고, 2010년이 플렉스너 보고서 발간 100주년이기 때문에, 우리는 100주년 기념행사를 이용하여 지난 100년 동안, 그리고 지난 10년 동안 얼마나 많이 변화했는지 보여 주기 위해 현재의 부록을 만들었습니다. 다른 중요한 교육적 변화들 중에서, 8개의 새로운 의과대학의 설립과 다가오는 몇 년간의 더 많은 약속들을 보았다.
The 2000 supplement certainly put that claim to rest and also has served as a useful reference. But there has been continued change in the education of medical students since 2000, and since 2010 marks the 100th anniversary of the publication of the Flexner Report, we took advantage of the 100th anniversary celebration to create the present supplement to show how much has changed both in the past 100 years and in the past ten, a decade that, among other important educational changes, has seen the establishment of eight new medical schools and the promise of several more in the coming years.

1910년에는 155개의 북아메리카 의과대학이 있었다; Flexner는 이 각각의 의과대학들을 방문했다. 여러분은 이 부록을 읽고 미국과 캐나다에 있는 128개의 의과대학들을 "방문"하도록 초대받았습니다. 그 중 일부는 2년, 일부는 200년 이상 된 것입니다. 10년 안에 8개의 새로운 학교가 도입되고 10개 이상의 학교가 더 있을 것이라는 전망과 함께, 미국과 캐나다는 곧 더 많지는 않더라도 155개의 의과대학이 다시 생길 것이라는 것을 고려하는 것은 흥미롭다.

In 1910 there were 155 North American medical schools; Flexner visited each of these. You are invited to read this supplement and “visit” 128 medical schools in the United States and Canada, some a mere two years old, others more than 200 years old. It is interesting to consider that with the introduction of eight new schools in a decade and the prospect of another 10 or more, the United States and Canada will again soon have 155 medical schools, if not more.


이 부록의 작성 방법
How This Supplement Was Created

스냅샷 보고서의 설명 및 예제

Explanations and Examples from the Snapshots Reports

 

 

커리큘럼 관리 및 거버넌스 구조
Curriculum Management and Governance Structure

• 가능하면 커리큘럼 관리 및 거버넌스 구조에 대한 도표를 제공하십시오.
• 커리큘럼을 담당하는 위원회 또는 그룹을 식별합니다(즉, 커리큘럼 위원회가 있습니까? 상임위원회인가요? 전체 교육 프로그램을 책임지는 위원회 외에 커리큘럼 연도별로 커리큘럼 위원회를 구성하고 있는가?
• Please provide a diagram of the curriculum management and governance structure, if possible.
• Identify the committees or groups responsible for the curriculum (i.e., is there a curriculum committee? Is it a standing committee? Are there curriculum committees organized by year of the curriculum in addition to a committee with responsibility for the entire educational program?).

 

대부분의 보고서에는 교육 프로그램 및/또는 커리큘럼 관리에 대한 다이어그램이 하나 이상 포함되어 있습니다. 2000년 부록에 있었던 것보다 더 많은 도표가 있으며, 거의 모든 경우에, 그들이 묘사한 구조는 2000년 보다 더 복잡하다. 프로그램의 더 많은 통합이 있으며, 일반적으로 위원회의 활동은 "교육부학장"의 단일 사무실에서 조정된다. 캘리포니아 대학교, 샌디에이고, 의과대학, 로마 린다 의과대학은 이러한 접근법을 사용하는 학교 중 하나이다.
The majority of the reports contain one, sometimes more than one, diagram of the management of the educational program and/or the curriculum. There are more diagrams than there were in the 2000 Supplement, and in almost every case, the structures they depict are more complex than they were in 2000. There is more integration of the program, and typically the activities of the committees are coordinated in a single office of a “vice dean for education”; the University of California, San Diego, School of Medicine and Loma Linda University School of Medicine are two of the schools that use this approach.

위원회 구성원들이 더 이상 학과를 대표하지 않고 대신 교육 프로그램을 대표하기 때문에 일부 학교들은 교육 프로그램에 참여하는 사람들의 수를 줄였다. 예를 들어, 투싼과 피닉스의 애리조나 의과 대학과 UMDNJ-뉴저지 의과 대학 같은 일부 학교에서는 교육 프로그램의 변화를 수용하기 위해 위원회 구조가 더 복잡해졌다.
In some cases, schools reduced the number of individuals involved in the educational program because the members of the committee no longer represent departments but instead represent the educational program. In some schools, for example, the University of Arizona College of Medicine at Tucson and Phoenix and UMDNJ–New Jersey Medical School, the committee structure became more complex to accommodate change in the educational program.

2000년부터의 중요한 변화 중 하나는 의과대학 [사서]들을 교과과정 거버넌스의 구성원으로 포함시키는 것이다.

One of the significant changes from 2000 is the inclusion of medical school librarians as members of the curriculum governance.

의학교육청
Office of Medical Education

 

• 의대생 교육 프로그램의 지원을 담당하는 사무소가 있습니까?
  
• 의료교육과 지정사무실 또는 직원(전체 또는 시간제)이 있는가? 이 사무실/부서와 관련된 전문가/교육자는 몇 명입니까?
  
• 교육 프로그램에서 교육/의학 교육부의 역할은 무엇입니까?
  
• 교육청이 없을 경우 의료교육 활동(교육과정 담당 위원회 외)을 조직하고 지원하는 일차적인 책임은 누가 줍니까?
• Is there an office with responsibility for support of the medical student education program?
• Is there a designated office of medical education or department of medical education with staff (full or part-time)? How many professionals/ educators are associated with this office/ department?
• What is the role of the office of education/medical education unit in the educational program?
• If there is no office of education, who holds the primary responsibility to organize and support medical education activities (other than the committees responsible for the curriculum)?

 

응답 학교 128곳 중 6곳을 제외한 나머지 학교는 모두 지정된 의학교육실office of medical education이 있으며, 지정된 사무소가 없는 학교는 교육프로그램 지원실이 있다. 이 부록에 실린 그녀의 에세이에서, "의학 교육의 변화를 요구하는 10년간의 보고서: 그들은 뭐라고 하는가?",2 Skochelak는 의학 교육을 변화시켜야 할 필요성에 대한 다양한 발표된 보고서에서 공통적으로 다루는 8가지 주제를 파악한다. 진정한 변화가 일어나려면 원로 지도부의 지지가 중요하다는 게 주제 중 하나다. 모든 학교와 제공된 모든 다이어그램에서 교육 프로그램을 지원하는 사무실 또는 행정 단위는 학장에게 자문하고, 학장 및/또는 그 지명자는 교육 프로그램의 관리를 책임진다.
All but six of the responding 128 schools have a designated office of medical education and those without a designated office have an office for support of the educational program. In her essay in this supplement, “A Decade of Reports Calling for Change in Medical Education: What Do They Say?”,2 Skochelak identifies eight themes common to a variety of published reports about the need to change medical education. One of the themes is the importance of the support of senior leadership if true change is to occur. In every school and in every diagram provided, the office or administrative unit that supports the educational program is advisory to the dean, and the dean and/or his or her designee is responsible for the administration of the educational program.

많은 학교들이 새로운 사무실을 만들었지만, 어떤 학교들은 30년 이상 된 학교들도 있다 – 남부 캘리포니아 대학의 케크 의과대학은 1963년에 설립되었고, 반면에 시카고의 일리노이 의과대학은 1958년에 설립되었다.
While many schools created new offices, some are more than 30 years old – the unit at the Keck School of Medicine of the University of Southern California was established in 1963, while the unit at the University of Illinois College of Medicine at Chicago began in 1958.

이들 사무실은 교육과정을 지원하는 것 이상의 일을 하고 있으며, 대다수의 학교에서는 교육 프로그램에 대한 변경이 영향을 미치는지(스코켈락이 에세이에서 확인한 또 다른 주제)를 결정하기 위해 연구를 수행하고 있는 교수진을 포함하고 있다. 이 사무실들은 [교수개발]과 [교사로서의 전공의의 개발]을 지원한다. 이 사무실의 여러 업무 중 하나는 [학생 서비스]와 [학생 문제] 그리고 [교육 기술의 지원 및 구현]이다.
These offices do more than support the curriculum, and in the majority of the schools, they include faculty who are conducting research to determine whether changes being made to the educational program have an impact (another of the themes identified by Skochelak in her essay). These offices support faculty development and the development of residents as teachers; among the many duties of members of these offices are work with student services and student affairs and the support and implementation of educational technology.

