Medical School in Israel
Doctors are a valuable resource in the State of Israel, which is facing a shortage of doctors in the coming years. Medicine is a prestigious field in Israel, and getting accepted to medical school is a journey of its own. Below is a brief overview of medical school in Israel and the criteria for acceptance.
Tracks of Study
There are two ways to study medicine in Israel:
The first option is a full six-year track, followed by a medical internship in Israel. These programs are offered at Hebrew University , The Technion , Tel-Aviv University , Bar-Ilan University and Ben – Gurion University . In addition to excellent high school grades and a bagrut equivalent * , schools only accept students with a very high score on the Psychometric Exam (usually not less than 740 although the “official” requirement is lower). SAT and ACT scores are not accepted. Olim applicants must obtain a score of at least a 105 or higher on the YAEL Hebrew proficiency exam, although some of the medical schools require an even higher score.
The second option is to study in a pre-med program (or a BSc which includes the prerequisites delineated below) followed by a four-year Medical School program offered at Tel Aviv University , Bar-Ilan University , Ariel University and Ben-Gurion University.
Olim students must have completed the Aliyah process in order to apply for any medical school program in Israel. The international schools at the Sackler School of Medicine at Tel Aviv University and the Technion American Medical School have permanently closed for enrollment as of the fall of 2023.
Ben-Gurion University is keeping its Medical School for International Health (MSIH) open for Olim/Israeli citizens only . Studies in years one and two are in English, and studies in years three and four are in Hebrew. More information is here. The acceptance criteria are here .
In order to be accepted to a 4-year medical program in Israel, students must have completed a Bachelor’s degree recognized in Israel and maintained at least an 80 average (and in some cases higher) with the following prerequisites ** :
- Biochemistry- 4 credits
- Cell biology- 4 credits
- Molecular biology- 4 credits
- Genetics– 3 credits
- Microbiology- 4 credits
- Physiology- 4 credits
- Statistics- 3 credits
Applicants must take a Mivhan Yeda , a medical knowledge exam (administered in Hebrew), once they have applied to the medical schools of their choice. This exam is offered twice a year, usually in May and June at Tel-Aviv University. More information about the test and registration is here . The application process includes an in-person, individual interview before final acceptance.
Each program has different acceptance criteria, and some may require applicants to take a personality test. Since each medical school program has its own unique requirements and application process, we recommend you see the websites of each medical school for exact prerequisites and updated information.
* A bagrut equivalent for applicants from the United States is 6 APs with a score of 4 or 5. Bagrut equivalency for Canadian Olim can be found here . For more information on bagrut equivalency, please see this.
** At present, BGU’s Medical School for International Health accepts applications with an MCAT score (in addition to applications with a Mivhan Yeda score). If applying with an MCAT score, the required prerequisites are different from the above. Please be in touch with BGU for more information: [email protected]
Updated: December 2023
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22 Best Medical schools in Israel
Updated: February 29, 2024
- Art & Design
- Computer Science
- Engineering
- Environmental Science
- Liberal Arts & Social Sciences
- Mathematics
Below is a list of best universities in Israel ranked based on their research performance in Medicine. A graph of 7.58M citations received by 255K academic papers made by 22 universities in Israel was used to calculate publications' ratings, which then were adjusted for release dates and added to final scores.
We don't distinguish between undergraduate and graduate programs nor do we adjust for current majors offered. You can find information about granted degrees on a university page but always double-check with the university website.
1. Tel Aviv University
For Medicine
2. Hebrew University of Jerusalem
3. Weizmann Institute of Science
4. Technion - Israel Institute of Technology
5. Ben-Gurion University of the Negev
6. Bar-Ilan University
7. University of Haifa
8. Ariel University
9. Interdisciplinary Center
10. Tel-Hai Academic College
11. Max Stern Academic College of Emek Yezreel
12. Ruppin Academic Center
13. Jerusalem College of Technology
14. Holon Institute of Technology
15. Ono Academic College
16. Sapir College
17. College of Management - Academic Studies
18. ORT Braude College
19. Netanya Academic College
20. Afeka Tel Aviv Academic College of Engineering
21. Jerusalem College of Engineering
22. Shenkar College of Engineering and Design
The best cities to study Medicine in Israel based on the number of universities and their ranks are Tel Aviv , Jerusalem , Rehovot , and Haifa .
Medicine subfields in Israel
- Open access
- Published: 12 November 2015
Undergraduate medical education in the U.S. and Israel: contrasts and common challenges
- Arthur M. Feldman 1
Israel Journal of Health Policy Research volume 4 , Article number: 56 ( 2015 ) Cite this article
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In 2014, the Israeli Council for Higher Education (CHE) commissioned an international panel of outstanding educators to prepare an ad hoc report reviewing the four established medical schools in Israel. The report described the strengths, weaknesses and challenges facing medical education in Israel with a focus on three specific areas: workforce planning, the structure of the curriculum and the financing of medical education.
There are interesting parallels between the challenges facing medical education in the U.S. and in Israel: a lack of clarity regarding the optimal size for the workforce and the optimal method for enhancing the number of primary care physicians; an absence of methodologies for evaluating innovations in medical education and a lack of transparency in funds flow. However, there are also important differences, one of the most important being an absence in Israel of students’ hands-on responsibility for their patients until year six of their undergraduate medical education.
The presence of a small number of medical schools with common funding and geographic proximity, in a relative sense, provides the Israeli medical schools with a unique opportunity to evaluate innovations in medical education and to set a high bar for inter-school collaboration and cooperation.
In 2014 the Israeli Council for Higher Education (CHE) commissioned an ad hoc committee composed of internationally respected physician-educators (four from the U.S., two from the U.K. and two from Israel) to provide an external review of Israel’s four established and accredited medical schools. In a recent IJHPR article, the report’s authors discuss three inter-related topics that bridge medical education and health care delivery: planning the physician and healthcare workforce to meet the needs of Israel’s population in the 21 st century; enhancing the coordination and efficiency of medical education across the continuum of education and training; and the financing of medical education. The members of the committee undertook an enormous task and have provided a comprehensive and scholarly assessment of the strengths and weaknesses of undergraduate medical education (UME) in Israel as well as the challenges faced in educating the next generation of physicians. Many of these challenges cross borders and continents; the overwhelming amount of new knowledge emanating from research laboratories and clinical trials, the financial stresses on hospitals and physicians that limit the resources that can be allocated to education, and pressures to shorten hospital stays and increase ambulatory care. How individual medical centers face those challenges is predicated in part on the influence of regulatory agencies in each country, the support – or lack of it – from universities, governments, and philanthropies, and the external influences of local and national politics [ 1 ]. However, the CHE report provides an opportunity to compare and contrast how Israel and the U.S. have approached the fundamental issues that face each of us and to explore ways in which lessons learned in the U.S. might inform efforts to reform UME in Israel.
Workforce planning
There are both interesting similarities and significant differences in “workforce planning” between Israel and the U.S. – although in both countries the term “workforce planning” might be described as an oxymoron. The CHE Report points out correctly that workforce planning in the U.S. is “highly fragmented” and experts cannot agree whether there is an actual physician shortage or whether the problem can be solved by better geographic distribution and an increase in the percentage of medical school graduates who pursue careers in primary care [ 2 ]. The latter view fails to recognize that an aging population requires not only primary care physicians but subspecialists who have expertise in caring for patients that have diseases that are over-represented in an aged population: degenerative joint disease, age-related macular degeneration, coronary artery disease, heart failure, critical care medicine, neurodegenerative diseases and cancer [ 3 , 4 ].
The paucity of U.S. students who pursue careers in primary care has been attributable to the high medical school debt of U.S. students - ~ $180,000 [ 5 ]. The fact that Israel has a similar shortage of primary care physicians despite substantial governmental support and far lower tuition costs suggests that career decisions are made on factors that are more complex than financial exigencies alone [ 6 ]. Both the CHE task force and U.S. primary care groups have proposed innovative programs to increase students’ interest in primary care: early immersion in a primary care setting, identification of ideal role models, and enhanced compensation models [ 7 ]. Unfortunately, none of these efforts have effectively shifted students’ interests. The current process of expanding Israel’s medical schools will help mitigate the existing and expected shortages in primary care physicians, but apparently this will not suffice and additional solutions are needed. Dr. Schoenbaum and his colleagues have proposed in the CHE report a concept that is gaining substantial interest in the U.S. for mitigating the shortage in primary care physicians: an increased use of non-physician clinicians as primary care providers [ 8 ]. While there is presently a limited number of non-physician clinicians in Israel, the opportunity to train physician assistants in a medical school environment using the model first described by Dr. Eugene Stead at Duke a half-century ago may mitigate some of the workforce issues while at the same time providing a new opportunity to increase medical school revenues.
The CHE report notes that the U.S. medical workforce is less dependent on foreign trained physicians than the Israeli workforce. This should not be construed as being a disadvantage for Israeli medicine because the demographics of the foreign trained workforce in the two countries are quite different. The majority of foreign-trained physicians who enter the Israeli workforce are Israeli citizens. By contrast, the majority of foreign-trained physicians who enter the U.S. workforce are foreign nationals who graduate from nearly 2,000 different medical schools worldwide including many from countries with whom the U.S. has relationships that are at times problematic. Without information about their schools of origin, these post-graduate trainees are selected based almost exclusively on scores on the USMLE examination; a test that provides limited information about a physician’s clinical capabilities. As a result there is wide variation in how these physicians perform on subsequent testing for licensure in the U.S. [ 9 , 10 ]. However, those who become licensed in the U.S. appear to perform well in practice although acculturation is an important but not obligatory part of their training. U.S. citizens who enter the U.S. medical workforce from abroad are most commonly graduates of for-profit medical schools in the Caribbean Islands that are unregulated, often graduate over 1,000 students per year, and farm their students out to U.S. hospitals for clinical clerkships by compensating the hospitals at a rate exceeding $500 per student per week – a reimbursement strategy that is problematic for a U.S. medical school [ 11 ].
