The clarion call for a third wave in medical education to optimise healthcare in the twenty-first century

Abstract

During the years preceding 1910, the education and training of physicians (doctors) -to-be was based mainly on a master–apprentice model; the primary focus then was on the teaching and development of clinical skills. In 1910, however, Abraham Flexner submitted a highly influential report to the American medical authorities: in it, he recommended that all medical schools should be university-based and that, importantly, medical practice should have a scientific basis strongly underpinned by the basic medical sciences. The recommendation provided the impetus for the design of medical education that begins with a pre-clinical phase to provide the strong scientific foundation for the clinical phase that follows. During the clinical phase, student learning will focus primarily on the clinical sciences relating to the diagnosis, treatment and management of patient care. Thus, two key ‘pillars’ (the basic sciences and the clinical sciences) of medical education were established; this two pillar model of medical education persisted for many decades thereafter and remained so till today. However, in order to optimise delivery of health care this must be viewed as an ‘eco-system’ taking into account the practice setting both present and future. The authors will attempt to provide a background to the changing trends in medical education and the changing practice environment, due primarily to the disruptive forces of change in this article.

Acknowledgments

We would like to acknowledge Professor Hooi Shing Chuan and Dr. Terry Pan, National University of Singapore for contributing ideas to the manuscript from the joint publication with the author in the NUS Medicine Newsletter on Future of Medicine and Future of Medical Education.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Notes on contributors

Dujeepa D. Samarasekera, FAMS, FAMEE, Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Poh Sun Goh, FAMS, FAMEE, Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Shuh Shing Lee, PhD, Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Matthew C.E. Gwee, PhD, Centre for Medical Education, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.