의학교육실은 2000년보다 현재 [학제간 프로그램]에 더 많은 지원을 하고 있다. 예를 들어, 조지 워싱턴 대학교 의학과 보건과학대학은 2002년에 현재의 학제간의학교육실인 작은 사무실을 확장했다; 뉴욕 대학교 의과대학과 플로리다 주립 대학교 의과대학은 2009년에 교육 프로그램을 더 잘 지원하기 위해 그들의 기존 사무실을 개편했다.e-루이스빌 의과대학과 노스웨스턴 대학교 파인버그 의과대학은 학생 프로그램으로 확장되었다.
The offices of medical education provide more support now than in 2000 for interdisciplinary programs. For example, George Washington University School of Medicine and Health Sciences expanded a small office, which is now the Office of Interdisciplinary Education, in 2002; New York University School of Medicine and Florida State University College of Medicine reorganized their existing offices in 2009 to better support education programs, and at the University of Louisville School of Medicine and Northwestern University The Feinberg School of Medicine, offices were expanded to include student programs.

로욜라대학교 스트릿치 의과대학과 같은 학교에서는 의학교육실의 물리적 위치가 학습 커뮤니티의 한가운데에 의도적으로 자리 잡고 있다. 의과대학들이 교육 프로그램에 관심을 쏟고 있는 중요한 실례는 목록 1에서 보듯이 의과대학 학생 교육에 전념하는 건물을 후원하고 건설한 많은 학교들이다.

In schools such as Loyola University Stritch School of Medicine, the physical location of the office of medical education is deliberately located in the midst of learning communities. A significant illustration of the attention medical schools are giving to their educational programs is the large number of schools that have funded and constructed buildings devoted to medical student education, as shown in List 1.

 

새로운 의과 대학들 외에도 콜로라도 덴버 의과 대학 (Anschutz Medical Campus), 하와이 대학교 (University of Hawaii University of Mänoa John A. 번스 의과대학과 미시간 주립대학의 휴먼 의과대학은 의과대학에 대한 새로운 위치와 완전히 새로운 캠퍼스를 가지고 있다.

In addition to the new medical schools, the University of Colorado Denver School of Medicine (Anschutz Medical Campus), the University of Hawaii at Mãnoa John A. Burns School of Medicine, and Michigan State University College of Human Medicine have new locations and entirely new campuses for their medical schools.

 

교육 프로그램의 재정 관리
Financial Management of Educational Programs

 

우리 대학들은 의과대학 교육이 심각하고 비용이 많이 드는 벤처라는 것을 깨닫는 것이 중요하다. 그리고 의과대학은 의과대학에 대한 청구서를 제출하고 교육을 대학 평면에 투하할 준비가 되어 있지 않는 한, 의과대학과의 모든 연결을 거부하거나 종료해야 한다.
It is important that our universities realize that medical education is a serious and costly venture; and that they should reject or terminate all connection with a medical school unless prepared to foot its bills and to pitch its instruction on a university plane.1(p13)

 

• 교육 프로그램을 계속 지원하기 위해 현재의 재정 위기를 어떻게 해결했습니까?
• How have you addressed the current financial crises to continue to support the educational programs?

 

이 질문에 대한 반응은 행복한 놀라움을 보여주었다. 학교들은 경기 침체가 영향을 미쳤다는 것을 인정했지만, 그 결과는 교육 프로그램을 보호하기 위한 움직임과 프로그램의 중요성을 강화한 것이 가장 많았다. 리소스를 중앙 집중화해야 하는 필요성이 효율성 향상으로 이어졌습니다. 오직 두 개의 학교에서만 실제 인원 감축이 있었다. 일부 사례에서 교수진은 연장된 '휴가'나 휴학을 강요받았고, 샌디에이고 의과대학 캘리포니아대에서는 수강료가 인상됐다. 하버드 의과대학과 세인트 워싱턴 대학교. 루이스 의과대학은 급여 인상이 없었다고 말했다.
The responses to this question presented a happy surprise. While the schools acknowledged that the downturn in the economy had an impact, the result was most often a move to protect the educational program and a subsequent strengthening of the importance of the program. The need to centralize resources led to greater efficiency. At only two schools was there actual downsizing of staff. In a few cases, faculty were forced to take extended “vacations” or furloughs, and at the University of California, San Diego, School of Medicine, there was an increase in student fees. Harvard Medical School and Washington University in St. Louis School of Medicine noted there were no salary increases.

학교들은 [지역 사회 및 지역 캠퍼스 커뮤니티와 제휴]하여 임상 교대에 필요한 지원을 제공하고 교육 프로그램을 지원하기 위한 수익을 창출하였다. 거의 모든 학교들은 학과 예산에서 배정된 것 외에 학장실과 학장의 교육 프로그램 지원금에 주목했다.
The schools developed partnerships with communities and with regional campus communities to provide the necessary support for clinical rotations and to generate revenue to support the educational program. Almost every school noted the support from the dean's office and a dean's fund for the educational program, in addition to that allocated from department budgets.

몇몇 학교는 [미션 기반 예산 운영]을 하고 있으며, 예산은 의대생 교육 노력에 따라 부서에 배정된다. 보스턴 의과대학, 매사추세츠 의과대학, UMDNJ-뉴저지 의과대학, 마운트 시나이 의과대학, 베일러 의과대학, 펜실베이니아 주립 의과대학 등이 있다.
Several schools have a mission-based budget management, and budgets are allocated to departments based on medical student teaching effort. Among those schools are Boston University School of Medicine, the University of Massachusetts Medical School, UMDNJ–New Jersey Medical School, Mount Sinai School of Medicine, Baylor College of Medicne, and Pennsylvania State University College of Medicine.

두 개 이상의 학교에서, 재정 위기는 분배된 자금의 수준과 교육 및 연구에 대한 부서의 참여를 연계하기 위해 새로운 방법론의 개발을 촉진하였다.
In more than one school, the financial exigencies fostered the development of new methodology to link the level of funds distributed and a department's participation in education and research.

교육 프로그램을 위한 예산이 따로 있는 학교들이 있습니다. 앨라배마 의과대학과 테네시 의과대학 건강과학센터, 의과대학, 프로그램에서는 첫 2년 동안에 대하여. 그리고 유타 의과대학의 전체 커리큘럼을 위하여 (다시 말해서, 그 학교의 교육의 중요성을 강조함) 오타와 의과대학은 교육을 위한 헌신적인 기금을 가지고 있다.

There are schools with a discrete budget for the educational program, including the University of Alabama School of Medicine and the University of Tennessee Health Science Center, College of Medicine, for the first two years of the program, and for the entire curriculum at the University of Utah School of Medicine (which, in turn, highlights the importance of education at that school). The University of Ottawa Faculty of Medicine has dedicated funds for education.

가치 교육
Valuing Teaching

반면에 의과대학이나 대학 교수진의 모든 교수가 진정으로 생산적인 과학자라는 것은 결코 일어나지 않을 것이다. 또 다른 유형의 남성들을 위한 공간이 있는데, 넓은 학습, 지속적인 수용성, 비판적 감각, 반응적 관심의 비생산적이고 동화적인 교사이다. 동정심에서는 카톨릭 신자, 정신과 방법에서는 학구적인 이 남성들이 새로운 아이디어가 조화를 이루고 최신이 되는 구매자와 배급자를 증명하는 경우가 드물지 않다. 그들은 균형을 유지하고 관계를 맺습니다. 의과대학에 자리가 없는 단 한 사람은 바로...[과학적으로 죽어있는 교육자practitioner]이다. 그의 지식은 정지한 지 오래고 그의 강의는, 그가 처음 의자에 앉았을 때, 마치 시냇물에 굴러다니는 조약돌처럼, 시간이 흐를수록 점점 더 부드러워진다.1

On the other hand, it will never happen that every professor in either the medical school or the university faculty is a genuinely productive scientist. There is room for men of another type, the nonproductive, assimilative teacher of wide learning, continuous receptivity, critical sense, and responsive interest. Not infrequently these men, catholic in their sympathies, scholarly in spirit and method, prove the purveyors and distributors through whom new ideas are harmonized and made current. They preserve balance and make connections. The one person for whom there is no place in the medical school….the scientifically dead practitioner, whose knowledge has long since come to a standstill and whose lectures, composed when he first took the chair, like pebbles rolling in a brook get smoother and smoother as the stream of time washes over them.1

♦ 귀하의 학교에는 교육자를 위한 학원/학원이 있습니까?
♦ 홍보 및 테뉴어 과정은 가르침을 어떻게 가치 있게 하는가?

• ♦ Does your school have an academy/ institute for educators?
• ♦ How does the promotion and tenure process value teaching?

