Today let us talk about medical and nursing education; how we train these most important healthcare professionals.
Most of us are not medical educators and, very likely, have practically no direct input into the formulation of medical school or nursing school curricula or the training of doctors and nurses.
On the other hand, we all, I suspect, know the kind of doctor or nurse that we will want to take care of us when we are sick or when we send a sick child, a father, a mother, a wife or a husband to a hospital.
Again, we all can understand that, in addition to their own innate characters, what is taught to medical and nursing students in medical/nursing schools in the classroom and the hospital wards, what they are taught and evaluated for during their initial practical training (housemanships, nursing clinical rotations) and, lastly, what they see their mentors and seniors do, are the things that mold them to become the caliber of medical professionals that we, eventually, see in our hospitals and clinics.
I believe that the fact that we know what kind of medical professional that we want to see in our hospitals gives us some permission, as it were, to comment on and to suggest to our medical educators what to consider when they draw up medical school and nursing school curricula, training manuals and selection criteria.
Someone once said that students for medical and nursing schools should be selected first on the basis of their hearts before we train their minds. A very apt idea, indeed, for producing compassionate doctors and nurses.
Our medical school curricula must train the kind of professionals that will meet our peculiar needs as a society. Luckily our “peculiar needs”, when it comes to our doctors and nurses, are similar, if not the same, as those in all parts of the world. We want to be taken care of by doctors and nurses who know their stuff, intellectually and technically, but who are also compassionate, caring and ethical. That is the universal characteristic of a “good” doctor/nurse all over the world. The fact that we have some who are not, makes those ones the abnormality rather than the norm.
So how should we educate our would-be doctors and nurses?
I believe that the selection/interview process is important. The heart and the character of the applicant are important. Very important, I believe. Between two equally, academically, qualified candidates, we should choose the one who we can perceive as empathetic. We should develop application and interview questions that will bring out this in an applicant.
We should choose the one who, by exceptional performance on entrance examinations, can succeed in a very academically demanding professional training.
These two criteria, to my mind, must have equal weight in selecting candidates for medical education.
Other selection parameters may be important to different institutions, such as ability-to-pay, for the full fee-paying schools, but I am of the opinion that no matter the additional parameters, the emphasis should be on selecting excellent candidates and training “good” doctors and nurses. Eventually, it is the quality of the products which determine the reputations of medical and nursing schools. And what are the good products? Well educated, compassionate and ethical doctors and nurses! Same as we, the patients are looking for!
Personally, as I have noted and explained in a previous blog entry (May 27, 2013 under “What is wrong with healthcare in Ghana”), we should train our doctor under three themes or headings: the science and practice of medicine; the art of medicine; and the business of medicine.
We should develop training programs and evaluation methods that can confirm that the important things that have been taught in medical school are being practiced in real life. Let me give an example. Any student who does not demonstrate at least an average level of academic grasp of scientific medical knowledge or practice in real life most likely would fail his/her examinations and would be considered a sub-standard doctor in real practice. We teach ethics in our medical schools (as has been clearly established on this blog), and I suspect that students are examined and likely pass their ethics classes. The question is, how much of this ethics training manifests in real life practice? Why do students seem to lose the ethics training (which should include empathy, respect for patients and equity) in practice?
How much emphasis are we putting on the non-pure science component of medical education? Ethics classes and instruction should not be “fillers” to make curricula complete. They should be as important in student training and subsequent evaluation as the knowledge of anatomy, physiology, internal medicine, nursing practice and surgery.
The art of medicine should be as important as the science of medicine.
That is my take. What is yours?