Medical expertise, and music of the spheres as much as of the hands
I like the image below as a metaphor for how we should train doctors. Of course, the parallels between learning many musical instruments and acquiring surgical expertise are obvious (for a nice read on this have a look at Gary Marcus on guitar playing). But much cognitive science suggests that these parallels go much deeper than we have thought for many areas of expertise that do not involve surgical skills. It is one of the reasons why I do not think you can easily demarcate between craft specialties in medicine and non-craft specialities. So, dermatology and pathology are to me craft specialties, where perceptual skills take the place of motor skills (leaving aside my dermatological surgeon colleagues for a moment too). The corollary of this view includes all sorts of implications that many would prefer did not exist. If we imagine much of medicine is akin to high level musical instrument expertise, what are we to make of part time practice, how long a period of intensive training is required in the first instance and how much day-to-day practice is necessary to maintain competence. And what is necessary to stay at the top of one’s game: is this just performance alone, or the myriad of exercises that are the daily routine of the musical master. Is direct clinical practise the most efficient way to stay expert (I no not think so but…)
Carl Wieman keeps making similar arguments that appeal to me. In Science recently:
“The mastery of science and math is not a matter of simply transferring knowledge into the brain, which is the traditional model,” Wieman explained. “Rather, such learning and expertise is a response to strenuous practice.” ……
Effective STEM teaching, he said, “is a lot like effective coaching. First, the coach figures out the central skills needed, creates challenging practicing activities that the players carry out, motivates them to achieve that level of expertise, and offers frequent and targeted instruction. All these techniques apply to teaching STEM. … This approach has been demonstrated, but it’s profoundly different than what is found in the typical K-12 or college classroom.”
I think he is right, but he then points out some of the institutional factors that hinder progress, and I think these are as true— if not more so— in medicine than in many other areas of higher education.
Wieman told the committee that “powerful, vested interests” on college campuses discourage the adoption of new ways to teach science and train future science teachers, saying that most universities place a higher priority on research productivity than on student learning