2000년, 두 학교(캘리포니아 대학교, 샌프란시스코 대학교, 의과 대학, 시카고 일리노이 의과 대학)는 교수진을 지원하는 아카데미를 설립했다. 2010년에 아카데미가 있는 학교는 부록 1에 명시되어 있다; 이 글의 현재 또는 곧 개교할 65개의 학교가 있다. 또한, 캘리포니아 대학교, 샌프란시스코, 의과 대학, 조지아 의과 대학, 하버드 의과 대학 등 일부 학교는 학원의 영향과 결과에 대한 기사를 실었다. 2008년 하버드에서 교직은 "교직과 교육 리더십"이 교수진의 우수 영역으로 지정되었기 때문에 승진과 종신 재직 분야에서 새로운 단계로 격상되었다.
In 2000, two schools (the University of California, San Francisco, School of Medicine, and the University of Illinois College of Medicine at Chicago) had identified academies to support the faculty. Schools with academies in 2010 are identified in Appendix 1; as of this writing, there are 65 in existence or about to be launched. In addition, some of the schools—the University of California, San Francisco, School of Medicine, the Medical College of Georgia, and Harvard Medical School—have published articles about the impact and the outcomes of the academies. In 2008, at Harvard, teaching was elevated to a new level in the areas of promotion and tenure because “teaching and educational leadership” was designated as an area of excellence for faculty.

지정된 아카데미가 없는 학교들은 다양한 교수상을 제공하며, 종종 졸업식 때 수여되며, 모두 강력한 교수진 육성 프로그램을 가지고 있다. 보고서 전반에 걸쳐 교수진 개발에 대한 관심이 확연히 높아지고 있다. 푸에르토리코에 있는 Universidad Central del Caribe School of Medicine에서, 새로운 위원회가 교직원의 교육을 지원하기 위한 평가 기준과 도구를 확립하는 데 전념하는 데 임명되었다. 그리고 유타 의과대학에서 전문성, 책임감, 평가에 전념하는 새로운 사무실이 설립되었습니다; 그 목표들 중 하나는 의료 교육에 대한 교수진의 기여도를 평가하는 것입니다. 컬럼비아 대학교 의사 및 외과의 대학에는 성찰적 실천을 촉진하는 교수진 개발 프로그램이 있으며, 뉴욕 메디컬 칼리지에는 "교사로서의 레지던트" 프로그램이 있다.
The schools without designated academies offer various teaching awards, often conferred during commencement, and all have strong faculty development programs. Throughout the reports, there is a decided increase in attention to faculty development. At Universidad Central del Caribe School of Medicine in Puerto Rico, a new committee has been named devoted to establishing criteria for the evaluation of and tools to support faculty teaching. And at the University of Utah School of Medicine, a new office has been created that is devoted to professionalism, accountability, and assessment; one of the goals is to evaluate faculty contributions to medical education. At Columbia University College of Physicians and Surgeons there is a faculty development program to promote reflective practice, and at New York Medical College there is a “Resident as Teacher” program.

일부 학교는 정식 아카데미가 없는 대신 사회와 학회 내 교직원이 지원돼 의대생 교육에 시간(30%)을 할애할 수 있는 소사이어티(에모리대 의대)를 두고 있다. 워싱턴 대학 의과대학 프로그램은 의과대학 교수들로 구성된 학습 커뮤니티를 만들었다. 웨이크 포레스트 대학 보건과학대학은 교수진의 핵심 그룹을 지정하는 메커니즘을 마련했다.
Some schools do not have a formal academy but have societies (Emory University School of Medicine) where students are assigned to societies and faculty in the societies are supported so they can devote time (30%) to medical student education. At the University of Washington School of Medicine the Colleges program has created a learning community of medical school faculty. Wake Forest University Health Sciences School of Medicine has instituted a mechanism to designate a core group of teaching faculty.

학교들은 다르지만 모두 똑같이 가치 있는 교수진의 종류가 있다는 Flexner의 주장을 인정하기 위해 다른 트랙을 개발했습니다. [임상 교육자 트랙]은 1997년 예일 대학교 의과대학에서 시작되었다. 비슷한 트랙이 보스턴 의과대학이나 폰세 의과대학 같은 곳에 존재한다. 어떤 경우에는 "교육 트랙"이 비정년 트랙이 되기도 하지만, 모든 경우에 있어서 승진의 기초는 탁월한 교육excellence in teaching이다. 한 학교는 교육과정 개혁이 교수진 교육의 중요성과 교수진의 시간 보호에 초점을 맞춰 새로운 교육과정 시행에 성공했다고 지적한다.
Schools have developed different tracks to acknowledge Flexner's assertion that there are different and equally valuable kinds of faculty. A clinical educator track was initiated at Yale University School of Medicine in 1997. A similar track exists at places like Boston University School of Medicine and Ponce School of Medicine. In some instances the “teaching track” is a nontenure track, but in every instance the basis for promotion is excellence in teaching. One school notes that its curriculum reform focused on the importance of faculty teaching and on protecting faculty members' time so they could succeed in implementing the new curriculum.

이 학교들은 승진과 종신 재직권 정책에서의 장학금 4와 종신 재직권에 대한 요건으로 teaching을 포함시키고, 승진과 종신 재직권이 부여되는 하나의 기준으로 교육적 우수성에 초점을 맞추고 있다고 보고한다.
The schools report an increased focus on scholarship4 in their promotion and tenure policies and the inclusion of teaching as an expectation for tenure (University of Arkansas for Medical Sciences College of Medicine) and educational excellence as one criteria on which promotion and tenure are granted (University of Alabama School of Medicine).

교육적 가치 단위(EVU, Relative Value Unit, RVU)는 사우스 플로리다 의과대학과 버지니아 커먼웰스 의과대학에 개설된 교육적 노력과 자원의 정렬이다. 한 학과에서 시행된 아이오와 대학교 카버 의과대학에서, 그 성공으로 의과대학 전체에 걸쳐 새로운 학장이 그것을 시행하게 되었다.

The Educational Value Unit (EVU—also called the Relative Value Unit (RVU)—is the alignment of resources with teaching effort that has been instituted at the University of South Florida College of Medicine and at the Virginia Commonwealth University School of Medicine. At the University of Iowa Carver College of Medicine, where it was implemented in a department, its success led a new dean to implement it throughout the medical school.

 

커리큘럼 갱신 프로세스
'Curriculum Renewal Process

 

• 현재 진행 중인 품질 개선 활동 외에 이 프로세스가 시작된 날짜가 따로 있었습니까?
  
• ' 커리큘럼 갱신 프로세스의 주요 목표를 식별합니다.
• '갱신 프로세스의 구성 요소를 식별합니다.

 

• ‘Was there a particular date on which this process was launched in addition to being an ongoing quality improvement activity?
• ‘Identify the key objectives for the curriculum renewal process.
• ‘Identify the components of the renewal process.

부록 1의 "교육과정 갱신" 열에 있는 날짜는 모든 대응 학교가 커리큘럼 검토 및 갱신에 대한 진행 중인 프로세스와 이 과정에 참여했던 연도를 가지고 있음을 나타낸다. 이들 중 상당수는 다음과 같은 새로운 커리큘럼의 상표명을 보유하고 있습니다.
The dates in the “curriculum renewal” column of Appendix 1 indicate that every responding school has an ongoing process for curriculum review and renewal and the years in which they have been engaged in this process. Many of them have trademarked names for their new curricula including:

 

 

• 사회에의 유전자—존스 홉킨스 의과대학
  
• 쥬빌리 커리큘럼—미국 뉴저지 의과대학(UMDNJ)-뉴저지 의과대학
  
• 컬럼비아 교육과정—Columbia University 의사 및 외과의 대학
  
• 21세기 교육과정 - 뉴욕대학교 의과정에 관한 연구
  
• 더블 헬릭스—로체스터 의과대학 및 치과대학
  
• 우수성을 위한 기반—듀크 의과대학
  
• 환자 중심 학습—North Dakota University of Medicine and Health Sciences
  
• 커리큘럼 2000—Pennsylvania University of Medicine
  
• 버몬트 통합 교육과정 - 버몬트 의과대학
  
• 나침반 교육 과정—Michael G. DeGroote School of Medicine of Health Sciences, McMaster University
• Genes to Society —Johns Hopkins University School of Medicine
• Jubilee Curriculum—University of Medicine and Dentistry of New Jersey (UMDNJ)–New Jersey Medical School
• Columbia Curriculum—Columbia University College of Physicians and Surgeons
• Curriculum for the 21st Century—New York University School of Medicine
• Double Helix—University of Rochester School of Medicine and Dentistry
• Foundations for Excellence—Duke University School of Medicine
• Patient-Centered Learning—University of North Dakota School of Medicine and Health Sciences
• Curriculum 2000—University of Pennsylvania School of Medicine
• The Vermont Integrated Curriculum (the VIC) —University of Vermont College of Medicine
• COMPASS curriculum—Michael G. DeGroote School of Medicine Faculty of Health Sciences, McMaster University

