Historically, basic medical, nursing, and other healthcare training started with the mastery of a specified body of didactic material demonstrated by successful completion of written, often multiple choice, tests in each subject area. Next, basic patient evaluation and treatment in a clinical setting with expert guidance and feedback provided by experienced clinicians was coupled with directed reading and/or lectures. Evaluation consisted of more written exams, and perhaps a clinical grade that encompassed the faculty's overall impression of the student's clinical performance. If successful, the student would progress to specialty training with a focused apprenticeship in the area of interest. Board exams were viewed as an end-point designating competency for future practice. Ongoing education was largely left up to the initiative of the individual, or perhaps to the local requirements of the workplace, and measured in hours of continuing education.
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