A Critical Look at Medical Education in the United States with Comments on the Role of the "Specialty Boards"

A CRITICAL LOOK AT MEDICAL EDUCATION IN THEUNITED STATES WITH COMMENTS ON THEROLE OF THE "SPECIALTY BOARDS"* RUSSELL MEYERS, M.D., F.A.C.S. An eclectic view of medical education makes it apparent that the education of a physician begins early in the preschool period and continues throughout all the years ofhis practice. Beyond the internship his education may or may not include a residency, fellowship, and formal courses ofpostgraduate study; but it is, in any case, certain to include the widening ofexperience and maturing ofjudgment engendered by daily practice, the reading ofmedical literature, frequent contacts and consultations with fellow practitioners, and attendance at hospital rounds, staff, and society meetings. This is, in essence, a deterministic concept, and its adoption carries important heuristic implications for what follows in this article, not the least ofwhich is that any serious effort to improve the training of physicians must contemplate going well beyond the content and form of current-day premedicai, medical, paramedical, and postgraduate programs and penetrating boldly into general education and the broad sociopoliticoeconomic milieu in which the latter is set (i). Let us preface our inquiry into medical education in the United States by recalling the traditional ideals that have for many centuries constituted the vade mecum of the practitioner of Western medicine, viz., the preservation ofthe patient's life for as long as possible; the achievement of optimal function in health and disease; and the giving of comfort and assurance to those who stand in sorrow and pain. These ideals, often loosely referred to as the "philosophy" of medicine, subtend medical * Portion ofa paper entiled "The Search for Better Ways: A Critical Look at Medical Education," presented at the fifty-second annual Congress on Medical Education and Licensure ofthe American Medical Association, Chicago, Illinois, February 13, 1956. The author is chairman of the Division of Neurosurgery, State University of Iowa Hospitals, Iowa City, Iowa. 48 Russell Meyers · Critique oj Medical Education Perspectives in Biology and Medicine · Autumn 1957 education no less than the actual practice ofthe art, for medical education manifestly aims to produce practitioners capable of effectively pursuing these goals. Our difficulties as teachers of medicine and allied subjects develop as soon as we attempt to translate these laudable general aims into particulars . Mindful, as we are, of the ever present necessities of economizing time, energy, money, and available facilities, we see that virtually all our problems in pedagogy revolve around two questions: (a)Just what educative devices shall we employ in the effort to fashion practitioners capable ofpursuing the stated goals? and (¿) How shall we satisfy ourselves that the devices adopted do constitute "the best" pedagogy under the prevailing circumstances? In contemplation of the numerous present-day endeavors to deal with these questions, certain recurring errors of omission and commission become apparent to the detached observer. It is no exaggeration to say that in the course ofa single year the sensitive critic, observing the verbal and non-verbal behavior ofhis students, his colleagues, and himself, can collect hundreds of "horrible examples"—the consequences of defections in the exercise ofscientific method and established principles ofgeneral education . The limited time at our disposal precludes the citation in extenso of such documented episodes (i) as might render the present essay convincing to the more incredulous among us. Fortunately, many listeners will be able, upon review of their own experiences, readily to furnish their own examples. (To those teachers barren of such experiences, the rest of us offer warmest congratulations and express the wish that their good fortune may long continue!) But the mere collection of incidents that thus exemplify departures from sound educational procedures is not likely to advance our cause very much. At best, such might be counted upon to suggest specific measures to be adopted for the recurrences of specific incidents. What we might more profitably address ourselves to is the identification of the principles they exhibit in common—principles which, being honored or dishonored, have inevitable consequences for good or ill in our day-by-day activity. To this end, the writer proposes to categorize the more obvious departures in principle, as he sees them; to draw inferences as to their more conspicuous effects; and, where...