WHITHER THE FUTURE? OR “Is calculus really required for medical practice?” WARM-UP Or, “You will definitely want to form groups of five. Trust me.” DIFFERENTIATE y = (3x 2 +1) COMPUTE Limit (x∞) 100 2 (x +5) SOLVE • As illustrated in Fig. 2 below, an object of mass m = 2.0 kg is pulled along a surface by a horizontal force F of 12 N to the right a distance s of 4.0 m. The coefficient of friction between the object and the surface is 0.5. Find the work done by (a) F, (b) the normal force FN, (c) the weight mg of the object, (d) the frictional force f, (e) the net force. SOLVE IT STARTS WITH FLEXNER THE HISTORY OF AMERICAN MEDICAL SCHOOL • Started as supplement to apprenticeships (1600s-1700s) • After training sought out additional learning at European hospitals • Philadelphia begins to offer similar training, organizes first school (1700s) • Joined by King’s College (New York), Harvard College, Dartmouth College • Proprietary schools debut in Maryland (1800s) • Apprenticeship system declines education shifts to classroom (1800s) • “Since that day medical colleges have multiplied without restraint, now by fission, now by sheer spontaneous generation.” • 457 schools started in US and Canada, 155 extant during time of report HISTORY CONTINUED (SO DISMAL) • “These enterprises—for the most part they can be called schools or institutions only by courtesy—were frequently set up regardless of opportunity or need.” • “Wherever and whenever the roster of untitled practitioners rose above a half a dozen, a medical school was likely at any moment to be precipitated.” • “A hall could be cheaply rented…occasional dissections…a box of old bones...other equipment there was practically none. The teaching was, except for a little anatomy, wholly didactic.” • “Schools were essentially private ventures, money-making in spirit and object. A school that began in October would graduate a class the next spring.” • “Income was divided among the lecturers, who reaped a rich harvest.” • “In the entire United States…[on] average one doctor for every 568 persons…many small towns with less than 200 inhabitants each have two or three physicians!” HISTORY CONCLUDED (HE SURE LIKED JOHNS HOPKINS) “Johns Hopkins Medical School…was the first medical school in America of genuine university type…well equipped laboratories conducted by modern teachers, devoting themselves unreservedly to medical investigation and instruction, and with its own hospital, in which the training of physicians and the healing of the sick harmoniously combine to the infinite advantage of both.” CONCLUSIONS & RECOMMENDATIONS • Medical curriculum heavily relies on biology, chemistry, and physics • Admission must require “competent knowledge” in these fields • “It is immaterial where the student gets the introduction” • Two years of college = minimum • Fundamental sciences not enough • Practitioner needs “insight and sympathy” • Requires a “varied and enlarging cultural experience” • “Society relies [on physicians] to enforce the conditions that prevent disease and make positively for physical and moral well-being” TODAY…SORT OF? Biology Physics General Chemistry English Organic Chemistry TODAY…NO, REALLY. Illustration redacted (usage rights) …AND USUHS Illustration redacted (usage rights) COMPETENCIES Or, “Why the change?” AAMC-HHMI SCIENTIFIC FOUNDATIONS FOR FUTURE PHYSICIANS • AAMC HHMI panel examined natural science competencies needed to practice medicine • Recommended move from static prerequisite courses to evolving competencies • Recommend undergraduate institutions move to interdisciplinary and integrative science courses • MCAT will begin testing for these competencies in 2015 THE NATURAL SCIENCE COMPETENCIES • E1: Apply quantitative reasoning and appropriate mathematics to describe or explain phenomena in the natural world • E2: Demonstrate understanding of the process of scientific inquiry and explain how scientific knowledge is discovered and validated • E3: Demonstrate knowledge of basic physical principles and their applications to the understanding of living systems • E4: Demonstrate knowledge of basic principles of chemistry and some of their applications to the understanding of living systems COMPETENCIES, CONTINUED • E5: Demonstrate knowledge of how biomolecules contribute to the structure and function of cells • E6: Apply understanding of principles of how molecular and cell assemblies, organs, and organisms develop structure and carry out function • E7: Explain how organisms sense and control their internal environment and how they respond to external change • E8: Demonstrate