Rethinking Medical Education

Here’s to the crazy ones. The misfits. The rebels. The troublemakers. The round pegs in the square holes. The ones who see things differently. They’re not fond of rules. And they have no respect for the status quo. You can quote them, disagree with them, glorify or vilify them. About the only thing you can’t do is ignore them. Because they change things. They push the human race forward. And while some may see them as the crazy ones, we see genius. Because the people who are crazy enough to think they can change the world, are the ones who do.

Medical education and medicine are topics about which I often find myself thinking. I’m always interested in the questions of “Are we doing it the best way?”, “Is there a better way?”, “How do we adapt the fields to emerging changes?”, and so on. Too often I come to the conclusion that we’re not keeping up with advancements and, as Wayne Gretzky might have put it, we’re skating to where the puck is, and not to where it is going. 

Consider our exams v. real world experience: In a licensing exam, a question is presenting for some aspect of medicine. In this situation, an examinee either knows the correct answer, or he/she doesn’t. There is no opportunity for quick reference and no consultation. This is despite being told over and over that medicine is not a solo exercise, but a team sport.

Contrast this with the real world. A doctor or student presented with a case in which he or she does not know the correct solution has the advantage of asking colleagues or consulting reference material. However, this is only useful if he/she has been trained to understand quick reference, medical software, and the advantages that clinical informatics provides to the information age. As important as clinical informatics is, it should be part of our daily lives and part of our testing and evaluation. Not knowing the solution to a random problem during an exam says nothing about what kind of physician the person is. However, not being able to reason out the solution in a simulated real-world environment with access to electronic reference says volumes. It shows a lack of understanding of how medicine can and should work. Medical knowledge doubles roughly ever five years and no one can be expected to know everything. But if when given real-world tools, it is troubling if the person can not figure out the problem. This is the real issue and this is what should be taught and tested.

Remember that no study has ever demonstrated a correlation between the score on a standardized examination and the caliber of physician a person will become. It has never been demonstrated because, as we measure things now, there is no correlation.

We must not stop there. Medicine has become increasingly technological as data has exploded. What a doctor learned 10 years ago may today be hopelessly obsolete. It is in medicine’s best interest and the best interest of our patients to integrate a training and knowledge of clinical informatics into our practice. It will require rethinking some of our most fundamental approaches to education, but it will result in a stronger, safer and more comprehensive medical knowledge base that each practitioner will wield with skill and certainty.

I know I am not alone in this way of thinking. IBM and its Watson supercomputer are already moving toward computerizing diagnosis and treatment advice. Clinical Informatics has recently become a recognized board specialty. Everything is medicine is pointing towards an informatics-based future and we have to start adapting to keep up with the trend.

I understand this line of thinking will be controversial. It will draw backlash from some academicians, testing companies that have a vested financial interest in the current approach, and doctors who ascribe to the dogma of “I went through it, and now it’s your turn.” But progress is only made by pushing boundaries and ignoring dogma. It’s made by looking at a situation, seeing how it’s being shaped and then skating to where the puck will be and not to where it is.

To those who agree with me on integrating clinical informatics, on ignoring the age-old dogma, and on having the courage to say and propose this openly, I say, “here’s to the crazy ones.” Because if we’re just crazy enough to think we can reshape medicine, we just might succeed.

One Response

  1. Hats off to woheevr wrote this up and posted it.

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