Enhancing the coordination and efficiency of medical education across the continuum of physician education and training
The structure of pre-clinical and clinical ume.
The construct of UME in Israel differs substantively from that in the U.S. The most important difference between UME in the U.S. and Israel appears to be that Israeli students have less substantive contact with patients. William Osler, the father of American medical education, pointed out a century ago that: “To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all. [ 12 ]. Students are benefited when they are exposed to patients from day one of medical school and by incorporating clinical cases into basic science instruction or problem based learning [ 13 ]. During the clinical years students should be an integral part of the medical team – caring for assigned patients under the guidance of a resident and a faculty member rather than simply observers, and they should not be allowed to have “jobs” or any other extra-curricular activities that limit their participation in the medical curriculum and in particular, their clinical rotations. Not mentioned in the Report is the valuable role that standardized patients have played in the U.S. for nearly two decades [ 14 ]. They help students learn how to interview and examine a patient, they allow students to hone their clinical skills, and they provide both summative and formative feedback for the students. More recently, new technologies have supplemented the traditional standardized patient format in order to optimize assessment and evaluation such as adding Google glasses [ 15 ]. Small group workshops that use role play prior to patient interviews as well as videotaping patient encounters followed by group discussion have also proved useful [ 16 ]. In the U.S., a relatively new standard for medical education is inclusion in the curriculum of “translational medicine” [ 17 ]. Some schools have approached this by including instruction in the social sciences, statistical analysis, population health, the fundamentals of healthcare safety and quality, bioethics and health care finance. We believe that wherever possible students should have hands-on experience in translational research; however, this is not practical for schools that do not have programs in translational research. This could be an opportunity to link medical education in Israel with the robust and medically oriented Israeli biotechnology industry and the outstanding basic and translational science laboratories at Israeli academic institutions.
Dr. Thomas Nasca, the President of the American College of Graduate Medical Education (ACGME),m pointed out that medical school graduates today are an “undifferentiated primordial mass that must be shaped during residency” into medical practitioners [ 18 ]. Thus it is critical that UME and GME be viewed as a continuum during which a student progresses from a student to a practicing physician as they develop increasing competencies [ 19 ]. Each pre-clinical block and clinical clerkship should have well defined core competencies that each student is expected to attain. As individual specialty and subspecialty organizations develop milestones and entrustable professional activities (EPA’s) for GME, these concepts should be introduced into the undergraduate curriculum and incorporated into the assessment and evaluation of each student [ 20 ]. The CHE Report suggests that grading students based on achieved milestones might provide an opportunity for students to transition from a student to a resident based on their individual timeframe for understanding and using information. While intriguing, the complexities associated with assessing, tracking and scheduling hundreds of students based on individual metrics would likely be problematic if for no other reason than the need for additional support staff and the attendant costs.
The authors of the CHE Report were clearly influenced by the 2010 Carnegie Report on UME and the recent survey by Nara et al. [ 21 , 22 ]. These reports posited that there is a need for medical schools to decide whether to “continue in the directions established over a hundred years ago [by the 1910 Flexner Report] or take a fundamentally different course guided by contemporary innovation and new understanding about how people learn”[ 21 ]. It must be remembered that the definition of “innovation” is a “new idea or method” but not one that has necessarily proven successful. Thus, while changes such as flipped classrooms, active learning, e-learning, team learning, and simulation have been implemented at some – but certainly not all – U.S. medical schools, they have not yet undergone a thorough evaluation because the requisite tools have not been developed and it often takes many years to reach measurable endpoints [ 23 ]. In addition, many of the innovations in UME are expensive. For example, flipped classrooms and active learning require the availability of a large teaching faculty to facilitate small group discussions, multiple small classrooms and a collection of professionally produced on-line lectures. These novel teaching tools can be incorporated into the curriculum in selected areas rather than across the entire curriculum. For example, in our own curriculum, we use the more traditional lecture format for didactics in anatomy, biochemistry, immunology and microbiology. The remainder of the curriculum is system-based with approximately 40 % of the curriculum presented in the lecture format.
The CHE Report raised the concern that there were limited sites for clinical clerkships in Israel due to a paucity of hospital beds per capita and an over-reliance on hospital versus ambulatory teaching. This raises two possibilities. First, the possibility of increasing the number of clerkship opportunities for students by decreasing the number of patients on each clinical team could be evaluated. Kenneth Ludmerer pointed out in his book Let Me Heal that in an era of cost containment, a resident’s primary job is to churn patients through the hospital system as rapidly as possible [ 24 ]. This obviates the ability of students and residents to see the full spectrum of a patient’s disease, to have the time to get to know each patient and to ensure that students have appreciated the key elements of the history and physical examination. Students are invariably part of large teams. Two innovative programs have taken a very different approach. Hopkins Bayview (The Aliki Initiative) and the Brigham and Women’s Hospital have created teams with half the normal complement of patients so that students and residents have more time to spend with each patient [ 25 , 26 ]. The Aliki Initiative is associated with higher patient satisfaction, higher resident satisfaction and improved patient outcomes although the cost of restructuring the clinical teams might be prohibitive. Second, opportunities for increased outpatient exposure should be evaluated. In the U.S., there is a strong financial incentive for providing as much care as possible in the outpatient environment. In fact, many health care economists and policy pundits posit that the hospital of the future will be a large intensive care unit – much of today’s care being administered in outpatient clinics. How to compensate busy outpatient physicians for teaching will be the challenge of increasing outpatient exposure albeit with a strong societal benefit.
Financing of medical education
Medical education financing is a universal problem with enormous differences in UME and GME funds flow across different countries and in the U.S., across different medical schools: a problem that has increased as reimbursements have precluded cost-shifting from practice plans and hospital revenues to support the academic missions of the medical school [ 27 ]. At research-intensive medical schools in the U.S. tuition does not begin to cover the medical school budget because Federal funding does not cover the cost of research even if all investigators were optimally funded. Research-intensive medical schools in the U.S. therefore depend on university support, endowments, philanthropy and commercialization of intellectual property to support the research enterprise and in some cases, obtain support from associated health systems. An increasing number of medical schools in the U.S. have received significant financial contributions from wealthy individuals whose names are now incorporated into the name of the medical school: for example, Weill Cornell Medical College, Icahn School of Medicine at Mount Sinai, and Warren Alpert Medical School at Brown University. By contrast with Israeli schools, many U.S. medical schools compensate basic science teachers based on the number of hours they teach and the number of hours required to prepare a lecture. As a result, tenured faculty who no longer have grants to support their salaries often increase the time they spend teaching. For clinical faculty who spend significant amounts of time with students on their inpatient or outpatient services, many U.S. medical schools lower the relative value unit (RVU) expectations commensurate with the time they teach or pay teachers directly for their services [ 28 ]. This is important because without incentives, both pre-clinical and clinical educators are less likely to teach. Many medical schools have also developed multiple pathways to promotion in order that educators can be promoted based on their teaching evaluations and education scholarship rather than on extramural funding and the number of scientific publications and in some institutions educators can also achieve tenure. These incentives are critical for not only attracting teachers but also in making them feel that they are an important component of the medical school and university.
Lost in discussions of U.S. medical school financing is the fact that medical schools that do not or cannot support a research program have an economic profile that is significantly better than that of the traditional research-intensive schools [ 17 ]. In fact, a publicly traded company owns at least one offshore for profit medical school. In addition, the Liaison Committee on Medical Education (LCME) recently accredited the first for-profit allopathic medical school in the U.S. and for-profit osteopathic medical schools have previously been approved in the U.S. We have argued that it is important for medical students to have exposure to physician-scientists and clinician investigators who pursue translational research in either laboratory or clinical research centers while at the same time caring for patients [ 29 ]. Exposure to these research-oriented clinicians provides important role models, the opportunity to have hands-on participation in research activities and a perspective on medicine and medical education than is different from that which a student would obtain when their instruction is in a community hospital. The absence of physician-scientists and clinician-investigators at new medical schools and at for-profit medical schools threatens to create a two-tiered system of medical education in the U.S., yet without resources, more and more U.S. medical schools may shift to the second tier model. Thus, the presence of governmental funding for medical education in Israel is a critically important financial foundation that should be continued and increased as necessary.
Unique opportunities for Israeli medical education
Israel has only five medical schools – the four established schools covered in the report and a new medical school in the Galilee. The existence of only five medical schools which are largely funded by the government through the Council for Higher Education and which are located relatively close to one another, provides unique opportunities for both UME and GME. First, as pointed out in the CHE Report, there is the opportunity to share resources. The best lecturers and the best lectures from across the five schools can be used for the didactic portion of pre-clinical courses across the schools. In an era when many medical schools are implementing innovative but unproven and often expensive new teaching formats, there is also an opportunity to use the five Israeli medical schools as innovation incubators to actually test whether one educational strategy is better than another. Outcome metrics for comparisons of different education formats can include scores on standardized tests, OSCI’s or even oral examinations. The outcome of these studies would be useful to Israel for optimizing the educational experience for students and student outcomes as well as benefiting medical schools in other industrialized countries.
