Priorities in Medical Education

PRIORITIES IN MEDICAL EDUCATION PAUL B. BEESON* The quality ofa dvilization does not depend only on its science, economics or soriology, but even more on its standards, values, ideab, its sense ofwhat is first-rate in life, its religion. [1, vol. 1, p. 129] Introduction Education, like politics or religion, is subject to widely differing opinions and strongly held points of view. So, when the editor of thisjournal invited me to contribute my thoughts about medical education for its twenty-fifth anniversary volume, I willingly accepted the opportunity to air my prejudices, which are based on a long career in academic medicine in Canada, the United States, and Britain. Lest some things I shall say later may seem "anti-science," let me say at the beginning that I am strongly "pro-science." That is the only path we can follow in a quest for curative medical treatments. The past few decades have been historic in this respect, and I am glad I had the privilege of being professionally active when so many wonderful things were going on. In other writings, I have presented evidence about the accomplishments of biomedical research, in support of my belief that a patient today is likely to have a more accurate diagnostic evaluation and a much better chance of effective treatment than was the case when I began medical practice [2, 3]. The possibilities are still limitless. Today's medical students will see a continuous stream of improvements in diagnosis and treatment. Who can say? They may witness the advent of effective therapy for schizophrenia or Alzheimer's disease. But in spite of this "good news," we have to realize that all is not well with the practice of medicine in our country or in the whole Western world. Adverse criticisms of medical service are heard and read everywhere , coming from politicians, economists, sociologists, and the lay public—even from members of our own profession [4-6]. It is said that ?Professor of medicine, emeritus, University of Washington, Seattle, Washington. Address : 8262 Avondale Road, Redmond, Washington 98052.© 1982 by The University of Chicago. AU rights reserved. 0031-5982/82/2504-0302$01 .00 Perspectives in Biology and Mediane, 25, 4 ¦ Summer 1982 | 673 today's medical practice, while more effective, has become cold, dictatorial , and costly. My concern is that some aspects of our current system of medical education will exaggerate that malaise in the future. In particular, I regard the overwhelming emphasis now placed on the technology of medical practice to be concealing from physicians-intraining some of the broad responsibilities that members of our profession ought to accept if we are to make the best possible contribution to the welfare of mankind in the decades immediately before us. Most of this essay will emphasize features of current clinical training which I think may not be advantageous in the long run. The things that worry me are indirect consequences of the great developments in biomedical science that I praised in my introductory words. I shall focus first on the clinical phase of formal medical education, and then shift to the place of our profession in the affairs of the world. Todays Medical Students In general, today's clinical students appear to me to be far ahead of those of my generation. I admire their knowledge, their maturity, and their general capability. Their improved preparation reflects not only better grounding in biomedical science, but other scholastic influences as well. One change has been a reduction in time given to formal, didactic teaching, so that our students have more opportunity to think, to learn, and to form opinions for themselves. Although long employed as a clinical teacher, I still have some difficulty in appraising the kinds of learning opportunities that enable medical students to gather clinical information with such astonishing speed. Granting that people learn in different ways, and that many things are going on at the same time, I have the impression that one of the most useful mechanisms has nothing to do with the curriculum, nothing to do with the quality of research by the faculty—rather it is the informal discussion and good-natured arguments that students engage in, with classmates and with...