Medical Schools or medical education is mainly done in universities. Medical education in universities especially undergraduate education in North America as well as in Europe are full with very basic science such as chemistry, physics, but also laboratory branches such as biochemical education. I can still remember long afternoons using a pipette in endless rows of test tubes. Scientific research is also integrated in Med Schools. Even community based schools are strongly connected with universities.
This model stems from the beginning of the previous century. Obviously medical education liaised with the universities has many benefits, the close partnership results in a scientific approach and early adaption of scientific discoveries in the medical curricula. But medical education is also about training good professionals as well as good communicators. The modern physician also needs knowledge about prevention, medical decision making, ethics and cultural competence to name a few. This kind of knowledge needed by modern physicians is very different from the knowledge learned in basic sciences taught during medical education.
The solution to this problem is according to some authors:
A richer, broader education that can be achieved through more flexible and individualized paths to the MD and facilitated by realizing medical schools’ full academic citizenship in the university.
This proposal for more individual learner-centered education is the new buzz in medical education. Medical students should have the opportunity to follow their intellectual curiosity about phenomena of illness and disease, their understanding of the human condition, and their exploration of the many other disciplines that relate to medicine and the life sciences.
Students might explore issues of stigma or disability, or the economics of health care. Those interested in pediatrics could study the history of childhood, cross-cultural breastfeeding practices, or public policy that affects children’s health. The possibilities are legion, and few (geology, perhaps?) are irrelevant to clinical practice, medical research, or the societal contributions of the profession.
The main problem is the fact that medical curricula are all ready overcrowded with required content. This limits the pursuit of individualized interests and learning goals. The solution to this problem from the authors of one of the recent publications on this subject is the adaptation of the medical curriculum to the need of the medical student. Those wanting to become a surgeon can have different needs with more procedural and technical skills than those becoming a psychiatrist.
Psychiatry medical student education e.g. should consist of three subsets in addition to a core curriculum. A track for students bound to become primary care physicians. This curriculum would include more detailed knowledge and skills in assessment and actual treatment of straightforward presentations of common mental disorders. Another track for them interested in neuroscience research. This should consist of the core curriculum and additional emphasis on neuroscience electives and research throughout the course of medical school. The last track is for those aiming at becoming psychiatrists. They should broaden their knowledge and skills in other fields since this could be their last available opportunity before becoming a psychiatrist.
The new medical education should be broader and more personalized with flexible and individualized paths to the MD. Choices should be made also during clerkship towards future interests, but how many students already know what they want to be. To my opinion very few, what do you think?. These are just a few options mentioned in the articles discussed. To me the personalized view on medical education was the most interesting part and important overlap between the discussed articles.
Curry RH, & Montgomery K (2010). Toward a liberal education in medicine. Academic medicine : journal of the Association of American Medical Colleges, 85 (2), 283-7 PMID: 20107358
Thornhill JT 4th, & Tong L (2006). From Yoda to Sackett: the future of psychiatry medical student education. Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, 30 (1), 23-8 PMID: 16473990
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None of my first year medical classmates who stated that they wanted to be psychiatrists became psychiatrists when they went on to residency four years later.
I chose psychiatry in the last semester of my fourth year after wanting to be a surgeon and taking mostly surgery courses. In fact I chose psychiatry during an interview with the chairman of the surgery department when I realized that being a surgeon like him was not what I wanted to do. I have never regretted the decision, but under this early tracking theory I would have been very unhappy.
A better solution might be to demand a broad undergraduate education or a six year program with some of the issues addressed early on. I don’t think you can teach being a caring ethical person in a classroom but you can select those who already have those qualities.
Medical education is not just facts and procedures. All those facts and ideas that the authors refer to as being crucial to being a good specialist will be changed ten years later.
Medical education imbues a way of looking at the details of a person’s health and well being and figuring out what is happening and how to rectify problems. Facts change all the time but process remains. Along the way students are able to become doctors (which involves a lot of interaction with both patients and others) by learning to think like physicians – a technique that is the useful in any aspect of medicine.
Medical schools have to take those who can pass the rigorous standards needed to be a competent physician (95th percentile of intelligence, work ethic, drive, time, money, etc. – that’s not a whole lot of people) and choose those who are already capable of being the interactive well balanced people we hope our physicians will be. I don’t think that you can teach this in a classroom.
Are there credible studies that drive such a radical change (more like a radical add-on unless you want to eliminate the medical/scientific part) or is this just a philosophical sea change? You state that “The modern physician also needs knowledge about prevention, medical decision making, ethics and cultural competence to name a few.” Is there some proof that physicians are incapable of this kind of behavior now? Granted we are not all experts in prevention (nor is there any incentive to be on a global scale) but medical decision making is the heart of residency (no one goes without a residency these days) and ethical considerations are part of the physician’s inner workings. He or she either has an ethical viewpoint or they don’t. Education will not change that (although being educated by the state board might.)
Medical education is an “in medias res” experience in which smart driven persons are turned into physicians. It is not as clear cut as the authors seem to think. In the process, which usually takes at least seven years past college, a lot is learned and a lot more questions are asked. After residency many of the issues brought up in the paper are addressed with more competency since the number of patients and the presence of peers accelerates the process. It probably takes ten more years to reach full competency as a physician but the initial product is pretty good.
One more thing.
In the early 70s the criteria for psychiatric residency changed five times in three years. The upshot was that a medical student could declare he (usually then) wanted to be psychiatrist and his fourth year of medical school would be his first year of residency. I met students who never took medicine or surgery because they were tracked into psychiatry. My opinion of their abilities as physicians was not very good and later on I noted that they were not able to deal effectively with the rapid changes in the field.
This experiment was noted to be a monumental failure because a) the students who chose it were not well trained and b) they were stuck in a field that was not very friendly to them later on when actual science took over. [You can add c) that those who chose the field and then tried to change could not get a decent residency later on in any field because they lacked basic knowledge.]
In addition what are the residencies going to think about the medical schools forcing students into tracks? They will lose some of the autonomy they have now and the students who want a high paying residency may not be able to get what they want. Will those students who lose out be able to get another residency or will their lack of tracking put them in limbo?
It’s really a stupid idea.
I agree, I think basic subjects as anatomy, physiology, physiopathology, should be included in a core curriculum. Medical schools could have a more nurturing approach to medical students, that is: after careful evaluation of the interests and abilities of students, the rest of the curriculum could be tailored and oriented to the best students’ performance in the long run. Some students are oriented to the more social aspects of medicine, others to the more scientific (and not necessarily away from social), others tend to be the best in handling their surgical skills, etc.
Thnx your comment is appreciated, take care Dr Shock
In this article, those wanting to become psychiatrist are put in a track with other specialties but psychiatry. Seems they have learned from the experience in the 70. Thanks Dr Shock
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