1. Clinical Professor of Medicine Stanford University School of Medicine
Educating Doctors in
America
Peter Pompei, M.D.
Clinical Professor of Medicine
Stanford University School of Medicine
Our destination or career goal of becoming a physician is the same, but we follow different paths to get there.
When I served as associate program director, adhering to work hours was a challenge and I wondered how they dealt with this in Europe, knowing how my European friends value vacation and disparage us for working so hard.
Though we view our systems in the USA as rigorous and based in science, do we really do a better job than in other parts of the world?
You are probably familiar with evidence that outcomes like maternal mortality during childbirth and longevity are better in western Europe.
What about things closer to what you do? What outcomes of patients admitted with an acute MI would be of interest to you? Here are outcomes reported from the Global Registry of Acute Coronary Events.

2. カリフォルニア州へようこそ！

3. China

4. Taiwan

5. Educational Steps towards a Medical Degree in America
Medical School
University
Secondary School
Primary School 5 14 18 22 26
Age in Years

6. Medical Schools and Graduates
Country
Numbers
of Medical Schools
Numbers of Graduates
Graduates per 100,000 population
Japan 80
7800
6.0
China
>100 ?
Taiwan 12
1300
5.5
USA
141
16,000
6.3
California 11
1055
2.8
The final column normalizes the number of graduates for a population of 100,000 and you can see that most European countries are graduating many more physicians than we are.
Black out slide
Post-graduate experiences in Europe:
What is internal medicine? Cardiology and GI are considered separate.
Focus on employment and on the job training rather than education
Slide
Let’s look at Residency in a little more detail.
Source: Organization for Economic Cooperation and Development

7. Brief Summary of Medical School Education in America
Selection to medical school is determined by academic preparation, performance on a standardized exam, evidence of accomplishments and commitment to service
The traditional 2 years of basic science followed by 2 years of clinical work is being transformed to allow for earlier clinical experiences
The curriculum for the first 2 years is commonly organized in one of 2 ways
By discipline: anatomy, histology, physiology, pathology …
By organ system: pulmonary, cardiology, gastroenterology …
Lectures are increasingly being replaced by interactive clinical case-based learning or video delivery of content followed by in-class active learning
Clinical rotations have changed very little over the years with required rotations in the ‘core’ disciplines (surgery, medicine, pediatrics, obstetrics & gynecology, psychiatry) and electives in other disciplines

8. Reflections on Post-Graduate Medical Education in Europe
Selection and advancement in medical education/training is largely determined by performance on standardized exams
Work hours are shorter than in the USA with the primary tradeoff being supervision and continuity with patients
The length of rotations and the absence of “redundant” responsibilities within teams of doctors distinguish post-graduate education in Europe from what we know in the USA
Despite differences in the education/training organization, the time preparing for a career in internal medicine is about the same in Europe and the USA
Career opportunities in Internal Medicine focus on hospital based work with fewer experiences in and less focus on ambulatory care