 

커리큘럼 갱신은 사회적 관심사, 의료 격차, 품질 향상, 노인 돌봄, 완화의료, 말기 진료 등을 해결하기 위한 의료 교육의 필요성에 의해 동기 부여되었다. [통합]은 각 프로그램의 핵심 요소이다. 학생들의 프로그램에서 [유연성]을 창조하는 것은 문화적 역량, 다양성, 노인학에 대한 강조와 함께 다른 사람들에게 동기를 부여했다. 이러한 각각의 동기 부여 요인이 스코켈라크의 리뷰에서 확인된다는 것은 흥미롭다.2
The curriculum renewal has been motivated by the need for medical education to address societal concerns, health care disparities, quality improvement, care for the elderly, palliative care, and end-of-life care, among other areas; integration is a key ingredient of each program. Creating flexibility in the students' programs motivated others, coupled with an increased emphasis on cultural competency, diversity, and geriatrics. It is interesting to note that each of these motivating factors are identified in Skochelak's review.2

 

대부분의 보고서에 설명된 커리큘럼을 통해 짜여진 것은 의학에 기초하는 과학의 탄탄한 기초와 함께 [임상 의학에 대한 조기 노출]이다. 입원환자 교육 현장의 변화, 병원 밖에서의 임상 교육의 이동, 새롭고 다른 종류의 의대생이 있다는 인식에서 개혁의 추가적인 동기가 나왔다. 하나는 정교함과 세계 경험을 증가시킨다고 묘사된다.
Woven throughout the curricula described in most of the reports is early exposure to clinical medicine with a solid grounding in the sciences basic to medicine. Additional motivation to reform has come from changes in inpatient teaching sites, the movement of clinical education out of the hospital, and the recognition that there is a new and different kind of medical student, one described as having increased sophistication and world experience.

앨라배마 의과대학, 노스웨스턴 대학 파인버그 의과대학, 버지니아 의과대학은 모두 의학에 기초하는 과학의 중요성을 강조하면서 임상 및 기초과학의 커리큘럼 통합의 예를 제공한다; 애리조나 의과대학은 다음과 같은 것들을 포함한다.인문학을 포함한 행동 및 사회과학에 대해 설명합니다. 모든 경우에 있어서, 그 접근 방식은 캘리포니아 대학교 샌프란시스코 의과대학에서 보여지는 협력적 학습의 하나이다.
The University of Alabama School of Medicine, Northwestern University The Feinberg School of Medicine, and the University of Virginia School of Medicine all provide examples of curricular integration of the clinical and basic sciences, emphasizing the importance of the sciences basic to medicine; the University of Arizona College of Medicine includes the behavioral and social sciences, including the humanities. In every case, the approach is one of collaborative learning, as illustrated by the program at the University of California, San Francisco, School of Medicine.

의과대학 경험 전반에 걸쳐 의학분야의 전문직업성을 강조하는 커리큘럼의 예로는 맥길대 의과대학 내과대학 내과대학에서 4년간 '리본'으로 운영되는 분야를 강조하는 과정으로 구성돼 있다.
An example of a curriculum that emphasizes professionalism in medicine throughout the medical school experience is the physicianship program at McGill University Faculty of Medicine, which consists of courses emphasizing those areas that run as “ribbons” through the four years.

전문직업성에 대한 주제는 메릴랜드 의과대학, 드렉셀 의과대학 (전문 피어 리뷰 포함), 토마스 제퍼슨 의과대학의 제퍼슨 의과대학과 같은 거의 모든 학교의 포커스였다.

The topic of professionalism is a focus in almost all schools–for example, at the University of Maryland School of Medicine, Drexel University College of Medicine (which includes Professional Peer Review), and Jefferson Medical College of Thomas Jefferson University.

학습 성과/역량
Learning Outcomes/Competencies

• 당신의 학원은 당신의 졸업생들을 위해 확인된 능력이나 학습 성과를 가지고 있는가? 그렇다면 사본을 포함하십시오.
• Does your institution have competencies or learning outcomes identified for your graduates? If so, please include a copy.

 

 

이 질문이 있었던 것은, 10년 전만 해도 소수의 학교만이 학습 성과를 명확하게 밝혀냈기 때문이다. 이젠, 모든 학교에는 이런 학습 성과, 때로는 능력이라고 불리는 것들이 있을 뿐만 아니라, 대개 학교 웹사이트에서 이용할 수 있는 목록들도 있습니다. 부록 1은 이러한 학습 결과를 가진 모든 학교에 대한 표시를 제공하며, 개별 문서에는 가능한 경우 목표 URL이 포함되어 있습니다. 학교들은 ACGME 핵심역량, 5 의과대학 목표 프로젝트 보고서 I, 6 캔메드, 7 그리고 한 가지 사례로는 모범 의료 관행 – USA.8을 사용하여 학습 성과를 공식화하였다.
This question was posed to the schools because ten years ago, only a handful of the schools had identified learning outcomes that were articulated. Now, not only does every school have these learning outcomes, sometimes called competencies, but they have lists available, usually on the school Web site. Appendix 1 provides an indication of all the schools with these learning outcomes, and the individual articles contain the URLs for the objectives, wherever possible. The schools formulated their learning outcomes using the ACGME core competencies,5 the Medical School Objectives Project Report I,6 Canmeds,7 and in one case, Good Medical Practice – USA.8

 

학습 성과와 역량의 명백한 목적은 교육 프로그램이 달성해야 하는 목표를 명확히 설명하는 것이다. 이러한 목표를 달성하기 위한 학교들의 노력은 다음 세 절에 요약되어 있다.

The obvious purpose of the learning outcomes and competencies is to articulate the goals that the educational program should achieve. The schools' efforts to achieve those goals are summarized under the next three sections.

 

커리큘럼의 새 항목
New Topics in the Curriculum

 

• 2000년 이후 학교 커리큘럼에 새로 추가된 주제를 파악합니다.
  
• 환자 안전, 품질 개선, 팀 기반 학습 및 시뮬레이션에 대한 주제를 구체적으로 설명합니다.
• Identify any topics that are new to your school's curriculum since 2000.
• Comment specifically on the topics of patient safety, quality improvement, Team-Based Learnin, and simulations.

우리는 학교들의 구체적인 반응을 부록 1에 요약했지만, 동일한 관심사가 학교 보고서에 기술된 많은 새로운 주제이다. 여기에는 다음이 포함됩니다.

We have summarized the schools' specific responses in Appendix 1, but of equal interest are the many new topics described in the school reports. These include:

 

• 비판적 사고/임상적 추론: 세인트루이스 의과대학과 뉴욕 의과대학
  
• 생체 테러, 재난 준비: Loma Linda University of Medicine; Howard University of Medicine; 툴레인 대학교 의과대학; 보건과학 대학교 F. 에드워드 헤버트 의과대학; 올버니 의과대학; 신시내티 의과대학; 피츠버그 의과대학
  
• 노인학: 시카고 대학 생물과학부 프리츠커 의과대학(완화진료 포함) 미주리 대학교 - 캔자스 시립 의과대학 (전체에 통합) 오클라호마 의과대학과 사우스캐롤라이나 의과대학(그들의 "Senior Mentor"
  
• 의료 서비스 차이: 시카고 대학 생물과학부 프리츠커 의과대학 폰세 의과대학 위스콘신 의과대학
  
• 문화적 다양성/문화적 역량: 뉴저지 의과대학 로버트 우드 존슨 의과대학, 노스 다코타 의과 및 보건과학 대학(인디안 인더스 인더스 인더스 인더스 인더스 인더스 인더스 의과대학) 텍사스 기술 대학교 보건 과학 센터 의과 대학(스페인어 의학) 텍사스 공과대학교 보건과학센터 폴 L. 포스터 의과대학과 워싱턴 의과대학
  
• 학생에게 필요한 학자/연구 활동: 다른 많은 학교들 중에서, 다음 학교들은 의대생들을 위한 필수 연구 또는 학술 활동을 시행하고 있다. 앨라배마 의과 대학; 피닉스 애리조나 의과 대학; 아이오와 의과 대학; 스탠포드 의과 대학; 콜로라도 덴버 의과 대학; 노스웨스턴 대학교 더 페인버그 의과 대학; 뉴저지 의과 대학d 존슨 의과대학; 뉴멕시코 의과대학; 예시바 대학의 알버트 아인슈타인 의과 대학; 컬럼비아 대학 의사 및 외과의사 의과 대학; 듀크 대학 의학 대학; 케이스 웨스턴 리저브 대학 의과 클리블랜드 클리닉; 펜실베니아 주립 대학센트럴 플로리다 의과 대학; 그리고 피츠버그 의과 대학.
  
