Table 2 Observations and Knowledge Related to Enhancing the Coordination and Efficiency of Medical Education across the Continuum of Physician Education and Training

• In addition, all medical schools in Israel also base their selection on an assessment of the applicant’s humanistic qualities.

• The standard education of Israeli physicians consists of: three preclinical years; three clinical years; a one-year rotating internship (stáge) that must be completed before the MD degree is granted; and four or more years of residency, depending upon the specialty.

o There also are relatively new four-year, undergraduate medical teaching programs for persons who already have a bachelors or advanced degree in the sciences.

• The course of study and training for an Israeli student who chooses to go into a primary care field such as family medicine or pediatrics, is at least as long as in the U.S.

o By comparison, the U.S. student who has four years of college, has about three of those to pursue academic interests other than those required for medical school admission; whereas, the curriculum for the Israeli student is fully prescribed.

• In most Israeli schools there has been little integration of the basic sciences and clinical knowledge.

o Students voiced strong complaints about the lack of relevance of what they were taught in the basic sciences to their future careers.

• The majority of undergraduate teaching, especially in the preclinical basic science curricula, is lecture-based.

o On average, attendance at lectures is poor.

o Faculty members report that Israeli medical students want to be “spoon-fed.” Students report that they would prefer more interactive teaching.

• Almost all evaluation is done by multiple-choice question (MCQ) examinations.

o Faculty report that given the numbers of students they must evaluate, they have no alternative to MCQs.

• Responsibility for the continuum/trajectory of physician education is divided.

o Responsibility for undergraduate curricula rests within the universities.

o Responsibility for the rotating internship (stáge) rests with the collective group of medical school deans, the Deans Forum, and the Israel Medical Association.

o Responsibility for residency programs rests with the Israel Medical Association.

• The CHE performs a periodic external review of the undergraduate teaching programs.

o This is not coordinated or integrated with review of the rotating internship (stáge), or review of graduate medical education programs.

• Israeli medical schools do not have an explicit set of competencies to guide curriculum development.

• Individual courses and clerkships in Israeli medical schools generally do not have specific learning objectives to form the basis for student and faculty accountability.

• The majority of clinical education in Israel has been in hospital settings.

o Increasingly health care delivery is occurring in ambulatory settings.

o All medical schools report scarcity of hospital resources for teaching, especially as class sizes are increasing in response to government requests.

o Ambulatory medical education is occurring increasingly in the U.S. and U.K.

o Ambulatory education requires facilities suitable for teaching and learning, faculty development, and appropriate incentives to engage the faculty.

o The committee did observe teaching of undergraduate medical students in two clinics jointly developed by Clalit and Ben-Gurion University.

• Interprofessional education (IPE) is important for preparing learners to practice effectively in teams.

o IPE is occurring in most schools in the U.S. and U.K.

o IPE is occurring at only one university in Israel.

• Promotions for clinical faculty are generally based on research criteria similar to those for pre-clinical faculty.

o Teaching ability, though considered in promotions, is not a deciding criterion.

o Many students have a job while in medical school; and it is common for students to leave their clinical clerkships in mid-afternoon in order to work.