I don't want this blog to turn into a series of negative rants, such that I come across as a grumpy old(er) man, but I will discuss one topic about which I and many of my colleagues feel strongly.
Having worked their way up from kindergarten, through grade school, and undergraduate programs, the expert educators (ie. Ed.D.s) of the world have now turned their sights on "improving" how medical schools teach medicine. Unfortunately, they seem to have convinced the deans and accrediting agencies of their expertise in this regard without any (as far as I can tell) outcomes analysis.
Like most of you, my first 24 months of medical school was the traditional specialty-directed approach with first year consisting of normal biochemistry, anatomy, histology, physiology, etc. The second year was devoted to disease, again in a specialty-directed format with courses in pathology, pharmacology, hematology, mechanisms of disease (internal medicine), etc. The backbone of each course was a series of 1-hour lectures, often followed by labs or tutorials in smaller groups. There was a huge amount of material that had to be mastered and in many instances just simply memorized. The lecture format is a tremendously efficient albeit passive way of imparting a large amount of information in a limited time and giving appropriate weight and context to the facts presented. Not long after I graduated, many medical schools switched to a more disease-oriented approach in which, for example, the normal anatomy, histology, and physiology of the liver, the pathology of its diseases, and the clinical features and treatment of those diseases were presented more or less together. This approach had much to recommend it and was still basically centered around the lecture format.
Now, however, the experts have decided that lecture-based learning is just too passive and medicine should be learned through directed discovery in which a small group of students, with a prior reading assignment and limited guidance from a faculty leader discuss topics together and discover the principles of medicine on their own. This would be an interesting and maybe even a beneficial approach IF medical school were a 5- or 6-year program. But this new approach is now frequently being combined with a reduction from 24 to 18 or fewer months of training in the fundamentals of medicine before ward rotations begin. This approach may be active but I believe that it is FAR, FAR too inefficient and unorganized to allow for meaningful training, especially when combined with an abbreviated schedule.
Although the lecture-based system for the first half of medical school training has worked well for generations, the accrediting agencies, as well as many medical school deans and their underlings, appear to have accepted the need for change and are mandating an "active self-discovery" approach to medical education with no evidence that this system will actually be an improvement. It won't be. The emperor has no clothes. And what wakes me up at night is the sobering fact that these haphazardly educated students, likely to know some things well and many things not at all, will be taking care of me in my old age..... and you too!
I promise my next blog will be positive, light-hearted, and maybe even humorous.