21st Century Paradigm shift in medical education.

I spend Friday and Saturday, examining final year medical students in their final professional exam. It went well, but the mark sheet presented to me to assess them ( give them marks ) really surprised me. 

They still insist on how they do the "heel shin test", how they, stroke the toes, how they feel for thrills and listen to murmurs, in this era of ubiquitous use of imaging techniques. The mark sheet does not give enough marks for the students ability to synthesize facts and arrive at a diagnosis and work out what could be wrong. I have mention this to the "bosses" repeatedly, but apparently this is what thw examination board wants?

I am sure, that anyone who hears a murmur ( be it diastolic or systolic ) will instantly order an cardiac ultrasound and doppler and they can see the valves the dysfunctional blood flow and arrive at the diagnosis. It is much more important, to have them know the pathology, how to integrate the gross clinical signs pick up ( enough to know which system is disordered ) and investigate accordingly and probably more actually and spend time discussing management. 

Investigations, especially imaging techniques are so common and so good nowadays, that it has become an vital tool for good management. I suppose if I am stuck in the deep jungles of Sabah and Sarawak, I may have to rely solely on percussion, auscultation and scratching the toes and rubbing the shins. But then my misdiagnosis rates will be higher and clinical outcome poorer.

Previously, a 5 year program for medical education will be sufficient, but in the 21st century is 5 years sufficient? We are seeing more types of diseases, with more complications, more treatment modalities with more treatment side effects and complications, even organs have been found to have new functions we never realise before. 

We have open up a whole new field of gene therapy and immunology. Is 5 years sufficient? Even if the answer for some is yes, should those 5 years be spend on teaching detail techniques of examination at the risk of losing out in anatomy of imaging modalities and how to better understand human organ function and inter system interaction to better treat the patient.

Medical education must make a paradigm shift and not do the same thing the same way, since the time of Sir William Harvey. It is nice to know the Wallenburg Syndrome, but an MRI of the brain will surely give me a more accurate assessment and aid my management better.

In the next posting  we shall address the Paradigm shift on "What is the truth?"