Medical knowledge has exploded and future doctors need more training to be competent, or so the argument goes. But has our obsession with length of courses blown undergraduate medical education and postgraduate medical training courses out of proportion?
Today, if you want to be a general practitioner you’ll spend your first five years at medical school followed by one to two years in a hospital, then a further one to two years in a GP training program, after which you will hopefully find an associate position in a practice where you will wait years for a principal role. And if surgery is your goal, don’t expect to see your first patient for seven to ten years after you graduate – by which time you’ll be in your mid thirties, if you’re lucky.
Students should shadow consultants on a daily basis to see what life will be like
The trouble is length is standing in the way of competency … and a very simple solution: stream students at the end of first year and expose them early to the range of career choices on offer. Communication training and problem solving are important skills but they shouldn’t be the start point of medical education. Rather, students should shadow consultants on a daily basis to see what life will be like at the end of their training.
Early experience enables rational decisions about which specialty a student is suited to and whether or not they are suited to medicine. And streamlined training provides health planners with useable workforce information. It will also reduce the current high numbers of disgruntled younger doctors because they would be better prepared for the day to day challenges of their careers and more able to adapt to the professional lifestyle of their choice.
Streaming also enables personalized curricula, which is important because contemporary medical practice requires tailoring care to the individual patient. With highly technical information readily available on the Internet doctors don’t need to regurgitate reams of facts but rather understand the implication and ensure optimal practice within their area of expertise.
For example a cardiothoracic surgeon will share basic skills, such as cutting and communication, with a dermatologist but beyond that the emphasis of their education should differ: the surgeon needs to understand heart-lung bypass technology while the dermatologist must be competent in the immunology of the skin. Neither will ever require even the most basic understanding of the other’s field.
Medicine can no longer afford to train an undifferentiated doctor in order to provide hospitals with cheap medical labor. A radiologist reading MRIs doesn’t need to learn how to suture or resuscitate a patient. A family doctor doesn’t need to know which sequence of therapies is appropriate to treat refractory multiple myeloma. But our healthcare system does. And if we enable doctors to focus on their final destination earlier we will not only ensure the optimal use of resources but produce confident, competent and professionally fulfilled doctors.
The Thinker 
An interesting blog but the reasoning seems far too simplistic and lacking in depth. This ‘streaming’ argument seems to be going against the new thinking which has moved away from worshipping at the altar of ‘ologists’ and is tilting the balance back towards holism and integration. By having a lot of superspecialists with no general grounding one will accelerate even greater the fragmentation of care and high costs that are generated by referrals, re-referrals, misunderstanding and lack of continuity. I am not advocating maintaining the status quo, far from it. Clearly curricula need to change as sciences and society change so there should be frequent revisions of what is relevant in both undergraduate and postgraduate courses.
Medical schools and postgraduate deaneries/HEE were not established to provide hospitals with ‘cheap’ medical labour. That was a deliberately provocative phrase intended to poke fun at the absurdity of employing people who are expensively educated to perform relatively menial tasks which could done at a lower cost by individuals or teams with limited knowledge and expertise. Of course, the main purpose of medical training and further education should be to produce doctors, medical scientists, researchers, medical educators and leaders.
However, the issue of ‘competence’ is sometimes misunderstood even by well educated professionals. A student, trainee or a practitioner is required to become ‘competent’ and over time may become expert. A specialist and/or a superspecialist is required to be more than competent and should be regarded to be an ‘expert’. On occasions specialists in whatever field of work may be the most expert person who has ever practised in that specialism. Yet we need more ‘generalists’ as the vast majority of people are ‘normal’ by definition, so have general problems requiring more generic, holistic knowledge and skills to treat them rather than esoteric knowledege and skills held by some single organ/ single system ‘ologists’. General Practitioners to function effectively need a high level of wisdom as well as knowledge. This sagacity does not just arrive with competence but is aided by life as well as professional experience. With the increasingly aged population and changing demographics all over the World it is increasingly important that healthcare professionals have general knowledge as well as maturity to function efficiently. Furthermore, throughout developed and underdeveloped nations the complexity of human life, increased migration, income inequality, water shortages, ethnic tensions, energy unsustainability and political instability require a whole new cadre of well educated, multi-faceted and integrated thinkers to enable the human race to continue to thrive and survive on our beautiful planet Earth.
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