Teaching science vs. the apprentice model--do we really have the choice?

The debate about the appropriate methodology of medical education has been (and still is) dominated by the opposing poles of teaching science versus teaching practical skills. I will argue that this conflict between scientific education and practical training has its roots in the underlying, more systematic question about the conceptual foundation of medicine: how far or in what respects can medicine be considered to be a science? By analyzing the epistemological status of medicine I will show that the internal aim of medicine ("promoting health through the prevention and treatment of disease") differs from the internal aim of science ("the methodological and systematic acquisition of knowledge"). Therefore, medicine as a whole discipline should not be considered as a science. However, medicine can be conceptually and methodologically scientific in so much as it is based on scientific knowledge. There is evidence from cognitive science research that diagnostic reasoning not only relies on the application of scientific knowledge but also--especially in routine cases--on a process of pattern recognition, a reasoning strategy based on the memory of previously encountered patients. Hence, medical education must contain both: the imparting of scientific knowledge and the rich exposure to concrete cases during practical training. Hence, the question of teaching science vs. the apprentice model will not be "either-or" but rather "both--but in which proportion?"