Rethinking the basis of medical knowledge
Article first published online: 14 DEC 2010
© Blackwell Publishing Ltd 2010
Volume 45, Issue 1, pages 36–43, January 2011
How to Cite
Kuper, A. and D’Eon, M. (2011), Rethinking the basis of medical knowledge. Medical Education, 45: 36–43. doi: 10.1111/j.1365-2923.2010.03791.x
- Issue published online: 14 DEC 2010
- Article first published online: 14 DEC 2010
- Received 30 January 2010; editorial comments to authors 7 April 2010; accepted for publication 25 June 2010
Medical Education 2011: 45: 36–43
Context Twentieth-century medical education constructed medicine as biomedical science. Although bioscientific knowledge has brought large benefits to clinical practice, many have questioned the appropriateness of its domination of the medical curriculum. As the content of that curriculum is itself a historically mediated social construct, it can be changed to fit current descriptions of the competent doctors medical schools are expected to produce. Such doctors are expected not only to have biomedical expertise, but also to carry out multiple other roles as described in competency frameworks such as that of CanMEDS. Many of these other roles are socio-culturally based and thus not supported by bioscientific knowledge.
Methods We designed a thought experiment to delineate the need to identify and integrate the range of foundational knowledges required to support the development of doctors capable of performing all the roles described in the competency frameworks. We specified assumptions and demarcated our scope. To illustrate our ideas, we selected examples from the medical curriculum that linked to non-Medical Expert roles and outlined the disciplines that supported them.
Results Students educated in the foundational knowledge necessary for competence in all doctor roles would need to be exposed to ideas and ways of thinking from a wide array of disciplines outside the traditional biomedical sciences. These would need to be introduced in context and in ways that would support future medical practice. They would also broaden students’ understanding of the nature of legitimate medical knowledge.
Conclusions There are currently major gaps between the goals and objectives of competency frameworks such as CanMEDS and the actual contents of medical curricula. Addressing these will require curricular transformation to add knowledges, in context and in ways that positively affect practice, from disciplines not currently present within the medical school. In order to accomplish this, we will need to engage with colleagues throughout the university.