My son’s in medical school,” Fred told me. “First year.”
“Which school?”
Fred named a newly-chartered one.
“Really innovative curriculum,” he said.
“He got into a different school, too,” he said, “but he didn’t like how that school had canceled all lectures. Students just watch the lecture videos on their devices, so they scratched all the live ones.”
“Now that they don’t need lecturers, did they cut tuition?” I asked.
We both chuckled.
I was exposed to educational innovation on Day One of medical school, in the fall of 1968. (Go ahead, do the math.) “We’ve abolished tests,” the dean told our entering class.
“We cut preclinical study from 2 years to 18 months, followed by one comprehensive exam. We want to get you into the clinic right away, because you chose to be doctors to help people. Even during the preclinical period, you’ll be getting not just dry frontal teaching but exposure to actual patients,” he said.
We guessed that sounded good, especially the part about no tests. Less day-to-day studying. A lot less.
Of course, we still had lectures – although we ran out of time during one anatomy lecture and did all four extremities in one hour – but we felt little need to pay close attention. After all, any details we’d have to memorize would be diluted over three semesters, and 18 months was so far away.
As to the lectures themselves, I’ve never been diagnosed with actual narcolepsy, but when they turned out the lights and started showing slides, I typically fell fast asleep.
Most of us passed the comprehensive exam and moved on to the clinic. (We didn’t get into med school without knowing how to take tests, did we?)
The basic science faculty hated this educational innovation and recognized – correctly – that without tests we would take their classes less seriously. A couple of years later, the students themselves demanded that the tests be reinstated. The lack of regular, numerical feedback made them anxious. So it was back to exams every 2 weeks for them. Poor devils.
***
Over lunch at a friend’s house, I recently met a young woman in her second year at a medical school in Chicago.
“The school has an exciting, innovative curriculum,” she told me.
“No kidding,” I said. “What’s that?”
“They want to get us into the clinic as soon as possible,” she replied. “So they cut preclinical years to 18 months. And no regular tests. Just a comprehensive exam at the end. Much less day-to-day pressure.”
“Very innovative,” I observed.
***
When I entered practice, I joined the clinical faculty of a local medical school. For 35 years, I hosted senior medical students for a month-long elective. During that time, I tried to pass on to them some learnings that weren’t on the standard academic curriculum. For instance, the reality that medical advice is often more a negotion than an order. We are often faced with patients who have their own ideas about what is wrong with them, how it got that way, and what to do about it. Students seemed to find such notions – and their daily illustrations in the office – of some interest and practical.
I put some of these learnings, and related deep thoughts, between the covers of a book and sent a copy to the medical school registrar, from whom I had heard little over the years unless my student evaluations were 2 days late. My cover letter suggested that the school’s educators might be curious about what I’d been teaching their charges for 35 years.
The registrar replied by e-mail. “Thank you for your book,” she wrote. “I showed it to our dean of education, who told me that we would definitely not be changing our curriculum on the basis of your book. You might contact the medical librarian to see if they want to display it.”
I didn’t recall thinking, much less saying, that my ruminations ought to overturn the medical curriculum. I just thought they might be of some passing interest, coming as they did from an outside perspective.
Not so much, it turns out.
In any event, there are so many exciting realms of educational innovation to develop: genomics, precision medicine, and replacing physicians with mid-levels and clinical judgment with algorithms. The next generation of physicians, better educated, will survey so many shining vistas, just as we did.
Surely, they will know more about the origins and insertions of the leg muscles. They could hardly know any less.
Dr. Rockoff practices dermatology in Brookline, Mass., and is a longtime contributor to Dermatology News. He serves on the clinical faculty at Tufts University, Boston, and has taught senior medical students and other trainees for 30 years. His second book, “Act Like a Doctor, Think Like a Patient,” is available at amazon.com and barnesandnoble.com. Write to him at dermnews@frontlinemedcom.com.