• 집중적인 개별화된 연구 경험: 플로리다 의과 대학, 버몬트 의과 대학, 에모리 의과 대학, 시카고 대학 학부(학생의 60% 이상이 그들의 연구를 발표한 곳)
  
• 레즈비언, 게이, 양성애자, 성전환자 – 보스턴 의과대학
  
• 예일대학교 의과대학은 "파워 다이내믹스"를 보고 학생들에게 병원 내 복잡한 파워 다이내믹스와 의학과 상호 전문성의 실천을 소개한다.
• Critical thinking/clinical reasoning: Saint Louis University School of Medicine and New York Medical College
• Bioterrorism, disaster preparation: required at Loma Linda University School of Medicine; Howard University College of Medicine; Tulane University School of Medicine; Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine; Albany Medical College; University of Cincinnati College of Medicine; and the University of Pittsburgh School of Medicine, among others
• Geriatrics: University of Chicago Division of the Biological Sciences Pritzker School of Medicine (including palliative care); University of Missouri– Kansas City School of Medicine (integrated throughout); University of Oklahoma College of Medicine; and the University of South Carolina School of Medicine (their “Senior Mentor” program)
• Health care disparities: University of Chicago Division of the Biological Sciences Pritzker School of Medicine; Ponce School of Medicine; Medical College of Wisconsin
• Cultural diversity/cultural competence: University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School; University of North Dakota School of Medicine and Health Sciences (Indians into Medicine); Texas Tech University Health Sciences Center School of Medicine (medical Spanish); Texas Tech University Health Sciences Center Paul L. Foster School of Medicine; and University of Washington School of Medicine
• Required scholarly/research activity for students: Among many others, the following schools have in place a required research or scholarly activity for medical students: University of Alabama School of Medicine; University of Arizona College of Medicine, Phoenix; University of Iowa Carver College of Medicine; Stanford University School of Medicine; University of Colorado Denver School of Medicine; Northwestern University The Feinberg School of Medicine; University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School; University of New Mexico School of Medicine; Albert Einstein College of Medicine of Yeshiva University; Columbia University College of Physicians and Surgeons; Duke University School of Medicine; Case Western Reserve University School of Medicine and Cleveland Clinic; Pennsylvania State University College of Medicine; University of Central Florida College of Medicine; and University of Pittsburgh School of Medicine.
• Focused individualized research experience: the University of Florida College of Medicine; University of Vermont College of Medicine, Emory University School of Medicine; and the University of Chicago Division of the Biological Sciences Pritzker School of Medicine (where more than 60% of students have published their research)
• Lesbian, gay, bisexual, and transsexual topics – Boston University School of Medicine
• Yale University School of Medicine reports on “Power dynamics” to introduce students to the complicated power dynamics in the hospital and the practice of medicine and interprofessionalism.

 

사회적 책무성은 스코첼락이 에세이 2에서 확인한 주제 중 하나로 많은 학교가 지역사회에 대한 학교의 관계, 사회적 책임, 서비스 학습 기회에 대해 보고한다. 이러한 서비스 학습 경험은 아이오와 대학교 카버 의과대학; 애리조나 대학교 의과대학; 조지타운 대학교 의과대학에서 "Social Justice Scholars" 프로그램을 통해 볼 수 있으며, 플로리다 국제대학교 허버트 워트하임 의과대학과 이웃돕기 프로그램을 통해 볼 수 있다.의학의 우얼(1학년 프로그램); 하와이 대학교 마노아 존 A. 번스 의과대학; 툴레인 대학 의과 대학; 보스턴 의과 대학; 미시간 주립 대학 인체의학 대학 (사회 헌신을 위한 계약) 미주리 대학교 – 캔자스 시립 의과 대학, 뉴저지 의과 대학 로버트 우드 존슨 의과 대학 및 뉴멕시코 의과 대학; 버지니아 공대 의과 및 연구소에서 전문 서비스 학습을 가르칩니다. 뉴욕 주립 대학교 스토니 브룩 대학 의학 센터에서는 학생이 운영하는 클리닉을 설명하고 있으며, 웨스트 버지니아 대학 의과대학의 버섯 프로젝트는 노숙자들을 위한 학생 주도의 클리닉이다.
Social accountability is one of the themes Skochelak identified in her essay2 and many of the schools report on the relationship of the school to the community, its social responsibility, and service learning opportunities. These service learning experiences can be found at the University of Iowa Carver College of Medicine; University of Arizona College of Medicine; Georgetown University School of Medicine with its “Social Justice Scholars” program; Florida International University Herbert Wertheim College of Medicine with the Neighborhood HELP program; Morehouse School of Medicine (a first-year program); University of Hawaii at Mãnoa John A. Burns School of Medicine; Tulane University School of Medicine; Boston University School of Medicine; Michigan State University College of Human Medicine (The Contract for Social Commitment); University of Missouri – Kansas City School of Medicine; University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School and the University of New Mexico School of Medicine; interprofessional service learning is taught at Virginia Tech Carilion School of Medicine and Research Institute. The State University of New York, Stony Brook University Medical Center describes a student-run clinic, and the MUSHROOM project at West Virginia University School of Medicine is a student-initiated clinic for the homeless.

지역 봉사 프로그램이 있는 학교로는 템플 대학교 의과대학, 유니버시아드 센트럴 델 캐리비어 의과대학, 이스트 테네시 주립 대학교 등이 있다. 텍사스 공과대학교 보건과학센터 폴 L. Foster School of Medicine은 지역사회와 학생들에게 멕시코/미국 국경에서의 경험을 제공하는데 전념하고 있다. 지역사회 단체와 협력할 수 있는 기회는 맥길 대학교 의과대학에 있는 지역사회 건강 동맹 프로그램(CHAP)에서도 찾을 수 있다.
Schools with community service programs include Temple University School of Medicine, Universidad Central del Caribe School of Medicine, and East Tennessee State University. Texas Tech University Health Sciences Center Paul L. Foster School of Medicine has a commitment to community and to providing students with experiences at the Mexico/US border. Opportunity to work with community organizations are also found at the Community Health Alliance Program (CHAP) at McGill University Faculty of Medicine.

[영성과 의학]과 같은 주제에 관한 종방향 커리큘럼은 루이스빌 의과대학과 이스트캐롤라이나 대학의 브로디 의과대학에서 찾을 수 있다. 버몬트 의과대학은 [영적 치료, 지구 건강, 영양]과 같은 주제에 대한 종적 커리큘럼을 도입했다. Vanderbilt University School of Medicine에서는 1-3년 동안 진행되었던 [만성 질환 교육과정]이 있으며, Virginia Commonwealth University School of Medicine에서는 종방향 커리큘럼이 있다.

Longitudinal curricula in topics such as spirituality and medicine are found at the University of Louisville School of Medicine and at the Brody School of Medicine East Carolina University. The University of Vermont College of Medicine has introduced longitudinal curricula on topics such as spiritual care, global health, and nutrition (to name a few). There is a chronic illness curriculum threaded through years 1–3 at Vanderbilt University School of Medicine, and a longitudinal curriculum at Virginia Commonwealth University School of Medicine

 

교육학의 발전
Advances in Pedagogy

 

사실, 이 recital에 언급된 많은 학교들은 아마도 어떤 종류의 특징도 보충하지 못할 것이다.교재는 교재나 퀴즈 보상의 비지시적 리허설이며, 환자, 악기, 모델, 그림 없이 가르친 수술과 마주친다. 1(p142)
As a matter of fact, many of the schools mentioned in the course of this recital are probably without redeeming features of any kind…The teaching is an uninstructive rehearsal of textbook or quiz compend; one encounters surgery taught without patient, instrument, model or drawing. 1(p142)

 

• 2000년 이후 교육학에서 어떤 변화가 시행되었는가?
  
• 그러한 교육학적 변화의 성공은 어떻게 측정되었는가?
• What changes, if any, in pedagogy have been implemented since 2000?
• How was the success of such pedagogical changes measured?

한 학교(토머스 제퍼슨 대학의 제퍼슨 의과대학)는 "교육학의 변화에 영향을 받지 않은 커리큘럼의 한 요소는 없습니다."라고 지적한다. 이것은 2000년 이후 그리고 확실히 플렉스너 보고서 이후 교육학의 변화에 대한 정확한 설명이다.
One school (Jefferson Medical College of Thomas Jefferson University) notes that “there is not one element of the…. curriculum that has not been affected by changes in pedagogy.” This is a fair description of the changes in pedagogy since 2000 and certainly since the Flexner Report.

