[Medical epistemologies and pedagogies from Flexner to genomics].

The ongoing debate on the challenges and aims of medical education shows several difficulties to conceive integrated and effective curricular pathways to improve the quality of physicians. the problem is how to teach the medical student most of the huge and increasing amount of scientific and technical knowledge necessary to achieve the appropriateness of medical interventions and prescriptions, but also how to make the future physicians aware of the psychological, social and ethical values involved in the relationships with patients and society. The essay comparatively analyses the epistemologies of medical knowledge and practice that inspired the main educational reforms of the XXth century, namely the so called Flexner Reform at the beginning of the century and the more recent introduction of the problem based teaching. The hypothesis that some difficulties in the face of medical pedagogy are due to a kind of epistemological dissonance of today medicine is advanced. In a sense, teaching medical humanities could promote such dissonance. Moreover, when we look at the history of medical education and take into consideration the epistemological and the practical demands that drove the two most important reforms of medical pedagogy it seems apparent that they corresponded to quite definite ideas about the status and aims of medicine. The conceptual and practical challenges emerging with the genomic transformation of medicine can represent the opportunity to redefine on a more coherent basis the theoretical and methodological foundations of medical knowledge and practice. The pedagogical implications of the new epistemological perspective of genomic medicine will be examined.