Interesting exchange of letters in Academic Medicine. At first, it almost seems counterintuitive, that defining a curriculum might afford more control and greater flexibility. But what the authors (see the earlier letters) are highlighting is the increasing damage ‘standardised’ testing may do to long term goals. The letter also would make me wonder how much of the medical school curriculum could be moved on online outwith the bricks and mortar, with medical schools just certifying some preclinical knowledge. Yes, the whole online world has been talking disintermediation for some time, but this is the serious literature catching up with the real world. If we are serious about broadening access and reducing costs and training more doctors, this seems to me to be one way to go. Of course this means we might need to look at how the course can be more modular, and flexible.
Implementing a universal preclinical curriculum could redefine the requirements for entering medical school and could even call into question the necessity of delivering the pre–Step 1 curriculum in a brick-and-mortar setting. Students could decide whether to take courses offered by medical schools, enroll in courses at other academic institutions, or study the material on their own (as they, in part, do now). Perhaps Step 1 will eventually become the entrance examination for medical school admission. It is essential that medical school curricula provide greater scope and nuance than that of the Step 1 blueprint. Consideration of a universal preclinical curriculum could help us focus the medical school’s primary role in establishing and implementing the teaching and evaluation of essential knowledge, attitudes, and skills required of students as they are trained to become competent, entrustable physicians, not master test takers.