The DOI matches its Crossref record; 83 of the 83 references it cites were found in a registry or an index.
Medical education today: all that glitters is not gold
Open accessAbstract
BACKGROUND: The medical education system based on principles advocated by Flexner and Osler has produced generations of scientifically grounded and clinically skilled physicians whose collective experiences and contributions have served medicine and patients well. Yet sweeping changes launched around the turn of the millennium have constituted a revolution in medical education. In this article, a critique is presented of the new undergraduate medical education (UME) curricula in relationship to graduate medical education (GME) and clinical practice. DISCUSSION: Medical education has changed and will continue to change in response to scientific advances and societal needs. However, enthusiasm for reform needs to be tempered by a more measured approach to avoid unintended consequences. Movement from novice to master in medicine cannot be rushed. An argument is made for a shoring up of biomedical science in revised curricula with the beneficiaries being nascent practitioners, developing physician-scientists --and the public. CONCLUSION: Unless there is further modification, the new integrated curricula are at risk of produce graduates deficient in the characteristics that have set physicians apart from other healthcare professionals, namely high-level clinical expertise based on a deep grounding in biomedical science and understanding of the pathologic basis of disease. The challenges for education of the best possible physicians are great but the benefits to medicine and society are enormous.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., Fineberg, H., Garcia, P., Ke, Y., Kelley, P., et al. (2010) · The Lancet · doi:10.1016/s0140-6736(10)61854-5 · Cited by 5,960
The clinical application of the biopsychosocial model
(1980) · American Journal of Psychiatry · doi:10.1176/ajp.137.5.535 · Cited by 3,294
Twenge, J. M. (2006) · Cited by 1,293
Irby, D. M., Cooke, M., & OʼBrien, B. C. (2010) · Academic Medicine · doi:10.1097/acm.0b013e3181c88449 · Cited by 924
American Medical Education 100 Years after the Flexner Report
Cooke, M., Irby, D. M., Sullivan, W., & Ludmerer, K. M. (2006) · New England Journal of Medicine · doi:10.1056/nejmra055445 · Cited by 883
Perfectionism is increasing over time: A meta-analysis of birth cohort differences from 1989 to 2016
Curran, T., & Hill, A. P. (2019) · Psychological Bulletin · doi:10.1037/bul0000138 · Cited by 780 · cited 1×
“Perfectionism, defined as a combination of high standards and high self-criticism, is also on the rise [38, 39].”
The Effectiveness of Blended Learning in Health Professions: Systematic Review and Meta-Analysis
Liu, Q., Peng, W., Zhang, F., Hu, R., Li, Y., & Yan, W. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.4807 · Cited by 691
American medical education 100 years after the Flexner report.
Saidi, F. (2007) · PubMed · Cited by 679
Time to heal: American medical education from the turn of the century to the era of managed care
(2000) · Choice Reviews Online · doi:10.5860/choice.37-4543 · Cited by 650
Burnout syndrome among medical residents: A systematic review and meta-analysis
Rodrigues, H., Cobucci, R., Oliveira, A., Cabral, J. V., Medeiros, L., Gurgel, K., Souza, T., & Gonçalves, A. K. (2018) · PLoS ONE · doi:10.1371/journal.pone.0206840 · Cited by 589
Research works printed but not linked: 46
- Gutierrez CM, Cox SM, Dalrymple JL. The revolution in medical education. Texas Med. 2016;112:58–61.
- Ryan TJ. Osler and his teaching: relevant today. Postgrad Med J. 2015;91(1080):540–1. · doi:10.1136/postgradmedj-2015-133677
- Lee TH. Discovering strategy: a key challenge for academic health centers. Trans Am Clin Climatol Assn. 2016;127:300–12.
- Richmond JB, Fein R. The health care mess: how we got into it and what it will take to get out. Cambridge, Massachusetts: Harvard University Press; 2005. 308 pp · doi:10.4159/9780674042711
- Clifton GL Flatlined. Resuscitating American Medicine. New Brunswick: Rutgers University Press; 2009. p. 322.
- Relman AS. A second opinion: rescuing America’s health care. Cambridge, MA: The Century Foundation; 2007. p. 205.
- LeFanu J. The rise and fall of modern medicine. Revised Edition. New York: Basic Books, 2012, 590 pp.
