Continuity in Medical Education

Medical school has been a very fragmented experience. The first two years consist of a series of lectures with speakers often changing every hour. Even in moving to clinical learning in clerkship, rotations last a couple of months if not weeks, and supervisors often change even within that period. I have often felt confused about expectations, approaches, and even methods of practice. Which has led me to often wonder: why is medical school so fragmented, and is this fragmentation really necessary?

I've often thought about whether or not medicine can be viewed as an apprenticeship - where a student picks their teacher from which they will learn the trade. However I find the analogy falls short. Physicans do not act as individual experts but practice within complex system of professionals. It behooves us, then, to travel within the system as students so that we may have a diverse experience. The question of how many teachers do we need to have for a diverse experience is difficult to answer. Although a single teacher may give a better appreciation for lifestyle, career development, and also feedback over time, it would be just a small exposure to a piece of a greater system. 

The question then becomes whether our fragmented education is really just a reflection of  a fragmented system of a multitude of 'superspecialties'. Although this certainly allows for a diverse experience, it can be confusing for an early learner to function in a highly specialized environment, where too much expertise can lead to too narrowed an approach to certain presentation with limited patient exposures. Although expertise is often about pattern recognition, it is important to be able to pick out a given pattern from a variety of presentations. 

But does continuity really exclude diversity of experience? I would argue that it does not. Although our current clerkship structure approaches separate specialties as silos, many have argued that adding longitudinal elements to the curriculum can serve to unify the experience. Which elements should be longitudinal? Perhaps those elements that underlie all specialties - commmunication, clinical decision making, and critical appraisal. Or, perhaps a longitudinal patient interaction that will allow the medical student to better understand a patient's journey with illness. In order to reap the benefits of both approaches, it will be necessary to interleave both elements into the curriculum. 

-Sarah