Medical education and hard science

To the Editor: In response to the recent column on medical education,1 I would like to point out that many of the medical schools in Australia have broadened the content of their curricula to reflect the expected demands of professional practice and to satisfy the objectives of the accrediting body.2 Medical schools involved in curriculum change have tended to favour a broad education that emphasised learning across four domains (basic and clinical sciences, clinical skills, population health and ethics, and professional development). Another principle influencing changes to curricula was the need to ensure that the students were competent to enter supervised practice as an intern and be equipped with the desire to pursue life-long learning. Remarkably, medical schools have tended to deliver similar curricula in response to these and other issues (eg, emphasis on communication skills, critique and clinical application of evidence, exposure to rural health issues).

Medical educators see a need to prepare medical students to cope with continuing changes in healthcare. Some of us would argue that many of the principles of such ongoing learning are fundamental to problem-based learning programs, and expect that graduates of such programs will be able to adapt to new continuing professional development programs. However, there is as yet no hard evidence that incorporating self-directed and problem-based learning techniques into medical curricula has any beneficial effect.

Although it is not yet possible to measure the long-term effects of the changes in medical curricula, in the short term objective measures are encouraging. Today’s Australian medical school graduates function well as interns and residents.3 However, many in the profession are concerned about the level of knowledge of current graduates, particularly (but not exclusively) about anatomy. Although knowledge of anatomy needed by doctors varies considerably between disciplines, the basic sciences, including anatomy, do need to be included in college training programs.

Clearly, the profession needs to measure the outcome of changes to medical school curricula.4 Ideally, as you say in your column, the outcome measures would be generally agreed by the profession.1 A debate in the Journal about the most appropriate outcome measures for medical schools would ensure that the concerns of many medical practitioners could be considered. Meanwhile, those involved in medical education need to develop and publish the outcomes that are measured in the medical schools.