Maximilian Buja, MD from McGovern Medical School, The University of Texas Health Science Center at Houston, highlights challenges in imparting clinical skills in contemporary undergraduate medical education & graduate medical education.


Beginning in the late twentieth century and continuing into the present time, major changes have taken place in undergraduate medical education (UME) and graduate medical education (GME), based on the general rationale that changing times require fundamentally different educational approaches to produce physicians with needed new skill sets (Buja, 2019). Yet, there are paradoxes in contemporary medical education. The fully integrated UME curriculum is promoted as the optimal model to produce physicians with skills in modern clinical reasoning and decision-making (Brauer and Ferguson, 2015). Yet, the solid grounding in the basic biomedical sciences and the pathology and pathophysiology of disease required for high-level clinical reasoning and decision-making have been diminished.

There is strong momentum toward competency-based medical education (CBME) with an enhanced integration of UME and GME built around measurable milestones and entrustable professional activities (EPAs) (Powell and Carraccio, 2018). CBME is regarded as an optimal learner-centric educational system that can bring about a healthcare system with an enhanced patient-centric healthcare system.

Yet, there is evidence that history taking and physical examination skills of medical trainees have been greatly deteriorating over the past 20 years. Blatant examples have been documented of poor interviewing skills by students, skills which are key to problem detection and accuracy of diagnoses (Faustinella and Jacobs, 2018). Thus, the reality is in contrast to the rhetoric. It, therefore, behoves academic medical institutions to examine the possible causes leading to the decline of specific clinical skills such as history taking and physical examination to mitigate the problem.

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