Appendix 71 - Teaching

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]

Education means the enterprise of supplying the conditions that insure growth - John Dewey[836]

In a Robert Wood Johnson Foundation survey of 1,400 medical school deans, faculty and department heads, 61 percent said they believe U.S. medical education needs "fundamental change or thorough reform."[837] David Rogers, then dean of the Johns Hopkins School of Medicine and president of the Robert Wood Johnson Foundation, tried to hold rap sessions with an entire class of 200 medical students. The results were described as a, "veritable avalanche of criticism and anger." In his words:

An outpouring of frustration, disappointment, and real rage came crashing down about me. The session soon became an enormous, interactive, mournful song of anger.... There were blistering testimonials about the poor quality of lectures, about the lack of faculty interest in them as individuals, of dreary never-ending series of quizzes, tests, and other bracings, of insufficient time to study, of the absence of personal contact with faculty, of school unresponsiveness to their needs or their complaints.[838]

"Students should see that the faculty takes teaching as seriously as students are expected to take learning."[839]

From An Overview of Medical Education Today:

Medical students are, to a large extent, taught by people who have undertaken little or no formal study in the field of education.... Would you send your child to a school where the teachers were untrained at recruitment, where no instructions were given them, and where promotion was independent of teaching excellence? Yes you would, provided it was a medical school.[840]

From "Reform Without Change" in Academic Medicine:

Almost 90 years and multiple calls for the educational reform of medical education have failed to bring about true change in medical education because of researcher's conflict of interest - that is, the time spent providing effective education equals time away from the research necessary to maintain their careers.

Medical education's manifest humanistic mission is little more than a screen for the research mission which is the major concern of the institution's social structure.[841]

According to an article in Pharos, "Although the traditional lip service is paid to teaching, in general, teaching can only hurt an academic career and rarely helps."[842] From JAMA article "Educational Malpractice":

The reality is that the faculty needs to generate money through research and through seeing patients, and teaching is time-consuming and hard to do well, does not pay, and will not help much in promotion.[843]

"Academic medicine is an industry," one commentator writes. "I know we don't like to think of ourselves that way. But, stripped to the core, that's clearly what we are."[844]



[836] Green MJ. Annals of Internal Medicine 123(1995):512-517.

[837] New Physician 1998(December):8.

[838] Rogers, DE. "Some Musings on Medical Education." The Pharos 1982(Spring):11-14.

[839] Dubovsky, SL. New England Journal of Medicine 315(1986):1672-1674.

[840] Kent, A. An Overview of Medical Education Today. Thesis.

[841] Regan-Smith, MG. "'Reform Without Change.'" Academic Medicine 73(1998):505-507.

[842] Gamble, JG. The Pharos 1994(Spring):16-19.

[843] Stitham, S. "Educational Malpractice." JAMA 266(1991):905-906.

[844] Cohen, JJ. "Learning to Care, for a Healthier Tomorrow." Academic Medicine 71(1996):121-125.



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