The economies of scale across the five schools might also provide novel opportunities for the medical schools to create ambulatory care facilities that could provide a collaborative learning environment for students from multiple schools. If these facilities are built in areas that are underserved in medicine, the creation of joint programs focused on health disparities and population health could also decrease health disparities that have occurred in ethnic or economically deprived areas. The five medical schools should also work together to lobby the government to transition from a university-centric funding model to a medical school-centric funding model as there is little rationale for the funds flow coming through the university as it is unlikely that this can be done with complete transparency. Furthermore, there will always be questions as to whether the universities apportion some of the funds for university infrastructure rather than for direct support to UME. The five medical schools should also look for opportunities to participate and actually lead the development of new physician assistant and nurse practitioner programs. By embedding these programs in the medical school both medical students and non-physician clinicians are exposed to the concepts of inter-professional education and learn to work seamlessly as a part of the care delivery team.
Israeli medical schools should also take advantage of the enormous investment in biotechnology in Israel by creating medical school-based incubator facilities and early stage venture funds to take advantage of intellectual property coming out of medical school laboratories. This effort should be collaborative across the five medical schools because the expertise of each may be distinct yet synergistic - making the aggregate intellectual property more valuable when bundled rather than put out to the market as individual pieces. Finally, Israeli medical schools should follow the lead of successful U.S. medical schools in pursuing philanthropy from both Israel and the U.S. that supports all three missions of the academic medical center: teaching, research and patient care. The message to potential donors and to grateful patients is the same in the U.S. as in Israel – without a continuing supply of new medical graduates with the skills to provide effective and efficient care in the short term and the ability to be learners throughout their careers, the health of the nation will suffer.
Conclusions
There are both differences and similarities between medical education in the U.S. and Israel. Important differences could be mitigated by focusing restructuring on: increasing the clinical exposure for medical students both during the pre-clinical and clinical years of medical school; eliminating student “moonlighting;” evaluating innovative methods for restructuring clinical teams in order to provide more clerkship opportunities; enhancing utilization of outpatient clinics for student education; developing clear rewards for educators including new pathways to promotion and tenure; establishing transparent funds flow for both pre-clinical and clinical educators; and financing undergraduate medical education through direct funds flow to medical schools rather than through university finance offices. Finally, the presence of only five medical schools within a relatively small geographic footprint should provide an opportunity for the schools to collaborate and cooperate in medical education in order to lower costs, optimize patient and space resources and take advantage of the unique academic and scientific strengths of the medical schools in Israel.
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Schoenbaum SC et al. Policy issues related to educating the future Israeli medical workforce: an international perspective. Isr J of Health Policy Res. 2015; 4:37.
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Feldman, A.M. Undergraduate medical education in the U.S. and Israel: contrasts and common challenges. Isr J Health Policy Res 4 , 56 (2015). https://doi.org/10.1186/s13584-015-0053-4
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Medical Education in Israel: Directions and Challenges
- Medical School for International Health
Research output : Contribution to journal › Article › peer-review
Israeli medical education faces considerable stresses that include severe budgetary constraints and a recent influx of immigrant physicians who need professional upgrading or retraining. Ben-Gurion University developed a licensing preparation course after the government in 1988 required foreign-trained physicians to take a licensing examination. A standard, countrywide licensing examination is under study, but its development is hampered by the almost-complete autonomy of Israeli medical schools and minimal staffing of medical education units. To overcome these problems, the Israeli Society for Medical Education was founded in 1991. Ben-Gurion University Medical School, the newest and smallest, but most innovative, has sparked by its example many changes in the more traditional medical schools. It has introduced an increased emphasis on family medicine, early clinical teaching, integration of health services and medical education in the Beer Sheva region, the teaching of interviewing and communication skills, unification of single-discipline departments, courses in medical decision making and medical ethics, advances in computerization of medical records and in local budget autonomy for community clinics (a change from rigidly centralized medical administration), and voluntary peer evaluation.
Original language | English |
---|---|
Pages (from-to) | 195-199 |
Number of pages | 5 |
Journal | |
Volume | 3 |
Issue number | 4 |
DOIs | |
State | Published - 1 Jan 1991 |
ASJC Scopus subject areas
This output contributes to the following UN Sustainable Development Goals (SDGs)
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- 10.1080/10401339109539512
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- Israel Social Sciences 100%
- Israeli Social Sciences 79%
- physician Social Sciences 45%
- autonomy Social Sciences 42%
- medical ethics Social Sciences 37%
- retraining Social Sciences 37%
- education Social Sciences 36%
- Medical records Social Sciences 35%
T1 - Medical Education in Israel
T2 - Directions and Challenges
AU - Glick, Shimon
AU - Margolis, Carmi
PY - 1991/1/1
Y1 - 1991/1/1
N2 - Israeli medical education faces considerable stresses that include severe budgetary constraints and a recent influx of immigrant physicians who need professional upgrading or retraining. Ben-Gurion University developed a licensing preparation course after the government in 1988 required foreign-trained physicians to take a licensing examination. A standard, countrywide licensing examination is under study, but its development is hampered by the almost-complete autonomy of Israeli medical schools and minimal staffing of medical education units. To overcome these problems, the Israeli Society for Medical Education was founded in 1991. Ben-Gurion University Medical School, the newest and smallest, but most innovative, has sparked by its example many changes in the more traditional medical schools. It has introduced an increased emphasis on family medicine, early clinical teaching, integration of health services and medical education in the Beer Sheva region, the teaching of interviewing and communication skills, unification of single-discipline departments, courses in medical decision making and medical ethics, advances in computerization of medical records and in local budget autonomy for community clinics (a change from rigidly centralized medical administration), and voluntary peer evaluation.
AB - Israeli medical education faces considerable stresses that include severe budgetary constraints and a recent influx of immigrant physicians who need professional upgrading or retraining. Ben-Gurion University developed a licensing preparation course after the government in 1988 required foreign-trained physicians to take a licensing examination. A standard, countrywide licensing examination is under study, but its development is hampered by the almost-complete autonomy of Israeli medical schools and minimal staffing of medical education units. To overcome these problems, the Israeli Society for Medical Education was founded in 1991. Ben-Gurion University Medical School, the newest and smallest, but most innovative, has sparked by its example many changes in the more traditional medical schools. It has introduced an increased emphasis on family medicine, early clinical teaching, integration of health services and medical education in the Beer Sheva region, the teaching of interviewing and communication skills, unification of single-discipline departments, courses in medical decision making and medical ethics, advances in computerization of medical records and in local budget autonomy for community clinics (a change from rigidly centralized medical administration), and voluntary peer evaluation.
UR - http://www.scopus.com/inward/record.url?scp=0008404469&partnerID=8YFLogxK
U2 - 10.1080/10401339109539512
DO - 10.1080/10401339109539512
M3 - Article
AN - SCOPUS:0008404469
SN - 1040-1334
JO - Teaching and Learning in Medicine
JF - Teaching and Learning in Medicine
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The current state of basic medical education in Israel: implications for a new medical school
Affiliation.
- 1 The Technion-Israel Institute of Technology, Israel. [email protected]
- PMID: 19909037
- DOI: 10.3109/01421590903092426
The recent government decision to establish a new medical school, the fifth in Israel, is an opportune moment to reflect on the state of Basic Medical Education (BME) in the country and globally. It provides a rare opportunity for planning an educational agenda tailored to local needs. This article moves from a description of the context of Israeli health care and the medical education system to a short overview of two existing Israeli medical schools where reforms have recently taken place. This is followed by an assessment of Israeli BME and an effort to use the insights from this assessment to inform the fifth medical school blueprint. The fifth medical school presents an opportunity for further curricular reforms and educational innovations. Reforms and innovations include: fostering self-directed professional development methods; emphasis on teaching in the community; use of appropriate educational technology; an emphasis on patient safety and simulation training; promoting the humanities in medicine; and finally the accountability to the community that the graduates will serve.
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Undergraduate medical education in the U.S. and Israel: contrasts and common challenges
Arthur m. feldman.
Temple University School of Medicine, 3500 N. Broad Street, Suite 1150, Philadelphia, 19107 PA USA
In 2014, the Israeli Council for Higher Education (CHE) commissioned an international panel of outstanding educators to prepare an ad hoc report reviewing the four established medical schools in Israel. The report described the strengths, weaknesses and challenges facing medical education in Israel with a focus on three specific areas: workforce planning, the structure of the curriculum and the financing of medical education.
There are interesting parallels between the challenges facing medical education in the U.S. and in Israel: a lack of clarity regarding the optimal size for the workforce and the optimal method for enhancing the number of primary care physicians; an absence of methodologies for evaluating innovations in medical education and a lack of transparency in funds flow. However, there are also important differences, one of the most important being an absence in Israel of students’ hands-on responsibility for their patients until year six of their undergraduate medical education.
The presence of a small number of medical schools with common funding and geographic proximity, in a relative sense, provides the Israeli medical schools with a unique opportunity to evaluate innovations in medical education and to set a high bar for inter-school collaboration and cooperation.
