Teaching family medicine in medical schools - Editorial

Education Medical schools Teaching family medicine in medical schools - Editorial

This year marks the 50th anniversary of the founding of the Liaison Committee on Medical Education (LCME). It is also the year in which the LCME is considering proposed changes in the accreditation standards.

At the time of the founding of the LCME in February 1942, Dr. Morris Fishbein wrote: "Now anything that the medical colleges do has vast implications for the whole structural scheme of medical service in this country."[1] Today, a half century later, seems to be an appropriate time to ask, "How are we doing?"

San Francisco and Boston, for example, have as many as 600 physicians per 100,000 population, compared with less than 100 in Appalachia.[2] From 1963 through 1986, the number of physicians in primary care specialties in the United States declined 15 percent.[3] From 1986 through 1991, the number of medical school graduates entering primary care training programs dropped l9 percent.[4] In the United States, only 27 percent of physicians function as generalists.[5] The conclusion: We are graduating physicians inadequately skilled and motivated to meet the needs of the public.

What do Americans think about how our graduates serve this nation? In one survey, 89 percent indicated a need for fundamental change in the direction and structure of the U.S. health system.[6] In the same survey, residents of Canada and Great Britain expressed a high level of satisfaction with their health care systems. The high level of public satisfaction with health care in these countries is probably not a result of medical care being socialized or "free," but because it is a "bottom-up," primary-care-based model, with onehalf or more of physicians practicing true primary care.

The good news in primary care in the United States has been the success of the family practice movement and, notably, family practice, clerkships in medical schools. A study based on the 1990 Association of American Medical Colleges medical school graduation questionnaire indicated that 15.6 percent of graduates from schools with a required third-year clerkship in family medicine planned first-year residencies in family practice, while only 6.9 percent of students did so in schools that did not require a third-year clerkship in family medicine.[7] The study also indicated that 57 schools required third-year clerkships in family medicine, while 64 schools did not. ("Primary care" or "ambulatory care" clerkships or preceptorships in the third year were classified as "family medicine" if the experience was obligatory for all students and pre-dominantly family medicine.)

Academic medicine is a public trust[2] and there is a growing community consensus for increased attention to primary care.[8] At this time of proposed changes, the LCME should give priority to the needs of the American public and to the future of American medicine. Changes should be implemented that will encourage, and even require, family medicine departments in all American medical schools and family practice clerkships for all medical students in the United States.


[1.] Fishbein M. A history of the American Medical Association, 1847-1947. Chicago: American Medical Association, 1947. [2.] Schroeder SA, Zones JS, Showstack JA. Academic medicine as a public trust. JAMA 1989; 262:803-12. [3.]Barnett PG, Midtling JE. Public policy and the supply of primary care physicians. JAMA 1989;262:2864-8. [4.] Colwill JM. Where have all the primary care applicants gone? N Engl J Med 1992;326:387-93. [5.] Schroeder SH. The making of a medical generalist. Health Aff 1985;4:22-46. [6.] Blendon RJ, Taylor H. Views on health care: public opinion in three nations. Health Aff 1989;8:150-7. [7.] Kassebaum DG, Haynes RA. Relationship between third-year clerkships in family medicine and graduating students' choices of family practice careers. Academic Med 1992;67: 217-9. [8.] Petersdorf RG. Primary care's time has come. Academic Med 1992;67:337.

COPYRIGHT 1992 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group

Article By: Robert B. Taylor

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