should med schools reassess how they develop diagnostic skills ii

Last time, we started discussing the rather shocking levels at which misdiagnoses are made by physicians here in the U.S. and how some experts are now attributing part of this problem to the traditional clinical apprenticeship approach relied upon by the nation’s medical schools.

In general, the traditional clinical apprenticeship approach calls for the physician-in-training to develop and hone their diagnostic skills through careful consultations with more experienced physicians about patients under their care.

According to experts, however, this approach is not without its limitations and could actually serve to hamper the development of a young physician’s diagnostic skills.

Some of the reasons they provide for this position, include:

  • There is no guarantee the clerkship programs currently used by medical schools — many of which utilize a variety of sites — will provide students with sufficient exposure to the mix of patients otherwise needed to hone their knowledge and gain diagnostic experience.
  • The relatively new hour restrictions governing residents can serve to reduce resident- student interactions and mentoring. In other words, the senior resident may be off duty because of these hour restrictions, meaning the student may report to an intern whose knowledge level is not nearly as developed.
  • The brevity of shifts and rotations can deprive a student of the opportunity to see whether their diagnosis and treatment of a particular patient proved accurate over the long term.
  • Many physician educators, who possess strong diagnostic skills, may nevertheless be lacking the ability to effectively communicate with students or articulate their proven approaches.

According to experts, some of the ways in which medical schools can compensate for these shortcomings are by extending the duration of clerkship programs, putting more of an emphasis on teaching students how best to administer tests and speak with patients, and incorporating more online patient simulations into curricula to supplement real world experience.

Only time will tell if medical schools prove willing to adopt any changes to the traditional clinical apprenticeship approach. Given the aforementioned statistics on misdiagnosis, such changes may be past due.

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