Duke University School of Medicine - Aesculapian Yearbook (Durham, NC)

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pleasure in solving it, we are satisfied. We are not concerned that a new area of knowledge is being explored without our guidance. In caring for our patients with ill-defined genetic and acquired differences and with many variables of unknown strength at play, many erroneous conclusions are drawn. The student has to learn to examine statements, both oral and written, with care and to ask of all au- thorities the source of data which underlie their conclusions. One way for the student to learn the difficulties in drawing accurate con- clusions about biological systems is to give him the opportunity to establish some fact on the basis of his own work. We call this re- search and find it a very effective method of teaching. The intellectual discipline involved better prepares him for the role of a lifetime learner. The health field is a broad one. Anyone with intelligence enough to gain entrance to the medical school can find an area where he can be happy and productive. We are interested MORTON D. BOGDONOFF, M.D. MEDICINE . . . a scholar who is prepared to provide care for patients. A philosophy of medical education and prac- tice begins with a definition of the role of the physician. A definition is critical since the physician occupies an unusual place in the world of science: at one time, investigators of the biology of molecules, at another time, bed- side counselor of a distressed patient. lt is this extraordinary breadth of the spectrum of his interests that singularly characterizes the physician. It leads to the definition of his role as: a scholar in human biology who is prepared to provide care for patients. There is a trend extant in medical education circles, with which I emphatically disagree, to read this two-part definition as an either-or dichotomy. Much more to the point, the components of scholar- ship and service are inseparable, and it is unity of these two elements that constitutes the ef- fective physician. Once having defined our man, the process of education must be designed to create such a person. It must be based upon scholarship at all levels, that is, a knowledgeable conver- sancy with the important themes and prospects of the many sciences that constitute the prac- tice of medicine. It is true for the science of service to the patient as for all other scientific disciplines. It is my particular interest to pro- vide a rigorous methodology for this area of medical education. Since patient care means . X1 J Q .-.Nw -W in producing manpower for the entire field. We are not interested in molding our students into any single career in the health field. The faculty accepts the fact that our intake is heterogeneous, and that our output will be heterogeneous. Our role is to identify the area where the individual will be most productive and happy and to help him reach this goal. We will continue to produce general practi- tioners, specialists, administrators, research workers, biologists, government workers and various combinations. There is no special honor attached to any of these roles. Our primary interest is that our graduates are productive and receive emotional and intellectual satis- faction from their work. MQ ft rf f', . l,'i. A X the interaction of molecules and of people, the sciences of people-interaction fthe social sci- ences of sociology and psychologyl merit em- phasis. twenty-three

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The Department of Medicine traditionally has the responsibility of preparing the student for a life- time of learning as he gives care to patients who ask him for help. The first step is to begin to think and act like a doctor. Two courses in the second year- Introduction to Clinical Diagnosis and Clinical Mic- roscopy-prepare the student so that he can take an active role in patient care. In the third and fourth years, the student assigned to Medicine acts in the role of a physician. His desire to give good care is the motive which drives him to excellence. He learns to properly identify the problems of the patient. Having identified the problems, he marshalls the information which he can bring to bear on them by his past training, he recognizes the gaps in his knowledge as he attempts to focus the information learned from the basic sciences onto the specific clinical problem. Using the patient as his means of integration, he re-reads his anatomy, physiology, microbiology, pharmacol- ogy and biochemistry. In this clinical setting he has the opportunity to speak many words which he has previously only read, he discusses the prob- lem with his fellow students, interns, residents and senior staffg he gains familiarity with ideas and concepts by actively manipulating them. The student crystallizes his idea of the best diag- nostic and therapeutic approach to this particular patient. He identifies the reasons for each of these EUGENE A. STEAD, JR., M.D. MEDICINE Our role is to identify the area where the indi- vidual will be most happy and productive and to help him reach this goal. decisions. He has real curiosity to see if his evalua- tion of the situation is correct or if he will have to admit that certain data which he had interpreted as rock-like support for his house of cards have turned out to be shifting sand. He learns that the course of biology is uniniluenced by strong state- ments, by the rank of the faculty member, or by the number of supporting references not quite ap- plicable to the points in question. Under guidance from his fellow students and from faculty of all ranks, he slowly appreciates the difficulties of learning in this system of multiple variables operating on only partially defined sub- strates. Part of a doctor's learning is only experi- mental. He knows from living with his patients that certain things are possible, but he does not know the underlying sequence of events. In other in- stances, his learning is more precise because he understands and can control some of the important variables. He must learn both the liabilities and virtues of attempting to use logic in clinical practice. The goal of the Department of Medicine is for the student to have as many learning experiences as possible in which he plays an active role. We hope that he will enjoy these learning experiences so much that he will continue them as long as he sees patients. We are not interested in covering the entire field of medicine. If one of our graduates meets a new problem, correctly identifies it, and has twenty-two

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Though the care of patients may be suc- cinctly summarized CFrances Peabody, 1927: The secret of the care of the patient lies in caring for the patient. D, there must also be a consistent educational effort to indicate the subtleties, implications and horizons of the process of patient care. It is not an easy task for one individual to be responsible for the health of another. It is quite necessary that the scholar in human biology be afforded as much information in how to discharge this obligation as is now known. The more the 'en-...,,., 1 Q 5 KA , .,., N A contemporary philosophy of medical edu- cation requires an appraisal of the social set- ting, the role of the medical profession in it, and the responsibilities of the university med- ical center. Within our medical faculty one would surely find diverse analyses of the pres- ent, and varied convictions regarding our prop- er course for the future. My comments will be restricted to those aspects of the current scene of particular relevance to students at l unuasnnguuann- physician can practice from the position of educated intent, rather than from untutored intuition, the more likely will he be able to effectively serve the needs of his patients. mlm if JAMES B. WYNGAARDEN, M.D. MEDICINE The role of the faculty is to prepare the student for a lifetime of learning. Duke University, and to interns, residents and fellows in our Department of Medicine. The scientific, educational and social refer- ences of medical education are continually changing. The volume of basic science and clinical information is already far too vast for anyone to master, and it is growing logarith- mically. The physician ten or twenty years out of school deals with languages, facts and concepts which were unknown when he was twenty-four