There is More Wrong with Medical Education than Accreditation: A Commentary on de Leeuw, “The Politics of Medical Curriculum Accreditation: Thoughts, Not Facts?”

There is More Wrong with Medical Education than Accreditation: A Commentary on de Leeuw, “The Politics of Medical Curriculum Accreditation: Thoughts, Not Facts?”

Joachim P. Sturmberg (Monash University and the University of Newcastle, Australia)
Copyright: © 2012 |Pages: 6
DOI: 10.4018/ijudh.2012010114
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The failures of health professional education are multi-faceted. The governance issues described by de Leeuw represent ‘the tip of the iceberg’ of the problems. Other, probably more important issues, are the loss of the ‘core values’ underpinning the healing professions, and a scientism-based approach to practice based on a naive view of evidence that fails to register ‘one’s delusion of certainty’. The selection of students lacking humanistic trades perpetuates the demise of the healing (meaning making whole again of all of the dis-ease domains) professions. The change required to achieve ‘balanced’ health professionals that treat the human condition of dis-ease with the scientific advances of managing disease is a change in core values and a selection of patient-centred role models. An example shows how patients can ultimately be our best allies in achieving these ‘long-overdue’ changes.
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De Leeuw raises an important issue, namely accreditation of medical programmes, and its impact on the future of medical practitioners in particular and medicine at large. One cannot help but agree with the general observations put into focus in this paper. However, I would suggest, there are important other issues that maintain the current status-quo of the healthcare professions (the pleural is intended as other healthcare disciplines are equally affected).

The Underpinnings of Health Care Make Health Care a Social Endeavor

The notion that the medical professions are grounded in sound social and philosophical commitments to human well-being and advancement is the very foundation of medicine since time in memoriam (Illich, 1976; Pellegrino & Thomasma, 1981; Sturmberg, 2007). It should not be frowned upon, rather it should be the starting point of re-thinking the purpose, meaning and operation of caring. Caring in fact should be the imperative work since most patients we care for have no medical condition explainable by the mechanistic biomedical model (Green, Fryer, Yawn, Lanier, & Dovey, 2001; White, Williams, & Greenberg, 1961). These studies show that the epidemiology of health, illness, dis-ease and disease in the community follows a Pareto distribution (Figure 1), with only a minor percentage requiring tertiary hospital medicine (Sturmberg, O’Halloran, & Martin, 2011). A point important to take into consideration when thinking about health professionals’ education.

Figure 1.


Given the needs of the people to address their subjective wellbeing of health, illness and dis-ease rather than merely an underlying less frequent disease (Lewis, 2003; Sturmberg et al., 2011), humanities should rightly be the driver of the healthcare system (Sturmberg, Martin, & Moes, 2010; Sturmberg, O’Halloran, & Martin, 2010). We tend to talk about systems in a very loose way, and approach system change with an unshakable cause-and-effect mindset, a fatal mistake. Systems not only consist of many interconnected agents acting in nonlinear (and non deterministic) ways, it also entails that their configuration and dynamics are governed by a common goal, a core driver. It is this core driver that ultimately “determines” the fate of any system (Cilliers, 1998).

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