How Different Is Medical School Education Today Compared To 50 Years Ago?

This question was originally posted on Quora.com and was answered by Michael Keyes, M.D. Psychiatry, Tulane University School of Medicine (1970)



I graduated from medical school in 1970, not quite 50 years ago, and have taught in two medical schools since then (Vanderbilt and Kansas.). The main differences are the content of the knowledge and the demographics of the students.

When I applied to medical school in 1966 I only had to compete against white males. This was before grade inflation but during a draft. If you had a 3.0 GPA and came from a school noted for producing good pre-med candidates, you had a good chance of getting into medical school. Because of the draft, there were more students applying to post graduate schools and these students may have been a little more motivated to get in. The numbers of applicants for the 90 or so allopathic schools was not as high as it is now and there was no informal requirement for research or medical shadowing. (I happened to do all that including being published in a refereed medical journal as second author, but it never came up in my interviews.)

Most medical schools (in the US and Canada) tend to teach exactly the same things these days while, surprisingly, there was considerable variation due to the constant changes in residency requirements in the sixties and seventies. The eligibility requirement for psychiatry changed at least three times while I was in medical school including one year in which you could take only psychiatry your last year and it would count as part of your residency. (This produced some inadequately trained psychiatrists to my mind as very little science was taught, but that is a different story.)

Today, every student takes the USMLE parts 1 and 2 which is vital for residency acceptance and most schools have a Pass/Fail grading system. Most of the information has been upgraded in the past 50 years, but the complaint that “medical students don’t learn enough about (fill in the blank)” still exists. In my day (I’ve always wanted to say that), we took state boards and hoped there was reciprocation. (A form of national boards was present, but not universally taken except to standardize the test.)

The basic differences are that students are more alike than in the past as far as test scores and GPAs and more diverse in all other aspects. I had 10 women in my class of 110, now it is around 50/50. Black students mostly went to Meharry or Howard (that was changing, however) and the cultural group that bigots complained about was Jews, not Asians.

One other difference is the resident match. About the time I graduated, this was being introduced as a more equitable way of choosing who gets what residency. Prior to that it was usually a matter of who knew who or a student taking an elective at the place that they wanted to go. If you had a very good recommendation chairman to chairman (they were all men), you could get a residency. Class ranking also played a part. Some residencies, such as the OB/GYN residency at Tulane, refused to take women who were encouraged to go into pediatrics, psychiatry or general practice so they could take care of the children. Those days are past although there is still a disparity.

When I compared my son’s education to mine at the same school, there were clear differences in style. We all wore ties and were expected to look “professional.” (This was true throughout my education from parochial school on.) We were expected to be at all lectures, roll was taken and if we missed lectures, we might have been dismissed. (It never happened.) We were graded in everything (our class, top to bottom, had an 87–94 range reflecting the abilities of the students) and, while there was no curve, there was competition for grades that was almost humorous at times. My son’s class had none of those restrictions yet he managed to do well.

All the women in my class were ranked in the top twenty (all 10) which was also true in my wife’s class several years later. I didn’t meet my first “average” female medical student until about 1984 when the numbers were changing significantly. (“Average” in this case means smart, just not brain melting smart.)

There are certainly differences, differences that, in general, reflect the changes in society in the last fifty years and are not surprising. Medical school is still hard to get into and is still a lot of work and skill building. The content has changed, but that is a constant in the medical domain and not unexpected. The work load is probably close but there are more choices these days.


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