Original Article Philosophy of medical education HOSSAIN RONAGHY University of California San Diego, USA Introduction: Education is defined as an art with scientific principle. It is Corresponding author: described as a form of learning by which knowledge, skills and attitudes of an Hossain Ronaghy, age group are transferred from one generation to the next through teaching, Address: The Department training, research and practice. of Medicine, University of California San Diego (UCSD) Method: This is a historical review about the philosophy of medical education Email: [email protected] and its changes during the time. Results: It is unfortunate that many developing countries follow the US system rather than those with public financing pattern. Indeed, these systems are “disease care” and not “healthcare” and are mainly motivated by profit. Conclusion: The educational planners in medical schools must design a Please cite this paper as: Ronaghy H. Philosophy of curricula for students and residents to acquire a crucial set of professional values Medical Education. J. Adv and qualities, by which the willingness to put the needs of the patient and society Med&Prof. 2013;1(2):43-45. first. Keywords: Education, Medical education, Philosophy Introduction after the old physician died (2). ducation is defined as an art with scientific Medicine used to be an art for thousands of years. Eprinciple. It is described as a form of learning The effective and successful practitioners were by which knowledge, skills and attitudes of an age those who were most familiar with the psychology group are transferred from one generation to the next of their patients. For centuries, this type of practice through teaching, training, research and practice (1). continued and since there was no basis for measuring The process of education is expected to bring a the expertise of the practitioner, many quacks and change in thinking, feeling and acting of learners and charlatans impersonated the physician and in some give them the knowledge and skills in general or in a instances they were even more successful than the so- specific branch of science. called “trained physician”. Medical education varies from many other branches of science, technology, literature and art; since it deals Method with human life and well-being, and requires special This is a historical review about the philosophy of knowledge, skills and behavior. medical education and its changes during the time. In ancient times, with limited knowledge of From ancient times of the Greeks, Persians and medicine, the student would usually act as an assistant Romans, official schools for training physicians were to a physician. After years of apprenticeship, through recorded. Following the European renaissance in this experience, medical knowledge was relayed, and the early 16th century, most European universities by working alongside the experienced clinician, the established medical schools based on Canon book student would replace the old “traditional doctor” of Avicenna (Ibn Sina), the famous Persian physician J. Adv Med&Prof. 2013;1(2) 43 Ronaghy H. Philosophy of medical education and philosopher (3). largely put aside. In the United States the first medical school was In early 1960’s the research on molecular biology established at the University of Pennsylvania in 1756. became the primary objective of most medical Within 150 years over 155 medical schools were schools in the Western countries and patient care established in North America (4, 5). was further pushed aside. The culture of “publish or In1862, Louis Pasteur discovered bacteria and perish” dominated most of the medical institutions. Koch introduced his famous discovery, “the Koch This pattern was also followed in those countries with phenomena” of reproducing a medical experience, scientific ties with the West. by which the causes and effects of infectious diseases Following the introduction of ‘government care’ in were proven. This was the era when medicine started the United States, the medical faculty in the US was to transform into science (1, 2). Furthermore, with under pressure to generate income for the university gradual gain in the knowledge of physiology, anatomy hospitals. This had practically pushed aside the and pathology, medicine turned into a scientific teaching of clinical medicine and bedside skills. The discipline. main emphasis shifted toward tertiary care, specialty, It was during the 18th and 19th centuries that the and sub-specialty training which generated the most flurry of scientific-based medical schools were revenue for their respective institutions. Professors established all over the Western Europe, the United in these areas were role models for their students. States and Russia. There was a tendency toward subspecialty training. This evolution in medicine created institutions Procedure and technology oriented practice became of medical teaching as a science. In the early 20th the aim of the most medical graduates. For profit Century, with the introduction of medical journals, hospitals with the latest technology were established many reports from educators, foundations, and task in many parts of the world, including developing forces criticized the medical education, which was nations. The resources were prioritized toward tertiary norm in the United States and Western Europe, for care. The primary care physician, family practice and not emphasizing on scientific knowledge, biologic public health were ignored and the power of finance understanding, and clinical judgment and skills on overcame the compassionate care for the patient. The scientific grounds. general health and welfare of society as a whole were In 1910, Flexner made a famous report about completely ignored. medical education, which changed the philosophy The qualifications required for entering an and the pattern of education in medical schools of academic position were mostly based on specialty and the United States and Canada. This, in turn, affected subspecialty training as well as board certification in medical education around the world. His emphasis those very narrow fields of medicine. was on the scientific basis of medicine and based on his report, a number of medical schools were forced Results into closure (6, 7). The “Art of Medicine” lasted for many centuries; The Flexner report also addressed the need for however, the “Science of Medicine” did not last very enhancement in the quality of medical curriculum long. For the past few decades the “Business of and education. Attempts were made to make changes, Medicine” had been mixed, if not completely replaced namely that of admission into medical schools and the primary goal of many medical institutions. also changing the content of the medical school Universities were obliged to compete with the curriculum toward basic science. To improve medical “Market” in the ever-increasing crowded “for profit” education, admission policies and processes were also medical establishments. Most other free market radically changed. economies of Europe, despite their free enterprise and The creation of a standardized test in the United capitalistic system, have chosen publicly administered States for medical school admissions was the initial system of medical care. Despite some criticism by step. The Medical College Admission Test (MCAT) Western European and Canadian physicians, as well as was developed in 1928 (8). some members of the public, the health parameters in This examination was designed to improve attrition these countries remains superior to those in countries rates for medical schools which at the time ranged with a free enterprise system of health care such as from 5% to 50%. With the administration of the the USA and those countries in the world who follow MCAT, by 1946 the entrance into attrition rates such a system. decreased to 7 percent in US medical universities (9). It is unfortunate that many developing countries In this process and evolution of medical education, follow the US system rather than those with public the emphasis was put on the basic science. financing pattern. Indeed, these systems are “disease Consequently, clinical science and patient care were care” and not “healthcare” and are mainly motivated 44 J. Adv Med&Prof. 2013;1(2) Philosophy of medical education Ronaghy H. by profit. The percentage of gross national product obvious differences in the use of life saving tools in (GNP) spent for healthcare nowadays in the United innumerable health care settings, as compared to the States exceed 17%, which is highest in the world, university hospitals creates a major conflict for the while its infant mortality rate ranks 13th (10). medical student. The interaction of physician/teachers Any reform in medical care and education cannot be has been further complicated by the promotional attained in isolation; it must be alongside prioritizing activities of some of the researchers with the the most relevant problems of the respected societies pharmaceutical companies and medical instrument in which the medical schools are being served. firms. Naturally, the researchers are biased in favor of Medical profession and education seems to be in an their sponsors. endless state of discontent. From the early 1900s to As long as financial gains and obligations of medical the present, many have criticized medical education institutions remains the primary objective of medical for too much emphasis on scientific knowledge over schools, it would be practically impossible to modify biologic understanding, clinical reasoning, skill, the present crisis in medicine and medical education. and the development of character, compassion, and integrity (11). Refrences How did we end up with such a tragic situation, and 1. Koch, R. 2 Die Aetiologie der Tuberkulose. Mitt Kaiser what can be done about it? Gesundh. 1884; 1–88. The changes in medical education over the past 2. Pasteur, L. The History of a Mind. Philadelphia, Pennsylvania: century and the current challenges are a huge task for W.B. Saunders Company. 3. Gutas, D. AVICENNA ii. Biography, Encyclopedia Iranica. medical educators as well as medical profession as a 2012; 01-07. whole. Applying and using the following objectives: 4.