As I have the opportunity to give my talk titled, ”Learning How to Think like a Clinician,” many older physicians want to talk afterwards. Usually they lament the current state of clinical skills both history taking and physical examination. Now I suppose they may overestimate the skills that they currently have and were taught, but we often do talk about the skills that help internists do their job well.
Students and residents seem extremely interested in learning the skills of history taking and physical examination. But the old school crowd and the learners suggest that many younger clinician educators do not have the skills necessary to teach these skills.
So the question we must ask, is old school teaching a good or bad aspiration.
I have selective memory. I can give great examples of the value of the history and the physical examination. During my 37 years of ward attending, it seems that these skills have improved, allowing me to be a better educator.
Am I right? If old school medical education has importance, then how do we help our younger clinician educators fully develop old school skills?
Now old school does not exclude including newer basic science and testing.
To me old school represents a style of careful history taking that informs the physical exam. It involves an understanding of the laboratory tests and the implications of their results. It directs our ordering of imaging to answer specific questions.
Am I missing something? Have I constructed a straw man argument? What does old school mean to you?
db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.