Practicality
Educating medical students occurs in a context of:
Biomedical Information
· Abundant and growing
· Decreasingly discipline dependent
· Rapidly accessible and communicable
· Increasingly digital
Paradox of diagnosing
versus understanding
Understanding the molecular basis of medicine is neither necessary
nor sufficient to make diagnoses or render therapies. Molecular
medicine is necessary to understand the mechanisms of disease.
Clinical decision making is not a process reasoned from first principles,
but rather by arguments of analogy in a knowledge domain based on experience
(Cognitive Science in Medicine. Evans DA, Patel VL, eds. The MIT Press,
Cambridge, Mass., 1989).
When a clinician confronts a patient, the cognitive processes leading
to diagnosis and treatment do not require reasoning from basic principles,
but rather from familiarity with the clinical constellation of signs and
symptoms, that is, reasoning by analogy.
Accordingly, 'basic science' is not essential in the forward reasoning
exercised by clinicians. What the basic sciences provide is an explanation
of the biology that the physician is witnessing and treating. It also provides
a framework for following the course of a disease, and for developing new
therapies. But it is not essential to know about myosin to diagnose or
treat cardiac failure. What this means for medical education and medical
research is that the knowledge domain of 'basic science' is not essential
to diagnose and treat, but is rather needed to understand,
to varying degrees, the biology of the recognized clinical entity. The
intellectual property of the pathologist
addresses this paradox.
Medical Practice
· Increasingly system based
· Increasingly outcomes sensitive
· Increasingly price sensitive
· Increasingly using molecules and computers
informative testing procedures
smart drugs
genetic or gene based therapies
tissue & biomaterials transplantation