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Rapid Responses: Rapid Responses published:
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Unhidden curriculum
- Lalitha D'Souza (1 October 2004)
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Learning Package on Effective Teaching Developed by WHO and JHPIEGO Corporation
- Rebecca J. Bailey, Rick Sullivan, JHPIEGO Corporation (1 October 2004)
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How do we get into academic medicine?
- Sherief Elsayed (3 October 2004)
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Four old pillars or two new ones?
- Peter N Furness (4 October 2004)
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Adding Props to Pillars
- A.A.W. Amarasinghe, MD, (4 October 2004)
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Academic medicine must deliver skilled physicians. A different academic training is needed
- Søren Ventegodt, Joav Merrick (10 October 2004)
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Whether you like it or not?
- Dr. Naseem A. Qureshi MD, IMAPA, LMIPS (26 October 2004)
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Lalitha D'Souza, Researcher Mother and Infant Research Unit, 22, Hyde Terrace, University of Leeds LS2 9LN
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There is at least one exception to the 'hidden curriculum', the six learning processes in medical education. It would appear that the intercalated BSc in international health at the University of Leeds, open to second and third year medical students, has an unhidden curriculum - to build idealism, actively prevent emotional neutralisation, veer away from a "ritualised" professional identity, strive to encourage ethical integrity, and reject hierarchy - briefly to encourage medical students to think. Whether these students will be able hold on to what was taught in one very busy year out until the time they will teach and inform education policy in medical schools, only time will tell. Competing interests: None declared |
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Rebecca J. Bailey, Technical Officer World Health Organization, 1211 Geneva 27, Rick Sullivan, JHPIEGO Corporation
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Research in the field of education has shown that learners need an appropriate environment and a variety of learning activities that include opportunities to practice and receive feedback on their performance. Education is known to be more effective when expected outcomes build on existing knowledge, skills, and attitudes, are relevant to the future tasks of the healthcare provider, correspond to the health needs of a society, and are supported by policies and practices in governments and at healthcare facilities. Because the needs of healthcare consumers are diverse, education should focus on preparing healthcare providers who can function in a variety of roles, including the key roles of clinician, communicator, educator, counselor, administrator, and manager. That is: - Caregivers, who consider each patient holistically as an individual and as an integral part of a family and community, and provide high- quality, comprehensive, continual, and personalized care within a relationship based on trust - Decision-makers, who choose interventions and technologies in an ethical and cost-effective way - Communicators, who are able to ask appropriate questions, listen, advise, encourage, counsel, and educate individuals and groups to help them improve and protect their health -Community leaders, who advocate for health and initiate health activities on behalf of the community - Managers, who work effectively with colleagues, staff, and other organizations—and who collect, analyze, and use health data—to meet the health needs of individuals and communities Because health systems evolve and adapt to the current and anticipated health needs of individuals and societies, and to continuing advances in knowledge and technology, healthcare providers who enter the profession this year may not be the same providers who are needed next year. Undergraduate education, therefore, has the dual task of preparing healthcare providers to enter professional practice as well as preparing them as life-long learners who continue learning and improving their practice throughout their professional careers. To satisfy these two important objectives, it is crucial for educators to carefully define a feasible set of core or essential competencies that graduates must achieve in an academic program. There are a number of challenges in