Friday, July 31, 2015

Is there an upside to the noise of seemingly irrelevant content in medical education?

As I have worked in planning curriculum in medical school either as a course/ clerkship director or in various school-level committees, a common question keeps coming up. How much is too much information?  Or conversely how little do you need to know about basic science to be able to competently practice medicine?

The age of the 'Google' search and other tools like Epocrates and PubMed being capable of getting a seemingly endless stream of factoids answered instantly makes this question more difficult. How much do I need to know versus how much do I need to be able to know how to look it up?

I don't think there is a perfect answer to this question, but let's use as an example GI histology. As a neurologist, if you asked me how much I have used my knowledge from medical school of GI histology in the past six months, I would probably laugh. Most neurologists would probably laugh as when you ask that, what comes to mind immediately is the day in med school microscopy lab where we looked at the slides of intestines and identified the villi cells. I don't do that anymore - like ever.

However, in the last six months I have taken care of Parkinson's patients with gut motility problems and constipation and I've also taken care of people on whom we were considering gluten-sensitivity as differential diagnostic points. We also know the carbidopa/levodopa competes with protein in small intestine absorption. How much of my ability to understand these basic problems with occur daily in my clinic is founded in part on my original knowledge of GI histology? What I think it critical to consider when considering what level of detail of GI histology is important to physician training is to consider what is implicit knowledge that allows me to solve problems. This means looking beyond the typical response to any given topic where a practicing physician says, "I never use that." (Biochemistry anyone?) This means spending time unpacking the implicit framework knowledge on which you have built much more complex concepts. On the flip side, there are some things which I learned in med school which I really don't ever seem to use much now even as much as I try to rack my brain to figure out if I do use them.

I'm not sure of the best way to puzzle this question out. I'm a little worried about running the grand experiment of just stopping teaching the med students all the tiny details we have taught in the past without first pausing to understand the repercussions. There is not likely going to be a firm line in the sand somewhere where a given topic is relevant or irrelevant, it'll look likely more like a large sandy smudge. However, every teacher of med students has to draw their line somewhere, and it would be good to have some alignment within a med school system.

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