In 2014 the Israeli Council for Higher Education (CHE) commissioned an ad hoc committee composed of internationally respected physician-educators (four from the U.S., two from the U.K. and two from Israel) to provide an external review of Israel’s four established and accredited medical schools. In a recent IJHPR article, the report’s authors discuss three inter-related topics that bridge medical education and health care delivery: planning the physician and healthcare workforce to meet the needs of Israel’s population in the 21 st century; enhancing the coordination and efficiency of medical education across the continuum of education and training; and the financing of medical education. The members of the committee undertook an enormous task and have provided a comprehensive and scholarly assessment of the strengths and weaknesses of undergraduate medical education (UME) in Israel as well as the challenges faced in educating the next generation of physicians. Many of these challenges cross borders and continents; the overwhelming amount of new knowledge emanating from research laboratories and clinical trials, the financial stresses on hospitals and physicians that limit the resources that can be allocated to education, and pressures to shorten hospital stays and increase ambulatory care. How individual medical centers face those challenges is predicated in part on the influence of regulatory agencies in each country, the support – or lack of it – from universities, governments, and philanthropies, and the external influences of local and national politics [ 1 ]. However, the CHE report provides an opportunity to compare and contrast how Israel and the U.S. have approached the fundamental issues that face each of us and to explore ways in which lessons learned in the U.S. might inform efforts to reform UME in Israel.
Workforce planning
There are both interesting similarities and significant differences in “workforce planning” between Israel and the U.S. – although in both countries the term “workforce planning” might be described as an oxymoron. The CHE Report points out correctly that workforce planning in the U.S. is “highly fragmented” and experts cannot agree whether there is an actual physician shortage or whether the problem can be solved by better geographic distribution and an increase in the percentage of medical school graduates who pursue careers in primary care [ 2 ]. The latter view fails to recognize that an aging population requires not only primary care physicians but subspecialists who have expertise in caring for patients that have diseases that are over-represented in an aged population: degenerative joint disease, age-related macular degeneration, coronary artery disease, heart failure, critical care medicine, neurodegenerative diseases and cancer [ 3 , 4 ].
The paucity of U.S. students who pursue careers in primary care has been attributable to the high medical school debt of U.S. students - ~ $180,000 [ 5 ]. The fact that Israel has a similar shortage of primary care physicians despite substantial governmental support and far lower tuition costs suggests that career decisions are made on factors that are more complex than financial exigencies alone [ 6 ]. Both the CHE task force and U.S. primary care groups have proposed innovative programs to increase students’ interest in primary care: early immersion in a primary care setting, identification of ideal role models, and enhanced compensation models [ 7 ]. Unfortunately, none of these efforts have effectively shifted students’ interests. The current process of expanding Israel’s medical schools will help mitigate the existing and expected shortages in primary care physicians, but apparently this will not suffice and additional solutions are needed. Dr. Schoenbaum and his colleagues have proposed in the CHE report a concept that is gaining substantial interest in the U.S. for mitigating the shortage in primary care physicians: an increased use of non-physician clinicians as primary care providers [ 8 ]. While there is presently a limited number of non-physician clinicians in Israel, the opportunity to train physician assistants in a medical school environment using the model first described by Dr. Eugene Stead at Duke a half-century ago may mitigate some of the workforce issues while at the same time providing a new opportunity to increase medical school revenues.
The CHE report notes that the U.S. medical workforce is less dependent on foreign trained physicians than the Israeli workforce. This should not be construed as being a disadvantage for Israeli medicine because the demographics of the foreign trained workforce in the two countries are quite different. The majority of foreign-trained physicians who enter the Israeli workforce are Israeli citizens. By contrast, the majority of foreign-trained physicians who enter the U.S. workforce are foreign nationals who graduate from nearly 2,000 different medical schools worldwide including many from countries with whom the U.S. has relationships that are at times problematic. Without information about their schools of origin, these post-graduate trainees are selected based almost exclusively on scores on the USMLE examination; a test that provides limited information about a physician’s clinical capabilities. As a result there is wide variation in how these physicians perform on subsequent testing for licensure in the U.S. [ 9 , 10 ]. However, those who become licensed in the U.S. appear to perform well in practice although acculturation is an important but not obligatory part of their training. U.S. citizens who enter the U.S. medical workforce from abroad are most commonly graduates of for-profit medical schools in the Caribbean Islands that are unregulated, often graduate over 1,000 students per year, and farm their students out to U.S. hospitals for clinical clerkships by compensating the hospitals at a rate exceeding $500 per student per week – a reimbursement strategy that is problematic for a U.S. medical school [ 11 ].
Enhancing the coordination and efficiency of medical education across the continuum of physician education and training
The structure of pre-clinical and clinical ume.
The construct of UME in Israel differs substantively from that in the U.S. The most important difference between UME in the U.S. and Israel appears to be that Israeli students have less substantive contact with patients. William Osler, the father of American medical education, pointed out a century ago that: “To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all. [ 12 ]. Students are benefited when they are exposed to patients from day one of medical school and by incorporating clinical cases into basic science instruction or problem based learning [ 13 ]. During the clinical years students should be an integral part of the medical team – caring for assigned patients under the guidance of a resident and a faculty member rather than simply observers, and they should not be allowed to have “jobs” or any other extra-curricular activities that limit their participation in the medical curriculum and in particular, their clinical rotations. Not mentioned in the Report is the valuable role that standardized patients have played in the U.S. for nearly two decades [ 14 ]. They help students learn how to interview and examine a patient, they allow students to hone their clinical skills, and they provide both summative and formative feedback for the students. More recently, new technologies have supplemented the traditional standardized patient format in order to optimize assessment and evaluation such as adding Google glasses [ 15 ]. Small group workshops that use role play prior to patient interviews as well as videotaping patient encounters followed by group discussion have also proved useful [ 16 ]. In the U.S., a relatively new standard for medical education is inclusion in the curriculum of “translational medicine” [ 17 ]. Some schools have approached this by including instruction in the social sciences, statistical analysis, population health, the fundamentals of healthcare safety and quality, bioethics and health care finance. We believe that wherever possible students should have hands-on experience in translational research; however, this is not practical for schools that do not have programs in translational research. This could be an opportunity to link medical education in Israel with the robust and medically oriented Israeli biotechnology industry and the outstanding basic and translational science laboratories at Israeli academic institutions.
Dr. Thomas Nasca, the President of the American College of Graduate Medical Education (ACGME),m pointed out that medical school graduates today are an “undifferentiated primordial mass that must be shaped during residency” into medical practitioners [ 18 ]. Thus it is critical that UME and GME be viewed as a continuum during which a student progresses from a student to a practicing physician as they develop increasing competencies [ 19 ]. Each pre-clinical block and clinical clerkship should have well defined core competencies that each student is expected to attain. As individual specialty and subspecialty organizations develop milestones and entrustable professional activities (EPA’s) for GME, these concepts should be introduced into the undergraduate curriculum and incorporated into the assessment and evaluation of each student [ 20 ]. The CHE Report suggests that grading students based on achieved milestones might provide an opportunity for students to transition from a student to a resident based on their individual timeframe for understanding and using information. While intriguing, the complexities associated with assessing, tracking and scheduling hundreds of students based on individual metrics would likely be problematic if for no other reason than the need for additional support staff and the attendant costs.
The authors of the CHE Report were clearly influenced by the 2010 Carnegie Report on UME and the recent survey by Nara et al. [ 21 , 22 ]. These reports posited that there is a need for medical schools to decide whether to “continue in the directions established over a hundred years ago [by the 1910 Flexner Report] or take a fundamentally different course guided by contemporary innovation and new understanding about how people learn”[ 21 ]. It must be remembered that the definition of “innovation” is a “new idea or method” but not one that has necessarily proven successful. Thus, while changes such as flipped classrooms, active learning, e-learning, team learning, and simulation have been implemented at some – but certainly not all – U.S. medical schools, they have not yet undergone a thorough evaluation because the requisite tools have not been developed and it often takes many years to reach measurable endpoints [ 23 ]. In addition, many of the innovations in UME are expensive. For example, flipped classrooms and active learning require the availability of a large teaching faculty to facilitate small group discussions, multiple small classrooms and a collection of professionally produced on-line lectures. These novel teaching tools can be incorporated into the curriculum in selected areas rather than across the entire curriculum. For example, in our own curriculum, we use the more traditional lecture format for didactics in anatomy, biochemistry, immunology and microbiology. The remainder of the curriculum is system-based with approximately 40 % of the curriculum presented in the lecture format.
The CHE Report raised the concern that there were limited sites for clinical clerkships in Israel due to a paucity of hospital beds per capita and an over-reliance on hospital versus ambulatory teaching. This raises two possibilities. First, the possibility of increasing the number of clerkship opportunities for students by decreasing the number of patients on each clinical team could be evaluated. Kenneth Ludmerer pointed out in his book Let Me Heal that in an era of cost containment, a resident’s primary job is to churn patients through the hospital system as rapidly as possible [ 24 ]. This obviates the ability of students and residents to see the full spectrum of a patient’s disease, to have the time to get to know each patient and to ensure that students have appreciated the key elements of the history and physical examination. Students are invariably part of large teams. Two innovative programs have taken a very different approach. Hopkins Bayview (The Aliki Initiative) and the Brigham and Women’s Hospital have created teams with half the normal complement of patients so that students and residents have more time to spend with each patient [ 25 , 26 ]. The Aliki Initiative is associated with higher patient satisfaction, higher resident satisfaction and improved patient outcomes although the cost of restructuring the clinical teams might be prohibitive. Second, opportunities for increased outpatient exposure should be evaluated. In the U.S., there is a strong financial incentive for providing as much care as possible in the outpatient environment. In fact, many health care economists and policy pundits posit that the hospital of the future will be a large intensive care unit – much of today’s care being administered in outpatient clinics. How to compensate busy outpatient physicians for teaching will be the challenge of increasing outpatient exposure albeit with a strong societal benefit.
