For more than 100 years, exposing students to basic and clinical research has been an essential component of a medical school education in the United States. However, today, new models of medical education in which research plays a minimal role are likely to create a two-tiered system of education, decrease the physician-scientist pipeline and diminish the application of scientific advances to patient care.

Those are the concerns outlined in “American Medical Education at a Crossroads” – a position paper published April 29 by Science Translational Medicine and co-authored by Arthur Feldman, MD, PhD, Executive Dean of Temple University School of Medicine and Chief Academic Officer for the Temple University Health System, Arthur H. Rubenstein, MBBCh, Professor of Medicine at the Perelman School of Medicine at the University of Pennsylvania, and colleagues. The abstract explores the reasons why research is being deemphasized, particularly at some of the nation’s newer medical schools, and at those which are not affiliated with a major research university. The authors argue that the U.S. is headed for a two-tiered system, one that exposes students to research and physician-scientists, and another that trains students with exclusively practitioners as role models. 

“Research at our nation’s medical schools has led to discoveries that have changed the face of American medicine,” says Dr. Feldman. “Unfortunately, many of the nation’s newer medical schools do not prioritize research or are unable to compete for scarce research funding. The result is an increased proportion of U.S. medical school graduates matriculating from programs where the faculty members pursue little to no clinical or translational research.”

According to the authors, many of the new U.S. medical schools share other features beyond just the absence of a research portfolio: they are not partnered with major research universities; they have a small basic science faculty; and, in many cases, their students take clerkships solely in community hospitals rather than in research-oriented quaternary care hospitals. 

Proponents of this model argue that empiric instruction (i.e., exposure to clinical settings) is sufficient and students who intend to pursue a career in primary care do not require hands-on exposure to laboratory-based translational research, to clinical research that is focused on the complex array of disease found in research-oriented hospitals, or to outcomes research, comparative effectiveness research and investigations centered on health care delivery systems.