designing educational programs for healthcare providers. Although they vary from institution to institution, common challenges are large numbers of students, limited opportunities for relevant practical experiences, and a growing amount of information that needs to be covered. The WHO Department of Child and Adolescent Health and Development (CAH) and JHPIEGO Corporation, a non- profit affiliate of Johns Hopkins University, recently developed a learning package on effective teaching that recognizes these common challenges and proposes a variety of practical approaches that educators who plan and conduct courses can use to improve the effectiveness of their teaching. Competing interests: None declared |
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Sherief Elsayed, Research Fellow, Orthopaedics Royal Gwent Hospital, NP20 2UB
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Dear Sir I read with interest the recent flurry of articles regarding academic medicine. Having enjoyed being taught throughout medical school and my subsequent posts, I have often thought of academic teaching. Indeed a colleague and I run a revision course for final year medical students every year. Apart from teaching, I believe the world of academia has much to offer society - continuously advancing our understanding of disease, and enabling better, more informed patient choice. The most elusive factor I feel however is simply how one gets into an academic post. There seem to be few available, particularly in my specialty of orthopaedics, and I am unable to identify a clear (or unclear) structure to it. If we would collectively define some sort of structure, a starting point even, with guaranteed funding for research and salary, I believe we would encourage many more doctors into the interesting and very rewarding world of academia. Competing interests: None declared |
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Peter N Furness, Consultant Histopathologist Leicester General Hospital LE5 4PW
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Sir Your ‘four pillars of academic medicine’ correspond closely with my perception of academic medicine as it was when I took up my first academic post 20 years ago As a result, to be a clinical academic was regarded as a privilege. What’s more, for those who made the grade, it was enjoyable. But, at least in the UK, you have the tense of the verb wrong when you say this is what academic medicine IS about. It WAS, but no more. In the UK, the two pillars of academic medicine are now getting large research grants and publishing papers in journals with a high impact factor. These two may or may not be relevant to your first ‘pillar’, but they are pretty irrelevant to the other three. For example, teaching is devalued unless it is turned into an academic speciality in its own right, spawning ‘educationalists’ who have research grants and publish papers on teaching. Actually doing the teaching is of far lower value. How can these new two pillars be made to support all four of your pillars? I don’t know. So I have recently and with great sadness abandoned a 20-year academic career for a substantive NHS post, and I know of many colleagues who are doing or at least contemplating doing the same. All the talk about improving recruitment to academic medicine is completely pointless unless these issues are addressed and being a clinical academic once again becomes a privilege, and fun. There was no shortage of bright, keen applicants for academic posts when I was newly qualified. But at that time, academic medicine had your four pillars, not just the two of the research assessment exercise. Competing interests: None declared |
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A.A.W. Amarasinghe, MD,, Consultant Psychiatrist 102 Bayberry Hills McDonough Ga USA30253 4005
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For the contemporary as well as the future society, ethical practice of medicine is of utmost importance. It is immaterial whether the venue is bedside, bench or the podium. The large share of the responsibility of inculating the ethical practice of medicine by the physicians rests on medical teachers. I wish medical ethics be included in every pillar of academic medicine. Competing interests: None declared |
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Søren Ventegodt, Director The Quality of Life Research Center, Teglgårdstræde 4-8, DK-1452 Copenhagen K, Denmark, Joav Merrick
