The medical school curriculum is undergoing another revision. These changes to the course of instruction occur more frequently than those of an infant’s diaper. They typically are accompanied by statements like “A curriculum change can have a large impact on a student body.” Such a statement presumably assumes the impact will be positive. It is as are all such claims associated with alterations in the medical school curriculum totally uncontaminated by data.
One of the cliches that are sprinkled on medicine like confetti at a wedding is that Evidence Based Medicine is the gold standard for how physicians should practice their profession. Yet, as far as I know, none of the endless revisions of the curriculum is neither preceded nor followed by rigorous examination of their effect on student education. If you are going to change the curriculum it should be for a good reason. Rigorous examination of what is to be changed should be undertaken. What is expected to be accomplished should be defined. Then a plan of evaluation should be instituted. Data should be gathered which show whether the new curriculum has the desired effect. Even this evaluation is not enough. Change may have been effected, but this change may not have any salutary effect on patient care which ultimately is the only reason to change the curriculum. None of these procedures ever tarnishes a medical school curriculum change. The anti-platonic ideal pervades the environs of the associate dean for medical education – The examined life is not worth living.
What’s the real reason for changing the medical curriculum? It’s the only component of the medical school that the legion of administrators that populates its best offices can change. Medicine is beset by titanic forces which are beyond the control of medical schools, indeed they seem to be beyond the control of anyone. The federal government sets endless rules and regulations governing the awarding of money through grants and contracts. Certifying boards for both undergraduate and graduate medical education impose onerous restrictions on how schools must operate that, like those mandated by their federal cousins, produce enormous constraints on what can be done, how it can be done, and how much time (a lot) must be spent complying.
The practice of medicine generates a large portion of every medical school’s budget. Here too the government along with its henchmen, the insurance companies, impose rules and procedures which govern how medicine is practiced and paid for. The faculty and administration find themselves in as much control over their professional activities as a cork in the Gulf Stream. That the two groups tend to dislike each other further impedes control over what they do.
So beset by furious turmoil medical school administrators attend to the only activity they have any control over – the medical curriculum. They change it every few years unconcerned as to its effect on anything meaningful. They do it for emotional reasons. They need to feel in control of something. That the medical curriculum has little, or likely no, effect on any meaningful outcome is irrelevant.
A medical school is like a big sack. Medical students are thrown into it, shaken for four years and then dumped out. In the interval the smart ones have observed what’s going on in the sack and taught themselves something. They’ll continue to do so during their postgraduate years. Medical education, like all education, is self learning. A good teacher can set an example and point students in the right direction, but that’s about it. The curriculum in place during the students time in the sack has no impact on what they’re like when they’re thrown out. But it makes those who devote their time to the structure of medical education feel good about themselves. Those faculty busy with teaching, research, and/or patient care are oblivious to the curriculum du jour. They’re too busy to pay attention to the emanations from the administrative suite. They also spend much of the day hiking from their parking spaces in remote locations of the medical center. All the closer ones are taken by the administrators.
Feeling good about yourself is not unique to medical school education. It motivates much of what poses as useful activity in the liberal democracies of the west. But those most devoted to Evidence Based Medicine should also spend some time with Evidence Based Curricula.