PubMed · 10964201
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G Parsell. 2000. Asking questions - improving teaching.. https://doi.org/10.1046/j.1365-2923.2000.00750.x
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The Accreditation Council for Graduate Medical Education (ACGME) is requiring that all medical specialties adopt a new paradigm for residency education: competency-based residency education. Competency-based education includes not only the acquisition of knowledge and the demonstration of safe medical practice, but also competency in practice-based learning, practice improvement, interpersonal skills and communication, professionalism, and an awareness of pathology's role in a larger health care system. Implementation of this new training program will require new educational resources and the implementation of new faculty and resident skills and incentives.
The debate about the appropriate methodology of medical education has been (and still is) dominated by the opposing poles of teaching science versus teaching practical skills. I will argue that this conflict between scientific education and practical training has its roots in the underlying, more systematic question about the conceptual foundation of medicine: how far or in what respects can medicine be considered to be a science? By analyzing the epistemological status of medicine I will show that the internal aim of medicine ("promoting health through the prevention and treatment of disease") differs from the internal aim of science ("the methodological and systematic acquisition of knowledge"). Therefore, medicine as a whole discipline should not be considered as a science. However, medicine can be conceptually and methodologically scientific in so much as it is based on scientific knowledge. There is evidence from cognitive science research that diagnostic reasoning not only relies on the application of scientific knowledge but also--especially in routine cases--on a process of pattern recognition, a reasoning strategy based on the memory of previously encountered patients. Hence, medical education must contain both: the imparting of scientific knowledge and the rich exposure to concrete cases during practical training. Hence, the question of teaching science vs. the apprentice model will not be "either-or" but rather "both--but in which proportion?"
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