I really do try not to be a "grumpy old man!" I'm not usually grumpy and I'm not that old. I just turned 60, which as we all know, the new 40! However, when I look at the radical ways in which medical education is being altered, strikingly for the worse in my opinion, I can't help but be concerned for the future of those of us destined to be under the care of these poorly educated, lacking in the fundamentals, future physicians. Rather than requiring a core knowledge of the basic medical sciences, the new approach seems to be, "don't worry about the details, just get the big picture by guided self-discovery," whatever that is.
Medical schools are clearly abrogating their responsibility to teach core biologic / medical principles. Some schools have acknowledged this and noted that they are now requiring significantly more undergraduate training in the basic sciences before acceptance into medical school. I certainly hope so, because it is abundantly clear that they're no longer getting this material in medical school. How an English major can expect to ever come to grips with the science background necessary to be a physician when it is no longer being taught in the first two years of medical school is quite beyond me.
Even if you come to medical school with a stellar basic science background, you are unlikely to learn the fundamentals of anatomy, histology, and pathology that should underpin a solid medical school education. Indeed, courses with these names no longer exist in most medical schools, being folded into "big picture" courses with names like, "Fundamentals of Human Disease." We see the effects of this all too clearly in our residents. Although we have been fortunate to attract some of the best and brightest into our residency program, these individuals, through no fault of their own, are lacking in the fundamentals of anatomy, histology, and pathology. In fact, I would say that these excellent, highly motivated students of today, almost all AOA members, would fare quite poorly in these subject areas, when matched with the lowest 10% of a medical school class from two decades ago. Pathology is hard enough to learn in 4 years when you enter a program well trained in the basics. It's almost impossible when you begin and are unable tell the dermis from the epidermis on a microscopic slide.
As a side issue, given how little exposure medical students have to gross and microscopic pathology during their training, it's a wonder that ANY of them is attracted to a career in pathology.
When I consider what medical school tuition COSTS today, even for an in-state student in a state-supported school, I can't help but think that they're definitely NOT getting their money's worth!
The argument against all this is to say that although those going into pathology might benefit from more training in these areas, for most physicians it just isn't important. Histology is, after all, "archaic." I know it must be, because a second-year medical student told me so recently!
In 1952, Dr. Robert A. Moore, a well-known pathologist who was then the Dean of the Washington University Medical School in St. Louis published an article in the journal, Academic Medicine entitled, "The Place of Pathology in Medical Education." I wish that this were mandatory reading for new medical students, or more pointedly for those altering medical school curricula. Dr. Moore's point that understanding pathology is pivotal to the ability to think and reason as a physician is right on the mark. If you're interested, and I hope that you are, you can get a PDF of the article at this site