Hi DanME,
The question of weather a physician is a scientist or not is interesting. My experience in medical school and in practice doesn't demonstrate to me a correlation between how good a physician is by how much a scientist he/she are. The real question is what amount of time should be devoted to research in a medical school curriculum. As it stands, in the United States, for the most part, the first two years of medical school are devoted to the class room where physiology, biochemistry, anatomy, histology, microbiology, immunology, pathology, pharmacology, etc are taught. The last two years of school is general clinical training, How to interview a patient, write a rx, perform a physical exam, rotate on various clinical services like surgery, medicine, pediatrics, psychiatry, and other subspecialties. You receive some exposure to subspecialties like cardiology, ophthalmology, endocrinology, emergency medicine, dermatology, neurosurgery, urology, rheumatology, geriatrics, critical care medicine, infectious disease, neurology, etc. As you can see by this partial list of subjects a physician is expected to be exposed to is rather daunting.
So, what should be left out from the core curriculum so that there is enough time to perform research. Something has to give. There certainly many physician scientist who have research labs and publish frequently, but they are in the minority. I'm not a scientist, although I have developed many surgical techniques which I have taught resident which have been incorporated into their own practices. So what is more important to the average clinician, being a good scientist or a good clinician? I realize they aren't mutually exclusive but for many it is a choice of time, ability, desire to fit their individual talents.
Best,
Gary
Since you have been a real doctor and not only a student like me, I think, you are the authority in this debate.
But here is nevertheless my opinion.
The German system is a bit different.
The first two years you learn the scientific basics of medicine. Mainly physiology, biochemistry, anatomy (inculding histology) and psychology.
Then you have three years of clinical training in combination with classes of microbiology, immunology, pathology, pharmacology, statistics, ethics, medical economics (like how to run a hospital), medical sociology (like comparing different health systems in the world) and again psychology. You are "trained" in all subspecialities, you mentioned, though practical time is mostly limited to three weeks in each field.
Usually you extend the second part of three years to four years to start your doctorate in a field, you are interested in. Also you have to do an optional advanced course in a field, you like. You can do everything from ethics to immunology. I did a course, which was called "the biology of cancer", which I loved and which was very much focused on research. The last year (usually the sixth or seventh) is your practical year. You do rotation in internal medicine, surgery and an optional field (like dermatology or psychiatry). After that you are have the final exams and you are officially a doctor and can start a career.
In theory the German system is not bad. I think, it maintains a good balance between clinical work and theoretical courses. I also like, that you are able to extend your knowledge in fields, you are interested in.
Back to our question, if a doctor should be a clinician or a scientist. Of course he should be focused on beeing a good clinician and this is much more important. I don't want us to be scientists. It's a completely different kind of work. What I want us to be is more aware of what science is and how the scientific world works. We should be trained to be cautious about the facts, we learn. A lot of them will stay facts, but some of the theories we learned in med school will be turned on their heads in our lifetime. A lot of doctors have never thought about the fact, that psychosomatics has indeed a very hard time to prove its main concept and fails at a very basic level to do so. It cannot disprove it's own hypotheses. And furthermore psychosomatic studies have usually no control group. Also a lot of my friends, who are already working, know that homepathy doesn't work, but don't know, why it doesn't work and why it is so fundamentally flawed. Let's talk about statins. They reduce the risk of cardiovascular events, but usually only to the extend of 1-2%. This is the absolute risk reduction of the average patient. Not 50%, which is the relative risk reduction. Some doctors out there don't know the difference between the two, which is a shame. Then ME. The medical world has absolutely failed us for four decades! This is outragous. A doctor at med school told me that ME is psychological and was absolutely sure about that. Why? Because he is not able to do his own research and to critise studies. He wasn't even able to admit, that there are a lot of diseases out there, which medicine hasn't understood yet and has even wrongly classified. This is what I criticise.
My answer is education. Education in scientific and critical thinking. That's all. We should learn to be cautious sometimes and we should all be able to follow scientific debates. It's not about beeing actual scientists.
So what to leave out of the curriculum. I think, a lot of things we learn are to extensive and too detailed. Why do I have to learn every muscle of the body, if I am going to be an GP, an immunologist or an psychiatrist? Why do I have to learn about all psychological models, if I am going to be a surgeon? Makes no sense to me. We could concentrate on the basics, on structural knowlegde and the moment I want to become a surgeon I can learn about the 40 minor muscles, med school skipped. Also the moment, I become a psychiatrist, I can learn about the 10 different psychological models for anorexia. For the rest, it's enough to know the major symptoms and complications.