**5.1 Restore a focus on the scientific basis of medical practice**

The first two years of the UME curriculum is the time when the fundamentals of biomedical science and the clinical skills of taking a history and physical examination are to be formally taught and learned. A combination of factual knowledge and relationships among facts is crucial for developing clinical skills, critical thinking and evidence-based medical decision-making. Clinical skill and judgment are gained from the integration of conceptual knowledge (facts, "what" information), strategic knowledge ("how" information) and conditional knowledge ("why" information) [13]. The learning experience of the core material in the pre-clinical years should not be diluted by substituting other topics that are best learned after a foundation is laid for clinical practice.

There are more effective ways to achieve the objective of integration in the curriculum without sacrificing the foundations of a good medical education. An overarching priority is the repositioning of medical science in the medical education curriculum to reflect its unchanging and continued importance. While restoration of subject-based foundational courses is unlikely to happen, the integrity and cohesion of the foundational disciplines should be maintained. This is especially true for pathology which fulfills the essential functions of linking basic biomedical

science to clinical medicine and providing an understanding of the pathological basis of disease. Studies have repeatedly shown that factual knowledge of biomedical science is essential for the development of clinical skills [1]. The deemphasis on biomedical science also cannot be good for the development of future physicianscientists, a small and already endangered group [1].

There is general agreement that medical education should be focused on developing competent physicians. However, application of competency-based curriculum adapted from lower-level occupations to highly skilled professions including medicine is controversial [14]. The logistics of implementing such programs are daunting and represent another major draw on faculty time to provide evaluation of the set of competencies and entrustable professional activities (EPAs) expected of the learners. A more feasible approach would be to maintain fixed time programs but allow accelerated advancement coupled with opportunities for dual degrees, pursuit of research, and other projects.

It is also important to counter the undue influence of the United States Medical Licensing Exam (USMLE) Step 1, as the sole objective evaluator of medical students' cognitive achievement. This has created an adverse "Step 1 climate" in the preclinical years [15]. The recent decision of the National Board of Medical Examiners to make the USMLE a pass/fail exam without reported numerical score is well intended. However, the most residency program directors have raised concerns and are seeking alternatives for objective assessment of residency candidates [16]. A definitive solution requires a return to providing meaningful grades for courses and an overall rigorous summative evaluation for the four years of medical school.

#### **5.2 Promote a culture of professionalism**

A major goal of the new curriculum is the development of holistic, ethical physicians who manifest empathy and compassion for patients. These ideals of the medical profession are time-honored and intrinsic to its code of ethics. A longstanding consensus holds that professionalism and professional identity formation need to be key elements of medical education. However, there is not a unifying theoretical or practical model to integrate the teaching of professionalism into the medical curriculum. Nevertheless, there is recognition that the most effective techniques for developing professionalism involve role modeling and personal reflections guided by faculty rather than blocks of time devoted to didactic exercises. A practical approach to dealing with differing expectations and to effectively instill professionalism is to provide students, residents and staff with a written list of expected behaviors coupled with teaching and role modeling, assessment and remediation [17].

Clinician educators have crucially important roles in developing clinical skills in trainees as well as serving as role models of professionalism and excellence in medical practice [18]. Medical schools need to address barriers to the professional development of clinician educators and provide appropriate incentives to foster their ongoing educational activities. Similar recognition should be given to a cadre of basic science educators. The Academy movement has developed to meet the need to recognize and support medical educators [19].

#### **5.3 Focus on the physician as medical expert**

There is a broad consensus that the good doctor manifests a combination of humanistic and scientific attributes and capabilities. Seven key roles of the ideal doctor have been identified as communicator, collaborator, manager, health advocate, scholar, professional, and the integrating role of medical expert [20].

*Contemporary Medical Education: Revolution versus Evolution DOI: http://dx.doi.org/10.5772/intechopen.99453*

Importantly all the roles overlap equally to create the 'Medical Expert'. Maturation from novice to master in (medical expert) needs to be built on a solid foundation in biomedical science and the pathobiology of disease. The time and place to inculcate the core of this foundation is the first two years of the UME. A solid foundation in biomedical science is essential for perfecting clinical skills and practicing evidencebased medicine. A byproduct of a restoration of a strong medical science curriculum will be a boost to the development of future generations of physician-scientists. Conversely, the combination of educational deficiencies coupled with lifestyle preferences carries the risk of diminishing the status of future physicians.