Financing of medical education
Medical education financing is a universal problem with enormous differences in UME and GME funds flow across different countries and in the U.S., across different medical schools: a problem that has increased as reimbursements have precluded cost-shifting from practice plans and hospital revenues to support the academic missions of the medical school [ 27 ]. At research-intensive medical schools in the U.S. tuition does not begin to cover the medical school budget because Federal funding does not cover the cost of research even if all investigators were optimally funded. Research-intensive medical schools in the U.S. therefore depend on university support, endowments, philanthropy and commercialization of intellectual property to support the research enterprise and in some cases, obtain support from associated health systems. An increasing number of medical schools in the U.S. have received significant financial contributions from wealthy individuals whose names are now incorporated into the name of the medical school: for example, Weill Cornell Medical College, Icahn School of Medicine at Mount Sinai, and Warren Alpert Medical School at Brown University. By contrast with Israeli schools, many U.S. medical schools compensate basic science teachers based on the number of hours they teach and the number of hours required to prepare a lecture. As a result, tenured faculty who no longer have grants to support their salaries often increase the time they spend teaching. For clinical faculty who spend significant amounts of time with students on their inpatient or outpatient services, many U.S. medical schools lower the relative value unit (RVU) expectations commensurate with the time they teach or pay teachers directly for their services [ 28 ]. This is important because without incentives, both pre-clinical and clinical educators are less likely to teach. Many medical schools have also developed multiple pathways to promotion in order that educators can be promoted based on their teaching evaluations and education scholarship rather than on extramural funding and the number of scientific publications and in some institutions educators can also achieve tenure. These incentives are critical for not only attracting teachers but also in making them feel that they are an important component of the medical school and university.
Lost in discussions of U.S. medical school financing is the fact that medical schools that do not or cannot support a research program have an economic profile that is significantly better than that of the traditional research-intensive schools [ 17 ]. In fact, a publicly traded company owns at least one offshore for profit medical school. In addition, the Liaison Committee on Medical Education (LCME) recently accredited the first for-profit allopathic medical school in the U.S. and for-profit osteopathic medical schools have previously been approved in the U.S. We have argued that it is important for medical students to have exposure to physician-scientists and clinician investigators who pursue translational research in either laboratory or clinical research centers while at the same time caring for patients [ 29 ]. Exposure to these research-oriented clinicians provides important role models, the opportunity to have hands-on participation in research activities and a perspective on medicine and medical education than is different from that which a student would obtain when their instruction is in a community hospital. The absence of physician-scientists and clinician-investigators at new medical schools and at for-profit medical schools threatens to create a two-tiered system of medical education in the U.S., yet without resources, more and more U.S. medical schools may shift to the second tier model. Thus, the presence of governmental funding for medical education in Israel is a critically important financial foundation that should be continued and increased as necessary.
Unique opportunities for Israeli medical education
Israel has only five medical schools – the four established schools covered in the report and a new medical school in the Galilee. The existence of only five medical schools which are largely funded by the government through the Council for Higher Education and which are located relatively close to one another, provides unique opportunities for both UME and GME. First, as pointed out in the CHE Report, there is the opportunity to share resources. The best lecturers and the best lectures from across the five schools can be used for the didactic portion of pre-clinical courses across the schools. In an era when many medical schools are implementing innovative but unproven and often expensive new teaching formats, there is also an opportunity to use the five Israeli medical schools as innovation incubators to actually test whether one educational strategy is better than another. Outcome metrics for comparisons of different education formats can include scores on standardized tests, OSCI’s or even oral examinations. The outcome of these studies would be useful to Israel for optimizing the educational experience for students and student outcomes as well as benefiting medical schools in other industrialized countries.
The economies of scale across the five schools might also provide novel opportunities for the medical schools to create ambulatory care facilities that could provide a collaborative learning environment for students from multiple schools. If these facilities are built in areas that are underserved in medicine, the creation of joint programs focused on health disparities and population health could also decrease health disparities that have occurred in ethnic or economically deprived areas. The five medical schools should also work together to lobby the government to transition from a university-centric funding model to a medical school-centric funding model as there is little rationale for the funds flow coming through the university as it is unlikely that this can be done with complete transparency. Furthermore, there will always be questions as to whether the universities apportion some of the funds for university infrastructure rather than for direct support to UME. The five medical schools should also look for opportunities to participate and actually lead the development of new physician assistant and nurse practitioner programs. By embedding these programs in the medical school both medical students and non-physician clinicians are exposed to the concepts of inter-professional education and learn to work seamlessly as a part of the care delivery team.
Israeli medical schools should also take advantage of the enormous investment in biotechnology in Israel by creating medical school-based incubator facilities and early stage venture funds to take advantage of intellectual property coming out of medical school laboratories. This effort should be collaborative across the five medical schools because the expertise of each may be distinct yet synergistic - making the aggregate intellectual property more valuable when bundled rather than put out to the market as individual pieces. Finally, Israeli medical schools should follow the lead of successful U.S. medical schools in pursuing philanthropy from both Israel and the U.S. that supports all three missions of the academic medical center: teaching, research and patient care. The message to potential donors and to grateful patients is the same in the U.S. as in Israel – without a continuing supply of new medical graduates with the skills to provide effective and efficient care in the short term and the ability to be learners throughout their careers, the health of the nation will suffer.
Conclusions
There are both differences and similarities between medical education in the U.S. and Israel. Important differences could be mitigated by focusing restructuring on: increasing the clinical exposure for medical students both during the pre-clinical and clinical years of medical school; eliminating student “moonlighting;” evaluating innovative methods for restructuring clinical teams in order to provide more clerkship opportunities; enhancing utilization of outpatient clinics for student education; developing clear rewards for educators including new pathways to promotion and tenure; establishing transparent funds flow for both pre-clinical and clinical educators; and financing undergraduate medical education through direct funds flow to medical schools rather than through university finance offices. Finally, the presence of only five medical schools within a relatively small geographic footprint should provide an opportunity for the schools to collaborate and cooperate in medical education in order to lower costs, optimize patient and space resources and take advantage of the unique academic and scientific strengths of the medical schools in Israel.
Commentary on
Schoenbaum SC et al. Policy issues related to educating the future Israeli medical workforce: an international perspective. Isr J of Health Policy Res. 2015; 4:37.
Funding sources
The author received no funding for this commentary. His research is funded by the National Institutes of Health.
Competing interests
The author has no competing interests relevant to this commentary.
Authors’ information
The author is the Executive Dean of the Temple University School of Medicine, Chief Academic Officer of the Temple Health System and Laura H. Carnell Professor of Medicine. A cardiologist, he is a physician scientist who studies the molecular and cellular mechanisms responsible for the development of heart muscle disease and heart failure.
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You are here, medical education in israel: achievements and problems.
When Reichman University initiated the establishment of Israel’s first private medical school, it was, as its website put it, "with the aim of helping to solve the existing shortage, and to immediately increase in the number of medical students in Israel.
The new school, according to Reichman’s optimistic plan, will open as early as 2024, if the curriculum receives approval from the Council for Higher Education of Israel (CHE). It will initially train about 80 students a year in the first phase, and will peak at approximately 120 students a year. The school will be established in cooperation with Sheba Medical Center at Tel HaShomer, and health funds Clalit Health Services and its central region hospitals, and Maccabi Health Services.
While the program’s leaders are excited about its implementation, and tout its use of medical simulators, there are those who claim that it is a delusion, a project that will not really help increase the number of doctors but will be established using public resources at the expense of other solutions. There is no doubt that the school will charge its students significantly higher fees than those at Israel’s public universities, but the opponents of the move also cast doubt on the professional standard that the students will receive in return.
Racing to stay in place
But first, some background on the situation which the new school is entering. There are about 30,000 doctors in Israel, only 3.2 doctors per thousand people, compared with an OECD average of 3.4 T. Even this low number is will soon fall significantly, mainly because of the Yatziv reform in licensing foreign medical graduates (Prof. Shaul Yatziv is head of the Division of Licensing of Health Professions in the Ministry of Health) that disqualified many institutions, but not just that. Other reasons include population increase and, in the coming years, a massive retirement wave of doctors who came to Israel during the mass immigration from the former Soviet Union during the 1990s and filled a void which had already begun to form at that time and was never dealt with.
During the past decade, the number of medical school graduates in Israel has increased significantly, but still has not managed to keep up with population growth. A committee headed by Prof. Ronni Gamzu, CEO of Tel Aviv Sourasky Medical Center (Ichilov), published a report in early 2022 with recommendations for a rapid increase in the number of students so that the number of medical license recipients in Israel would increase to 2,000 a year by 2035 (compared with approximately 1,800 today), of which about 1,200 (60%) would be home-grown. Meaning, by the middle of the next decade, the ratio of doctors per capita would return to roughly the same level as today. However, if the plan is not implemented, is delayed, or not budgeted, or if doctors leaves the country or the profession en masse, it will be very difficult to close the gap. Currently, another Gamzu committee is working on expanding the recommendations, while the Ministry of Health is itself preparing a plan that should make these recommendations operational, although nothing has yet been officially decided or budgeted.
Today, only about 40% of new doctors entering Israel’s medical system have studied in Israel, the lowest rate of locally-trained qualified doctors among all OECD countries. In a special OECD report on medical education and training In Israel, published in May of this year, Israel received low marks for its number of medical school graduates, the lowest in the OECD relative to the population.
