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Synthesize rather than memorize

October 17, 2010

Skeptical Scalpel writing at KevinMD in a post giving some advice to second year medical students nails the problem with medical education on the head:

Rather than forcing [medical students] to memorize information, we should be teaching you how analyze and synthesize it as it relates to your patient.

Our increasingly sophisticated and robust understanding of the pathophysiology of human disease processes coupled with the growth in diagnostic testing power means the ability to integrate disparate information is becoming much more important for patient care than memorization of disease lists.  The increasing pervasiveness of electronic medical records (EMRs) will only further this shift as comprehensive patient information becomes the norm rather than the exception.  Instead of relying on a progress note and one set of recent labs, we will be able to see a patient’s entire medical history with every lab and every imaging study they have ever had.

Probably the biggest threat to efficient patient care today is unreliable or missing information–poor history from the patient and missing or incomplete records from other physicians and past hospitalizations.  In this environment, good history taking and physical exam skills are king.

In the coming years, instead of trying to deal with incomplete information we will be struggling to cope with too much information.  Being able to critically evaluate information and integrate it with the patient’s current condition will become the biggest challenge for physicians.  Yet medical education is stuck in an educational paradigm from nearly 100 years ago.  In this era, where we had few diseases, knew less about them, had fewer tools to diagnose them and a limited set of therapeutic options, memorization of key disease processes and relevant pharmacology was prudent.  Today, where so much information is at our fingertips, being able to find the right information quickly and apply it is much more important.  Each and every time I am in a clinical setting I see a physician access outside information–textbooks, UpToDate, ePocrates, Sanford Antimicrobial Guide, medical journals, etc–but didactic use of these resources is almost never incorporated into medical education.

Memorization of key aspects of physiology, pathology, and anatomy will always be integral to medical education.  However, our system needs to evolve and begin incorporating educational activities emphasizing how to efficiently integrate disparate pieces of information into clinical medicine.  These activities need to focus on finding information, evaluating the quality and importance of such information, and synthesis of this information with the presentation of the patient.  Instead of leaving it up to students to develop their own strategies as they take on their own patients in residency, we should proactively incorporate these skills into formal medical education from the beginning and systematically teach the best methods.

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