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EDITOR---The very important concept of educating the medical student and the physician is addressed brilliantly by the BMJs acting editor [1]. We also believe that the academic training of medical students and physicians can be dramatically improved [2] and have some comments to “the four pillars of global academic medicine”. Let us look at them one by one. “FIRSTLY ACADEMIC MERDICINE IS ABOUT ANSWERING IMPORTANT QUESTIONS THROUGH RELEVANT RESEARCH” This is so true and the theoretical part must be set equal to the practical training. Unfortunately many medical schools are only training their students in a very limited spectrum of the theoretical and practical knowledge a physician needs to help his patients. Most medical students are trained in biomedicine and in surgery, while manual medicine [3,4] and holistic medicine [5,6,7,8], although older and a much more integrated part of medical art, are often forgotten. The reason for this is not the lack of good medical theory or fine medical practice – although the theory and philosophy of manual and holistic medicine [9-30] are often harder to understand than the theories and philosophy of natural science [31]. The reason is that biomedical theory – basically biochemistry and pharmacology - has come to substitute all other medical perspectives and toolboxes. As it is evident that “the drugs don’t work” [32] in so many cases of chronic diseases [5], which is a disaster for the patients, who will not get the help they need, and for the medical students as well, who will be extremely disappointed when they realise that they are not dressed up by their academic studies to help their patients sufficiently. Academic medicine therefore must stress the importance of theory and practice of manual and holistic medicine and give these disciplines the same priority as biomedicine. “SECONDLY, THE EVIDENCE GENERATED BY THAT RESEARCH HAS TO BE IMPLEMENTED AND THE “KNOW-DO-GAP” CLOSED“ In medical science noting is as simple as one would like it to be. When we have several complementary perspectives of health, carried by different patients and different medical systems – manual, biomedical or consciousness-based holistic – much of the competence of a good physician is really to chose the right medical paradigm [6,33] to begin with. As we seriously doubt that this will be adequately explored in the near future by medical science, since almost no government gives priority to such research and no pharmaceutical company are likely to carry out this kind of research, the mastery of medical practice will still be conquered in practice at the medical clinic and not on the school bench. The know-do gap is therefore a learning-by-doing issue, not a standard academic issue learned by listening to even the best lectures. Following in the footsteps of the master of medicine will always be the way to obtain mastery. Much of the art of medicine is about love, care, communication, relationship, understanding and intuition. We actually believe that this is more important for helping the patient than the academic knowledge itself [34-39]. To do is not only to know mentally; because the best physicians carry their knowledge and understanding of the process of healing [40,41] not only in the mind, but “in the body”. “THIRDLY, ACADEMIC MEDICINE MUST ENSURE THAT MEDICAL STUDENTS AND DOCTORS ARE ADEQUATELY TRAINED” This is a very interesting point, because the only way to see if this is done is to look at the outcome of the physicians work. If the physician’s patients are healthy, he is good doctor; if they are not, he is a bad doctor. It is really this simple. And as we have so many chronically ill patients in our society, most physicians are simply not good enough. The reason for this is simple: they only master one toolbox, the drugs, and the drugs will not solve most of the medical problems of the patients [42]. The reason why the physicians are inadequate is because their academic training has failed. The physician of today is not equipped with the tool they need to help their patients. But it is not to late to change that. Fortunately the theories and toolboxes of manual [3] and holistic [7] medicine are possible to teach to every doctor, who seriously wants an upgrade. “FINALLY, THE QUALITY OF HEALTHCARE DELIVERY MUST BE OPTIMISED, PARTLY THROUGH IMPROVED ACCESS TO HEALTH INFORMATION” Here we are at the most crucial and difficult point: why is the physician of today loosing his impact, power and trust. Medicine is NOT about information, but it is about using information. The patient cannot accumulate sufficient knowledge to be his/her own physician, as many patients of today try to