The reason is that there are not enough places in Israel’s medical schools to train enough doctors for the country’s entire medical system. But there is also a revolving door: universities in Israel -- Tel Aviv University, Ben-Gurion University of the Negev, and the Technion-Israel Institute of Technology -- train foreign students (in 2021, 113 out of a total of 1,020 new registrants for all of Israel). In addition, those who study in Israel do not always remain within the system, but move abroad for work, with 9% of Israeli-trained doctors employed abroad at any given time.
The gaps in the system are filled by Israeli students who studied abroad, usually in Western or Eastern Europe. Some, but not all, of these foreign education institutions are excellent. The Yatziv reform defined threshold conditions for medical schools abroad graduates of which could be integrated into the Israeli health system. According to Gamzu report estimates, the Yatziv reform will subtract about 400-500 doctors a year from the supply of new doctors available to the Israeli health system, mainly in the periphery.
The country woke up late to the need to train a critical mass of new doctors, but steps have nevertheless been taken in recent years. Up until 2009, four faculties of medicine operated in Israel, at the Hebrew University of Jerusalem, Tel Aviv University, the Technion, and Ben Gurion University, with only 250-350 graduates each year. By 2020, 850 students began studying at Israel’s various faculties of medicine, that is, triple the number of students within a decade. This was done by consolidating the existing faculties, opening a four-year medical study track at Tel Aviv University for those already holding a bachelor's degree, with another similar track at Ariel University, as well as establishing a new medical school, the Bar-Ilan University Azrieli Faculty of Medicine in Safed, where there is also supplemental training for foreign-trained graduates who do not meet the new criteria. A special degree is also planned for research physicians at the Weizmann Institute, which will open in the coming years.
Despite the claims about the limited capacity of the medical training system in Israel, the universities themselves are not the bottleneck. The main problem: the clinical fields (clinical rotations), meaning, the training that students undergo at hospitals. Today, all the medical teaching institutions in Israel rely on clinical fields. Naturally, competition for places will intensify as new institutions enter the picture.
NIS 90,000 yearly tuition, no cadavers
Prof. Uriel Reichman, founding president and chairperson of the board of directors of Reichman University, explains why he decided to enter the arena: "Up until 1995, the gates of higher education were closed, and under the control of seven large universities. Hundreds of thousands of people were denied social mobility. Anyone who wanted to study law, for example, and was not accepted to one of these very few places, had to go to study in England, and this damaged the social fabric of our country.
"Fortunately, the Freedom of Occupation law was passed in the meantime, and they told me - okay, open a university, but you won't get a cent from the state. My goal has always been to establish an institution that will be a university in every respect. The medical school is important to us because of this vision, and because we are an interdisciplinary institution. We want to make medicine part of the other faculties here. We’re also doing it as a mission, because of the lack of doctors, and even though this faculty will be loss-making in the first years. We were happy to receive a large donation from Udi Recanati [the school will be named after his late mother, Dina Recanati - G.W.], which helps us get started and later we will raise more."
The person designated as the dean of the new school is Prof. Arnon Afek, the associate director general and acting director of Sheba General Hospital. Afek has some innovative ideas for the new school. "We’re educating the doctors of the future and it is a big challenge to teach them differently. We want to give them skills and not just knowledge. This will be a discussion."
Afek plans to rely more broadly on medical simulators than other institutions do, to enable additional practice beyond the medical internships at hospitals, and reduce clinical fields demands. Also, unlike its competitors, the Reichman School of Medicine will not dissect cadavers. "Not because we can't do it, but because we don't need that today. Simulations are enough," says Afek.
"Every additional seat in a medical school is a blessing," says Dr. Orly Weinstein, deputy director and head of the Hospitals Division at Clalit Health Services. "I'm sure people raise an eyebrow at the fact that it's a private platform. But studying abroad at good institutions is more expensive than at Reichman. So, if there are going to be private schools, then better to keep the doctors here in Israel."
One of the major claims against the program is the very fact that it is private. The claim is that a public resource is being allocated to a private entity.
Afek: "I’d like to note that Reichman is not a for-profit institution. It is a non-profit. It is simply not funded by the CHE." Regarding the price, he says: "At a public university medical school, tuition is about NIS 12,000 per student. With us, the same student's studies will cost NIS 90,000 a year."
That’s a bit of difference.
"Yes, but it's not because we’re making a profit, but because at other universities, the state makes up the difference, while at ours, the student pays." Afek points out that one option being examined is for the CHE to fund tuition, but only for those students who, after receiving their degree, commit to working for a period of time in the periphery, or in a particular specialization that is in short supply. This seemingly solves two problems in one fell swoop. It enables students from financially weaker families to study, and more properly plans manpower allocation.
Institutions in Eastern Europe, not all of which will remain relevant after the Yatziv reform, can cost about NIS 15,000 a year, but there are also institutions in Europe where the cost of studying is about NIS 80,000 a year and they still attract Israeli students.
"What do they add? Nothing"
However, voices are heard from other schools claiming that there is no need for another university, certainly not a private one. A faculty member at one of the existing medical schools summed it up in the most emphatic way: "What does Reichman add? Nothing. Who’s going to teach there? Lecturers from other medical schools. Where will they do their training? At our clinical fields. The Gamzu program determines exactly how many doctors we need to train: 2,000 doctors a year. The existing medical schools can do it. Easily. I can add as many as the CHE will let me.
"Instead, they take something that is a college -- actually more like a high school -- and permit it to teach medicine. Medical studies are supposed to be academic. The lecturers are doctors and senior researchers. Reichman doesn’t even offer a bachelor's degree biology major yet. Who will they bring in? Either our doctors, or people who are not at research centers. This is dangerous and bad, and degrades the level of instruction.
"And then, where will they do their clinical training? This will also be at the expense of our clinical fields. If we had more clinical fields to work in, we would gladly increase the number of students we have. In practice, what’s happening is that they’re taking an institution that lacks experience and ability in the field, and it will basically sell our public system at a higher price, and use it less well.
"I have nothing against Reichman personally. But what’s the next step? Will every college be able to teach medicine? So, a lot of people can throw their caps in the sky and say they are doctors -- and the whole level of medical professionalism will decline. Just the way it happened with the legal profession. But the state will approve it in the end, if only as revenge on the Israel Medical Association for protesting and striking against the government’s legal system reforms."
"It's just not true," says Afek, who has a response to every critique. Regarding the lecturers, he says: "I don't intend to take professors from the other universities. That won't happen. I’ve chosen brilliant young doctors who are dying to teach, and I'm taking retired doctors to be their mentors. There are plenty of young doctors at Sheba, more than enough to fill the teaching hours for Tel Aviv".
One exception is Afek himself, who today is a professor at Tel Aviv University and who was formerly the head of the Sackler NY Medical Program at Tel Aviv University for medical students from abroad. When the new Reichman School of Medicine receives official approval, Afek is expected to leave his position at Tel Aviv University and join the Reichman faculty.
And what about the clinical fields?
"There is no shortage of clinical fields. There is every indication that the hospitals can and do want to teach more, and the OECD report that came out in May also agrees with us." Indeed, the report states that clinical fields in Israel are underutilized, and there are far fewer medical students per hospital bed than in other countries.
Reichman adds, "We’ve heard the criticisms and they’re disgraceful. If there aren’t enough clinical fields, and they are a 'national resource', how was it that, for years, the existing medical schools taught foreign students? Did they make a business out of it? This is hypocrisy."
Weinstein: "In the past, I also thought it was impossible to increase the number of medical students significantly because there were no clinical fields. But now that Clalit is also training doctors, we’ve seen there are unused resources in this area at the hospitals as well."
Training largely outside of hospitals
One of the proposed solutions is clinical fields in the community. Dr. Daniel Landsberger, chief physician at the Medical Division of Maccabi Health Services and responsible for the health fund’s relationship with the new medical school, explains: "Can you only learn about diabetes at a hospital, or can you also learn from the same endocrinologist who works at the hospital, but also treats patients in the community? After all, the medical world is actually trending away from hospitals and towards the community.
"No one intends for medical students in Israel to leave their studies straight away to specialize without going through a hospital internship at all, but that period can be divided into a year and a half in a hospital, and two and a half years in the community, for example. I have 400-500 doctors who are willing to be instructors. Even now, we have students doing some of their clinical fields in the community. This is happening not only here, but all over the world. In Canada, for example, all students are also required to train in the community."
And will these students aim to become community doctors?
"Not necessarily. When a student chooses their specialization, they usually follow a mentor. If they studied with an endocrinologist in the community, they will later join up with them at their hospital."
Landsberger also sees some challenges to this method. "The hospitals where Reichman's students are expected to undergo training are in the central region, but communities are all over the country. Perhaps it will be less convenient for them, but perhaps this way they will actually be exposed to the periphery."
In response, the official from the competing school muses: "Can you see Reichman students, the ones who drive to university in their SUVs and complain if their parking space isn’t wide enough, covering night shifts in the periphery? I don't think so."
There is also a diversity issue. Among students who go abroad to study, at the cheaper foreign institutions expected to be disqualified by the Yatziv reform, there is a higher proportion of students from Israel’s Arab population. We are eliminating this channel, and bringing Reichman students into the system instead.
Landsberger: "Things are not that dichotomous, of course. I know Arab families who have the resources, or make sacrifices, to send their children to very high-level institutions abroad, and they will also be able to send them to Reichman. At least that way they will stay in the country. And for those who cannot afford these studies, scholarships will be awarded. In any case, you must be realistic. Money plays a role today in every field."