학교 대부분은 문제 기반 학습과 팀 기반 학습의 지속적 성장 등 [강의 시간 감소]와 [능동적 학습]의 증가에 주목했다.
Most of the schools noted a continued reduction in lecture time and an increase in active learning, including continued growth of problem-based learning and Team-Based Learning.

[시뮬레이션]은 표 1의 영역으로 포함되며, 모든 학교는 다양한 형태의 시뮬레이션 적용에 대해 기록합니다.
Simulation is included as an area on Table 1, and every single school writes about the application of simulations in their various forms.

 

예를 들어, Morehouse School of Medicine, University of Morhouse School of Medicine, ITunesU, University of Biological Sciences Pritzker School of Medicine(TIME) 프로젝트와 같은 온라인 강의 자료를 사용하면 전체 커리큘럼을 통해 강의 내용을 이용할 수 있습니다. 전임상 학년과 임상 학년 교육의 통합을 촉진한다. 존스 홉킨스 의과 대학과 터프츠 의과 대학을 포함한 많은 학교에는 [학습 관리 소프트웨어]가 설치되어 있다. 밴더빌트 의과대학에는 새로운 [경험학습 및 평가 센터(CELA)]가 생겼으며, 올해 오타와 의과대학에 개설된 시뮬레이션 센터가 있다. 
The use of online materials for instruction— for example, at Morehouse School of Medicine; the University of Central Florida College of Medicine (ITunesU); the University of Chicago Division of the Biological Sciences Pritzker School of Medicine (the Technology in Medical Education (TIME) project)—makes the entire curriculum available through online media, fostering integration between preclinical and clinical years. There is learning management software in place at many schools, including Johns Hopkins University School of Medicine and Tufts University School of Medicine. Vanderbilt University School of Medicine has a new Center for Experiential Learning and Assessment (CELA), and there is a simulation center opening this year at the University of Ottawa Faculty of Medicine.

사우스캐롤라이나 대학교 의과대학은 [무선wireless 캠퍼스]이며 수직 초음파 교육과정을 시행하고 있다.
The University of South Carolina School of Medicine is a wireless campus and has implemented a vertical ultrasound curriculum.

사우스 앨라배마 의과 대학과 터프츠 의과 대학을 포함한 여러 학교들이 교육 프로그램 전반에 걸쳐 [청중 반응 시스템]을 시행하고 있다. 자료는 텍스트북보다는 [팟캐스트를 통하거나 오디오 및/또는 비디오 녹화된 강의](로잘린드 프랭클린 의과대학의 시카고 의과대학)를 통해 전달된다. [스트리밍 비디오]는 또한 [분산 교육 사이트 간의 교육 일관성]을 강화하는 데 사용된다.
Several schools have implemented audience response systems throughout the educational program, including the University of South Alabama College of Medicine and Tufts University School of Medicine. Material is delivered not through textbooks as often as through podcasts of lectures and teaching materials, and via audio and/or video recorded lectures (Chicago Medical School at Rosalind Franklin University of Medicine and Science). Streaming videos are also used to foster consistency in teaching across distributed education sites.

많은 학교들이 [사례 기반 학습]을 시행하고 있다. 임상 프레젠테이션을 중심으로 커리큘럼을 구성한 학교에는 노스이스트 오하이오 대학 의과 대학, 텍사스 공과 대학 보건 과학 센터 폴 L이 있다. 포스터 의과대학과 캘거리 의과대학. 유타 의과대학은 여러 학교와 마찬가지로 더 이상 학과별로 커리큘럼을 구성하지 않고, 오히려 통합적이고 질병에 기반을 두고 있다.

Many schools have implemented case-based learning. Schools that have organized the curriculum around clinical presentations include Northeastern Ohio Universities College of Medicine; Texas Tech University Health Sciences Center Paul L. Foster School of Medicine; and the University of Calgary Faculty of Medicine. The University of Utah School of Medicine, like several schools, no longer has organized the curriculum along departmental lines; rather, it is integrated and disease-based.

거의 모든 학교 보고서는 교육 및 평가를 위한 표준화된 환자(SP)의 사용이 증가하고 있다는 점에 주목하고 있다. 사우스 플로리다 의과대학. Rush Medical College에는 새로운 SP 센터가 있습니다; Rush Medical College에는 SP와 만나는 학생이 행동 과학자와 함께 검토되는 의사 자격 프로그램이 있습니다. 머서대학교 의과대학은 1년 2년 후에 학생들이 하나의 "지정된" SP와 함께 연속성을 설정하면서 작업하는 프로그램을 가지고 있다. 루이빌 의과대학에는 SP와 시뮬레이션 센터가 있으며, 신시내티 의과대학은 심센터에 대해 보고한다.

Almost every school report notes an increased use of standardized patients (SPs) for teaching and assessment. The University of South Florida College of Medicine. has a new SP center; Rush Medical College has a physicianship program in which student encounters with an SP are reviewed with a behavioral scientist. Mercer University School of Medicine has a program in which students work with one “designated” SP in a continuity setting in years one and two. The University of Louisville School of Medicine has an SP and simulation center, and the University of Cincinnati College of Medicine reports on their SimCenter.

 

앞에서 언급했듯이, TBL은 라이트 주립 대학교 분쇼프 의과 대학과 오클라호마 의과 대학을 포함한 많은 학교에서 시행되고 있다. 북부 온타리오 의과대학(Northern Ontario School of Medicine)은 팀 학습을 전문학문(Interprofessional learning)이라고 하며, 펜실베이니아 대학교는 와튼 스쿨 MBA 모델을 기반으로 팀 훈련을 통합하여 팀의 구성원과 리더가 될 수 있도록 육성하고 있다.
As noted previously, Team Based Learning is in place in many of the schools including Wright State University Boonshoft School of Medicine and the University of Oklahoma College of Medicine. Northern Ontario School of Medicine refers to team learning as interprofessional learning, and the University of Pennsylvania incorporates team training based on the Wharton School MBA model to foster being both a member and a leader of a team.

'교육과 의료행위에 신기술 활용'은 스코첼락(2)이 파악한 또 다른 테마로, 교육학과 평가 모두에서 의과대학 전반에 걸쳐 시행되고 있다.

“Use of new technology in education and medical practice” is another of the themes identified by Skochelak,2 and it is in place throughout the medical schools in both pedagogy and assessment.

 

평가의 진전
Advances in Assessment

• 2000년 이후로 학생 평가에 어떤 변화가 시행되었는가?
• What changes, if any, in student assessment have been implemented since 2000?

 

평가의 초점은 학습 목표의 결과를 측정하고 교육 목표의 숙달성을 평가하는 데 있다. 모든 학교는 종합적인 임상 평가뿐만 아니라 평가를 위한 OSCE의 증가된 사용을 설명한다. 기술을 평가에 적용하는 데 많은 변화가 있고, 평가의 초점은 단순한 총괄평가가 아닌 형성평가를 강조하는 쪽으로 옮겨갔다. 학교들은 콜로라도 대학 덴버 의과대학과 러시 의과대학에서의 환자 접견에 대한 온라인 기록을 통합했다. 일리노이 대학 캠퍼스는 웹 기반 테스트를 시행하고 있다. 캘거리 의과대학은 온라인 형성평가를 위한 시스템을 개발했다.
The focus of assessment is on measuring outcomes of learning objectives and evaluating mastery of the educational objectives. Every school describes the increased use of the OSCE for assessment as well as for comprehensive clinical assessments. There are many changes to the application of technology to assessment, and the focus of the assessment has shifted to emphasize formative assessment, not just summative assessment. Schools have incorporated online logs of patient encounters at the University of Colorado Denver School of Medicine and Rush Medical College. The University of Illinois campuses have Web-based testing in place. The University of Calgary Faculty of Medicine has developed systems for the delivery of online formative evaluations.

성찰적인 글과 포트폴리오가 플로리다 주립 의과 대학; 미네소타 의과 대학; 마이애미 대학교 레너드 M.의 평가 도구로서 마련되어 있다. 밀러 의과대학; 미시간 의과대학; 컬럼비아의 미주리 의과대학; 뉴욕 주립대학, 스토니브룩 대학 의학센터; 케이스 웨스턴 리저브 의과대학과 클리블랜드 클리닉.베일러 의과대학도요
Reflective writings and portfolios are in place as assessment tools at Florida State University College of Medicine; University of Minnesota Medical School; the University of Miami Leonard M. Miller School of Medicine; University of Michigan Medical School; University of Missouri School of Medicine in Columbia; State University of New York, Stony Brook University Medical Center; Case Western Reserve University School of Medicine and Cleveland Clinic.; and Baylor College of Medicine.