do by reading about their disease on the internet or in medical books. Because every patient has got a different understanding of life, every patient also needs an individual treatment: some needs to talk, some needs to be touched and cared for and some need a drug. In biomedicine, when we do pharmaceutical research, we are using standard concentrations and standard intervals of administration, but having a carrying physician who gives an individually adjusted dose normally helps a patient much better. The idea that medicine is about information and that everybody, who can read can make the doctor redundant is candidate to be the most dangerous idea of our time, reducing the physician to nothing more that a delivery machine of pills, a clever pharmacist. This is not how it should be: the excellent physician helps his patients to heal and stay healthy. To deliver this kind of physician must be the most important ambition for the academic medicine. FURTHER EDUCATION AND INTERNATIONAL DISCUSSION In Denmark we see this need urgently and will therefore start a holistic medical complementary academic training for physicians, nurses and therapists this winter. We have also arranged an international conference on “Scientific Holistic Medicine in Copenhagen” the 1st and 2nd of November 2004 to focus on the recent important progress in this field visible to the medical society [43,44]. AFFILIATION Søren Ventegodt, MD, is a general practitioner and the director of the Quality of Life Research Center in Copenhagen, Denmark. E-mail: ventegodt@livskvalitet.org Website: www.livskvalitet.org/ Joav Merrick, MD, DMSc is professor of child health and human development, director of the National Institute of Child Health and Human Development and the medical director of the Division for Mental Retardation, Ministry of Social Affairs, Jerusalem, Israel. E-mail: jmerrick@internet-zahav.net. Website: www.nichd-israel.com REFERENCES 1. Abbasi K. The four pillars of global academic medicine. BMJ 2004;329 (October 2), doi:10.1136/bmj.329.7469.0-g 2. Ventegodt S, Merrick J. Medicine and the past. Lesson to learn about the pelvic examination and its sexually suppressive procedure. BMJ. Rapid Responses, 20 February 2004 3. Ventegodt S, Morad M, Merrick J. Clinical holistic medicine: Classic art of healing or the therapeutic touch. ScientificWorldJournal 2004;4:134 -47. 4. Rosen M, Brenner S. Rosen method bodywork. Accesing the unconscious through touch. Berkeley: North Atlantic Books, 2003. 5. Ventegodt S, Morad M, Merrick J. Chronic illness, the patient and the holistic medical toolbox. BMJ 2004 (September 15), http://bmj.bmjjournals.com/cgi/eletters/329/7466/582#74372 6. Ventegodt S, Morad M, Merrick J. Clinical holistic medicine: The “new medicine”, the multi-paradigmatic physician and the medical record. ScientificWorldJournal 2004;4:273-85. 7. Ventegodt S, Morad M, Andersen NJ, Merrick J. Clinical holistic medicine Tools for a medical science based on consciousness. ScientificWorldJournal 2004;4:347-61. 8. Ventegodt S, Morad M, Merrick J. Clinical holistic medicine: Prevention through healthy lifestyle and quality of life. Accepted by Oral Health & Preventive Dentistry 2004. 9. Jung CG. Man and his symbols. New York: Anchor Press, 1964. 10. Jung CG. Psychology and alchemy. Collected works of CG Jung. Princeton, NJ: Princeton Univ Press, 1968. 11. Maslow AH. Toward a psychology of being. New York: Van Nostrand, 1962. 12. Antonovsky A. Health, stress and coping. London: Jossey-Bass, 1985. 13. Antonovsky A. Unravelling the mystery of health. How people manage stress and stay well. San Franscisco: Jossey-Bass, 1987. 14. Frankl V. Man´s search for meaning. New York: Pocket Books, 1985. 15. Fromm E. The art of lving. New York, Harper Collins, 2000. 16. Goleman DL. Emotional intelligence. New York: Bantam, 1995. 17. Goleman DL. Destructive emotions. New York: Mind Life Inst, 2003. 18. Sartre JP Being and nothingness. London: Routledge, London, 2002. 19. Kierkegaard SA. The sickness unto death. Princeton, NJ: Princeton Univ Press, 1983. 20. Allardt E. To have, to love, to be – about welfare in the Nordic countries. Lund: Argos, 1975. [Swedish] 21. Ventegodt S, Andersen NJ, Merrick J. Editorial: Five theories of human existence. ScientificWorldJournal 2003;3:1272-6. 22. Ventegodt S. The life mission theory: A theory for a consciousness- based medicine. Int J Adolesc Med Health 2003;15(1):89-91. 23. Ventegodt S, Andersen NJ, Merrick J. The life mission theory II: The structure of the life purpose and the ego. ScientificWorldJournal 2003;3:1277-85. 