Tuesday, April 06, 2010

Med school then and now

The latest issue of Vanderbilt Medicine updates the recent evolution of Vanderbilt Medical School's curriculum:

On Bonnie Miller’s to do list: dismantle the 100-year-old medical education system.

“We can’t change the way we provide care without also changing the way we educate providers. It simply won’t work,” said Miller, M.D., senior associate dean for Health Sciences Education. “In the world of personalized medicine, there will be no way that one provider can know everything needed for every patient encounter every time, but medical education is still built on this assumption of the omniscient doctor.”

Vandy curriculum planners know students can't learn it all. It wasn't always so. On my first day of class there in the 1970s the anatomy professor told us in his introductory remarks that while the course content may seem like a lot of minutiae, it was all relevant. Learn it all and learn it well, he said. At the beginning of our third year Medicine clerkship the students met in a conference room with the chief resident. He held up a copy of Cecil's and announced that we were expected to be “thoroughly familiar with the contents of this book.” We knew he was blowing a little hot air but the message was clear. If you didn't know it all you needed to try harder.

In the same issue of Vanderbilt Medicine is an account of Dr. John Shapiro's legendary second year pathology course in the mid 1950s:

Dr. Shapiro’s lectures were peppered with questions. Since pathology involves both gross and microscopic examinations, most lectures were given in a darkened room while slides were projected. There was no doubt that he could see through the back of his head and in the dark because every few minutes he would spin around on his stiff leg, point to one of us, call us by name and fire a question. Any incorrect answer evoked a caustic, demeaning retort...

One of my classmates was so terrorized by Dr. Shapiro that he could not walk past the entrance to the wing housing the Department of Pathology. When approaching the third-floor wing, he would descend to the second floor, walk past the frightening area and then climb back to the third floor again...

If the never-ending volume of facts to memorize, the constant stress in class, the military-like requirements of dress and behavior and the ever-present atmosphere of fear were difficult to endure, they paled compared to “Organ Recitals”. An Organ Recital bore no relation to music. “Organ” referred to hearts, livers, spleens, etc.

Our class was divided into groups of four to attend autopsies in rotation. There, we observed the resident’s examination and performed minor tasks. However, the next day was a different story. The class assembled in the autopsy room and stood on movable stands close to the autopsy table. The unlucky four stood beside the autopsy table while the resident presented the patient’s internal organs to Dr. Shapiro. After several cogent comments on the pathologic findings, he began to question one of the four students standing across the table. His questioning was brutal and, with almost savage glee, he exploited any weakness in a student’s knowledge. Occasionally, with fierce expletives, he expelled a particularly unprepared student from the room.

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