Inadequacy of Teaching Medicine on the Wards

I am re-publishing another GHEC listserv response, because it is a thoughtful response from one of my GHEC heroes:

“I find myself agreeing with both sides here. I don’t think students from developing nations can learn much in North America that can (or should) be used at home UNLESS they are here to learn clinical epi or research methodology in the context of an ongoing project they can continue.

…The wards, on the other hand, might be toxic: I’ve become very disillusioned with the quality of clinical education that ACTUALLY occurs on our wards these days, practice patterns and ways of thinking that are particularly irrelevant in the developing world and possibly harmful to export: workups by computer; unnecessary labs and imaging; (apparent) diagnoses made before meeting the patient; cursory histories, unskilled physicals, unappreciated signs of psychological duress; histories retro-fit to false positive test results; high-tech diagnostic algorithms that too often ARE malpractice driven not evidence-based. Unfortunately, most clinical education is in theINFORMAL curriculum, quite apart from what we educators teach.

…. if I were a visiting international student (or U.S. student!), working with [a thoughtful and skilled physician educator] would undoubtedly be the best and most pertinent experience of my medical education. But unless you can ensure that your visitors will have someone who can teach… and be culturally aware, sensitive to doctor-patient communication, and evidence-based, the average US clinical experience is more likely to lead to a gnawing sense ofinadequacy, frustration with resource scarcity, and desire to practice medicine where certainty abounds and money is made.” ~ Jerry Paccione


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