- Kirch DG, Mitchell K, Ast C. The new 2015 MCAT: testing competencies. JAMA. 2013;310:2243–4. · doi:10.1001/jama.2013.282093
- Finnerty EP, Chauvin S, Bonaminio G, Andrews M, Carroll RG, Pangaro LN. Flexner revisited: the role and value of the basic sciences in medical education. Acad Med. 2010;85:349–55. · doi:10.1097/acm.0b013e3181c88b09
- Violato C, Gao H, O’Brien MC, Grier D, Shen E. How do physicians become medical experts? A test of three competing theories: distinct domains, independent influence and encapsulation models. Adv Health Sci Educ. 2018;23:249–63. · doi:10.1007/s10459-017-9784-z
- Leach DC. The ACGME competencies: substance or form? Accreditation Council for Graduate Medical Education. J Am Coll Surg. 2001;192:396–8. · doi:10.1016/s1072-7515(01)00771-2
- Leach DC. Changing education to improve patient care. Postgrad Med J. 2008;84:437–41. · doi:10.1136/qhc.100054
- Byrne LM, Miller RS, Philibert I, Ling LJ, Potts JR 3rd, Lieh-Lai MW, Nasca TJ. Program performance in the next accreditation system (NAS): results of the 2015-2016 annual data review. J Grad Med Educ. 2017;9:406–10. · doi:10.4300/jgme-d-17-00320.1
- Wagner R, Weiss KB, Passiment ML, Nasca TJ. Pursuing E\excellence in clinical learning environments. J Grad Med Educ. 2016;8:124–7. · doi:10.4300/jgme-d-15-00737.1
- Powell DE, Carriccio C. Toward competency based medical education. N Engl J Med. 2018;378:3–5. · doi:10.1056/nejmp1712900
- Robins JA, McInnes MD, Esmail K. What information is provided in transcripts and medical student performance records from Canadian medical schools? A retrospective cohort study. Med Ed Online. 2014;19:25181. · doi:10.3402/meo.v19.25181
- Schuman AD, Heisel CJ, Black KM, Matusko N, Gilbert CM, James CL, Reddy RM, et al. Student factors that influence clerkship grades and matching into a surgical residency. J Surg Educ. 2019;76:393–400. · doi:10.1016/j.jsurg.2018.08.023
- Katsufrakis PJ, Chaudhry HJ. Improving residency selection requires close study and better understanding of stakeholder needs. Acad Med. 2019;94:305–8. · doi:10.1097/acm.0000000000002559
- Naidich JB, Grimaldi GM, Lombardi P, Davis LP, Naidich JJ. A program director's guide to the medical student performance evaluation (former dean's letter) with a database. J Am Coll Radiol. 2014;11:611–5. · doi:10.1016/j.jacr.2013.11.012
- Andolsek KM. Improving the medical student performance evaluation to facilitate resident selection. Acad Med. 2016;91:1475–9. · doi:10.1097/acm.0000000000001386
- Grayson MS, Newton DA, Patrick PA, Smith L. Impact of AOA status and perceived lifestyle on career choices of medical school graduates. J Gen Intern Med. 2011;26:1434–40. · doi:10.1007/s11606-011-1811-9
- Frishman WH, Alpert JS. Medicine as a meritocracy. Am J Med. 2019;132:401–2. · doi:10.1016/j.amjmed.2018.10.032
- Polastri M, Truisi MC. Meritocracy? Ask yourself. J Intensive Care Soc. 2017. p. 276–8. · doi:10.1177/1751143717714679
- Cofrancesco Jr J, Ziegelstein RC, Hellmann DB. Developing foundational principles for teaching and education for a school of medicine. The pharos/Spring 2018, pp. 43–46.
- Riddick FA Jr. The code of ethics of the American Medical Association. Oschner J. 2003;5:6–10.
- Kumar V, Abbas AK, Aster JC, editors. Robbins and Cotran pathologic basis of disease, ninth edition. Philadelphia: Saunders/Elsevier, 2015, 1391 pp.
- Majno G, Joris I. Cells, Tissues, and Disease. Principles of General Pathology. Second Edition. Oxford and New York: Oxford University Press, 2004, 1005 pp. (see pp. vii-ix).
- Buja LM, Krueger GRF. Netter’s illustrated human pathology. Teterboro, NJ: icon learning systems; 2005. Second edition: Elsevier; 2014. p. 528.
- Krueger GRF, Buja LM, Chandrasekhar C, editors. Atlas of anatomic pathology with imaging. London: Springer; 2013. p. 821.
- Buja LM, Butany J, editors. Cardiovascular pathology, 4th edition. New York: Elsevier; December 2016. p. 814.
- Association of Pathology Chairs Pathology Competencies for Med Educ (PCME). https://journals.sagepub.com/page/apc/pcme
- Holland L, Bosch B. Medical students’ perceptions of pathology and the effect of the second-year pathology course. Human Pathol. 2006;37:1–8. · doi:10.1016/j.humpath.2005.10.004
- Magid MS, Cambor CL. The integration of pathology into the clinical years of undergraduate medical education: a survey and review of the literature. Human Pathol. 2012;43:567–76. · doi:10.1016/j.humpath.2011.06.006
- Knollmann-Ritschel BEC, Suarez E, Gilliland W, Conran R, Pock A. Pathology course director perspectives of a recent LCME experience: preparation in an integrated curriculum with the revised standards. Acad Pathol. 2017;4:1–7.