2000년 이후 clinical skill laboratories가 늘어난 것으로 나타났다. 시카고 일리노이 의과대학이 그 예이다. 인디애나 의과대학의 시뮬레이션 센터(미국 최대) 텍사스 대학교 샌안토니오 의과대학; 위스콘신 대학교 의과 공중 보건 의과 대학; 북동 오하이오 대학교 의과 대학; 밴더빌트 의과 대학, 오하이오 주립 의과 대학, 그리고 과제 트레이너가 있는 오하이오 주립 의과 대학.
There is an increase since 2000 in the number of schools with clinical skills laboratories. Examples include the University of Illinois College of Medicine at Chicago; Indiana University School of Medicine's simulation center (largest of its kind in the United States); University of Texas Health Science Center at San Antonio School of Medicine; University of Wisconsin School of Medicine and Public Health; Northeastern Ohio Universities College of Medicine; Vanderbilt University School of Medicine, and Ohio State University College of Medicine, where task trainers are in place.

로욜라대 시카고스트라이치 의과대학은 학생들의 진도를 평가하기 위한 종방향 수행평가 프로그램을, 서던일리노이대 의과대학은 종방향 수행평가를 실시해 임상적 추론과 시간에 따른 성장을 시험한다.

Loyola University Chicago Stritch School of Medicine has a longitudinal performance assessment program in place to evaluate students' progress, and Southern Illinois University School of Medicine has a longitudinal performance examination to test clinical reasoning and its growth over time.

임상 경험
Clinical Experiences

• 임상 교육을 위한 사이트를 식별하십시오.
  
• 학생의 임상 교육에 따른 어려움과 예상치 못한 결과는 무엇입니까?
• Please identify the site(s) for clinical education
• What are the challenges and the unanticipated outcomes with your students' clinical education

 

임상 경험은 이 부록에 보고된 거의 모든 학교에서 중요한 변화의 지점이었다. Dartmouth Medical School과 같은 학교에서는 임상 경험이 교육 프로그램 초기부터 시작됩니다(보통 의대 첫 달). 또한, 다트머스는 캘리포니아-태평양 의료 센터, 샌프란시스코와 제휴하여 학생들에게 큰 도시 센터에 대한 노출을 제공하고 있다. 위스콘신 대학교 의과 공중 보건 대학에는 Generalist Partners라고 불리는 필수 프로그램이 있는데, 이 프로그램은 모든 학생들이 Generalist 커뮤니티 의사와 매칭된다. 

Clinical experiences have been a point of significant change in almost every school reported in this supplement. At schools like Dartmouth Medical School, clinical experiences begin early in the educational program – usually in the first month of medical school. In addition, Dartmouth has formed an affiliation with California-Pacific Medical Center, San Francisco, to provide students with exposure to a large urban center. The University of Wisconsin School of Medicine and Public Health has a required program called Generalist Partners, where all students are matched with a generalist community physician.

 

임상 교육에 대한 도전은 여러 가지이다. 여기에는 다음이 포함됩니다.

The challenges to clinical education are several. They include:

 

• 임상교육기관의 확장 필요
  
• [지역 내 새로운 의과대학 개발로 인한 경쟁]을 포함한 장소site 경쟁
  
• 교수진에 대한 요구 증가, 교수진에 대한 임상 요구 및 교육 요구의 균형 조정
  
• 자원봉사 교직원의 지속적인 지원 및 가용성 확보 필요
  
• 이동 문제, 임상 교육 현장까지의 거리 때문에 발생하는 문제, 도달 시간과 능력이 필요한 문제
  
• 체류 기간 단축 및 상환액 감소, 사실상 모든 학술 의료 센터에서 학생들에게 의미 있는 임상 학습 기회를 제공하는 데 어려움을 겪고 있습니다.
  
• 임상 환경에서 교수진의 기여도를 인정하는 문제
  
• 동등한 교육 경험 보장 필요
  
• 진료 연속성을 위한 적절한 환자 식별 필요
  
  
• Need for expanded sites
• Competition for sites, including competition because of the development of new medical schools in the area
• Increasing demands on the faculty, and balancing clinical demands and educational needs for faculty
• Need to enlist the continued support and availability of volunteer faculty members
• Travel challenges, caused by distances to clinical teaching sites, which require time and ability to reach
• Decreasing lengths of stay and declining reimbursements, which present a challenge to virtually all academic medical centers to provide meaningful clinical learning opportunities for students
• Challenge to recognize faculty contributions in clinical settings
• Need to ensure comparable educational experiences
• Need to identify appropriate patients for continuity-of-care clinical experiences

푸에르토리코에서 응답한 두 학교 모두 1993년의 의료 개혁의 영향과 새로운 법률이 임상 교육 현장을 확인하는 부담을 덜어줄 지역 학술 의료 센터를 설립하는 것에 주목했다.

Both of the schools that responded from Puerto Rico noted the impact of the 1993 health care reform there and of new laws to establish regional academic medical centers that should relieve some of the burden of identifying clinical teaching sites.

지역 캠퍼스
Regional Campus

 

그러나 비록 그것이 사립학교에서 완전한 대학부로 가는 길의 중간 단계로서 용인될 수 있지만, divided school이 유기적인 전체로서 기능할 것이라고 믿을 이유는 거의 없다. 프리쳇 총장은 "처음 2년이 한 곳에, 지난 2년이 200마일 떨어진 곳에 주어진다면 공대의 교육학적이고 전문적인 이상에 어떤 영향을 미칠지 궁금하지 않을 수 없다"고 말했다.
But there is little reason to believe that the divided school will ever function as an organic whole, though it may be tolerable as a halfway stage on the road from the proprietary school to the complete university department. “I cannot help wondering,” said President Pritchett, “how it would affect the pedagogic and professional ideals of an engineering school if the first two years were given in one place and the last two years in a place two hundred miles away. 1(p73)

 

• 교육 프로그램과 관련된 지역 캠퍼스 또는 캠퍼스가 있습니까? 설명해 주세요.
• Is there a regional campus or campuses associated with the educational program? Please describe.

[지역 캠퍼스]에는 의과대학만큼이나 많은 변형이 있다. 부록 1에서 확인된 일부 지역 캠퍼스는 4년제 프로그램(투싼과 피닉스의 애리조나 의과 대학; 일리노이 대학교; 머서 의과 대학 (사바나의 자매 캠퍼스)으로 전환하고 있다.
There are as many variations in regional campuses as there are in medical schools. Some of the regional campuses identified in Appendix 1 are moving toward becoming four-year programs (University of Arizona College of Medicine at Tucson and at Phoenix; University of Illinois; Mercer University School of Medicine (sister campus in Savannah).

크레이튼 의과대학이 애리조나주 피닉스에 지역 캠퍼스를 설립하고 토론토 의과대학이 새로운 지역 부지를 개설한다. 아마도 가장 독특한 지역 체계는 5개 주에서 의과대학 역할을 하는 워싱턴 의과대학의 그것일 것이다. 브리티시컬럼비아 대학교 의과대학은 교육 프로그램을 분산형 교육 모델로 바꾸었다.

Creighton University School of Medicine will establish a regional campus in Phoenix, Arizona, and the University of Toronto, Faculty of Medicine is opening a new regional site. Perhaps the most unique regional system is that of the University of Washington School of Medicine, which serves as the medical school for five states. The University of British Columbia Faculty of Medicine has changed its educational program to a distributed education model.

 

프로그램의 주요 내용
Highlights of the Programs

이 페이지에는 이러한 "스냅샷"에 기술된 의대의 풍부한 질감과 혁신성을 완전히 포착하기 위한 충분한 공간이 없다. 다음은 본 부록의 뒷부분의 학교 보고서에서 보다 완전하게 읽을 수 있는 많은 프로그램의 주요 내용입니다. 우리는 이 하이라이트를 선택한 이유는 이 하이라이트가 세 개 이상의 학교에서 쓰여졌기 때문이며, 2000년 보충판 이후 변화의 영역을 나타내며, 스코첼락2가 파악한 현재 진행 중인 주제 중 일부와 의대생 교육의 지속적인 변화 요구에 응답하기 때문입니다.

There is not enough space on these pages to capture fully the rich texture and innovativeness of the medical schools described in these “snapshots.” The following are highlights of many of the programs you can read about more completely in the school reports later in this supplement. We chose these highlights because they were written about in more than three schools, they represent areas of change since the 2000 supplement, and because they respond to some of the ongoing themes identified by Skochelak2 and in continued calls for change in medical student education.

