Medical Education has Come a Long Way

By Mikalah • Education • 11 Dec 2012

The all famous Sir William Osler is certainly a character to mention in detail. Dr. Osler was the consummate clinician compassionate, imbued with science, an astute observer of human pathology. He embodied the spirit of the new medicine of the late 19th and early 20th century, as practiced at the Johns Hopkins hospital. Before the establishment of institutions such as Hopkins, physicians frequently had no firm training in science, prescribing treatments that were, at best, placebos, and at worst, life threatening. Hospitals were places where one was sent to die. The scientific movement in medicine took hold after the advent of fields such as microbiology, and the development of modern surgical and anesthetic techniques. The Flexner report of 1911 encouraged and promoted the new medical school, based on the model of Johns Hopkins. Physicians were to be trained as scientists, focused on laboratory methods and dedicated to the discovery of new methods of treatment.

Medicine has come a long way since 1911. We are now well ensconced in the era of the clinical trial, evidence based medicine, and the information revolution. Medical students are still trained by the methods of Flexner; encouraged to be laboratory scientists. What is needed is a new paradigm, however, one that takes into account the new clinical methods of investigation, and one that understands the importance of health policy and economics in the management of patients.

Students need to get a firmer base in information science, statistics, and management of health care systems before applying to jobs from listing sites including Leap Doctor. They need to be trained as physicians who can lead, who can be effective managers, and who can advocate for the greater public good through formulating sound policy strategies.

Health policy now seems to be in the exclusive domain of the non-medical, and non-scientifically trained bureaucrats. There seems to be a disconnect between the policy makers and the clinical practitioners. This disconnect needs to be addressed systematically, starting with medical education.

There is a science to management and business, and there is a great need to transmit this science to the students. No matter how dedicated and gifted physicians may be, their patients will not be served well if they cannot manage their clinics, and they cannot articulate a vision of care that their patients need.
I have seen a keen interest on the part of students to learn policy and medical economics. They are, of course, an idealistic bunch, and they come to this eagerness as a means to make things better. We in the medical community need to address this need. They need to know what the point of medical insurance is. What the logic behind the Medicare and Medicare programs is. How patients behave according to different clinical situations, and how the public health can be better served through good policy.

I came across a Business of Medicine colleague of mine this morning at a chance meeting at a local coffee shop. He is a military physician who is attempting to incorporate a business program to his residents. This is a wonderful idea. They will be called upon, after all, to manage large clinical and hospital systems. It behooves them, then, to know just how to manage these systems. Just as anecdotes don’t serve the patient well in the individual clinical setting, they don’t serve the patients well in the larger institutional setting.

Let’s wrest health policy from the bureaucrats and infuse the medical systems with fresh ideas from physicians. Let’s train the next generation of physicians to be leaders in all aspects of health care. They have to do a better job than the folks currently in control.

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