24. Ventegodt S, Andersen NJ, Merrick J. The life mission theory III: Theory of talent. ScientificWorldJournal 2003;3:1286-93. 25. Ventegodt S, Merrick J. The life mission theory IV. A theory of child development. ScientificWorldJournal 2003;3:1294-1301. 26. Ventegodt S, Andersen NJ, Merrick J. The life mission theory V. A theory of the anti-self and explaining the evil side of man. ScientificWorldJournal 2003;3:1302-13. 27. Ventegodt S, Merrick J, Andersen NJ. Quality of life theory I. The IQOL theory: An integrative theory of the global quality of life concept. ScientificWorldJournal 2003;3:1030-40. 28. Ventegodt S, Merrick J, Andersen NJ. Quality of life theory II. Quality of life as the realization of life potential: A biological theory of human being. ScientificWorldJournal 2003;3:1041-9. 29. Ventegodt S, Merrick J, Andersen NJ. Quality of life theory III. Maslow revisited. ScientificWorldJournal 2003;3:1050-7. 30. Gadamer H. Truth and method. New York: Continuum, 2003. 31. Chalmers A. What is this thing called science? Buckingham: Open Univ Press, 1999. 32. Ventegodt S, Morad M, Merrick J. If it doesn't work, stop it. Do something else! BMJ. Rapid Responses, 26 April 2004. 33. Kuhn TS. The structure of scientific revolutions. Int Encyclopedia Unified Sci 1962;2:2. 34. Ventegodt S, Morad M, Kandel I, Merrick J. Clinical holistic medicine: Social problems disguised as illness. ScientificWorldJournal 2004;4:286-94. 35. Ventegodt S, Morad M, Merrick J. Clinical holistic medicine: Holistic treatment of children. ScientificWorldJournal 2004;4:581-8. 36. Ventegodt S, Morad M, Kandel I, Merrick J. Clinical holistic medicine: Problems in sex and living together. ScientificWorldJournal 2004;4:562-70. 37. Ventegodt S, Morad M, Hyam E, Merrick J. Clinical holistic medicine: Holistic sexology and treatment of vulvodynia through existential therapy and acceptance through touch. ScientificWorldJournal 2004;4:571-80. 38. Ventegodt S, Flensborg-Madsen T, Andersen NJ, Morad M, Merrick J. Clinical holistic medicine: A Pilot on HIV and Quality of Life and a Suggested treatment of HIV and AIDS. ScientificWorldJournal 2004;4:264-72. 39. Ventegodt S, Morad M, Merrick J. Clinical holistic medicine: Induction of Spontaneous Remission of Cancer by Recovery of the Human Character and the Purpose of Life (the Life Mission). ScientificWorldJournal 2004;4:362-77. 40. Ventegodt S, Andersen NJ, Merrick J. Holistic Medicine III: The holistic process theory of healing. ScientificWorldJournal 2003;3:1138-46. 41. Ventegodt, S, Andersen NJ, Merrick J. Holistic Medicine IV: Principles of the holistic process of healing in a group setting. ScientificWorldJournal 2003;3:1294-1301. 42. Ventegodt S, Morad M, Hyam E, Merrick J. Clinical holistic medicine: Use and limitations of the biomedical paradigm ScientificWorldJournal 2004;4:295-306. 43. Ventegodt, S., and Merrick J. (2004) Philosophy of science: How can we identify the high-risk high-potential research for the day after tomorrow? ScientificWorldJOURNAL 4, 483-489 44. Ventegodt S, Andersen NJ, Merrick J. Holistic medicine: Scientific challenges. ScientificWorldJournal 2003;3:1108-16. Competing interests: None declared |
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Dr. Naseem A. Qureshi MD, IMAPA, LMIPS, Director CME&R POBox.2292, Buraidah Mental Health Hospital, Saudi Arabia.
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Sir, A decline in academic medicine is pervasive and global and hence concerned authorities organized international campaign to revitalize it, because academic medicine serves multiple functions that overall contribute to the improvement of human health. However, a decline in academic medicine is likened to slow and progressive failure in a bussiness venture. This shoddy state of affairs appears to result only from when either the quality of products, i.e., selected medical students (Science versus nontraditional) and thereafter trained doctors, is not the best or the top managerial persons, i.e., academicians, are corrupt and mismanaging the entire bussiness, i.e., medical training and research or some external competitive forces, i.e, opening many medical schools without recruiting competent academicians and administrators, were not considered beforehand. In a nutshell, like bussiness managers accountable for failures in bussiness academicians should be held directly responsible for the decline of academic medicine worldwide. Reference: Kamran Abbasi . The four pillars of global academic medicine. BMJ 2004; 329: 0-g Competing interests: None declared |
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