Dr. Landsberger adds: "I’m not sure that the research universities are really prepared to expand their medical schools. These studies are considered loss-making. In Reichman, they will not be unprofitable, because the teaching methods are more efficient, with more emphasis on the virtual, and also, of course, because the price per student will be higher."
Do you understand the criticisms against you?
Afek: "All competition is disruptive. When they established the medical school at Ariel, it was a world war. Even when they opened in Soroka, the Hebrew University said, no way. And when the medical school of the Hebrew University was established, do you know what they said? Who needs it, there’s an excellent school of medicine in Beirut. Why set limits? I think we should open as many medical schools as possible. At Weizmann, and Haifa too. But it will take years."
Landsberger: "5% more medical students at Reichman University is not what will shake up the system."
Reichman : "We really are not taking anyone's place. There is room for another medical school or two besides us. We also want to help, lend a hand, especially during the current period which is so difficult, and although we oppose the regime coup, as an institution we also say, ‘Let's keep on building, let's keep on being optimistic.’ We continue to struggle for the future of our society. So that we shouldn’t lose heart."
Gali Weinreb
Will rash of new medical schools solve Israel's doctor shortage?
Four new medical schools are planned in the coming years, but the government is not even aiming to reach the oecd average of doctors per thousand population..
In recent years, Israel’s academic institutions have been in a rush to open medical schools. Within the past few months, the University of Haifa and the Weizmann Institute have announced that they will open schools, joining Ariel University, which opened a medical school in 2019, and Bar-Ilan University, which did so a few years earlier, in 2012, in Safed (Zefat). Two further initiatives await approval from The Council for Higher Education: a medical school at Reichman University in collaboration with Maccabi Healthcare Services, and an international medical school in Eilat.
The target: 2,000 more doctors annually
The reason that more and more medical schools are being founded now is, first of all, Israel’s severe shortage of doctors. The number of doctors qualifying from medical schools in Israel is the lowest among the OECD countries.
For years, the medical system managed to overcome that fact thanks to immigrant doctors, mainly from the countries of the former Soviet Union in the 1990s, and to doctors trained overseas.
In the coming years, however, the shortage is expected to worsen considerably, both because many doctors are due to retire, and because the Yatziv reforms (spearheaded by Professor Shaul Yatziv) have limited the number of institutions abroad at which medical students can obtain qualifications recognized in Israel, in a bid to maintain standards in Israel’s health system.
Unless there is a change in the training of medical students, in 2035 Israel will have only 2.9 doctors per thousand people, which compares with an OECD average of 3.4.
Israel is not even aiming to reach the OECD average. The goal is 3.1 doctors per thousand people, and to reach it the country needs to add 2,000 doctors annually. Under the Yatziv reform, at least 1,400 have to come from the Israeli system, which currently produces 1,000-1,100 doctors annually.
Later, the intention is to expand further the number of doctors training within the Israeli education and health systems, so that they will not have to travel abroad, even to institutions that meet the criteria. Keeping students in Israel has a further advantage, which is that it will reduce the number of students lost to careers abroad.
A survey carried out a month ago by the Medical Doctor group headed by Dr. Moshe Cohen (who seeks to set up an international medical school in Eilat) found that 59% of these doctors said that they were considering a career in Europe or the US.
How many medical schools does Israel need?
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How many medical schools are required in Israel to train the additional students? It depends whom you ask. The existing institutions claim that they could absorb all of the additional demand if they were only allowed to do so, and that no new medical schools are required at all.
The planned new medical schools are designed to take in 80-100 students a year each, which means that if the existing schools are not expanded, there is room for three to four new ones in the near future.
The Gamzu committee, headed by Prof. Ronni Gamzu, CEO of Ichilov Hospital in Tel Aviv, recommended in its recently published report that the capacity of the existing medical schools should be expanded, and that one new school, or branches of the existing schools, should be considered, with an emphasis on locations in the periphery of the country.
The report states that the pre-clinical infrastructure (laboratories) at the medical schools is crowded, so that there is justification for setting up more medical schools rather than loading more students onto the same infrastructure.
Nevertheless, there are several obstacles to setting up additional medical schools, such as the NIS 75,000 annual subsidy required per student at the public medical schools, and finding the teaching staff for the medical school itself and room for clinical training in the hospitals. There is a fear that the new medical schools will deprive the existing schools of manpower and of clinical fields. The new plan compiled by the Gamzu committee proposes a solution to the last obstacle at least. It suggest that more clinical fields can be created by matching each hospital to one main medical school, adding teaching hours in the afternoons, expanding teaching groups, training at the health funds as well, and more. The report states that this need not be a constraint.
Besides the general shortage of doctors, there are specific shortages in certain disciplines and in outlying communities. The national plan for training medical students will need to prioritize institutions that take these issues into account, and give incentives to students who choose certain disciplines and specialties.
Published by Globes, Israel business news - en.globes.co.il - on June 19, 2024.
© Copyright of Globes Publisher Itonut (1983) Ltd., 2024.
Immigration & Residency
Immigration. Travel. Living.
Israel: medical education
First of all, it should be said that doctors here are highly respected among ordinary people. The opportunity to enroll in medical specialties is considered something unattainable. Only aircraft pilots are considered to be more valuable personnel. At first, the doctor receives a relatively small salary. At the same time, the work is very difficult. But on the other hand, great career and professional growth are possible in this area. The demand for doctors in Israel is incredibly high. Every year Israeli medicine requires about 800 new doctors and only 450 graduates. Therefore, not a single young graduate will be left without work. But how do become a doctor in this country?
Israel Universities
There are only 7 universities in the whole country, in 5 of which you can unlearn a doctor. Whether you want to do physical therapy or just become a nurse, there are many different colleges and courses at your disposal. But to obtain a doctorate specialty, you need to unlearn at one of these universities:
- Ben-Gurion University;
- Branch of Bar-Ilan University;
- Tel Aviv University;
- Hebrew University.
How to become a doctor in Israel?
There are four ways to get a position as a doctor:
- It is necessary to complete six years of training and a year of internship in Israel.
- Get medical education in one of the universities in Europe from the established list. After that, you need to return to the country and pass exams to confirm the credibility of the diploma. You also need to complete a one-year internship.
- A relatively new method – you can take an abbreviated four-year study if you have already completed an academic degree in some areas (for example, chemistry or biology).
- You can also unlearn half of the term (3 courses) abroad and finish the rest in Israel. After that, again, a year of internship, and you can work.
Requirements for admission to medical faculties
There are two training programs for a doctor in Israel:
- 6-year training program;
- 4-year program.
Admission to a 6-year study program
Admission to a 6-year study program includes two rounds:
- Passing a psychometric test and an Israeli matriculation certificate. Many people cannot pass this round due to the extremely high requirements for passing this test. Some of them have been trying to pass the exam for several years in order to still get into the second round.
- If the first part of the conditions was met, an applicant goes to the second round. At this stage, you need to pass a special entrance exam.
Admission to a 4-year study program
For admission to the 4-year program an applicant will need:
- Have at least a first degree (bachelor’s degree) with a GPA of at least 80.
- Have credits in this first degree in 7 courses in biology and receive a certain grade for each of them (those who did not take these courses will have to take them separately). On average, 300 applications per year are submitted in this way in Israel.
- Pass the GRE. It is a large exam in biochemistry, genetics, and cell biology in English, in the form of a test (180 questions in 170 minutes) with examples of experiments and pictures. Those who pass the first test are invited to the next two exams on the same day, one after the other.
- Mini psychometric test. The test lasts 1 hour and 15 minutes.
- Biography questions. 12 questions in 45 minutes. Questions such as: Describe a situation in which you disagreed with the majority opinion. Have you ever led a group of people? How do you prefer to work: as part of a group or as its leader? Have you participated in volunteer activities? Have you had a chance to look after a sick person? Tell us about how you hurt someone etc.
- The final step is passing a special entrance exam.
On average, only 65 applicants are allowed per year for four-year studies. There is a lot of competition in this area, so you have to prepare very thoroughly.
Tuition fees in Israel
Education in Israel is extremely expensive, but still, there is an opportunity to find part-time jobs, and an opportunity to receive a scholarship. The first half of the training (2 or 3 years, depending on the program) will cost about $ 2700. The second part is somewhat more expensive. It is about $ 3700.
How is the study of medicine in Israel going
There is no division of faculties into medical and pediatric in the medical system of studying in Israel. All future Israeli doctors undergo general training to become general practitioners. Later, each student chooses a specialization for himself. The entire training program is divided into three large stages.
First three years
Students spend almost all of their time at the university, rarely getting practical skills in hospitals. During this time, future doctors receive all the necessary theoretical knowledge.
Remaining three years
During this time, students begin their internship in Israeli hospitals and clinics. They help specialists to collect anamnesis, collect blood for analysis, give injections, etc.
Final stage
It is time for state exams. There are six of them in total, and each of them affects a specific area in medicine. Everyone prepares thoroughly for passing these exams since they greatly affect the future life of all specialists. Upon successful completion of this stage, the internship can begin.
The internship lasts for one year in a hospital in Israel. At the same time, the graduate does not choose the institution himself, a draw takes place. The internship is divided into cycles of therapy, surgery, pediatrics, emergency room, and two additional departments of your choice. After completing the internship, the person receives a Master’s Degree in Medicine (M.D.) and becomes a qualified doctor.
