Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Med Educ. 2011 Jan;45(1):36-43. doi: 10.1111/j.1365-2923.2010.03791.x.
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.
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.
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.
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.
二十世纪的医学教育将医学构建为生物医学科学。尽管生物科学知识为临床实践带来了巨大的益处，但许多人质疑其主导医学课程的适当性。由于该课程的内容本身是一种历史中介的社会建构，因此可以根据当前对医学院期望培养的合格医生的描述进行更改。这些医生不仅需要具备生物医学专业知识，还需要履行 CanMEDS 等能力框架中描述的多种其他角色。这些其他角色中的许多都是基于社会文化的，因此不受生物科学知识的支持。
我们设计了一个思想实验，以阐明需要确定和整合支持能够履行能力框架中描述的所有角色的医生所需的广泛基础知识。我们指定了假设并划定了范围。为了说明我们的想法，我们从与非医学专家角色相关联的医学课程中选择了示例，并概述了支持这些角色的学科。
接受过所有医生角色所需的基础知识教育的学生将需要接触到来自传统生物医学科学之外的广泛学科的思想和思维方式。这些需要在上下文中介绍，并以支持未来医学实践的方式介绍。它们还将拓宽学生对合法医学知识本质的理解。
目前，CanMEDS 等能力框架的目标和目的与医学课程的实际内容之间存在重大差距。解决这些问题需要课程改革，从目前不在医学院内的学科中添加知识，并以积极影响实践的方式进行。为了实现这一目标，我们将需要与大学中的同事合作。
