Academic journal article Peer Review

Scientism, Human Consciousness, and the STIRS Imperative

Academic journal article Peer Review

Scientism, Human Consciousness, and the STIRS Imperative

Article excerpt

From its inception in 2012, the Scientific Thinking and Integrative Reasoning Skills (STIRS) project has served as a call to action for faculty to develop and implement curricula in every discipline that will prepare students to address the most pressing global and local challenges of the day. The integrative learning framework upon which STIRS was founded recognizes the critical importance of cross-disciplinary thinking; the need to interrogate what constitutes evidence in proposing and constructing evidence-based solutions; and the imperative that decision making be grounded in the ethical principles of respect for persons, justice, and beneficence.


As someone whose teaching and research career has focused on applied ethics in medicine, law, and public policy, I am reminded daily of the ways in which technological advancements often precede thoughtful reflection regarding the ethical, legal, and social implications of the use of that technology. This is one of the many reasons why I welcomed the broadening of the Medical College Admission Test to include a more comprehensive approach to examining scientific inquiry within the context of behavioral and social sciences and the humanities, along with the development of STIRS to aid in student preparation.

In an age of electronic medical records, the ability to apply theories, methods, and skills in analyzing complex problems and make connections among concepts and experiences is more important than ever. Far from a panacea, the proliferation of data available to clinicians makes it impossible to keep pace. The availability of vast amounts of emerging information within data warehouses is meaningless in the absence of a physicians capacity to collate data sources or interpret the results. Fortunately, there are experts in various specialties who can be relied on to synthesize research findings. Nevertheless, the clinician is still required to have the ability to make sense of that data and evaluate its reliability in a manner that serves the needs of individual patients.

For instance, if a physician is considering a drug for a patient that carries a 5 percent risk of internal bleeding over a five-year period and reads a study indicating that an alternative drug reduces that risk by 40 percent, she needs to be able to determine whether the reduction of a bleeding risk to 2 percent over that same period is worth tripling the cost for the patient. In addition, if the drug carries a greater risk of heart attack in patients with a history of heart disease, the physician will need to spend time with the patient discerning and weighing that particular risk in relation to others.

The complexities don't stop there. A patients team of physicians might include an oncologist, surgeon, pulmonologist, cardiologist, palliative care specialist, hospitalist, and family practitioner, some of whom may arrive at different and conflicting conclusions about the best course of action for treatment. Under such circumstances, the patient becomes the nexus for decision making. In the past, family practitioners were the most likely to have the fullest understanding of whether a given medical decision was authentic-consistent with the way the patient has lived her life-after engaging in a values inventory over a period of years. Yet, in the case of hospitalized patients, a hospitalist may replace the family practitioner, and the system of Relative Value Units used in the United States to determine reimbursement for physician services has placed pressure on physicians to see more patients for shorter amounts of time, posing a challenge for the type of comprehensive information gathering necessary to act in the best interest of the patient.

Developing the type of deeper-level understanding across subject areas promoted by STIRS, connecting knowledge to expe- rience, and adopting a holistic approach to evidence-based problem solving that incorporates diverse, sometimes contradictory points of view, is more important than ever-not only in preparing medical students, but for all undergraduate and graduate students to address the twentyfirst century's unscripted problems. …

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