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Training to Teach in Medicine
This Harvard Medical School six-month, application-based certificate program aims to provide high-impact, evidence-based education for medical faculty and health care professionals.
Associated Schools
Harvard Medical School
What you'll learn.
Master evidence-based justifications for critical clinical education skill sets
Develop a framework to educate medical learners in practice through the study of educational theories
Learn and apply practical teaching skills to diverse groups of adult learners in bedside, ambulatory, classroom and other settings
Accelerate leadership and professional development in medical education pedagogies and teaching techniques
Course description
To successfully train the next generation of health care professionals, medical educators must utilize innovative teaching strategies and techniques in both classroom and clinical settings. Training to Teach in Medicine is an online program that integrates traditional and novel pedagogic methods, skills-based training, two live virtual workshops, online learning modules, individual and team projects, as well as a final capstone project to benefit your home institution.
Training to Teach in Medicine aims to develop skilled clinical educators who can apply educational theories and teaching best practices to instruct medical students and physicians-in-training, in turn equipping the future medical workforce for career success. Participants will graduate from the program with the skills, strategies and techniques required to educate medical students and adult learners in a variety of settings.
Participants will be eligible for Associate Alumni status upon successful completion of the program. Early tuition and need-based tuition reductions may be available.
Course Outline
Principles of Adult Learning
- Medical Education Pedagogy in the 21st Century
Application of Adult Learning and Theory to Teaching
- Enhancing Memory and Attention During Lectures
- Knowing Your Learner
Teaching Methods
- Flipped Classroom
- Strategies for Effective Teaching and Learning
Teaching on Wards and in Clinics
- Effective Teaching on the Wards and in the Clinic
- Microskills for Teaching in Clinical Settings
Contemporary Teaching Techniques
- Using Multimedia and Technology to Enhance Teaching
- Small Group Teaching
- Curriculum Development Steps
Assessment, Evaluation and Feedback
- Curriculum Development Steps- Selecting Assessment Tools
- The Use of Quizzes/Formative Assessments in Teaching and Learning
- How to Give and Get Effective Feedback
- Teaching and Assessment of Critical Thinking in Medicine
Physician Identify Formation and Life-Long Learning
- Promoting Lifelong Learning: Developing Curious Learners
- Reflection as a Teaching Tool in Medical Education
- Competence Assessment in Resident Training
- Leading Change in Academic Medicine
Medical Education Research
- Overview of Quantitative and Qualitative Methods
- Study Design in Medical Education Research
- Best Practices in Survey Design
Instructors
Jeremy Richards
Lauren Yang
Brian Persaud
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COMMENTS
Tracks of Study. There are two ways to study medicine in Israel: The first option is a full six-year track, followed by a medical internship in Israel. These programs are offered at Hebrew University, The Technion, Tel-Aviv University , Bar-Ilan University and Ben - Gurion University. In addition to excellent high school grades and a bagrut ...
During the British administration of the Palestine Mandate, before the foundation of Israel in 1948, the Jewish community built hospitals, developed a network of clinics, and established a fairly extensive coverage of health care.1 Yet not until 1949 was the first medical school founded at the Jerusalem-based Hebrew University of Jerusalem. Although much of the funding came from the Hadassah ...
Advisory Committee Medical Manpower Planning, ACMMP) is the lead author of the section on the Dutch model to medical workforce planning and policy-making (section 7). Daniel Padon (Ministry of Finance of Israel) and Alexey Belinsky (Ministry of Health of Israel) provided support and many useful inputs in the preparation of this report.
Medical Education: There is an apparent lack of expertise in the science of education as applied to medical education in Israel. Only a handful of academic professionals have formal credentials in medical education. The IRC recommends building medical education centers to provide the needed expertise . The authors share this sentiment, and most ...
The Council for Higher Education, Israel's national accrediting body, has been assessing each medical school periodically in the past decade. These assessments have become more stringent, yielding increasingly stronger recommendations for improvement. In 2014, an International Review Committee completed its assess-ment of all five medical ...
20. Afeka Tel Aviv Academic College of Engineering. 21. Jerusalem College of Engineering. 22. Shenkar College of Engineering and Design. The best cities to study Medicine in Israel based on the number of universities and their ranks are Tel Aviv, Jerusalem, Rehovot, and Haifa.
Standards of Medical Education in Israel STANDARD 1: MISSION, PLANNING, ORGANIZATION, AND INTEGRITY A medical school has a written statement of mission and goals for the medical education program, conducts ongoing planning, and has written bylaws that describe an effective organizational structure and governance process. In the
Medical education is a dynamic and continually evolving process, some of which is style, and some of which is linked to changing perspectives in medical practice. A paper by Reis et al., taken in conjunction with the recent paper from an ad hoc International Review Committee (Schoenbaum et al.), provides a reflective view of where Israeli medical education stood in 2014 and places it in an ...
Abstract: We reviewed the existing programs for basic medical education (BME) in Israel as well as their output, since they are in a phase of reassessment and transition. The transition has been informed, in part, by evaluation in 2014 by an International Review Committee (IRC). The review is followed by an analysis of its implications as well as the emergent roadmap for the future.
In 2014, the Israeli Council for Higher Education (CHE) commissioned an international panel of outstanding educators to prepare an ad hoc report reviewing the four established medical schools in Israel. The report described the strengths, weaknesses and challenges facing medical education in Israel with a focus on three specific areas: workforce planning, the structure of the curriculum and ...
MEDICAL EDUCATION IN ISRAEL. M. Prywes, M.D.,* Jerusalem, Israel. In 1953 the« number of physicians in Israel was 3717, including 700 women doctors. This number brings the doctor-population ratio in Israel to 1:430, which is one of the highest in the world. Eighty per cent of these.
Shiv Gaglani: Hi, I'm Shiv Gaglani, and today I'm delighted to welcome two faculty members from the medical school at Israel's second-largest academic institution, Bar-Ilan University.Dr. Peter Gilbey is an otolaryngologist and chair of the Department of Research and Innovation in Medical Education. And Dr. Yair Blumberg is a clinical exercise physiologist in cardiology and Physiology ...
The review documents a trend of modernizing, humanizing, and professionalizing Israeli medical education in general, and BME in particular, independently in each of the medical schools.
Israeli medical education faces considerable stresses that include severe budgetary constraints and a recent influx of immigrant physicians who need professional upgrading or retraining. Ben-Gurion University developed a licensing preparation course after the government in 1988 required foreign-trained physicians to take a licensing examination.
MEDICAL EDUCATION UNITS IN ISRAEL. In 2016, MEUs in Israel were either independent departments, units of the office of the Dean, or combinations thereof, and they varied in the number of full-time and part-time academic (MD and PhD) staff. 12 Beyond other activities, Israeli MEUs conducted workshops for faculty development and were involved in the teaching of the behavioral sciences and ...
Today there are two committees in Israel that examine the syllabus and teaching methods in the medical schools. The first is an internal CHE subcommittee, headed by professors Rivka Carmi and Ehud Grossman, and the second is an international committee appointed by CHE, which includes five members - three international experts on medical education from abroad, and two from Israel.
A standard, countrywide licensing examination is under study, but its development is hampered by the almost‐complete autonomy of Israeli medical schools and minimal staffing of medical education units. To overcome these problems, the Israeli Society for Medical Education was founded in 1991.
The recent government decision to establish a new medical school, the fifth in Israel, is an opportune moment to reflect on the state of Basic Medical Education (BME) in the country and globally. It provides a rare opportunity for planning an educational agenda tailored to local needs. This article moves from a description of the context of ...
606 Sept. 6, 1958 MEDICAL EDUCATION IN ISRAEL x, b* sh Medical journal that of American medical schools. Finally, a student does not graduate M.D. until after a year of rotating internship, during which he also has to write a thesis. Departments Visited Because of the impending move into a permanent centre,
This is a list of medical schools in Israel. Northern District. Azrieli Faculty of Medicine of Bar-Ilan University; Haifa District ... Joyce and Irving Goldman Medical School of Ben-Gurion University of the Negev This list is incomplete; you can help by adding missing items. (June 2014. This page was last ...
In 2014, the Israeli Council for Higher Education (CHE) commissioned an international panel of outstanding educators to prepare an ad hoc report reviewing the four established medical schools in Israel. The report described the strengths, weaknesses and challenges facing medical education in Israel with a focus on three specific areas: workforce planning, the structure of the curriculum and ...
Today, only about 40% of new doctors entering Israel's medical system have studied in Israel, the lowest rate of locally-trained qualified doctors among all OECD countries. In a special OECD report on medical education and training In Israel, published in May of this year, Israel received low marks for its number of medical school graduates ...
Unless there is a change in the training of medical students, in 2035 Israel will have only 2.9 doctors per thousand people, which compares with an OECD average of 3.4. Israel is not even aiming ...
Tuition fees in Israel. Education in Israel is extremely expensive, but still, there is an opportunity to find part-time jobs, and an opportunity to receive a scholarship. The first half of the training (2 or 3 years, depending on the program) will cost about $ 2700. The second part is somewhat more expensive. It is about $ 3700.
The University of Michigan failed to properly investigate dozens of incidents of alleged antisemitic behavior on campus over the past four years, according to a new report from the U.S. Department ...
Develop a framework to educate medical learners in practice through the study of educational theories. Learn and apply practical teaching skills to diverse groups of adult learners in bedside, ambulatory, classroom and other settings. Accelerate leadership and professional development in medical education pedagogies and teaching techniques
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