New doctor for the new century Tomasz J' Pasierski MD Department of Medical Humanities Warsaw Medica

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New doctor for the new century Tomasz J.
Pasierski MDDepartment of Medical Humanities
Warsaw Medical University
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New doctor for the new century why ?

• New ideas of what does it mean to be a doctor
• More advanced and complex medical knowledge
• Increasing prevalence of chronic diseases, sicker
  and older patients
• Splitting of medical practice into a collection
  of different specialties, which demand different
  skills
• Aknowledgment of patients autonomy
• Access of patients to various sources of medical
  knowledge (Internet)

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New ideas of being a doctor

• No longer independent practice
• Trust has been transfered from interpersonal to
  institutional
• Much more therapeutic opportunities and more
  complex ethical dilemmas
• Movement from paternalism to patient,s autonomy
  and then to shared decison making
• Necessity of team work

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Burden of chronic diseases
JAMA. 20042912616
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Hippocrates (400 BC)
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Abu Ali Husain ebn Abdallah Ebn-e Sina Awicenna
(1000 AD)
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Aristotle. Nicomachean ethics

• medical men do not seem
• to be made by a study of textbooks.

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How much medical education is different now?
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Is it time for another medical curriculum
revolution?

• Specialists whose expertise ought to be narrow
  but deep should have limited exposure to general
  medical theory and practice and then focus
  primarily on learning their specialties
• Front-line practitioners, on the other hand,
  need major exposure to the tools that will equip
  them to diagnose and manage the broad range of
  health problems that presents and should spend
  much less time on the finer points of dealing
  with advanced and complex diseases.

K M. Flegel, P C. Hébert, N MacDonald CMAJ
2008 1781
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What are core competences of doctor?

• Core competencies can be defined as the essential
  knowledge and skills required of all medical
  practitioners in order to think, talk and act
  like a doctor
• Every physician needs to be able to make a
  correct diagnosis, an essential first step to the
  next one treatment and prognosis.
• it is the physician's duty to teach the patient
  about the illness and its probable course.
• Core training should also ensure that all
  physicians are able to perform critical
  appraisals of medical literature, to communicate
  with their patients and other health
  professionals, to understand the ethics of their
  profession and to understand basic public health
  principles.

CMAJ 2008 1781
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Dr Gustavus Murray taking care of dying son of
painter Sir Luke Fieldsa
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Wladyslaw Bieganski Aphorism XXVII
What our teachers taught us?

• Education of mind without education of feelings
  makes man one sided, biased. This truth applies
  also to medicine

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What our teachers taught us?

• The physician needs a clear head and a kind
  heart his work is arduous and complex, requiring
  the exercise of the very highest faculties of the
  mind, while constantly appealing to the emotions
  and finer feelings.

William Osler
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New people to educate
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• Medical professionalism in the new millenium a
  physician charter Annals Int Med. 2002136243

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Teaching professionalism

• Professional status is not an inherent right, but
  is granted by society
• Its maintenance depends on the public's belief
  that professionals are trustworthy
• To remain trustworthy, professionals must meet
  the obligations expected by society
• The substance of professionalism should be taught
  at all levels of medical education as part of the
  profession's response to changing societal
  expectations

BMJ 19973151674-1677
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New physician for the new century

• Assertion of clinical ethics as the foundation of
  clinical medicine
• Recognition of central place of values in
  clinical decision making
• Cultivation of the ethos of human care
• Selection of medical students with dual
  capacities of strong cognitive skills and empathy
• Encouragement and support of faculty who can
  transmit the knowledge of clinical science
  coupled with the principles of human care
• R.A. Copper and AI Tauber Academic Medicine
  2005801086

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Problem-based learning

• both a method and philosophy involving
  problem-first learning via work in small groups
  and independent study

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Efficacy of PBL
CMAJ200817834