the “shotgun” approach to teaching medicine

There are several problems that I am beginning to notice with medical school. One in particular is the “shotgun” approach to teaching systems and pathologies. By this I mean that the instructors hit us with as much general information as they can in the shortest space possible with the hopes that a few of the details will stick for the long-term. For example, this past week, which was week 2 of the “Blood and Lymphatics” block, was on both bleeding disorders and malignancies of the blood (leukemia, lymphomas and myelodysplastic syndromes). Learning the basics about one or the other would take at least a week, if not more, and to be expected to learn both in one week was simply overwhelming.

The reason why the instructors pile on the information and expect so much from the students is that they are trying to make as best use of the time that they are given. Our curriculum is divided into system blocks such as cardiovascular, pulmonary, blood and lymphatics, etc. Each block has a certain amount of material that they are required to teach the students about, and certain amount of time given by those who set the schedule to do it in. Unfortunately because time is limited, and the schedule packed, there isn’t much room to maneuver. Therefore if a block needs more time to cover the material there isn’t any space available in the schedule to do so.

A problem that arises out of the shotgun approach is that the information that we are given tends to be very general in nature, and covers only the most common diseases or syndromes we’d expect to see. This can have the effect of marginalizing some pretty major diseases which significantly affect individuals. For example, in the Monday lecture the instructor remarked that we only needed to know that Marfan syndrome exists and we can disregard the other details. This was perhaps a poor choice of words because there is at least one individual in our class who is affected by Marfan syndrome and was no doubt devastated that we, as future physicians, were not taught anything about it.

I could go on as there are other examples (such as the concepts of nutrition being covered in one lecture) but I won’t. I understand to some extent why the classes are taught this way. There is an incredible depth to the material we are expected to learn and little time to do it in. We need at least a basic understanding of systems and their pathologies in order to begin to practice medicine and we will no doubt build on the base that is provided in these first few years. It is disconcerting to me and I hope that despite the limitations of the system I will have the tools to become a competent physician.


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