Terra Sigillata

As if everyone doesn’t have enough deadlines right now, 1 March is the deadline for submission of medical education manuscripts to the Journal of the American Medical Association (JAMA). The call for papers was issued in December and accepted manuscripts will appear in the 5 September 2007 issue:

Practicing physicians aspire to be good, whether this attribute is defined with respect to intellectual skills, manual skills, or professional standards. In medicine, it may indeed be nobler to teach others to be good (in any of these senses). However, doing so is arguably far more difficult. Those physicians with expertise may be strikingly inarticulate when trying to convey their reasoning. The complexity of the cognitive tasks required in making a diagnosis or recommending treatment makes determining the most effective formats and settings in which to transmit this knowledge a daunting task. This situation is not made any easier by clinical pressures and general lack of remuneration that often not only fail to provide tangible rewards for teaching but may perversely discourage the best–and most noble–clinicians from participating.

To be honest, it is a sad state of affairs to note that most health care educators do a good job at their own peril. Being an excellent educator rarely assists one in promotion and tenure decisions; however, being a bad teacher can hurt you. Good medical educators usually go about their mission of teaching as a scholarly activity simply out of a sense of personal and professional pride.

Anyway, here are some samples of the types of articles published in the past by JAMA:

Previous topics have included the effect of changes in resident work hours on physician health and patient safety, education in evidence-based medicine, diversity in medical education, cross-cultural care, inaccuracy of physician self-assessment, Internet-based education, and funding medical education research. While these remain of interest for this issue, other potential topics include (but are not limited to) the appropriate use of medical literature, successful models for providing incentives to faculty for teaching, professionalism and ethics, and the use of interdisciplinary approaches to learning. Given the role of educator that all physicians play, we are also interested in studies of the effectiveness of training physicians to be teachers, if these studies are conducted with methodological rigor and include important objective outcome measures.

Although I am not a practicing physician, I had begun to draft a manuscript on the value of the medical blogosphere as a teaching tool and forum for discussion of medical issues among health care providers and patients. However, that dang 5 March NIH grant deadline interfered.

Fortunately, the medical education issue is an annual feature of JAMA. Perhaps we’ll have better luck next year.

Comments

  1. #1 Joe
    February 28, 2007

    I wonder if anyone will submit an article deriding medical schools for incorporating quackery in the curriculum. (Orac has blogged quite a bit on this.) Chiropractors and naturopaths are currently crowing about a conference they will have at Harvard Med this fall!

    Web sites at Universities and medical centers (even the NIH) are often, at best neutral about quackery, and are often supportive of it. When the National Council Against Health Fraud (NCAHF) complained to the NIH, the powers that be investigated- and removed the NCAHF link from their web-site! How will we ever educate the public about quackery when our “health professionals” are so poorly informed?

  2. #2 Abel Pharmboy
    February 28, 2007

    Joe, I agree that it would be interesting to address how medical schools treat complementary and alternative medicine in the curriculum all while some of them are increasingly generating revenue from such enterprises. I also wrote about this awhile back.

    Physicians need to be educated about what their patients might be using out there but if CAM coursework is offered, it should be taught by impartial evidence-based instructors and not by advocates of on-campus CAM centers.

  3. #3 Joe
    February 28, 2007

    Abel, thanks for the reference, I thought you had written an item before. Here are two surveys of the problem:

    “Academic Medicine (2002) 77: 876-881.
    The Teaching of Complementary and Alternative Medicine in U.S. Medical Schools: A Survey of Course Directors
    James J. Brokaw, PhD, MPH, et al

    Conclusion. A wide variety of topics are being taught in U.S. medical schools under the umbrella of CAM. For the most part, the instruction appears to be founded on the assumption that unconventional therapies are effective, but little scientific evidence is offered. This approach is questionable, especially since mainstream medicine owes much of its success to a foundation of established scientific principles.

    Academic Medicine (2001) 76: 248-250.
    The Need for Educational Reform in Teaching about Alternative Therapies
    Wallace Sampson, MD

    Abstract: Advocacy and non-critical assessment are the approaches currently taken by most U.S. medical schools in their courses covering what is commonly called “complementary and alternative medicine” (CAM). … The author’s research indicates that most medical schools do not present CAM material in a form that encourages critiques and analyses of these claims. … A survey of CAM curricula in U.S. medical schools in 1995-1997 showed that of 56 course offerings related to CAM, only four were oriented to criticism. …”
    ___

    It seems the situation is only getting worse.

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