On the impossibility of being expertBMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c6815 (Published 14 December 2010) Cite this as: BMJ 2010;341:c6815
All rapid responses
Curriculum volume overload in undergraduate medical education is an important problem caused by continuing increase in medical information volume and time restriction for undergraduate medical education (1) . Undergraduate cardiology education is not an exception. It makes curriculum developers and trainers to recognize educational priorities more than before. Multiple studies were done on undergraduate cardiology education but less focused on this problem. This problem encouraged us to evaluate our undergraduate cardiology course, in Shiraz University of medical science, regarding to these priorities.
Lecture based classes, clinical rounds and final examinations are three important parts of this course. These three components of education were evaluated by recording duration of lectures and clinical rounds that spent on different discussed topics in three different monthly courses. In addition, all final examinations questions focused topics were evaluated in these three months. Then topics were classified in four groups (A to D) based on their educational priority and importance. Iran's ministry of Health and Medical Education guideline on "undergraduate medical student's educational priorities in the field of cardiology" was the basis for this classification(2) . This guideline offered four grade of importance for more than fifty cardiologic diseases in ten separate fields for each disease (definition, epidemiology, pathophisioogy, etiology, clinical manifestations, diagnostic approach, paraclinical findings, treatment, prognosis and patient education). For example, treatment of unstable angina has grade A of importance (must to know), when diagnosis and treatment of Brugada syndrome have grade C (nice to know) and D (no need to know) of importance for undergraduate medial students. This guideline suggests that at least 70% of educational time and questions of examinations spend on topics with grade A of priority. After dividing recorded times and questions in these four importance class, results were compared with expected percentage of each class (70% for "A" importance topics and 30% for other less important ones) and their concordance were evaluated with Chi-square test.
Descriptive results are summarized in chart1. Analysis with Chi-square test showed significant difference (P-value<0.01) between specified proportion to each priority grade (A-D) and desirable one in all classes, clinical rounds and final examinations of undergraduate cardiology course. It means that the most important cardiology topics are highly undervalued in different aspects of cardiology course.
This discrepancy in educational content priorities and desired ones has showed in other medical specialties(3). It shows that more attention needs to be paid by curriculum developers to find way out for this pervasive problem. Changing educational field from bedside training in hospital wards to more general clinics such as hypertension and coronary disease clinics can change training fields in favor of more important subjects. However sensitization of students, trainers and curriculum developers can be another short course solution for this problem.
1. Watmough S, O'Sullivan H, Taylor D. Graduates from a traditional medical curriculum evaluate the effectiveness of their medical curriculum through interviews. BMC Med Educ2009;9:64.
2. Yazdan Shahram, Hatami Saeed. General practitioner in Iran tasks and educational needs, 1st . Tehran: Shahid Beheshti; 2004
3. Zobeiri M, Ataei M, Abdolmaleki P. Continuing Medical Education (CME) Programs Efficiency and Needs of General Practitioners (GPs) (Kermanshah 2003).Behbood journal. Vol 11, No 1, Spring 2007
Competing interests: No competing interests
I'm afraid that these authors have a somewhat blinkered understanding of what makes an expert. Rather than an academic knowledge, the knowing of expertise is organic and developmental, and may be developed over long periods of immersion in a mileu of a practice community. It is a deep knowledge of, or a need to find out and reflect upon the causes of things. He or she fits experience to practice, not practice to experience: practice is not shoehorned to fit preconceived ideas. The expert has a need to understand and question his or her practice, but also to work at the boundaries, the cutting edge of practice: asking the right questions is a feature and uncertainty is cherished. Expertise cannot be taught, for that would be to reify practice
Competing interests: No competing interests