64B8-15.007. Educational Program for the Professional Degree

(1) The Educational Sequence in the United States.

(a) The system of medical education and practice in the United States differs from that of most other nations. To understand the basis of evaluation of foreign medical schools to determine reasonable comparability it is necessary to understand how students are educated to become physicians in the U.S.

(b) Most students complete twelve years of approximately nine months each prior to entering higher education in colleges or universities. The student prepares for entry into medical school by studying courses within a specified field designed for progressive learning. These include courses in the biological and physical sciences, the behavioral sciences, mathematics and the arts and letters. Upon completion of these studies requisite for the study of medicine the students present credentials of both potential and achievement to the medical school to which the student seeks admission.

(c) After admission to medical school, the student begins to study the basic medical sciences, including human anatomy, physiology, biochemistry, pharmacology, microbiology and immunology, pathology and behavioral science. This phase of medical education requires approximately two years of 9-10 months each in most U.S. medical schools.

(d) In transition between study of the basic medical sciences and the study of clinical medicine, the student is introduced to the fundamentals of medical interviewing, physical examination, and diagnosis. Studies in the major fields of clinical medicine are then begun. Patients in the teaching hospital and in outpatient settings are the central focus of this educational phase. All students receive experiences in diagnosis and treatment of patients in the fields of medicine, surgery, obstetrics and gynecology, pediatrics and psychiatry where teaching and learning is intensive and centered on the patient. The student meanwhile is directly supervised by the clinical faculty. Senior faculty, junior faculty, senior residents (three or more years after medical school), junior residents (one or two years after medical school) and both third and fourth year medical students generally work as a team in caring for patients in each of the services.

(e) Additional exposure of the medical student to other medical and surgical specialties varies with career objectives but in all cases the medical student is involved in his studies and care of patients under direct faculty supervision. The total course of study leading to the M.D. degree in the U.S. is at least 130 weeks in length.

(f) The foregoing is intended to provide a description of the system of medical education as it generally occurs in the United States. In order to determine the extent of reasonable comparability of programs of medical education in schools other than those accredited by the LCME a detailed description is needed.

(2) Duration. The program of medical education leading to the M.D. degree or its equivalent must include at least 130 weeks of instruction, in basic and clinical medical sciences, preferably scheduled over at least four calendar years.

(3) Design and Management.

(a) The program’s faculty must be responsible for the design, implementation, and evaluation of the educational program. A faculty committee should undertake this responsibility with full support of the chief academic officer and staff. The curriculum of the program leading to the professional medical degree must be designed to provide a general professional education, recognizing that, this alone, is insufficient to prepare a graduate for independent, unsupervised practice throughout a professional lifetime.

(b) The committee responsible for curriculum should give careful attention to the impact on students of the amount of work required. The committee should monitor the content provided in each discipline in order that objectives for education of a physician are achieved without attempting to present the complete, detailed, systematic body of knowledge in that discipline. The objectives, content, and methods of teaching and learning utilized for each segment of the curriculum, as well as for the entire curriculum, should be subjected to periodic evaluation. Undue repetition and serious omissions and deficiencies in the curriculum identified by these evaluations should be corrected. Review and necessary revision of the curriculum is an ongoing faculty responsibility.

(4) Content.

(a) The medical faculty is responsible for devising a curriculum that permits the student to learn the fundamental principles of medicine, to acquire skills of critical judgment based on evidence and experience, and to develop an ability to use principles and skills wisely in solving problems of health and disease. In addition, the curriculum must be designed so that students acquire an understanding of the scientific concepts underlying medicine. In designing the curriculum, the faculty must introduce current advances in the basic and clinical medical sciences, including therapy and technology; changes in the understanding of disease; and the effect of social needs and demands on medical care.

(b) The curriculum cannot be all-encompassing. However, it must include the sciences basic to medicine; a variety of clinical disciplines; and ethical, behavioral, and socioeconomic subjects pertinent to medicine. There should be presentation of material on medical ethics and human values. The faculty should foster in students the ability to learn through self-directed, independent study throughout their professional lives.

(c) The curriculum must include the contemporary content of those expanded disciplines that have been traditionally titled anatomy, biochemistry, physiology, microbiology and immunology, pathology, pharmacology and therapeutics, and preventive medicine. Instruction within these basic sciences should include laboratory or other practical exercises which facilitate the ability to make accurate quantitative observations of biomedical phenomena and critical analyses of data.

(d) The required clinical subjects which must be offered are internal medicine, obstetrics and gynecology, pediatrics, psychiatry and surgery. Teaching and learning must include extensive direct patient care experiences under supervision of the faculty. Additionally, many schools in the United States now require a clinical experience in family medicine. Schools that do not require such a clerkship should ensure that their students develop the knowledge, skills, attitudes and behaviors necessary to enter graduate medical education programs in family medicine or the other primary care specialties. In the required disciplines students should receive basis instruction in all organ systems. Instruction and experience in direct patient care must be provided in both ambulatory and hospital settings and must include the important aspects of acute, chronic, continuing, preventive and rehabilitative care.

