On Being a Doctor: Teaching the next generation of doctors

“I desire no other epitaph… than the statement that I taught medical students in the wards, as I regard this as by far the most useful and important work I have been called upon to do.”
- Sir William Osler, from The Fixed Period, in Aequanimitas

Teaching medical students the art and science of medicine occupies the time of many of us. Instruction ranges from teaching physical diagnosis to interpreting an ectrocardiogram to discussing of a differential diagnosis.

Osler was devoted to the importance of teaching, but bedside teaching more so than cramming books. Osler wrote:  “Medicine is learned by the bedside and not in the classroom. Let not your conceptions of disease come from words heard in the lecture room or read from the book. See, and then reason and compare and control. But see first.”

An article published in the Medical Journal of Australia by Jennifer Conn and colleagues caught my eye because it fleshes out some of the key theories that educators believe are central to the education experience, especially among adults. 

Conn and colleagues write: “Over the past few decades, developments in cognitive learning theories have led to a greater understanding of how students acquire clinical expertise. A number of key principles have emerged that are supported by substantial research activity. Foremost among these is that students learn more effectively if:

• instruction is systematically organised and coherently sequenced, with well defined objectives and meaningful theoretical frameworks to guide both formal and opportunistic learning;
• the educational opportunities provided are appropriate for the students’ stage of intellectual development; and
• skills acquisition takes place within the context in which it is to be applied (known as “situated learning”)."

Students need to be able to actively build on their knowledge and skills through interplay of existing expertise with new experiences. They also need opportunities to consolidate their new-found knowledge and skills by practice in a variety of clinical environments.

But, a new term that I had not come across that I certainly encourage students to do in practice is the “hypothesis-driven physical examination”. 

“clinicians [showing that they] more readily identify physical signs if diagnostic possibilities are kept in mind during the examination. Medical students have been shown to develop better physical diagnostic skills if they learn to examine patients using hypothesis-driven rather than rote approaches, and if they focus on a small number of prototypical cases within diagnostic categories."

How true!