medical education medical education medical education is education related to the practice of being a medical practitioner, including the initial training to become a physician (i.e., medical school and internship) and additional training thereafter (e.g., residency, fellowship, and continuing medical education). medical student in a laboratory at monterrey institute of technology and higher education, mexico city. medical student taking blood pressure during awareness campaign event medical education and training varies considerably across the world. various teaching methodologies have been used in medical education, which is an active area of educational research. medical education is also the subject-didactic academic field of educating medical doctors at all levels, including entry-level, post-graduate, and continuing medical education. specific requirements such as entrustable professional activities must be met before moving on in stages of medical education. common techniques and evidence base medical education applies theories of pedagogy specifically in the context of medical education. medical education has been a leader in the field of evidence-based education, through the development of evidence syntheses such as the best evidence medical education collection, formed in 1999, which aimed to "move from opinion-based education to evidence-based education". common evidence-based techniques include the objective structured clinical examination (commonly known as the 'osce) to assess clinical skills, and reliable checklist-based assessments to determine the development of soft skills such as professionalism. however there is a persistence of ineffective instructional methods in medical education, such as the matching of teaching to learning styles and edgar dales' "cone of learning". entry-level education main article: medical school faculty of medicine (comenius university in bratislava) slovakia entry-level medical education programs are tertiary-level courses undertaken at a medical school. depending on jurisdiction and university, these may be either undergraduate-entry (most of europe, asia, south america and oceania), or graduate-entry programs (mainly australia, philippines and north america). some jurisdictions and universities provide both undergraduate entry programs and graduate entry programs (australia, south korea). in general, initial training is taken at medical school. traditionally initial medical education is divided between preclinical and clinical studies. the former consists of the basic sciences such as anatomy, physiology, biochemistry, pharmacology, pathology, microbiology. the latter consists of teaching in the various areas of clinical medicine such as internal medicine, pediatrics, obstetrics and gynecology, psychiatry, general practice and surgery. there has been a proliferation of programmes that combine medical training with research (m.d./ph.d.) or management programmes (m.d./ mba), although this has been criticised because extended interruption to clinical study has been shown to have a detrimental effect on ultimate clinical knowledge. the lcme and the "function and structure of a medical school" the liaison committee on medical education (lcme) is a committee of educational accreditation for schools of medicine leading to an md in the united states and canada. in order to maintain accreditation, medical schools are required to ensure that students meet a certain set of standards and competencies, defined by the accreditation committees. the "function and structure of a medical school" article is a yearly published article from the lcme that defines 12 accreditation standards. entrustable professional activities for entering residency the association of american medical colleges (aamc) has recommended thirteen entrustable professional activities (epas) that medical students should be expected to accomplish prior to beginning a residency program. epas are based on the integrated core competencies developed over the course of medical school training. each epa lists its key feature, associated competencies, and observed behaviors required for completion of that activity. the students progress through levels of understanding and capability, developing with decreasing need for direct supervision. eventually students should be able to perform each activity independently, only requiring assistance in situations of unique or uncommon complexity. the list of topics that epas address include: history and physical exam skills differential diagnosis diagnostic/screening tests orders and prescriptions patient encounter documentation oral presentations of patient encounters clinical questioning/using evidence patient handovers/transitions of care teamwork urgent/emergency care informed consent procedures safety and improvement postgraduate education dean's office at the first faculty of medicine, charles university, prague following completion of entry-level training, newly graduated doctors are often required to undertake a period of supervised practice before full registration is granted; this is most often of one-year duration and may be referred to as an "internship" or "provisional registration" or "residency". further training in a particular field of medicine may be undertaken. in the u.s., further specialized training, completed after residency is referred to as "fellowship". in some jurisdictions, this is commenced immediately following completion of entry-level training, while other jurisdictions require junior doctors to undertake generalist (unstreamed) training for a number of years before commencing specialization. each residency and fellowship program is accredited by the accreditation council for graduate medical education (acgme), a non-profit organization led by physicians with the goal of enhancing educational standards among physicians. the acgme oversees all md and do residency programs in the united states. as of 2019, there were approximately 11,700 acgme accredited residencies and fellowship programs in 181 specialties and subspecialties. education theory itself is becoming an integral part of postgraduate medical training. formal qualifications in education are also becoming the norm for medical educators, such that there has been a rapid increase in the number of available graduate programs in medical education. continuing medical education in most countries, continuing medical education (cme) courses are required for continued licensing. cme requirements vary by state and by country. in the usa, accreditation is overseen by the accreditation council for continuing medical education (accme). physicians often attend dedicated lectures, grand rounds, conferences, and performance improvement activities in order to fulfill their requirements. additionally, physicians are increasingly opting to pursue further graduate-level training in the formal study of medical education as a pathway for continuing professional development. online learning medical education is increasingly utilizing online teaching, usually within learning management systems (lmss) or virtual learning environments (vles). additionally, several medical schools have incorporated the use of blended learning combining the use of video, asynchronous, and in-person