Are recent graduates of medical schools more patient-oriented than their predecessors? Some might say yes, given the changes in physician education over past decades — changes that have been documented by scholars who tracked the amount of attention given to two primary and at times opposing philosophies—science and care—in medical education since 1967.
Professional education is the key to understanding what causes change in a profession over time, because it shapes the knowledge, values and assumptions of the next generation," says Mary Dunn, lecturer in management at the University of Texas at Austin McCombs School of Business. Dunn and her colleague, Candace Jones of Boston College, wanted to find out what factors affected medical education over recent years. Using articles published in the Journal of Medical Association dating from 1965 to 2005, they tracked the attention given to two primary and at times opposing philosophies: science and care,
According to Dunn, their research showed that an emphasis on science curriculum achieves quality health care by building knowledge and creating innovative diagnostic and therapeutic procedures, while an emphasis on care highlights physicians' focus on clinical skills in treating patients and improving the health of the community.
Dunn and Jones found that, initially, medical schools emphasized science. In the late 1960s and early 1970s the emphasis on science dropped dramatically, stabilizing in 1977 and remaining consistent through 2005. Medical schools began to emphasize the "care" philosophy in the early 1990s through 2005.
Why the Switch from Science to Care?
Dunn explained that when many medical schools were first established in the early 1900s, it was important that medical education become standardized to distinguish professional doctors from quacks. Science dominated the curriculum. The first two years of study were in the science lab (preclinical), the last two years with patients (clinical).
The focus on science carried on until the late 1960s and early 1970s, when a new wave of physicians called for training physicians who were more caring and compassionate. Family practice emerged as a specialty for physicians who treated whole people vs. specific diseases.
Government funding for new medical schools allowed for greater diversity and experimentation in curriculum. Many of the new medical schools favored a public health philosophy, where the health of the community took precedence over the individual. The concept of managed care emerged in the 1970s and 1980s, increasing attention to care in medical school curriculum. Dunn and Jones theorize that some medical school faculty viewed managed care only as an organizational tool, perhaps a passing fad, that should not be taught in medical school.
The increasing number of women who entered medical school was also an important trend that gave rise to an emphasis on care over science. In the mid-1960s, only 6 percent of the average entering medical school class were women. New legislation supported women in the medical profession, and by the late 1990s around half of the average entering class in medical school were women.