Concerns & criticsm of new medical curricula in Australia/worldwide, part II

Part II of the recent “new medical curricula” discussion

Letters from the Australian newspaper in reply to articles about new courses and the need for more anatomy to be taught

Medicine struggling against Dark Ages not postmodernism

May 08, 2006
IT is easy, but so simplistic, to attribute medical students’ perceived lack of anatomical knowledge to trendy and postmodern teaching methods in current medical education (Editorial, 6-7/5). Yes, there are concerns among some surgeons and pathologists about anatomy training and my own research supports this case. But surely you are not suggesting we would all be better off if future doctors knew less about the complexities that modern medicine entails. Contrary to your argument, anatomy could be described as a soft subject in traditional teaching, requiring endless hours of memorising a million multi-syllabic Latin names for every bit of muscle, bone and tissue.

But is that harder than dealing with real patients? Anatomical knowledge is important but so is the ability to communicate with a suicidal, illiterate 16-year-old, or an elderly woman facing a painful, lonely death, or a middle-aged man too embarrassed to undergo a prostate examination, or an ill refugee who is terrified of authority.

None of these situations are easy. They involve personal skills that cannot be learned by rote. Good medicine demands a breadth of knowledge but what it also requires is the capacity to treat patients as individuals, not just body parts.
Philomena Horsley
Northcote, Vic

May 08, 2006
AS a final-year medical student at Monash University, I am quite satisfied and impressed with the way myself and my colleagues have been taught medicine. The Weekend Australian includes the debate relating to the teaching of anatomy as a part of the much-publicised “culture wars”. I would venture that far from being attacked by postmodernism, medical schools are struggling to emerge from the Dark Ages.

The new style of medical education, first adopted by Harvard Medical School 20 years ago, is being implemented because research and evidence from professional educationalists has shown it to be better than previous teaching methods. The appeals of opponents of this style of education are to tradition and isolated anecdotes, not to evidence.

It may put the public at ease to know that graduates of medical schools do not practice independently in the community immediately. They must go through a lengthy “apprenticeship”, at least four years, becoming an intern, then a resident, then registrar and pass more exams before going out on their own. The philosophy of Monash University is to train students to be good, safe interns who will then train for the next level of the apprenticeship. This seems more logical than cramming copious facts then losing them, then relearning them in the practical setting. It has been proved empirically to be the case.
Geoffrey Harper
Northcote, Vic

We learned how to learn
May 09, 2006
DESPITE the assertions in your editorial (”Postmodernism, M.D.”, 6-7/5), it is actually quite easy to mistake a heart for a liver through a surgical wound – they are both red and gelatinous-looking – and during cardiac surgery when the patient is on bypass (and the heart is not beating), they are both quiescent.

There is also no need for a medical student to “know what a spleen looks like”, unless they were doing postgraduate surgical training and actually operating on the spleen (something that only a few per cent of doctors will ever do).

I did my undergraduate medical training at the University of Newcastle from 1978 to 1983. We did no anatomy course. Instead, anatomy was integrated into our curriculum (the first medical course in Australia to do so). Because of this, I did not spend mindless hours learning some obscene mneumonic so that I could recite the dozen-and-a-half branches of the facial nerve at an examination (which would then be quickly forgotten). Instead, I actually learned how to understand and learn anatomy (or any other basic science subject) when I needed to and when it was relevant.

I’m not a cardiac surgeon, so I did not learn the minutia of the cardiac and vascular systems. One of my classmates who is a cardiothoracic surgeon (and who is head of cardiothoracic surgery at a major capital city teaching hospital), did learn such minutia, and he was well equipped by his undergraduate teaching to do so.

Other aspects of a modern medical school curricula, such as learning “cultural sensitivity”, has at least enabled me to recognise my limitations and improve my effectiveness when I am trying to help manage the problems of a pregnant Aboriginal woman who has been sent to me from a remote central Australian mission hospital.

My undergraduate education (the first curriculum to incorporate the “postmodern teaching” that you deride) equipped me well to learn how to take care of critically ill pregnant women and very sick unborn babies, and this learning process has not stopped over the past 28 years. The learning certainly did not stop when I finished medical school. In fact, the way medicine has changed over the past few decades, most of the “facts” that I learned at medical school have by now been rendered obsolete. It is only by learning “how to learn” that doctors (or any other professionals) can be effective and safe.
Dr Chris Wilkinson
Head of Maternal Fetal Medicine
Women’s and Children’s Hospital
North Adelaide, SA

‘Ignorant’ graduates
May 13, 2006

WE need more country GPs, not anatomy experts. Medical schools developing common sense, compassion and critical analysis in their students will go further in answering today’s needs of the medical profession than dinosaurs in ivory towers reciting the names of the ossicles of the middle ear. If junior doctors don’t know what organ is on view, the problem is the relevance of the anatomy they have been taught, not the amount of anatomy they have learnt.
Dr K. Allen
Mt Barker, SA