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Controversy over what your doctor should learn

July 07, 2004

The current fashion in teaching doctors, which allows medical students to decide what they want to learn and how to go about it, is strongly criticised in a paper published in the British Medical Journal this week (10th July 2004).

The authors argue that the new ideology may damage medical training in this country, and that there is now a risk that gaps in basic knowledge could actually interfere with a doctor's ability to diagnose and treat illnesses.

Both authors are at the University of Bristol. Professor Gareth Williams is Dean of the Medical School and Alice Lau is a fourth-year medical student. Although Lau will enter the medical profession almost thirty years after Williams, both are passionate supporters of a balanced medical training in which clinical experience is properly integrated with a sound understanding of the scientific basis of medicine - traditionally regarded as the essential foundation for becoming a doctor.

Currently gaining popularity in the UK is an approach that rejects the systematic and in-depth teaching of subjects like anatomy, pathology (the study of disease), and pharmacology (the study of drugs and their effects), in favour of 'problem-based learning' (PBL) which is directed by the students themselves. PBL is being promoted by enthusiasts as liberating students from the drudgery of learning facts, and improving their problem-solving skills. Lau and Williams argue that while PBL may be a more 'humane' teaching alternative, it deprives students of contact with inspirational teachers, and that cutting back on basic medical knowledge is a false economy.

They state: 'Becoming a proficient doctor has always demanded hard work; it is unacceptable to leave out large parts of the curriculum simply because there is a lot to learn'. They also argue that 'Educational reform is being driven by an evangelical zeal for change, rather than by rational responses to the shortcomings of the traditional curriculum. The training of doctors is too important an activity for bold experiments to be conducted before discovering what actually happens'.

Traditional teaching methods, including dissection and tuition by experts in their fields, are being replaced by these new methods, which are entirely untested; moreover, those driving the changes provide no evidence that those taught by these methods will make better doctors.

The authors hope to stimulate discussion in the medical profession, ultimately leading to a thorough study that will evaluate and identify sound principles for training the doctors of the future.

Bristol, University of