 

• [시골 지역의 건강 프로그램]은 네브래스카 의과 대학; 앨라배마 의과 대학; 애리조나 의과 대학; 록포드의 일리노이 의과 대학; 인디애나 의과 대학, 테레 오트 프로그램에서 시행되고 있다. 캔자스 의과대학; 켄터키 의과대학; 루이지애나 주립 대학교 보건 과학 센터 스쿨; 미네소타 의과 대학 (1971년 이후) 컬럼비아 미주리 의과대학, 오리건 보건 과학 대학 의과 대학, 이스트 테네시 주립 대학 제임스 H. 퀼런 의과 대학, 캘거리 의과 대학. 달하우시 대학 의학부 수석 부학장, 농촌 의학부 학장, 지역 의학부에 신설된 자리가 있다.
• Programs in rural health are in place at the University of Nebraska College of Medicine; University of Alabama School of Medicine; University of Arizona College of Medicine; University of Illinois College of Medicine at Rockford; Indiana University School of Medicine, Terre Haute program; University of Kansas School of Medicine; University of Kentucky College of Medicine; Louisiana State University Health Sciences Center School of Medicine at New Orleans; University of Minnesota Medical School (since 1971); University of Missouri School of Medicine in Columbia; Oregon Health and Science University School of Medicine; East Tennessee State University James H. Quillen College of Medicine; and University of Calgary Faculty of Medicine. There is a newly created position at Dalhousie University, Faculty of Medicine, of Senior Associate Dean, Rural and Regional Medicine.
• 많은 학교들이 "scholarly concentration"에 대해 썼는데, 이것은 학생들이 지구 건강, 정보학, 또는 재난 의학과 같은 분야에 집중할 수 있는 기회이다. 이들 학교들의 협동조합이 형성한 학문적 집중력을 가진 학교들은 충분히 있다. 이러한 특징을 가진 몇몇 학교들은 휴스턴의 텍사스 의과대학과 밴더빌트 의과대학이다. 브라운 대학의 워렌 앨퍼트 의과대학; 텍사스 공과대학교 보건과학 센터 폴 L. Foster School of Medicine; 그리고 위스콘신 의과대학 (경로 프로그램)입니다.
• Many schools wrote about “scholarly concentrations” – an opportunity for students to focus on an area such as global health, informatics, or disaster medicine. There are enough schools that have scholarly concentrations that a collaborative of these has formed. A few of the schools that have this feature are the University of Texas Medical School at Houston; Vanderbilt University School of Medicine; The Warren Alpert Medical School at Brown University; Texas Tech University Health Sciences Center Paul L. Foster School of Medicine; and the Medical College of Wisconsin (the Pathways program).
• 캘리포니아 대학 샌디에이고 의과대학에서 학생들은 [환자의 관점에서 질병을 학습]하는 데 두 달을 보낼 기회를 갖는다.
• At the University of California, San Diego, School of Medicine, students have the opportunity to spend two months studying a disease from the point of view of the patient.
• [전자 건강 기록]은 아칸소 의과대학, 오하이오 주립 의과 대학, 베일러 의과 대학, 플로리다 국제 대학 허버트 워트하임 의과 대학, 남부 일리노이 의과 대학, 그리고 메이요 의과 대학 의 교육 프로그램의 일부이다. 
• Electronic health records are part of the educational program at the University of Arkansas for Medical Sciences College of Medicine, The Ohio State University College of Medicine, Baylor College of Medicine, Florida International University Herbert Wertheim College of Medicine, Southern Illinois University School of Medicine, and Mayo Medical School.
• 로잘린드 프랭클린 의과대학의 시카고 의과대학, 켄터키 의과대학, 사우스캐롤라이나 의과대학, 제임스 퀼린 의과대학, 이스트테네시 주립대학, 제임스 퀼린 의과대학 등 다수의 학교에서 [전문직간 교육IPE]에 대한 특별한 초점을 두고 있다.마이클 G. 드그루트 의과대학 보건과학부, 맥마스터대, 로욜라대 시카고스트라이치 의과대학은 간호학교가 신설되고 협력학습센터가 설립된다. 노스웨스턴 대학교 파인버그 의과대학은 팀 기반 학습 환경에서 신제품 개발에 중점을 두고 있는 공학, 법학 및 경영 대학과의 협력을 맺고 있다. 뉴욕주립대학교 버팔로 의과 의과 의과대학에서 5개의 보건과학대학이 모의 환자와 함께 훈련한다.
• A special focus on interprofessional education is in place at a number of schools, including Chicago Medical School at Rosalind Franklin University of Medicine and Science, the University of Kentucky College of Medicine, the Medical University of South Carolina College of Medicine, East Tennessee State University James H. Quillen College of Medicine, Michael G. DeGroote School of Medicine Faculty of Health Sciences, McMaster University, and Loyola University Chicago Stritch School of Medicine, where a new nursing school is opening and a Center for Collaborative Learning will be established. Northwestern University The Feinberg School of Medicine has a collaboration with engineering, law, and business schools where the focus is on new product development in a Team-Based Learning setting. At the University at Buffalo, School of Medicine and Biomedical Sciences, State University of New York, five health science schools train together with simulated patients.
• 많은 학교에서 [공중 보건]에 대한 강조가 증가하고 있다. 뉴멕시코 의과대학은 졸업생들을 위한 공중 보건 자격증을 제정했다; 코넬 대학교의 Weill Cornell Medical College와 톨레도 의과대학에 필수 공중 보건 강좌가 있다. 위스콘신 대학교 의학과 보건대학은 의학과 공중 보건의 통합학교가 되었다.
• There is an increased emphasis on public health at many of the schools. The University of New Mexico School of Medicine has instituted a certificate in public health for its graduates; there is a required public health course at Weill Cornell Medical College of Cornell University and at the University of Toledo, College of Medicine. The University of Wisconsin School of Medicine and Public Health has become an integrated school of medicine and public health.
• [교육의 연속성]은 점점 더 많은 관심을 받고 있으며, 학생들의 레지던시 전환을 준비하기 위해 필요한 캡스톤 과정인 베일러 의과대학의 APEX와 같은 프로그램을 통해 지원되고 있다. 휴스턴에 있는 텍사스 의과대학에는 "레지던시로 전환"이라는 필수 달이 있다.
• The continuum of education is receiving increasing attention and is supported through programs like APEX at Baylor College of Medicine, a required capstone course to prepare students for the transition to residency. The University of Texas Medical School at Houston has a required “Transition to Residency” month.

우리가 이 에세이를 쓰는 동안에도 북미의 의과대학에는 변화가 일어나고 있다. 왜냐하면 그것들은 정적이 아니라 끊임없이 진화하는 실체이기 때문이다. 앞으로 1~2년 안에 의과대학 수가 바뀌게 되는데, 새로 인가된 모든 학교의 보고서를 이 부록에 포함시키는 것은 너무 최근에 인가받은 학교들이라 할 수 없었다. 우리는 그들이 21세기 의사들을 교육하기 위한 혁신적인 프로그램을 만들면서 그들에게서 더 많은 이야기를 듣게 될 것을 알고 있습니다.

Even as we write this essay, there is change occurring in North America's medical schools, for they are not static but, instead, are constantly evolving entities. The number of medical schools will change in the next year or two, and it was not possible to include reports from all of the newly accredited schools in this supplement because some were accredited too recently to have written about their institutions. We know we will be hearing more from them as they create innovative programs to educate physicians for the 21st century.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Acad Med. 2010 Sep;85(9 Suppl):S2-18.

 doi: 10.1097/ACM.0b013e3181f16f52.

Medical education in the United States and Canada, 2010

M Brownell Anderson 1, Steven L Kanter

Affiliations collapse

Affiliation

• 1Association of American Medical Colleges, Washington, DC 20037, USA. mbanderson@aamc.org

• PMID: 20736548

 

• DOI: 10.1097/ACM.0b013e3181f16f52

Abstract

The authors present an overview of the educational programs, infrastructure to support them, and the assessment strategies of 128 medical schools in the United States and Canada, based on reports submitted by those schools and published in this supplement to Academic Medicine. The authors explore many important changes that have occurred since the publication of the Flexner Report in 1910 as well as the progress that is evident since a similar collection of medical school reports was published in September 2000, also as a supplement to Academic Medicine. Drawing on the reports, the authors summarize, among other topics, the advances that have taken place in the support for faculty, the funding of medical student education, changes in pedagogy and assessment, and the expansion of medical education to distributed models and regional campuses.The authors observe that the reports from the 128 schools illustrate that medical student education has undergone and continues to undergo substantive change, has advanced markedly since the reforms stimulated by the Flexner Report, and has continued to evolve during the past decade. The reports illustrate the strength of support for the educational programs, even in a time of financial constraints, and the increasing recognition of the scholarly contributions of faculty through teaching. The authors provide examples of the changes in pedagogy and new topics in the required curriculum in the past decade and describe selected highlights of the 128 educational programs.