tag:blogger.com,1999:blog-2308282620289958037.post3844034654969284487..comments2023-08-08T08:41:19.586-04:00Comments on The Medical Contrarian: Uncertainty and how problems and solutions are framedThe Medical Contrarianhttp://www.blogger.com/profile/09240492315542223258noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-2308282620289958037.post-66593862933826156412016-12-20T09:55:22.169-05:002016-12-20T09:55:22.169-05:00The NEJM article "Tolerating Uncertainty--The...The NEJM article "Tolerating Uncertainty--The Next Medical Revolution" was very much on point for this issue. If I were to translate the substance of that into the medical school and post-graduate curriculum I would say the first thing would be to revise the level of detail in content that is presented and ultimately tested on for advancement and board certification. As an academic physician I'm impressed by the depth of knowledge of the residents I teach--but much of that knowledge is of negligible clinical value. I have heard them recite en mass the genetic defects of disorders that I've never seen or sometimes even heard of in 25+ years of medical practice. Yet just short of graduation in the presentation of a patient with oral lesions at grand rounds none could relate why an oral lesion would or would not be herpetic in nature simply by its anatomic location. Getting students into a meaningful clinical role early to absorb the uncertain environment that they will ultimately be practicing in would help inculcate the realities of disease and its treatment and formulate patterns of thought and learning attuned to dealing with the inherent uncertainties in all aspects of medical practice. The only recommendation in the article I would take exception to is the goal of becoming "comfortable" with uncertainty--that in and of itself is a form of certainty. It is that uneasiness and constant internal dialog reflecting on a patient's condition that fosters critical thinking and furthers learning in medicine.CAMnoreply@blogger.com