We are training physicians with an eye towards the past

How do you ask a person to be the last person to go through an education system that is failing them?  Yet we’re doing just that. Every day tens of thousands of medical student wake up to an education, and an education system, that is failing them.  This is not to say that we are not producing good doctors.  On the contrary, our doctors are likely the most well-educated, and knowledgeable in history; but this is part of the problem.  Every year the amount of information medical students are required to know increases.  We do not replace information with better, more relevant information, we simply add more. But is increasing the flow from the firehose from which medical students are supposed to drink producing better doctors?

For decades we defined physicians by the amount of knowledge they accumulated, knowledge that separated the physician from lay persons.  This knowledge was gleaned from years of study and kept in intimidating textbooks allowing the physician to enjoy a large knowledge advantage over his or her patients.  This is simply not true anymore, and the sooner we as a profession and industry recognize it, the faster we can adjust.

The more I reflect on this, the more I think that medical schools produce the used car salesmen of a decade ago.  Anyone who remembers buying a car ten years ago can remember being at the mercy of the dealership.  You would walk in to the dealership with little knowledge of anything on the lot — what cars had been in wrecks, or the prices the dealer paid.  Today, the playing field is level.  Consumers are able to research and comparison shop before ever walking into the dealership.  Today, physicians share the same advantages of the pre-Internet car salesmen.  Physicians are the gatekeepers of information, but this role is quickly becoming outdated.  Now information is just a Google search or a WebMD “diagnosis” away.

It’s easy to dismiss information individuals glean from Google, WebMD, or Wikipedia, although a survey by IMS Health found that 50% of Internet-using physicians consult Wikipedia for disease-related information.  But even if these information sources are not currently up to the standards to which we hold practicing physicians, we are quickly approaching a point where intelligent computing systems will be able to provide far more sophisticated results.  Even the best, most dedicated physician cannot stay up to date with all of the latest advances in medicine the way IBM’s Watson has been built to do.  Yes, Watson is currently designed to aid physicians in diagnosis, but these kinds of technological advances will eventually find their way directly to the public, and then the knowledge advantage that physicians enjoy will mostly disappear.

So why are we training physicians with an eye towards the past instead of the future?  Why are we training physicians to be the outdated used car salesmen of tomorrow?  Physicians, and future physicians, should recognize that we will soon no longer be arbiters of information. Instead we will become interpreters of information for patients who show up for appointments already informed (or misinformed).  This change in emphasis in physician training needs to begin with medical school.  The goal of basic science education should shift from cramming minutiae into students’ minds to instilling mechanistic understanding of disease.  The goal of medical school should change from trying to be the algorithmic computer to making, interpreting, and understanding these algorithms.

We can already see hints of these shifts in the inclusion of more literature interpretation, patient safety, and biostatistics in Step I and Step II, but we have not seen the same shift in medical education.  The mentality of the status quo will not suffice for the next generation of physicians.  After all, patients are already doing their part, coming to see their physicians with Internet printouts, 23andMe results, etc. Now it’s time for physicians and medical students to do ours.

Jon Coleman is a medical student.

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