WHY CONTINUING MEDICAL EDUCATION? TIME FOR CHANGE - Dr. Joseph Aluoch

There can be no question of the compliment implied by an invitation to appear on this program and I am human enough to feel a glow of satisfaction in having been asked. However, I am not optimistic about the usefulness of gatherings which merely place before an audience a group of speakers, particularly a group whose views are generally predictable from what they Dr. J. A Aluochhave already said and written before. Some have been saying essentially the same things for at least decades I sometimes wonder whether anyone listens.

For, despite a seemingly endless round of conferences, symposia, round-table discussions, and panel debates over the years, continuing medical education now is not greatly different from what it was 40 years ago. There is simply a greater quantity of the same familiar things.

Why continuing medical education? Three generalizations keep re-curing in the literature. We say first that it is the personal responsibility of professional to engage in never-ending refinement of his professional competence; second, that the body of biomedical knowledge is changing so rapidly that each of us must struggle constantly simply to keep up with an increasingly narrow field since it is hopeless to try to keep abreast of general medical knowledge; and third, that many deficiencies in health care not only exist but could be corrected by the appropriate continuing education of practitioners-particularly those practitioners who do not take part in programs of continuing education.

The diagnosis of deficiencies in the care of patients is surely an indispensable strategy, but far more difficult is the successful translation of even distasteful findings into sound educational practices that have some hope of alleviating the shortcomings which are identified. As a profession we seem more willing to consider or even to adopt new information or new technology than to change in any fundamental fashion the way we use ourselves.

We are convinced, or so the literature of continuing education would make us seem, that it is our failure to apply new knowledge that represents the weakest link in the chain of assuring that the highest quality of medical care is delivered by the greatest number of physicians to the largest number of patients.

While this view may be correct, I am not familiar with any solid data to support it. In fact, the correction of the major health problems in our country, as in other parts of the world, does not appear to require any substantial body of new knowledge. Rather, it requires that physicians use the knowledge they already have in a different way or more fully exhibit the professional attitudes that have characterized the physician’s role as long as there have been physicians.

As more eloquent speaker that recently said, “If I were asked to compose an epitaph on medical throughout the 20th Century, it would read: ‘Brilliant in its discoveries, superb in its technological breakthroughs, but woefully inept in its application to those most in need….’’’ Since I was a medical student 48 years ago, I have heard and I have read in medical literature covering a far longer period that physicians can be of the greatest service to society if they work at preventing disease rather than treating it. But which gets more academic attention and reward: the replacement of damaged arteries and heart valves or the prevention of smoking and obesity? We have been told again and again that most of those who consult us are the anxious well rather than the curable sick. But which gets more attention in our educational programs-the pharmacologic action of drugs and their side effects or the skill of listening and providing reassurance? In the manner recommended by their doctors.

I am afraid that most of us have been seduced by the notion that the professional responsibility to keep abreast of current information even if the information may have little use to many patients and even if it means diverting attention from other elements of professional competence that may be of far greater importance to those we serve. Having been convinced that “Keeping up” is the goal, we are easily led to the conclusion that the need in continuing education is for more instruction: for example.

Regrettably a recently completed survey by the World Health Organization of continuing education in member nations has shown that the lecture is still the most widely used instructional method by a large margin.

I have little hope that many of us will be changed significantly by what we hear today, although some of us may leave better informed than when we arrived. But if change in behavior is the goal of continuing education, whether it is offered to practitioners or to medical educators, then perhaps most of what we now do must be dismissed in much the same way as Oliver Wendell Holmes, the autocrat of the breakfast table and one-time dean of the Harvard Medical School, once dismissed another component of medicine when he said: “I firmly believe that if the whole “materia medica” as now used could be sunk to the bottom of the sea it would be all the better for mankind-and all the worse for the fishes.”

I suggest that it is time for us to start a new with continuing medical education.

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