**2.5 The twentieth century: the value of other than the scientific science in the curriculum**

As medical education was established in universities with emphasis on a scientific base, there were critiques about the intensity of the focus on the biosciences and the absence of subjects such as the history of medicine and social ethics as part of the curriculum. Rajan [17] argues that in the first two years, medical students sit in lecture rooms learning about DNA replication while it is more important to learn the interpersonal skills to be a good doctor. The medical historian Eugene Cordell, in a speech at the State of Maryland, in 1913, criticized the lack of any formal teaching on the history of medicine [18] and emphasized the importance of this knowledge throughout all stages of the educational program. A century later, and in support of Dr. Cordell presidential speech, Yarnall [18] emphasized the importance of studying the history of medicine because we learn from our successes and failures and many time scientists' names are associated with disease discoveries such as Cushing disease and Boerhaave syndrome. Yarnall quotes Maxmilien Littre as, "There is nothing in the most advanced contemporary medicine whose embryo cannot be found in the medicine of the past".

Besides history, El-Moamly [19] emphasized the importance of integrating medical humanities in medical curriculum and the use of the psychosocial-biological approach in understanding health, illness, life and death. To address the global new trends in medical practice, Irby and Wilkerson [20] suggested reforms in many directions. One of these areas involve the integration of multiple disciplines to be congruent with the current change in the meaning of human health and disease. The authors presented six core competencies that are necessary for practicing physicians: patient care, knowledge, practice-based learning and improvement, interpersonal communication skills, professionalism, and system-based practice. Need for reforms became imperative because of the new science of learning and technology, the changing communities' needs, and required skills in managing new patterns of health problems, examples of which are the recent COVID-19 pandemic, chronic diseases, pain management, and complementary medicine that is expanding widely recently. To conclude this section, a paradigm shift is now required as we quote from Gwee et al.: *"From students receiving intensive instruction of in-depth scientific facts derived from disciplinary courses, to student acquisition of scientific competencies required for the development of the desired habits of mind, behavior and action for medical practice in the 21st century"* [14].

In light of the worldwide historical evolvement of medical education with its ups and downs, the Association of Faculties of Medicine in Canada [21] has published its vision of undergraduate education in the collective report of the future of medical education in Canada (FMEC). The 10 recommendations address aspects of: "1. Address Individual and Community Needs 2. Enhance Admissions Processes 3. Build on the Scientific Basis of Medicine 4. Promote Prevention and Public Health 5. Address the Hidden Curriculum 6. Diversify Learning Contexts 7. Value Generalism 8. Advance Inter- and Intra-Professional Practice 9. Adopt a Competency-Based and Flexible Approach 10. Foster Medical Leadership". In this view, questions are raised as to how should the medical curriculum be redesigned to serve the scientific foundations of medicine in the 21st century [14].
