Since I am, among other things, a medical educator (Yale School of Medicine, 1960-1965; Stanford School of Medicine, 1965-1997; emeritus since then), I read the Autumn 2016 edition of Yale Medicine with great interest. The Yale system of medical education was the first real change from the standard curriculum that I had seen or heard of when I came to New Haven as an intern in 1953. The Yale system has stood the test of time. It is not suitable for all medical schools, but it has certainly worked out well for Yale. Many medical schools have tweaked their curricula with early clinical experience, a chance to revisit basic science experiences in the later years of medical school, longitudinal clinical experiences, and other changes. New technology has probably influenced medical—and other—education more than any other single factor in my lifetime.

My question is this: How do we know that any of these curricular changes make for better-educated medical students and healthier patients? There are so many variables in the equation that it is impossible to point to any one factor that has influenced medical education for the better. For one obvious thing, students today are both brighter and better educated when they enter medical school than we were in 1949. I have often said that I probably could not have gotten into or out of medical school in today’s world. The last study with real and meaningful impact on medical education was that of Abraham Flexner, a college preparatory school teacher in Louisville, Ky., in 1910.

We evaluate research in many ways. The randomized clinical trial is the gold standard for clinical research these days. Is there a similar standard for evaluating curricular changes in medical education? If so, are the changes at Yale being put to this test?

James B.D. Mark, M.D., HS ’60
Professor of Cardiothoracic Surgery Emeritus, Stanford University School of Medicine,
Stanford, Calif.