an understanding of how the organizing principle of evolution by natural selection explains the diversity of life on earth COMPETENCIES, EXPANDED • E5: Demonstrate knowledge of how biomolecules contribute to the structure and function of cells • 2. Demonstrate knowledge of the principles of chemical thermodynamics and kinetics that drive biological processes I the context of space and time Examples • Identify the six major types of biochemical reactions • Distinguish different types of enzyme control • Explain how membrane gradients and electron transport act to generate and store energy • Explain how glucose transport across epithelia depends on the sodium concentration gradient • Describe the role of the Na-K-ATPase in the maintenance of the resting membrane potential of cells • Etc. BEHAVIORAL AND SOCIAL SCIENCE COMPETENCIES • Two informing reports • IOM Improving Medical Education: Enhancing the Behavioral and Social Science Content of Medical School Curricula (2004) • AAMC-HHMI Behavioral and Social Science Foundations for future physicians (2011) • Recognition that natural science competencies “necessary but not sufficient” • Reminiscent of Flexner’s “varied and enlarging cultural experience” MCAT2015 • MCAT last revised 1991 • MR5 Committee formed in 2008 to review test in light of evolving needs • Balanced natural, social, and behavioral science needs with critical analysis and reasoning skills • Currently undergoing validity testing • Will go live in 2015, current freshman are taking coursework in preparation for THIS examination THE NEW TEST Biological & Biochemical Foundations of Living Systems Chemical & Physical Foundations of Biological Systems Psychological, Social, & Biological Foundations of Behavior Critical Analysis & Reasoning Skills Biological & Biochemical Foundations of Living Systems Concept 1 Concept 2 Concept 3 •Biomolecules have unique properties that determine how they contribute to the structure and function of cells, and how they participate in the processes necessary to maintain life. •Highly-organized assemblies of molecules, cells, and organs interact to carry out the functions of living organisms. •Complex systems of tissues and organs sense the internal and external environments of multicellular organisms, and through integrated functioning, maintain a stable internal environment within an ever-changing external environment. Chemical & Physical Foundations of Biological Systems Concept 4 • Complex living organisms transport materials, sense their environment, process signals, and respond to changes using processes that can be understood in terms of physical principles. Concept 5 • The principles that govern chemical interactions and reactions form the basis for a broader understanding of the molecular dynamics of living systems. Psychological, Social, & Biological Foundations of Behavior Concept 6 Concept 7 Concept 8 Concept 9 Concept 10 •Psychological, socio-cultural, and biological factors influence the ways that individuals perceive, think about, and react to the world. •Psychological, socio-cultural, and biological factors influence behavior and behavior change. •Psychological, socio-cultural, and biological factors influence the way we think about ourselves and others. •Cultural and social differences influence wellbeing. •Social stratification and access to resources influence wellbeing. SCIENTIFIC INQUIRY & REASONING SKILLS (SIRS) TESTED IN THE BBFLS, CPBS, AND PSBB SECTIONS 1 Knowledge of Scientific Concepts & Principles 2 Scientific Reasoning and Problem Solving 3 Reasoning About the Design and Execution of Research 4 Data-based and Statistical Reasoning 27 Critical Analysis & Reasoning Skills Passages from humanities* discuss topics in: • Architecture • Philosophy • Art • Popular Culture • Dance • Religion • Ethics • Studies in Diverse • Literature • Music Cultures • Theater • *Specific knowledge of these disciplines is not required for CARS section IT ENDS WITH USUHS It started with Flexner, but… OUR VISION The F. Edward Hébert School of Medicine is the Nation's medical school, recognized as the leader in the education of physicians and scientists to care for those in harm's way in a rapidly evolving global frontier WHAT DO WE NEED TO GET FROM HERE (ADMISSIONS) TO THERE (INDEPENDENT PRACTICE)? • Do we need to move to competency based admissions? • How do we assess incoming competencies? • Should we require any particular set of courses before students matriculate to the School of Medicine? • What courses would best prepare students to succeed in our curriculum and fulfil our unique vision?