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Too much basic science in medical school?

By Chris Rangel MD ⋅ May 6, 2006 ⋅  Email this post ⋅  Print this post ⋅ Post a comment

Do student doctors really need to know anatomy and that other basic science stuff?

Critics are accusing Aussie medical schools of cutting back too much on basic science education including anatomy (link via the basic science Nazis at Fark.com).

[Senior attending physicians] have been “horrified” to encounter final-year medical students who do not know where the prostate gland is, or what a healthy liver feels like.

When asked by a cardiac surgeon during a live operation to identify a part of the heart that he was pointing to, one group of final-year students thought it was the patient’s liver.

The critics claim that too much time is being devoted to “touchy-feely” subjects such as “cultural sensitivity”. The medical schools counter that there is so much medical knowledge to learn and only a limited amount of time to do it. Who’s right? Both are.

But such controversy begs the question; Do most of our doctors really need a liberal medical education? Do patients really give a crap whether or not their physician knows the basic structure of every type of amino acid or where the ligament of Treitz is? I’d take a wild guess and say no. Patients want something to help them sleep at night or to find out what’s causing their stomach pain. Knowing the chemical structure of an amino acid is not going to help one bit.

Physicians traditionally get a liberal education because we have this sense that we should create a well-rounded doc as physician-scientist. In decades past it was believed that physicians should not only be practitioners but investigators on the forefront of a mysterious new field. However, these days physicians are more often seen as “providers” who toil away following practice guidelines. The attitude these days seems to be “leave the science to the scientists. Let them find new diseases and develop new treatments.”

Basic science courses take up two whole years in most medical school curriculums before the student gets to see their first patient. But in the US there are alternative models of education and training of health care professionals.

The training programs of physician’s assistants (PAs) and nurse practitioners (NPs) dispense with much of the medical school minutia filled intense basic science courses and provide more direct practical clinical training in less than half the time it takes to train most MDs. In most states PAs and NPs are allowed to do almost as much as an MD with minimal supervision and in many states NPs are allowed to practice without a supervising physician and can make as much as an MD!

There is a lot of talk in this country of having PAs and NPs take over the basic patient care duties of many primary care providers (partly to alleviate shortages and to decrease costs). And the jury is still way, way out on whether or not getting treated by professionals who have far less basic science training changes the quality of care (for better or worse). In the future your primary care provider may have no idea what frame-shift genetic encoding is and you won’t care less as long as you get something to help you sleep.