- Rhatigan RM. The autopsy in modern undergraduate medical education: a qualitative study of uses and curriculum considerations. Comparing the case materials available from a teaching hospital's autopsies in 1968 and 20 years later. Acad Med. 1991;66:158–61. · doi:10.1097/00001888-199103000-00007
- Talmon G. The use of autopsy in preclinical medical education: a survey of pathology educators. Arch Pathol Lab Med. 2010;134:1047–53. · doi:10.5858/2009-0333-oa.1
- Yeh DH, Fung K, Malekzadeh S. Boot camps: preparing for residency. Otolaryngol Clin N Am. 2017;50:1003–13. · doi:10.1016/j.otc.2017.05.010
- Neylan CJ, Nelson EF, Dumon KR, Morris JB, Williams NN, Dempsey DT, Kelz RR, Fisher CS, Allen SR. Medical school surgical boot camps: a systematic review. J Surg Educ. 2017;74:384–9. · doi:10.1016/j.jsurg.2016.10.014
- Catastrophic neglect of the basic sciences in medicine. Lancet. 2012;379:1273. · doi:10.1016/s0140-6736(12)60539-x
- Ferrans VJ, Hibbs RG, Buja LM. Nucleoside phosphatase activity in atrial and ventricular myocardium of the rat: a light and electron microscopic study. Am J Anat. 1969;125:47–86. · doi:10.1002/aja.1001250104
- Buja LM. In memoriam: Victor J. Ferrans, MD, PhD Circulation 2002;105:544–5. · doi:10.1161/hc0502.104849
- Duke A. Thinking in bets. Making smarter decisions when you Don’t have all the facts. New York: Portfolio/Penguin; 2018. p. 276.
- Johns ME, Niparko JK. Averaging excellence out? Arch Otolaryngol Head Neck Surg. 1996;122:1039–40. · doi:10.1001/archotol.1996.01890220009001
- The Associated Press. Posted: Oct 15, 2018 1:55 PM ET | Last Updated: October 15, 2018.
- Keen WW. The ideal physician. JAMA. 1900;XXXIV:1592–4. · doi:10.1001/jama.1900.24610250004002
- Buja LM, Cox SM, Lieberman SA, MacClements J, Williams JF, Esterl RM Jr, Shine KI. A university system's approach to enhancing the educational mission of health science schools and institutions: the University of Texas Academy of Health Science Education. Med Educ Online. 2013;13:1–6. https://doi.org/10.3402/meo.v18i0.20540 . · doi:10.3402/meo.v18i0.20540
Cited by
A systematic review of large language models and their implications in medical education
Lucas, H. C., Upperman, J. S., & Robinson, J. R. (2024) · Medical Education · doi:10.1111/medu.15402 · Cited by 287
ChatGPT interactive medical simulations for early clinical education: Case study
Scherr, R., Halaseh, F. F., Spina, A., Andalib, S., & Rivera, R. (2023) · JMIR Medical Education · doi:10.2196/49877 · Cited by 122
Does developing multiple-choice Questions Improve Medical Students’ Learning? A Systematic Review
Touissi, Y., Hjiej, G., Hajjioui, A., Ibrahimi, A., & Fourtassi, M. (2022) · Medical Education Online · doi:10.1080/10872981.2021.2005505 · Cited by 46
Kwong, S.-Y. P., Yu, S.-R., Liao, K.-C., Liao, S.-C., Hsiao, C.-T., & Chaou, C.-H. (2025) · Perspectives on Medical Education · doi:10.5334/pme.1499 · Cited by 6
Micallef Grimaud, L., & Gathu, C. (2024) · doi:10.2196/preprints.57746 · Cited by 3
Metadata
- Authors
- Buja, L. M.
- Venue
- BMC Medical Education
- Published
- 2019-04-16
- Volume
- 19
- Issue
- 1
- Pages
- 110-110
- ISSN
- 1472-6920 (ISSN-L)
- OpenAlex
- W2944518496
- Cited by
- 284
- References
- 83
- FWCI
- 23.71
- Type
- journal article
- Language
- en
- Open access
- gold
- Licence
- creativecommons.org/licenses/by/4.0/ (tdm)
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
How to cite
Cite CoChat for the checks on this page, and the paper for its own findings.
- This page
- CoChat. (2026). Citation check: Medical education today: all that glitters is not gold. https://app.cochat.ai/papers/10.1186/s12909-019-1535-9
- The paper
- Buja, L. M. (2019). Medical education today: all that glitters is not gold. BMC Medical Education. https://doi.org/10.1186/s12909-019-1535-9
Data sources
Bibliographic data: Semantic Scholar, OpenAlex, Crossref.
Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.