Medical expertise, mashed potatoes and competency indigestion
One of my favourite papers about medical education was an article Geoff Norman wrote called ‘Medical expertise and mashed Potatoes’. In it he recounts a meeting with the famous chef Albert Roux. Norman uses the encounter to point out the similarities between expertise in what seems like very different domains. Since I have recently almost lost the will to live having tried to gorge on an ultimately inedible diet of pseudo-competency based descriptions of what doctors ‘are’ (really, the Danish devote pages to an exegesis of the CanMEDS, and tweaking of where to put ‘professionalism’ in a schema of what doctors ‘are’!) They all need to get a dose of Wittgenstein to see the folly of their ways..) Anyway I digress.
Medicine was historically an apprenticeship, but our problem (well, actually the students problem) is that in large part this is not mirrored in the way we organise it at the undergraduate level. As Alice Gopnik, the psychologist once remarked, at university we tend to think the way to teach people how to cook, is to lecture then for three years and then, and only then, allow them to crack an egg. Here is a nice video from the NYT of people who understand education much better than we do. The video, and Norman’s article, say more than the ever enlarging girth of the working groups.