Friday, June 12, 2015

MODIFICATION TO MEDICAL EDUCATION IMPERATIVE

I watched an ad on TV urging teachers to learn how to be more efficient in teaching science. Although I watched with bored disinterest, the message did not leave me. That message is knowledge is accumulating so rapidly; we cannot keep up. Like water flooding into a boat, we as educators are becoming overwhelmed and, as a result, are sure to sink unless we do something. The question is, what should we do? As a professor in the College of Veterinary Medicine, I was aware of the changing ways we were teaching medicine and surgery in my profession but it never registered with me what was happening and why. Administrators classically divide the veterinary curriculum into basic science and clinical science. They framed the curriculum around a strong prerequisite program at the beginning and extended it with a voluntary internship at the end of four formal years. The modern or lecture/apprentice mixture of medical education developed in essentially the 19th and 20th century grew out of what had been strictly an apprentice program that had been in places since ancient times. Obviously, a professor could teach the signs and symptoms of hundreds of diseases in a lecture hall that he or she could never accomplish by exposure to the diseases in question in a clinic setting. Those of us teaching in the basic science or interface between the basic sciences and clinics were acutely aware that we did not have time to teach what most of us felt needed teaching. Knowledge in basic science is expanding exponentially. We urged those teaching prerequisite course to expand their courses and for clinicians to include more basic science in their clinical teaching. There was strong pressure not to increase the number of years in professional school. Of course, jamming more and more material into the eight-hour day has natural limits. The point is basic science knowledge was overwhelming everyone. What happened was internships expanded to a bewildering plethora of residencies, which soon came to include both species specialties as well as of discipline specialties; equine surgeons, poultry medicine, and small ruminant specialists, for example. Also to residencies, there was the classic advanced PhD research degree hovering in the background of residencies. In some disciplines, PhD research degrees replaced residency board certification. At the end of a PhD program, the college administration awards an academic degree. In contrast, at the end of a residency, a board of specialist representing that specialty administers a certification examination. The difference is board certification can be and often is not under the control of academicians. In my discipline of veterinary pathology, the result was that the academician were teaching pathology of dog, cat , horse, cow, pig, sheep, and goat, while the board examination under the control of people working in industry (drug and chemical companies) examination was on the pathology of rat, mice, and Guinea pigs. The obvious problem of students who desired to become diagnostic pathologist did not want the burden of doing, writing about, and the defending a complicated research project. It should be obvious that residencies were an attempt to respond to the great expansion of basic science knowledge. It should also be obvious residency program concept has overwhelmed. Examining new and proposed curriculum clearly indicates a new direction to meet the challenge of expanding basic science is taking place. Colleges of veterinary medicine and medical colleges are teaching their students to be the equivalent of highly trained nurses, the doers, and not the thinkers, which creates an obvious void. The professions are rounding out their ranks with non-veterinarian or physician with holders of Ph.D. degrees in myriad disciplines such as genetics, pharmacology, pathology, microbiology, virology, and on and on. New curricula reflect this by a great diminution of time devoted to basic science and an equally expanded expansion of clinical courses based on the classic apprenticeship approach to medical education of the early centuries. The curious thing is Deans and educational administrators vehemently deny what they are doing. Apparently, they do this to protect the high station held in the public for medical professional. I was inclined to do, as a professor, was to tell my students, veterinary medicine is in the mind of the veterinarian and not in the eye of those who can see what they do. Students subject to this; they want of fix broken legs and diagnose disease, and neuter animals, and that entire lexicon of special skills veterinarian commonly exhibit. At the end of a long career, it is hard to admit I was wrong, but I was. It is time for the profession to agree; there is just too much knowledge for one person to comprehend, and educational administrators have to modify our education system to acknowledge this development. URL: firetreepub.blogspot.com Comments Invited and not moderated

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