Overspecialization in medical education: Is it hindering physician growth and stifling innovation?

In the recent book, Range: Why Generalists Triumph in a Specialized World, David Epstein makes a strong argument for exploring or sampling different interests and jobs before settling on a career of choice, a process that leads to “match quality,” which describes the degree of fit between one’s work and who they are. This idea flies in the face of our strongly held belief that early specialization, or focusing on a narrow skillset or field of study starting at the earliest possible age, is the path to success. Epstein illustrates how many innovators and leaders in their fields spent time trying out different vocations (or sports, musical instruments, styles of art, etc.), often failing at them or moving on because they lost interest, until they found the right fit. Those experiences were not wasted time or knowledge lost because they fell behind in choosing a career. A meandering, unconventional path cultivates valuable ideas, perspectives, ways of thinking, and ways of problem-solving that can be applied to other situations later in life and to other jobs. Often, these leaders rose to the top using knowledge and skills not otherwise learned in their eventual specialties.

I couldn’t help but think about these ideas in the context of medical training. Many of us in medicine can remember feeling pressure to choose medicine as early as middle or high school, and subsequently to choose a specialty early in medical school and then a subspecialty early in residency. Choosing early allows you to take the right classes, choose the right major and extracurricular activities that look good on your CV, find mentors in your field of interest, and participate in research in that field, again to bolster your CV and become a competitive applicant. If you wait too long to choose, you fall behind, and younger, smarter students will take your place, and you’ll never reach your career goals and full potential. Right? Not quite. Research shows that “late specializers” who take a more nontraditional path to their careers may seem behind their younger counterparts at first, but they quickly catch up since they have increased match quality after sampling other fields of interest, and they have more breadth of knowledge from their myriad experiences.

The lessons in Range also challenge the conventional ways in which we learn how to do scientific research and how we approach solving problems in medicine. Throughout the book, example after example demonstrates the drawbacks of overspecialization and the benefits of multidisciplinary collaboration and outside the box thinking. Arturo Casadevall, who became the chair of molecular biology and immunology at the Johns Hopkins Bloomberg School of Public Health in 2015, warned that the rate of retractions in scientific publications is outpacing new studies, implying that young scientists are not equipped to produce quality research. Casadevall proposed to de-specialize training and teach students how to integrate information, and how to think and reason with interdisciplinary classes (history, ethics, philosophy, etc.) and courses in how to identify scientific errors and poor research methods. He also aimed to decrease very detailed, highly specialized didactics focused on rote memorization. Reflecting back on my medical training, I can see why he would question the current system. Most medical school courses rely on memorizing facts and regurgitating them back for exams, and once we specialize, we forget much of it. Learning to critically evaluate the quality of research and how to conduct good research are more of an afterthought.

Innovation and discovery in medicine is a hot topic, with a great deal of funding being offered to physicians and scientists with novel ideas that could lead to breakthroughs. After reading this book, I wonder if, firstly, our culture of overspecialization and early specialization that discourages exploration and taking time to learn about ourselves and our interests stifles innovation and creative thinking. Secondly, maybe calls for innovation should extend outside our medical institutions, inviting thinkers from other disciplines to apply their knowledge and problem-solving skills to issues in medicine. This would allow for collaboration between physicians and scientists and smart, creative people from diverse backgrounds.

I hope this provides some food for thought for aspiring physicians of any age and background who are worried about being behind, educators in charge of teaching the next generation of doctors and scientists, and current physicians who are thinking about exploring other interests.

Katherine Bishop is an obstetrics-gynecology physician.

Image credit: Shutterstock.com

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