Blog entry by Meguid El Nahas

Picture of Meguid El Nahas
by Meguid El Nahas - Friday, 2 May 2014, 5:19 PM
Anyone in the world

It came to my attention over the years that medical education in some emerging countries is based on endless learning by rote (memorising knowledge based on repetition) without much in the way of focused or reflective learning.

Seniors educators seem to use these techniques to maintain some form of ascendency over juniors and restrict their progress. Whilst this sounds pernicious, it seems quite prevalent. Juniors learn endless list of differential diagnosis, never long enough for their seniors, who always find yet another rare or esoteric disease to trip the junior and show his supremacy. This is also the case in exams where examiners seem to take a malicious pleasure of tripping young doctors by asking them the most obtruse and obscure of medical questions... 

This attitude and deference to seniority seems in the long run to hamper the intellectual development of younger doctors and keep them in a subserviant state of dependency on the unreachable heights of the "Professor" encyclopedic...but really useless....knowledge!

This also translates in overall poor medical care, as those privy to such encyclopedic knowledge acquire it through a bookish attitude to learning rathern than an experiential one based on rich and diverse clinical practice; a huge dichotomy emerges between the exhalted knowledge of these senior doctors and their appalling medical practices...

The juniors, on the other hand, remain in the land of fear of authority, unable to challenge their seniors...and unable to acquire the sound and practical knowledge they crave. Consequently, they are also in a medical no man land where they struggle to find sound clinical guidance and advice.

To please their seniors and gain their approval and promotion, they follow the lead of "impression by rarity..." raising the most unusual and improbable diagnoses to deal with common diseases; so a straightforward UTI raises the possibility of a dysmorphic dysplasia of the bladder epithelium rather than just poor hygiene and faecal contamination of the urinary tract! Or, angina in a older patient with diabetes mellitus raised the spectrum of aneurysmal destruction of the coronary arteries by polyarteritis nodosa....and son on!

What can be done to refocus the minds of new generations of younger doctors subject to this distorted way of thinking?

1. Ignore the seniors as they will not change; they have a vested interest in this pernicious system; it serves them well...

2. For the juniors to make the most of the world of the internet to find alternative methods of educating themselves.

3. Rely on peer support.

4. Rely on network learning and use the amazing range of learning media through the internet to break free from the shackles of seniors who want to keep them enslaved to their whim...

Even then...seniors have ways to keep them at their mercy..."Unless you do as I say...you will not get your higher degree...", "unless you do as I say you will not be promoted..." 

Sad but true...this is the state of continuing medical education in many countries...

IT IS HIGH TIME THAT A NEW FORM OF REVOLUTION TAKES PLACE IN MEDICAL EDUCATION IN EMERGING COUNTRIES FREE OF THE RESTRAINTS OF OLDER GENERATIONS OF DICTATORIAL AND CONTROLLING EDUCATORS...

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