Making the physician sausage

I started teaching medical students in 1988 and have been an instructor and course director for one or more first-year med school courses continuously since 1990. When I started, there were two full years of pre-clinical course-work. Now we're down to a year and two-thirds and there are plans to shrink further. Some medical schools in the US already only have a single pre-clinical year.

Personally, I thought the pre-clinical lectures and exams were excessive in the beginning, particularly in courses like Medical Biochemistry (my course) and Human Anatomy, but probably also in most courses. Some of those lecture hours could have been replaced by flipped classroom problem-solving and other forms of problem-based learning. I ran PBL in my course for over 20 years. Now, the race is on to push medical students into the clinic as fast as possible.

On the other end, the sole path to licensure in the US currently is through an internship/residency. These are mostly supported by the federal government and the positions haven't kept up with the growth in medical school graduates. That means that more and more graduates don't match to an internship/residency and can't practice independently. Now, maybe we don't want all students who get dragged across the medical school graduation finish line to be treating people. But I'm now reading suggestions of how we can change the curriculum to avoid the internship/residency requirement.

Some of my geezer peers have been bleeting for decades about how we're dumbing down the curriculum. I'm not convinced that the curriculum I was handed in the beginning was "smart," but I'm increasingly worried about how well-prepared physicians are in the age of COVID, direct-to-consumer genomics and CRISPR genome editing.