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.