Medical Education past, present and futureредакционная статья
Аннотация: ‘Time present and time past Are both perhaps present in time future, And time future contained in time past.’ (TS Eliot, Four Quartets, Burnt Norton) It is a great pleasure to introduce this special issue of Medical Education. The issue marks the ruby anniversary of the journal, which was initially founded as the British Journal of Medical Education 40 years ago. When it first appeared as the official voice of the Association for the Study of Medical Education in December 1966, the journal was dedicated to serving as a ‘medium for interchange of information on medical education – Undergraduate, Postgraduate, and Continuing – in the United Kingdom and overseas’.1 Since that time, the editors and contributors have conscientiously and constructively addressed those aims, deepening global awareness of critical issues, developing educational research, driving curriculum reform, and evaluating the impact of major educational initiatives. As recent surveys suggest, Medical Education has become a leading international journal in the field, with an enviable and rising impact factor and immediacy index. The present collection of largely commissioned papers offers a convenient occasion not only to reflect on the rapidly changing face of medical education and practice over recent decades and, indeed, centuries, but also to take stock of the many current problems facing those responsible for moulding modern medical education and for shaping the lives of doctors and patients over coming years. By doing so, we can perhaps more accurately evaluate the opportunities and challenges created by the ever-increasing demands that will inevitably be made on medical students, doctors and their teachers in the 21st century and provide a tentative agenda for future contributors to the journal. The papers in this special issue are broad-ranging chronologically, geographically, and thematically. However, although they cover educational developments from the early modern period to the 21st century and explore trends and transitions in pedagogic theory and practice on both sides of the Atlantic, the papers collectively raise a number of critical and overlapping questions about the past trajectory and the possible future direction of medical education. In particular, they expose the merits of studying the past in order to understand the present and forge the future. At one level, several contributions demonstrate the manner in which the roots of many current concerns are firmly located in historical patterns of development. For example, as Sir David Weatherall argues, resurgent debates about the art and science of medicine can only be fully understood through close inspection of the gradual, but eventually devastating, rupture between science and the humanities which emerged in Western universities during the late 19th century and which was formalised in medical curricula during the 20th century.2 While recent reforms, and perhaps public opinion, have tended to challenge the traditional centrality of science in medical education and to bridge the divide between art and science, Sir David makes a provocative argument for the more prudent and more effective integration of biological sciences into the modern undergraduate curriculum. In practical terms, the shape of modern British medical education and the dominance of science in the curriculum were fashioned by the activities of the General Medical Council (GMC), established under the terms of the Medical Act in 1858. Significantly, as Sir Donald Irvine's paper on the GMC makes clear, the nature and parameters of many present day disputes about the regulatory autonomy of the medical profession and the most appropriate means of dealing with professional malpractice are also best explained by rigorous analysis of the origins and evolution of late 19th and 20th century concerns about the status and legitimacy of doctors.3 Although the GMC arguably remained relatively quiescent for much of the 20th century, several recent high-profile crises have forced the Council to confront and reconsider many of the controversial professional and political dilemmas that led to its creation nearly 150 years ago. Several papers in this issue also testify to the importance of history in other ways. In particular, they clearly reveal that many of the difficulties facing modern medical schools, students and doctors are neither new nor confined to the UK. As the papers by Christopher Lawrence,4 Helen Blackman5 and Constance Putnam6 suggest, our predecessors were regularly troubled by concerns about the place and weight of the biological sciences in medical education, about the maintenance and preservation of ethical standards, about regional variations in education and access to health care, and about the manner in which reforms often appear to have been obstructed (as well as facilitated) by local institutional and departmental, as well as national, politics. Historical case studies, including those published here, thus clearly reveal that both the content and form of undergraduate and postgraduate education have always been determined by social and political contingencies, as well as by intellectual developments within the biological and clinical sciences. The contingency of medical training is perhaps most evocatively demonstrated in this volume by K O'Flynn's focused discussion of the manner in which the London Blitz dramatically transformed the educational opportunities and experiences of a cohort of English medical students between 1939 and 1941.7 Inevitably, as the sociopolitical environment and public expectations have shifted in recent years, the GMC and the medical profession have been forced to adapt to new social stresses and strains and to accommodate novel approaches to education. As the papers by John McLachlan and Debra Patten,8 and Paul Bradley9 demonstrate, the teaching of anatomy has undergone substantial and often controversial revision, innovative approaches to learning have been introduced in many guises, and the framework for the modern curriculum tentatively outlined by the GMC in 1993, and further elaborated in 2002, has allowed greater exposure to medical humanities.10,11 Although generally applauded as progressive, these developments in medical education have not received universal approval, neither from clinicians and scientists more familiar with tight disciplinary and professional boundaries, nor from students, teachers and, sometimes, the media unaccustomed to problem-based learning and other equally non-traditional educational strategies. Confronted by the weight of many decades of resistance to reform and by the cultural ascendancy of science, recent pioneers in modern medical education have, like their forebears, struggled both to resist and adjust to the particular social, professional and political pressures of their day. Despite occasional opposition and institutional inertia, however, much has manifestly changed since the 1960s when this journal was founded. Modern trends in medical education, most notably the emancipation of the undergraduate curriculum and the formation of new medical schools, have served to release medical students from the shackles of rote learning and didactic styles of teaching that characterised medical education and training in the second half of the 20th century. In addition, recent developments in the field of postgraduate education, such as the formation of the Postgraduate Medical Education and Training Board, will, it is to be hoped, serve not only to provide a coherent framework for specialist training but also to establish and maintain more convincing links between undergraduate training and continuing professional development. However, while much has been achieved, there is no room for complacency. In 1903, an editorial in the Journal of the American Medical Association complained that a ‘true pedagogic method of medical instruction is still a desideratum’.12 Although the notion that there can ever be a ‘true pedagogic method’ is itself questionable, given the constraining effects of shifting sociopolitical circumstances, the editorial nevertheless contains a cogent and enduring reminder of the research questions that inevitably remain unanswered at any particular time and of the challenges that undoubtedly lie ahead. At one level, for example, it remains to be determined whether modern educational models, and particularly the evolving role of the teacher in facilitating learning, will produce doctors better equipped for the challenges and uncertainties of the post-modern world than previous educational strategies did. The recent revolution in medical education will require careful and honest assessment. At another level, it is unclear yet whether recent educational and regulatory reforms within the GMC will indeed generate ‘a culture of patient-centred professionalism’, as Sir Donald Irvine hopes.3 These broad questions, as well as many other more focused questions about the precise shape and content of the curriculum, await clear answers. We hope that this special issue of the journal at least serves to stimulate constructive debates about the complex professional, sociopolitical, and cultural contexts which continue to shape both the meaning and the achievability of good medical practice in the 21st century.
Год издания: 2006
Авторы: Mark Jackson
Издательство: Wiley
Источник: Medical Education
Ключевые слова: Innovations in Medical Education, Simulation-Based Education in Healthcare, Empathy and Medical Education
Другие ссылки: Medical Education (PDF)
Medical Education (HTML)
PubMed (HTML)
Medical Education (HTML)
PubMed (HTML)
Открытый доступ: bronze
Том: 40
Выпуск: 3
Страницы: 190–192