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Our View of Medical Education

Steven R. Daugherty, Ph.D.

I believe that we do not talk enough about the specifics of what a good physician needs to organize their knowledge and how they have to think. I hope to foster that discussion on this site.

Becoming a physician requires six things:
Task                               Learning                   
1. Perspective                How to see
2. Patterns                      What to see
3. Differentials                Essential distinctions
4. Decisions                    Making choices
5. Communication          Exchanging meanings
6. Commitment               Relationships over time

First, students must learn the different ways of looking at the human body and the human condition. Each of the core basic science areas offers a different lens for seeing something different. The way an anatomist sees the patient is different than how a microbiologist or a pathologist sees the same patient. As clinicians, doctors need to have all of these lens available and be able to use the best one to accurately perceive the problem at hand.

Second, students must be able to recognize essential patterns. Understanding how the details fit together is the essential cognitive skill allowing recognition of a problem. Our brains are pattern recognition devices. Medical education, at its best, should be about conveying the basic patterns to make sense of what the doctor will see. The cognitive psychologist Piaget called these patterns "schemas", and points out that these schemas in our heads are what give meaning to the world we perceive. What makes someone a physician is not what they know, but that they recognize and understand the things they see differently than the average person.

Third, students must be able to place these patterns side by side and focus on key features that allow them to be distinguished. The focus on distinctions allows physicians to sort out which of the patterns they know apply to the empirical case before them. The focus on distinctions also guides the physician as to what additional information they need to acquire to make sense of what is before them.

Fourth, students need to learn to make decisions, and these decisions must lead to actions. Medicine is not knowledge for knowledge sake, but knowledge for actions sake. A physician who knows all, but does not act on behalf of the patient is not fulfilling the essential obligation of the profession.
Having reviewed the patterns for understanding, physicians need to decide which one fits the patient issue before them and then map out the best response.

Fifth, having decided what are the key issues for a patient, the physician must be able to communicate those impressions and decisions to the patient. This means using language the patient understands and explaining complex issues in comprehensible terms. Communication also means developing the ability to listen attentively and take in important information offered by the patient and/or family. Good physicians are information sponges, soaking up all the details provided, because they are never sure which detail is the essential one until everything is sifted.

Sixth, students must have a professional stance and long-term commitment to both the patient they treat and the medical profession as a whole. The extended nature of the relationship is intended to foster compassion and caring.

Good medical education provides each of these six things. Deficits in these areas impact clinical skill as well as USMLE performance.

Steven R. Daugherty, Ph.D.

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