The future of medical education is a recurring theme. It is so because getting medical education right is important and because education and training at every stage of a medical career appear to be under threat. The reasons are several, including time pressures in clinical settings, rising demand for training from doctors and non-doctors, and the knowledge explosion that is driven by technology – pre-dating the rapid rise of artificial intelligence. 1 The flaws in the system are perpetuated, for one, because the time-poor doctor and the time-poor manager barely have time to think.
The concerns are amplified by the fact that medical colleges, societies, and the professional regulator don’t seem to have a coherent response. Medical education, once certain of its remit, is now full of uncertainty. The UK government has begun to describe how it would like to see medical education transformed to be fit for the 21st Century, but the proposed way forward isn’t entirely convincing.
A new two-part series explores 2 the challenges and the opportunities. But at the heart of the uncertainty is a tension between the notion of a thinking doctor, capable of navigating and leading complex decisions in a complex environment, and the protocol doctor – a human version of a standard operating procedure that productivity obsessed politicians seek.
Standard operating procedures imagine a standard person, the typical human cog beloved of macroeconomics. Other innovators want us to embrace the potential of genomics and personalised care, where the central thesis is that each individual requires an individualised approach. But you can’t have it both ways. The tension is both palpable and paralysing.
The protocol doctor runs counter to the notion of a profession, whereby facts and data are contextualised for patients by the values and experience of doctors. The protocol doctor is a functional deskilled version of the thinking doctor that professionals seek to be. The thinking doctor is better equipped to handle the complexities of medical practice, from clustering in long term conditions 3 to migration and variations in death rates. 4 The thinking doctor might have genuine interest in the problematic history of randomised controlled trials. 5 The thinking doctor is what we’d still want for staff and patients – if only we had time to think.
References
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