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

Page 28 text:

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

Page 27 text:

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

Page 29 text:

a student. The role of the faculty is to prepare the student for a lifetime of learning. We must introduce him to the basic principles of human biology with just enough specific information to illustrate these principles. We must provide him with a series of clinical experiences that will allow him to deal comfortably with pa- tients and to use all the facilities of the health field in understanding the sick, and in caring for them. We must also help the student iden- tify that area of medicine in which he will be most productive and happy. The practice of medicine is becoming more complex, both because of the pace of scientific advance and because of impending changes in financing of health care. Increasingly, physi- cians are enjoying the practice of medicine more when they join together in groups so that each may emphasize most strongly that area in which he has special training. The intel- lectual satisfactions are greater because the physician has mastered an area of specializa- tion. The personal satisfactions are greater be- cause he has rendered his patient superior care. In internal medicine, fewer and fewer of our residents enter the community as un- differentiated internists. They want also to be equipped as cardiologists, allergists, or gastro- enterologists. The communities expect them to bring more than could have been obtained in a residency at a non-teaching hospital. The trend toward subspecialization within large diversified group practices will continue. I ex- pect also that more and more community hos- pitals will establish complex special care units and supporting laboratory facilities, and ap- point geographical full-time staff members. This will enable them to compete more effec- tively with the continuing education of the community physician. Greater governmental participation in financing will bring this about. The report of the Presidential Commission on Cancer, Heart Disease and Strokes previews one aspect of coming changes. The Medical School and the Department of Medicine are facing these new challenges, for if we did not, our graduates would soon not be equipped for the roles of leadership and dis- tinction. We will continue to admit a hetero- geneous student body and to train practicing physicians, teachers, research workers, public health workers-professional manpower for the health field at all levels. In all branches of medicine the physician of the future will need a stronger basic science competence. This need not, indeed cannot, be catholic. One physician will need depth in neurophysiology, another in developmental biology or behavioral science. I have been impressed with how much more a student gets out of the laboratory after he has had an introductory clinical experience, has identified an area of curiosity, excitement, and relative ignorance, and has found a faculty member willing to guide his learning. Our curriculum most offer all students such an op- portunity. Our graduate programs in internal medicine must come seriously to grips with the problem of early career differentiation, so that our resi- dents and fellows can choose from the best opportunities in community or academic medi- cine. Their training must increasingly reflect the basic sciences relevant to their fields, and must equip them to deal with the complexities of scientific discovery and application. Our men must be skilled not only in ward and clinic medicine, but also in the intricacies of complex special units, such as the hyperbaric chamber, the chronic dialysis unit, the hemodynamic laboratory, the metabolic laboratory. This will require more individualization of residency training. We are unusually fortunate at Duke in having excellent working relationships be- tween clinical and preclinical departments. Within clinical departments the faculty in- cludes physicians oriented toward patient care and physician-scientists oriented toward dis- ease mechanisms. All have equal honor, and all are essential to the training of student and physician. It seems to me that one additional oppor- tunity will become increasingly urgent soon, and that is the chance of the practicing physi- cian to have a free year without incurring financial disaster. The universities long ago discovered the value of free years for their faculty, to enable a member to renew his out- look and keep up to date. Often this involves leaving one seat of learning and going to an- other. The practicing physician also needs this opportunity. The larger groups and community hospitals with full-time staffs should build such a provision into their structures, and plan its financing, in their own enlightened self inter- est. The university hospitals, the clinical, and perhaps the basic science departments also, should remain receptive for constructive ex- plorations. The career opportunities open to the medical student have never been more diverse or more attractive. The earlier he can identify the area which will permit full play of his talents, the better he can be trained for the future, and the more successful are the measures for his continuing education, the more significant will be the satisfactions that come to him. twenty-five