A Closing Word
A Closing Word
Despite all the changes in undergraduate medical education after World War II, especially in its core of scientific training, it actually had shifted only slightly in essential ways by the end of the twentieth century. If a student from an earlier era sat down in the classrooms and clinics of the 1990s—although doubtless overwhelmed by the new knowledge and technology—he or she would still find much that was familiar in the teaching methods, curriculum, conduct of clinics, bedside training, laboratory instruction, and educational preparation of fellow students. “The medicine of 1900,” writes William Bynum, “[is] closer to us almost a century later than it was to the medicine of 1790.” The historic differences among nations in teaching methods, too, though less striking than in earlier times, were still visible in the characteristic responses of medical educators and students to the social and scientific changes. Alone among the professions, education for medicine had come to combine a long period of theoretical study with an intensely practical experience in the observation, handling, and treatment of patients. The resulting tension and shifting balance between academic study and clinical training, between theory and practice, between medicine as art and medicine as science, has been the perpetual condition of medical pedagogy since the Enlightenment. That a different balance was struck at different times in different nations because of differing social and political circum- stances is the underlying theme of this book. In the first half of this century, if a boundless faith in science and the ultimate rationality of medicine came to dominate nearly everywhere, that faith has been overwhelmed in our own time by postmodern doubts about human progress and the explanatory powers of science. But the pendulum will doubtless swing again. In any case, for most educators and students, the ideal remains what it has been for most of the period covered in this book—a unity of systematic academic study, especially in the sciences, with hands-on experience to create a physician who thinks critically, can solve problems, possesses a wide knowledge of underlying disease processes, and is skilled at applying what has been learned to real-life situations.
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