In his essay on “Learning and Teaching Medicine” Dr Sutter succinctly presented guidelines for learning and teaching as they might apply to his subject of pharmacology or other basic sciences, but only briefly alluded to teaching clinical medicine, which is where the scientific content of the medical curriculum is applied to patient care. These different disciplines require different approaches.
The primary role of the medical school is to produce doctors who care for ill or injured people. Doctors must learn clinical skills that cannot be taught in the lecture room but can only be learned at the bedside, in the clinic, or in procedural areas such as the operating room. Teaching and learning these skills relies mainly on a master-apprenticeship system; how else can experienced doctors pass on practice skills and knowledge acquired by treating patients over the years? Unfortunately these skills are difficult to assess with written examinations alone.
Universities have served us well in keeping medical education “on the rails” after Flexner’s report. However the notion that only full-time scientists, dependent on research publications for advancement, can train doctors is out of date. The schools must adjust to the realities of changes in our social structure which in turn necessitate changes in the teaching of clinical medicine.
Although Dr Sutter stated there are “...relatively few good masters...” I disagree. There are many excellent clinical teacher role models potentially available throughout the province. UBC did well for its first 50 years by relying on volunteer efforts of community physicians to pass on clinical knowledge, but volunteerism is no longer adequate due to increasing pressures on doctors, not least of which is economic. This is even more problematic given the proposed massive expansion of the school. Good medical teaching takes time whether it involves basic science or clinical practice, and time is in short supply for practising clinicians. If universities continue to be the major source for medical education, they will have to understand that they cannot produce the doctors, which society expects, without excellent clinical teacher role-models who in turn must receive benefits accorded to full faculty and accorded compensation commensurate with their contributions.
—George E. Price, MD
1. Sutter M. Learning and teaching medicine. BC Med J 2002;44:554-555. Full Text
2. Flexner A. Medical education in the United States and Canada: A report to the Carnegie Foundation for the Advancement of Teaching. Bull 4. New York: The Carnegie Foundation, 1910. PubMed Citation Full Text
3. Rae A. Osler vindicated: The ghost of Flexner laid to rest. CMAJ 2001; 164:1860-1861. PubMed Abstract Full Text
4. Price GE. Clinical faculty and medical education—turmoil in academe. Clin Invest Med 2000;23:376-378. PubMed Citation Full Text —
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