21st Century Medical Education

By Birden, Hudson; Page, Sue | Australian Health Review, August 2007 | Go to article overview

21st Century Medical Education


Birden, Hudson, Page, Sue, Australian Health Review


Abstract

Australian universities provide good examples of how to meet the growing challenges to the training of doctors that have resulted from information overload in traditional curricula, new models of care, including multidisciplinary team dynamics, and the rigours of evidence-based practice.

Aust Health Rev 2007: 31(3): 341-350

. . . there is a difference between knowing and doing, and the focus of learning in medicine is to produce a set of informed behaviours.1

Richard Hays

FROM THE TIME of the often itinerant barbersurgeon,2 medicine has been seen as a synthesis of science and art.3,4 While the conceptualisation of medicine has become more sophisticated,5 the major focus in the training of doctors6 has continued to be the science base, increasingly influenced by the development of an extensive evidence base defining sound practice.

As the medical knowledge base has grown, it has become increasingly difficult to fit all the knowledge that is considered necessary in the training of a doctor into the time available within a curriculum.7 The traditional approach to curriculum development has been questioned, primarily in light of new teaching methods such as problem-based learning (PBL), content overload, and a growing perception that the human side of medicine, history taking, empathy, and seeing the patient as a whole person, was being shortchanged.

Consequently, medical curricula began to experiment with new, sometimes radical, approaches to training doctors. This paper reviews some of these trends in Australia and describes a new model in northern New South Wales.

Educational strategies

The integration of philosophical thinking into the educational process is . . . hampered by its apparent incompatibility with the scientific/reductionist mindset preeminent in modern medicine.3

James Brawer

The fundamental challenge in the evolution of educational pedagogy has been to identify the changes needed. In a recent editorial,8 Prideaux challenged designers of medical programs to consider the demands of projected workforce and skill shortages. He itemised a list of attributes that a "symbiotic curriculum"9,10 ought to embody (Box 1).

Writing with the perspective of a recently graduated medical student, Skinner identified flexible delivery, an outcomes-based curriculum, and a focus on future workforce needs as fundamental to a future-oriented medical education program.11

The United Kingdom (UK) has long argued for clinical skills to be the focus of medical education.12 Likewise, the Association of American Medical Colleges (AAMC) Task Force on the Clinical Skills Education of Medical Students developed the term "clinical method" to define that set of universal competencies that all doctors must acquire through their formal education. Each competency in turn comprises a set of discrete skills, and the AAMC determined that the focus of medical education should be mastery of these skills.13

Learning environment

The relationship between teachers and learners can be viewed as a set of filters, interpretive screens, or expectations that determine the effectiveness of interaction between teacher and student . . . learning is contextual, and one of the most important contexts for human beings is other people who said it and what is the relationship of the learner to the teacher.14

Richard Tiberius

Medical curricula are developed through opinionbased consensus-building processes, driven primarily by the most influential discipline groups involved.15 In each institution, a set of attitudes, beliefs, and customs evolves around the formal learning plans developed by a faculty. This set of largely unwritten rules influences, and often governs, the day-to-day interactions among faculty, administrators, and students. This is referred to as the "hidden curriculum,"16 which can be measured using a validated instrument. …

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