Education & Career Science & Technology

Challenges of Medical Schools in Preparing Physicians – I

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Most medical schools all over the world currently rely heavily on the relatively new, interdisciplinary field of bioethics to further the objective of preparing a new generation of physicians.  Prof. Ashoka critiques the attempt of a century-long history of recurrent, markedly similar attempts to reform medical education, in his erudite research paper, which we present in seven parts. Here’s part one, exclusively for Different Truths.

Medical educators presently espouse, and are pedagogically committed to, the goal of fostering medical students’ ability to integrate biomedical, social-scientific, and moral ways of perceiving, thinking, and understanding into the diagnostic, therapeutic, prognostic, and caring roles for which they are preparing a new generation of physicians. Most medical schools all over the world currently rely heavily on the relatively new, interdisciplinary field of bioethics to further this objective. Despite the fact the bioethics is only some 50 years old, both these patterns are associated with a century-long history of recurrent, markedly similar attempts to reform medical education. The foci and leitmotifs of these attempts are articulated in the 24 reports advocating improvements in medical education successively issued since the publication of the famed 1910 Flexncr Report, which radically altered medical education in the United States.

The foci and leitmotifs of these attempts are articulated in the 24 reports advocating improvements in medical education successively issued since the publication of the famed 1910 Flexncr Report, which radically altered medical education in the United States.

As physician and sociologist Nicholas A. Christakis has pointed out in a content analysis of these reports, every one of them proposed that the amount of “social science” offered in the curriculum be increased, though, as he observes, “what is considered to be ‘social science’ has changed over the years. “For example,” he notes in passing, “the early 1980s marked the emergence of the tendency to conflate medical ethics with the medical social sciences more generally.” Using a common vocabulary, the reports have repeatedly recommended that through the medium of such “non-biomedical fields” medical schools should augment their efforts to teach what are alternatively called the “behavioural, “social,” “psychosocial,” “humanistic, “and” ethical” components of the health and illness of “knowing patients as persons, “and of the character and comportment of “empathic,” “healing” physicians. This proposal is also consistently linked with educating physicians to recognise and fulfill their larger professional responsibility to meet “community needs,” “serve the public, “and promote the’ social good. “The strikingly reiterative nature of the reports, in these (and other) respects, is partly related to a more general characteristic of American medical education-what sociologist Samuel W. Bloom has described as its history of “reform without change, of repeated modifications of the…curriculum that alter only very slightly or not at all the experience of the critical participants, the students and the teachers.”

Within this framework of perennial curriculum reform and little deep-structure change, medical educators have identified certain disciplines as vehicles of the “non-biomedical” intellectual and attitudinal training of medical students they aspire to effect. The principal fields they have designated for this role have varied over time. In the 1950s and the 1960s, for example, it was to psychiatry and the social sciences that medical educators accorded this task (in a period when social scientists who had obtained positions in medical schools were most likely to be affiliated with departments of psychiatry.) During the mid-to-late, 1960s community medicine acquired relatively short-lived prominence in this regard. And from the beginning of the 1970s to the present, it is bioethics that has come to be regarded as the foremost conveyor of other-than-biomedical learning to medical students.

From the beginning of the 1970s to the present, it is bioethics that has come to be regarded as the foremost conveyor of other-than-biomedical learning to medical students.

The sequence involved here has been influenced by the state of these fields when they took on this medical educational assignment, and by the social climate that prevailed inside and outside the medical school during the particular decades in which they assumed it. In the post-World War II atmosphere of the 1950s into the 1960s psychoanalytically oriented psychiatry was at its height, and the social sciences were creatively flourishing. Both separately and collaboratively, these two fields were actively engaged in exploring the dynamic interplay of psychological, social, cultural, cross-cultural, and  biological factors in health, illness, and care; in studying the experiences, feelings, and behaviour of patients and families, doctors and nurses; in describing and analysing the attributes and impact of the hospital (particularly the “mental hospital”) as a social world; and in observing and  delineating the socialization pro­cess through which medical students were progressively trans­muted in to physicians. It was principally around these kinds of materials that medical schools in these decades fashioned what they usually entitled behavioral-science courses. The 1960s ushered in a period of social ferment and protest, and of raised consciousness about individual and communal responsibility for participating in the action to remedy some of the inequalities, injustice, and deprivation that violated basic American values. The fluorescence of community medicine in this era and its incorporation into the departmental organization as well as the curriculum of medical schools were catalysed by this cultural mood. The emergence of bioethics at the in caption of the 1970s, with its focus on problematic  aspects of medical, scientific, and technological advances, its “nee-individualism”  emphases, and its advertent and inadvertent involvement in questions of ulti­mate values and beliefs, coincided with medical and larger ­ than-medical developments taking place on the American scene. Thus there is intellectual and historical logic, as well as “sociologic,” in the fact that medical educators have singled out certain disciplines to impart non-bionomical knowledge and insights to medical students. However, the choices that have been made in this connection have not always been sufficiently[AR1]  informed. This is suggested by the tendency medical educators showed in the 1950s and 1960s to refer to all nonbiomedical subjects as social or behavioural science, and by their present inclination to lump them together under the label of bioethics. Such all-encompassing, nondifferentiated terms reveal a lack of clarity about the concepts, methods ,ways of reasoning, and knowledge bases of the various nonbiomedical fields educators have drawn into the teaching of medical students, a disposition to regard them as interchangeable, and  an inadequate, some­times erroneous idea of the role these various disciplines can and cannot be expected to play in the education of future physicians. There is a sense in which medical educators have rather unreflectively seized upon one or another of these fields in a given decade, treating it as though it were an intellectual panacea for dealing with the difficulties of imparting more than strictly defined biomedicine to medical students.

(To be Continued)

©Prof. Ashoka Jahnavi Prasad

Photos from the Internet


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