Ep. 46 Reforming Medical Education: Beyond the Usual Platitudes
Adam Cifu, MD
The reform of medical education is a usually boring conversation that needs its own reform. The discussion we have on this episode does just that. It goes far beyond the usual proposals to tweak the curriculum and directly addresses the question of what it means to be a physician.
Our guest is Dr. Adam Cifu, an award-winning medical educator and author. Dr. Cifu is a Master in the Academy of Distinguished Medical Educators at The University of Chicago. He has been selected as a Favorite Faculty Member by the graduating class of students 14 times. He is the author of Symptom to Diagnosis a manual on diagnostic reasoning, and co-author with Dr. Vinay Prasad of Ending Medical Reversal: Improving Outcomes, Saving Lives, one of the blockbuster medical books of the last few years.
GUEST:
Adam Cifu, MD. University of Chicago website and Twitter
LINKS:
Scott Stern and Adam Cifu, Symptom to Diagnosis: An Evidence-Based Guide (Amazon link)
Vinay Prasad and Adam Cifu, Ending Medical Reversals: Improving Outcomes, Saving Lives (Amazon link)
Michel Accad. Intolerable Laissez-Faire: The Early Years of the Mayo Clinic (Alert and Oriented blog)
WATCH ON YOUTUBE:
Watch the episode on our YouTube channel.
I feel more discussion and laws need to address medical students post-grad options. If nurse practitioners can practice after 2-3 years of schooling and clerkships, why can we not hire Med students to work with us and that training count toward residency training. Last year many students did not match in primary care programs. I feel I can use them in healthcare shortage areas and they cannot gather more experience than driving for Uber while studying for boards
I agree. Apprenticeship is critical to medicine and the laws and regulations make it very difficult to obtain.
Another nice discussion. While I agree wholeheartedly with your emphasis on ethics, I do think that the consumer of medical goods and services is the primary care director and that we doctors tend to overemphasize our roll. Of course this tendency is greatly exaggerated by our paternalistic third party payment system in which doctor’s permission is needed for everything. But a sense of ethical responsibility to provide members of the public with valuable products and services is not restricted to medical practice or even to the learned professions.
Doctors come with all types of personalities and patients link up with those they like just as in any other service they seek. Over time the one’s who don’t care for yours go elsewhere and those who like you stay and the bond is formed. Of course by its nature medicine is a highly personal endeavor and it would be hard to treat patients without serious interest in their outcome, but some of us are more technically inclined and migrate to those fields, even going all the way to pathology. I recall one doctor who yelled at his patients, another who told you not to come back if you didn’t follow his recommendations. I remember one guy who was a stickler for punctuality; he wasn’t warm and fuzzy but patients who didn’t like to sit in waiting rooms liked him.
Being an old guy with old friends who go to doctors a lot I hear a lot of talk about who likes what doctor. Mostly people put a lot of emphasis on doctors who give them time and take a personal interest in them. Sometimes these are specialists rather than primary care doctors. The point is that patients take an intense interest in this sort of thing and make a lot of choices about how they interact with the medical system and patronize the services that please them.
Your thoughts about group practices such as the Mayo Clinic are interesting. In general I have considered the rapid disappearance of independent medical practice to be a bad tendency when it comes to the physician’s sense of where his allegiance should be directed but surely in our modern, highly mobile world there’s a significant place for the large organization in which patients put their confidence. In our area we have Geisinger which I perceive to be a company that has adopted the modern tendency to view the organization as the caretaker with the individual practitioners being more like skilled technicians carrying out protocols. I don’t think that sits well with a lot of their doctors and I believe they have a substantial turnover.
Although some doctors like the safety of the flock, I think a great many, maybe the majority I hope, who take up this profession naturally have an independent streak and will continue to link their fortunes to the benefit of the patients who seek their help. In one of our first classes in freshman year at Temple, one of our lecturers told us that if we do good for our patients that we would do well for ourselves. That statement stuck in my memory and was a great guide for the next 50+ years.
By the way at Temple in 1960 we spent our first 6 months exclusively learning anatomy and dissecting a cadaver. What a time waster, since we then had zero knowledge of physiology or function. I often thought after how much better it would have been to have had that opportunity during a later stage of my training or career. I hope that has changed.
Yes, a clear waste, but that’s the Flexner legacy and this approach has the bad philosophical baggage I’ve mentioned before: study the parts of the machine first, put them together and you get the whole…