Eating the curriculum.

Abstract

The alimentary metaphor--learning as ingestion--is well established in medical education: students are spoonfed, forcefed; they cram, digest, and metabolize information; and they regurgitate it on tests. In the author's experience, these metaphors are inextricably bound with the attitudes and information they describe, organize, and sometimes generate in medical education. Alimentary imagery shapes discussions of the curriculum, and its perversities characterize and help perpetuate much that needs changing in North American medical education. Medical school teachers speak of their life's work as feeding students, not as chiefs but as the anxious caretakers of problem eaters, and the images used most often to describe the teacher-learner relationship suggest an underlying infantilization of medical students. Alimentary metaphors are not in themselves evil. A closer look at medicine's uses of the metaphor of learning as eating suggests a healthier educational philosophy. Despite the "full plate" that students are served, they are metaphorically starving. Fundamental curriculum reform should help them learn to be healthy eaters-using lessons from parents, pediatricians, and child psychologists about how to do this, which are discussed in detail. The difficult-to-achieve but imperative goal of medical education should be to put students in charge of their own "eating" and thereby produce intellectually curious, self-motivated, active, and "well-nourished" physicians who know how to feed themselves in the right amounts and at reasonable levels, maintain a healthy skepticism about the information they consume, and periodically check that information for freshness.