Revisiting the modern scientific physician

The 8 articles by Olli Miettinen are thought-provoking and timely.1^,2^,3^,4^,5^,6^,7^,8 Medicine as a profession has the obligation to review its basic premises in relation to the needs of society on a regular basis, and Miettinen recommends such a step. The series has removed some of the myths surrounding the concept of the physician and identifies the attributes of the scientific practitioner. This has obvious relevance to how physicians should be taught and trained. As practice is becoming increasing specialized, Miettinen identifies the need to re-examine what he calls “the medical common.” He has correctly identified the quite necessary relationship between the curriculum, medical licensing and postgraduate training, a subject on which he has previously published.9

There are several issues of concern. One wonders what the public response would be, as at the present time the public expects physicians to have a fairly broad pool of knowledge, no matter how specialized they may be. Experience in different subjects and practices is necessary to the extent that the student will learn to “know about” this broader field of knowledge. As a profession, medicine should consider these concepts in conjunction with the communities it serves so that physicians' skills and knowledge will meet society's needs and expectations. It would be of interest to know how Miettinen would accomplish this.

It would be instructive to know how Miettinen's “medical common” relates to the concept of the core curriculum that has been utilized in curricular design for some time. Is it different in concept, or only in content? It would also be instructive to know what process might be utilized to actually identify “the common.”

Medical education must be constantly re-evaluated, and Miettinen has challenged us to essentially start from the beginning, cutting ourselves loose from Flexnerian traditions. As we do this, the challenge will be to preserve the traditional values that have served society well while adapting to the reality of modern medicine.

Sylvia R. Cruess Richard L. Cruess Centre for Medical Education Faculty of Medicine McGill University Montreal, Que.