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The Impact of Medical Education Reform on the Teaching And THE IMPACT OF MEDICAL EDUCATION REFORM ON THE TEACHING AND LEARNING OF THE ANATOMICAL SCIENCES Melissa Anne Taylor Submitted to the faculty of the University Graduate School in partial fulfillment of the requirements for the degree Doctor of Philosophy in the Department of Anatomy and Cell Biology, Indiana University June 2019 Accepted by the Graduate Faculty of Indiana University, in partial fulfillment of the requirements for the degree of Doctor of Philosophy. Doctoral Committee ______________________________________ Valerie Dean O’Loughlin, Ph.D., Chair ______________________________________ James Brokaw, Ph.D. April 19, 2019 ______________________________________ Polly Husmann, Ph.D. ______________________________________ Jessica Lester, Ph.D. ii © 2019 Melissa Anne Taylor iii DEDICATION To my mom, Maggie and my dad, Kevin. Thank you so much for supporting me during my education, and especially these last six years in my PhD program. To my teachers and mentors throughout all my years of schooling, I could not have done this without you. And lastly, thank you to my cat, Seamus who always gives me cuddles whenever needed. iv ACKNOWLEDGEMENT This work would not have been possible without the guidance and encouragement of my mentor, Dr. Valerie O’Loughlin. Dr. O’Loughlin, you have supported me in my endeavors since day one, always pushing me to become the best student and researcher I could be. You are an inspiration. Additionally, I would like to acknowledge my other committee members, Dr. James Brokaw, Dr. Polly Husmann, and Dr. Jessica Lester. Dr. Lester, thank you for being a wonderful teacher my first year of my PhD program and for instilling the love of qualitative research in me. I will never look back. To the graduate students in the Anatomy Education PhD program, past and present, thank you so much for all the laughter, insightful conversations, and support over the years. I will miss you all dearly, but I know great things are heading your way. To the support staff of the Medical Sciences department, especially Ms. Jackie Cullison, Ms. Kelsey Butcher, Ms. Jen Barron, and Ms. Beth Watt, thank you for all the assistance with my research and general graduate school inquiries throughout the years. To Hannah Bolte, thank you very much for the statistical consulting you provided to me during this research. I have learned a great deal from you. And finally, to my parents, family, and friends who have supported me along my path, I am so appreciative of all the support and love you have given me during hard times and happy times in my life. v Melissa Anne Taylor THE IMPACT OF MEDICAL EDUCATION REFORM ON THE TEACHING AND LEARNING OF THE ANATOMICAL SCIENCES Curricular reform in medical education is a process that has been ongoing for quite some time. Major revision of medical curricula has been occurring since the early eighteenth century. In recent decades, curricular reform has had a monumental impact on the anatomical science subjects. This research investigated how specifically the anatomical science disciplines were impacted by curricular reform at various allopathic medical schools within the United States. The goal of this research was to discover curricular variations in medical schools and to examine the perceptions of those curricular programs by faculty and students alike. Four research questions were addressed to explore the role of curricular reform in medical education using a mixed methods study design. Medical curricular websites were qualitatively analyzed to discover common trends used to describe medical curricula and content organization. Perceptions about the medical curriculum were gathered through surveys and interviews of anatomical science faculty across the country and first year medical students at Indiana University School of Medicine-Bloomington. Finally, a case study of curricular changes at Indiana University School of Medicine was documented. Results from this research demonstrated that curricular reform has had a major impact on the anatomical disciplines. Didactic lectures have been supplemented or replaced by non-didactic teaching tools. Hours dedicated to the teaching of the anatomical sciences have greatly decreased, and most anatomical disciplines are no longer taught as stand-alone courses. Qualitative results discovered that vi there is an overall administrative control of the medical curriculum. Additional perceptual data demonstrated the need for measuring student success past the licensing exam scores. There’s a need for future studies to further analyze student success regarding lifelong learning, problem-solving, and critical thinking skills. Valerie Dean O’Loughlin, Ph.D., Chair vii TABLE OF CONTENTS LIST OF TABLES ............................................................................................................ xii LIST OF FIGURES ......................................................................................................... xiv LIST OF ABBREVIATIONS .......................................................................................... xvi CHAPTER 1: INTRODUCTION ........................................................................................1 Definitions from this Research ......................................................................................3 Statement of the Problem ...............................................................................................5 Research Purpose and Questions ...................................................................................6 Dissertation Outline and Methodologies .......................................................................8 CHAPTER 2: REVIEW OF LITERATURE .....................................................................11 History of Medical Education in the United States ....................................................13 Apprenticeships ......................................................................................................13 The Rise of Formal Medical Institutions ...............................................................14 Standard Medical Education Curricula in the 19th century ...................................17 Early Efforts of American Medical Education Reform .........................................21 Reform of the apprenticeship system .................................................................21 The American Medical Association (AMA) ......................................................22 The Association of American Medical Colleges (AAMC) ................................24 The Flexner Report ................................................................................................26 Overview of the Report ......................................................................................26 Impact of the Flexner Report on Medical Education .........................................28 Curricular Reform after Flexner –Mid to Late 20th Century ................................32 Definition of Curriculum in Education ........................................................................37 The Medical Curriculum ........................................................................................37 Overview of Medical Curricula .........................................................................37 20th Century Medical Curricular Models ..........................................................39 Discipline-based curriculum (aka ‘traditional’ medical curriculum) .............44 Organ-systems based curriculum (systems-based curriculum) ......................45 Problem-based curriculum .............................................................................46 Clinical Presentation (CP) Model ..................................................................49 Integrated Medical Curricula .............................................................................51 Medical Education Reform and the Anatomical Sciences ...........................................53 Effects of Curricular Reform in the Anatomical Disciplines .................................55 Anatomical Science Faculty Perceptions about Medical Curricular Reform ....56 Medical Student Perceptions about Medical Curricular Reform .......................56 Student Assessment of Performance ..................................................................57 Anatomical Science Curricular Reform after Pre-clerkship Years ....................60 Conclusion ..................................................................................................................62 CHAPTER 3: RESEARCH QUESTIONS AND METHODOLOGY ..............................64 Research Questions and Hypotheses ...........................................................................65 General Methodology to Answer the Research Questions ..........................................74 Part 1: Website Analysis of Medical School Curricula ...............................................81 Part 2: Survey and Interviews of US Allopathic Medical School Faculty ..................87 Survey of US Medical School Faculty...................................................................88 Composition and Revisions ...............................................................................89 viii Recruitment and Distribution .............................................................................92 Quantitative Analysis of Faculty Survey ...........................................................95 Qualitative Data Analysis of Faculty Survey .....................................................99
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