What’s Wrong With Medical Education Today?

A thoughtful and inspiring post from a psychiatrist, of all specialties, concerned about current medical education expanding its scope into practice and away from the centrality of the human body itself. In What’s Wrong With Medical Education Today?

“I was shocked, however, to learn that anatomy had been reduced to a mere eight weeks during the first year of medical school, instead of the full year that comprised my education 40 years ago. What’s more, those eight weeks now also included embryology and radiology — the logic for bundling these subjects together I could not understand nor did I ask. But eight weeks? How in the world could anyone dissect a cadaver in that time and actually learn about the human body? How could a doctor in the making have the ritualistic and for me awesome (in the best sense of the word) experience of really knowing “the body,”…”

Instead of in-depth human anatomy and procedure training, the trainees develop skill in bedside manner.

“We then were shepherded to the Clinical Skills Training area, down the hall from the anatomy lab. Here, 32 examining rooms, with video cameras, computers, electronic records and trained actors provided simulated doctor-patient encounters for the medical students throughout their full four years of medical school. …  Anatomy had been replaced by relationship training, by how to help a patient tell his or her story and how a doctor needs to learn how to listen, respond, assemble information and engage the person in their own care.”

What’s interesting to me as a design researcher is that the driver for these changes appears to be a customer-centered service orientation to the patient. With patients demanding more thoughtful and attentive care for their engagements with physicians, we may see education responding to essentially economic factors of the relationship. Physicians are being trained as health guides and problem-solvers, and not just as experts of the physical. Could this trend be because “we” as patients have too loudly asserted our rights as consumers? Why did we want to have a market-mediated relationship with our “doctor of choice?” Perhaps the consumer or customer role is not appropriate at all – perhaps the doctor’s role as a trusted and trained intervenor should be reconsidered.

Lloyd Sederer closes the article with:

“Dropping the body from a central role in medical education seems like a bad idea. So, I looked up the number one “Sentinel Event” in this country, a term used by The Joint Commission, which accredits all hospitals in this country, to define “…an unexpected [medical care] occurrence involving death or serious physical or psychological
injury…[which] signal the need for immediate investigation and response.” It is wrong sided surgery. I rest my case.”

Panels and commissions have been seriously urging changes to medical curricula for two decades now. And while “bedside manner” may be among the new practices, it wasn’t a huge thrust in the articles in NEJM and AMA urging these changes over the years. What we are dealing with is a huge increase of complexity of the apprentice model of learning, new forms of practice, research, education, and new technology. My response to Lloyd (where he rests his case) is that wrong-sided surgery may be a problem, but its related to communicative complexity, not anatomical training.

(Surgeons, after all, do not lift a scalpel till after years of new training after med school, and by then they have little bedside manner left!) So I would argue relationship training does not lend credence to  this problem – but perhaps to others. Your thoughts?

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