A Prescription

The rise of professionalism in American medicine has given us great refinements in and has improved the quality of medical care. At the same time it has created a far more rigid system of medicine, dominated in part by the medical schools and in part by professional societies. The dilemma is obvious. We have a system which at best is capable of providing care of the highest quality for certain individuals. Professionalism and scientific advance have contributed this to our society. But little has been done to provide a rational distribution of health services. Professionalism has not only contributed little to the solution of this problem, it has resisted change. . . .
There are certain principles which must guide the planning of the education of doctors.
1. There must be a recognition of individual aptitude and individual differences. Quite different kinds of people can contribute to medicine, and it is reasonable to assume that they will learn different things at different rates. The rigid lockstep system of American medical education must be broken if individual aptitudes are to be fostered.
2. There must be time in the medical curriculum to pursue knowledge in some area of particular interest, for this is how the student will learn in the future. If he is so heavily burdened with required courses during his educational experience that there is no time for independent study, his continuing education will be in jeopardy. Experience in a research laboratory may or may not fulfill this need. If his work in the laboratory is essentially that of a technician, it will not.
3. Responsibility must be given the student initially for a significant part of his own education and ultimately for the care of the patient, but the latter responsibility must be graded according to the student’s ability to assume it.
4. Rather than one curriculum there should be several responsive to the different interests and backgrounds of students. We are educating men and women for a variety of careers, and our educational process must recognize this fact while concurrently protecting against the creation of trade schools turning out specialist technicians.
Medical education is a total process. The artificial division between medical school and internship and residency makes little sense. There must be the opportunity to plan in a rational way the total education of the physician.
ROBERT H. EBERT, M.D.
Dean of the Harvard Medical School
From his Lowell Institute lecture, March 2, 1966