Summary: In his latest blog Professor Harden discusses a vision for the future and important current issues. Description: A vision for the future
In my June blog I argued that a major rethink was necessary as to the practice of medicine and the required training programme. The present programme where all doctors have a 13 year undergraduate and postgraduate experience is unsustainable. As suggested in my blog, doctors should require only 6-7 years training to equip them with the skills for a specialised area of medical practice. The results would be as competent, or better practice, than we have at present. As an endocrinologist, when a patient with thyrotoxicosis required thyroid surgery my choice of the surgeon was key if the risk of side effects of recurrent laryngeal nerve damage and damage to the parathyroids was to be kept to a minimum. Acquisition of the necessary skills could have been acquired in 7 years if the student was admitted to medical school with the aim of becoming a surgeon.

I found it interesting to read again an editorial I wrote in Medical Teacher in 2000, Evolution or Revolution and the future of medical education: Replacing the oak tree. In thinking about the future of medical education I suggested we can adopt two different approaches. We can look at the changes taking place in medical education as a journey where the future is a continuing evolution of what has happened in the past three decades or so – an evolutionary approach. Alternatively we may visualise a more dramatic journey to a different world where there are fundamental changes in medical education, some of which we may have difficulties envisioning at a point in time – a revolutionary approach.

The evolutionary approaches I envisaged in 2000 have more or less happened. In contrast, the two revolutionary changes I suggested have not. In my article I describe how in “Imagined worlds” Dyson (1998) marshals his gifts as a scientist and as a storyteller to present an illuminating account of possible developments in the future. He tells of a country doctor whose pride was his magnificent house and garden in a village in Germany. When Dyson admired the large oak tree that stood in front of the house the doctor said in a matter of fact tone “That tree will have to come down, it has passed its prime”. Dyson could see that the tree was in good health and had no signs of imminent collapse. He asked the doctor how he could bear to chop it down. The doctor replied “For the sake of the grandchildren. That tree would last my time, but it would not last theirs. I will plant a tree that they will enjoy when they are as old as I am now”. Dyson’s vision may be relevant when we are thinking about planning for the future in medical education.

My two visions in 2000 for a revolutionary change were a unitary approach with a continuum of medical education across the phases of undergraduate, postgraduate, and continuing education; and the second was a move away from a concept of a physical medical school as we know it today. Neither of the visions have come about, although we are seeing more use of online learning as a result of the COVID-19 pandemic.

The vision in my June blog of a fundamental change in the type of doctors we train, like the other two visions, may not happen but it merits further exploration.

Harden, R.M. 2000. Evolution or Revolution and the future of medical education: Replacing the oak tree. Medical Teacher. 22(5), 435-442. https://doi.org/10.1080/01421590050110669

Important current issues
A number of important issues are addressed in the May 2021 issue of Medical Teacher – the educational benefits of interprofessional training wards, the educational value of ward rounds, gathering and aggregating information to inform programmatic assessment, managing students from diverse backgrounds, fostering learner motivation, and the influence of a candidate’s physical attributes on assessor’s ratings.

In previous blogs I have suggested that more attention should be paid to student motivation. The AMEE Guide by Lyons et al provides health professions educators with an understanding of when and how learner motivation interventions work.

I have often wondered in a clinical examination whether the candidate’s physical attributes may influence an assessor’s ratings. Sam et al found that the presence of tattoos, purple hair, or a regional accent did not systematically negatively influence the grade or score awarded by assessors to candidates in a clinical examination.

Lyons, K.M., Cain, J.J., Hains, S.T., et al. 2020. The clinical educator’s guide to fostering learner motivation: AMEE Guide No. 137. Medical Teacher. 43(5), 492-500. https://doi.org/10.1080/0142159X.2020.1837764