exercises. a landmark scoping review published in 2018 demonstrated that online teaching modalities are becoming increasingly prevalent in medical education, with associated high student satisfaction and improvement on knowledge tests. however, the use of evidence-based multimedia design principles in the development of online lectures was seldom reported, despite their known effectiveness in medical student contexts. to enhance variety in an online delivery environment, the use of serious games, which have previously shown benefit in medical education, can be incorporated to break the monotony of online-delivered lectures. research areas into online medical education include practical applications, including simulated patients and virtual medical records (see also: telehealth). when compared to no intervention, simulation in medical education training is associated with positive effects on knowledge, skills, and behaviors and moderate effects for patient outcomes. however, data is inconsistent on the effectiveness of asynchronous online learning when compared to traditional in-person lectures. furthermore, studies utilizing modern visualization technology (i.e. virtual and augmented reality) have shown great promise as means to supplement lesson content in physiological and anatomical education. telemedicine/telehealth education with the advent of telemedicine (aka telehealth), students learn to interact with and treat patients online, an increasingly important skill in medical education. in training, students and clinicians enter a "virtual patient room" in which they interact and share information with a simulated or real patient actors. students are assessed based on professionalism, communication, medical history gathering, physical exam, and ability to make shared decisions with the patient actor. medical education systems by country jackson memorial hospital in miami, the primary teaching hospital for the leonard m. miller school of medicine at the university of miami, july 2010 at present, in the united kingdom, a typical medicine course at university is five years, or four years if the student already holds a degree. among some institutions and for some students, it may be six years (including the selection of an intercalated bsc—taking one year—at some point after the pre-clinical studies). all programs culminate in the bachelor of medicine and surgery degree (abbreviated mbchb, mbbs, mbbch, bm, etc.). this is followed by two clinical foundation years afterward, namely f1 and f2, similar to internship training. students register with the uk general medical council at the end of f1. at the end of f2, they may pursue further years of study. the system in australia is very similar, with registration by the australian medical council (amc). in the us and canada, a potential medical student must first complete an undergraduate degree in any subject before applying to a graduate medical school to pursue an (m.d. or d.o.) program. u.s. medical schools are almost all four-year programs. some students opt for the research-focused m.d./ph.d. dual degree program, which is usually completed in 7–10 years. there are certain courses that are pre-requisite for being accepted to medical school, such as general chemistry, organic chemistry, physics, mathematics, biology, english, labwork, etc. the specific requirements vary by school. in australia, there are two pathways to a medical degree. students can choose to take a five- or six-year undergraduate medical degree bachelor of medicine/bachelor of surgery (mbbs or bmed) as a first tertiary degree directly after secondary school graduation, or first complete a bachelor's degree (in general three years, usually in the medical sciences) and then apply for a four-year graduate entry bachelor of medicine/bachelor of surgery (mbbs) program. see: north america medical education in canada medical education in panama medical education in mexico medical education in the united states europe medical education in france medical education in norway medical education in the united kingdom asia/middle east/oceania medical education in australia medical education in china medical education in hong kong medical education in india medical education in jordan medical education in the philippines africa medical education in south africa medical education in uganda norms and values along with training individuals in the practice of medicine, medical education will influence the norms and values of those people who pass through it. this occur through explicit training in medical ethics, or implicitly through "hidden curriculum" a body of norms and values that students will come to understand implicitly but is not formally taught. the hidden curriculum and formal ethics curriculum will often contradict one another.. the aims of medical ethics training are to give medical doctors the ability to recognise ethical issues, reason about them morally and legally when making clinical decisions, and be able to interact to obtain the information necessary to do so. the hidden curriculum may include the use of unprofessional behaviours for efficiency or viewing the academic hierarchy as more important than the patient. the concept of "professionalism" may be used as a device to ensure obedience, with complaints about ethics and safety being labelled as unprofessional . the hidden curriculum was recently shown to be a cause of reduction in medical student empathy as they progress throughout medical school. integration with health policy as medical professional stakeholders in the field of health care (i.e. entities integrally involved in the health care system and affected by reform), the practice of medicine (i.e. diagnosing, treating, and monitoring disease) is directly affected by the ongoing changes in both national and local health policy and economics. there is a growing call for health professional training programs to not only adopt more rigorous health policy education and leadership training, but to apply a broader lens to the concept of teaching and implementing health policy through health equity and social disparities that largely affect health and patient outcomes. increased mortality and morbidity rates occur from birth to age 75, attributed to medical care (insurance access, quality of care), individual behavior (smoking, diet, exercise, drugs, risky behavior), socioeconomic and demographic factors (poverty, inequality, racial disparities, segregation), and physical environment (housing, education, transportation, urban planning). a country's health care delivery system reflects its “underlying values, tolerances, expectations, and cultures of the societies they serve”, and medical professionals stand in a unique position to influence opinion and policy of patients, healthcare administrators, & lawmakers. in order to truly integrate health policy matters into physician and medical education, training should begin as early as possible – ideally during medical school or premedical coursework – to build “foundational knowledge and analytical skills” continued during residency and reinforced throughout clinical practice, like any other core skill or competency. this source further recommends adopting a national standardized core health policy curriculum for