(e) The curriculum must provide grounding in the body of knowledge represented in the disciplines that support the fundamental clinical subjects, for example, diagnostic imaging and clinical pathology. Students must have opportunities to gain knowledge in those content areas that incorporate several disciplines in providing medical care, for example, emergency medicine and the care of the elderly and disabled. In addition, students should have the opportunity to participate in research and other scholarly activities of the faculty.

(f) Each required clinical clerkship must allow the student to undertake thorough study of a series of selected patients having the major and common types of disease problems represented in the primary and related disciplines of the clerkship. The committee responsible for curriculum must require close faculty supervision of the learning experience of each student at the appropriate level of graded clinical responsibility. Supervision must be provided throughout required clerkships by members of the school’s faculty.

(g) The student should have clinical experiences in both a hospital and an ambulatory care facility. The student must be provided the experience of initial patient “work-up” including the medical history, physical examination and preliminary diagnosis as an active participant, not as a passive preceptee. If required clerkships in a single discipline are conducted in several hospitals, every effort must be made to ensure that the students receive equivalent educational experiences.

(h) The faculty committee responsible for curriculum should develop, and the chief academic officer should enforce, the same rigorous standards for the content of each year of the program leading to the M.D. or comparable degree. The final year should complement and supplement the curriculum of the individual student so that each student will acquire appropriate competence in general medical care regardless of subsequent career specialty.

(i) The curriculum should include elective courses designed to supplement the required courses and to provide opportunities for students to pursue individual scholarly interests. Faculty advisors must be available to guide students in the choice of elective courses. If students are permitted to take electives at other institutions, there should be a system centralized in the dean’s office to screen the student’s proposed extramural program prior to approval and to ensure the return of a performance appraisal by the host program. Another system, devised and implemented by the dean, should verify the credentials of students from other schools wishing to take courses or clerkships at the school, approve assignments, maintain a complete roster of visiting students, and provide evaluations to the parent schools.

(j) All instruction should stress the need for students to be concerned with the total medical needs of their patients and the effect of social and cultural circumstances on their health. The students must be encouraged to develop and employ scrupulous ethical principles in caring for patients, in relating to patients’ families, and to others involved in the care of the patients. These principles are essential if the physician is to gain and maintain the trust of patients and colleagues and the respect of the community.

(k) Clinical medicine is best learned by active participation in the delivery of care. It is not enough to follow a physician preceptor about observing how he cares for his patients. “Hands on” participation of the student, with progression of responsibility in diagnosis and therapy, under faculty supervision, develops maturity in the student preparing for a medical career as an independent practitioner.

(5) Evaluation of Student Performance.

(a) The faculty must establish principles and methods for the evaluation of student performance and make decisions regarding promotion and graduation. The varied measures utilized should determine whether or not students have attained the school’s standards of performance, as well as national standards of performance, as measured by licensure examinations, and other examinations such as the Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS) (where applicable).

(b) The faculty of each discipline should set the standards for performance by students in the study of that discipline. Narrative descriptions of student performance should be recorded to supplement grade reports in all required clinical clerkships and in all courses where student-faculty interaction permits this form of assessment. The faculty should review the frequency of examinations and their scheduling, particularly when the students are enrolled in several subjects simultaneously. Schools should develop a system of evaluation that fosters self-initiated learning by students rather than frequent tests which condition students to memorize details for short-term retention only. Examinations should measure cognitive learning, mastery of basic clinical skills, and the ability to use data in realistic problem solving. If geographically separated campuses are operated, a single standard for promotion and graduation of students should be applied.

(c) The medical school must publicize to all faculty members and students its standards and procedures for the evaluation, advancement, and graduation of its students and for disciplinary action. The school should develop and publish a fair and relatively formal process for the faculty or administration to follow when taking any action that adversely affects the status of a student.

(d) The institutions must maintain adequate records. These records should include summaries of admission credentials, attendance, measurement of the performance and promotion of the student, and the degree to which requirements of the curriculum have been met. Qualitative evaluation of each student in each course should be part of the record.

(6) Academic Counseling. The chief academic officer and the directors of all courses and clerkships must design and implement a system of evaluation of the work of each student during progression through each course or clerkship. Each student should be evaluated early enough during a unit of study to allow time for remediation. Course directors and faculty assigned to advise students should consider this duty a primary responsibility. All course directors or departmental heads, or their designates, should serve as expert consultants to the chief academic officer for facilitation of performance of both students and faculty.

Specific Authority 458.309, 458.314(4) FS. Law Implemented 458.314 FS. History–New 8-24-87, Formerly 21M-42.007, 61F6-42.007, 59R-15.007.