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September 15th, 2019
A Former Medical School Dean Invents a False Dichotomy in Curriculum Content, and Advises Physicians to Stay in Their Lane
Over on the editorial pages of the Wall Street Journal, a piece appeared last week with the following provocative title and subtitle:
Take Two Aspirin and Call Me by My Pronouns
At ‘woke’ medical schools, curricula are increasingly focused on social justice rather than treating illness.
Dr. Stanley Goldfarb, former associate dean of curriculum at the University of Pennsylvania, argues that current medical schools focus so much on advocacy, social justice, and various (left-leaning) causes that students don’t have time to learn how to care for patients.
And what are some of the distractions these medical students must endure as they try to master the craft of medicine?
Cultural diversity, gun control, climate change, health disparities. Teaching about these topics “comes at the expense of rigorous training in medical science.”
He cites no actual data that this is true, of course, which means it’s his opinion — an opinion I strongly suspect he harbors based on how he feels about these topics himself.
Regardless of how we feel about them, however, most will recognize the “back in my day we studied real medicine” tone. This one turns up frequently when many of us old-timers weigh in on the state of medical education today, be it in medical school or residency. You know, “back in the days of the Giants”, bringing to mind the “OLD MAN YELLS AT CLOUD” internet meme.
But back to the topic of his piece — is it really a new phenomenon that medical schools include a societal (as well as individual) view of medicine, and that students show interest in these topics?
Absolutely not — back when I went to medical school a million years ago (ok, in the early 1980s), we were urged always to consider our patients in the context of their community, and also to think broadly about what we could do as doctors to improve not just individual, but also community health. While patient care was a the core of our efforts, my classmates ended up choosing a huge range of different passions to pursue.
A quick list: Basic science research. Clinical research. Public health and epidemiology. Health disparities, both here and globally. Domestic healthcare policies. Healthcare finance. Teaching. The medico-legal interface. Investment banking and consulting. One even started her own footwear company!
In short, one of the great things about medical training is that it’s adaptable to a wide range of health-related pursuits. Since what we include in a medical school curriculum cannot possibly cover everything — more true today than ever — why not include topics that are important from a societal level too? Don’t these influence patient outcomes?
Of course they do — sometimes powerfully so, something most University of Pennsylvania doctors readily acknowledge, citing the vast economic disparities evident right there in Philadelphia.
I respectfully disagree with Dr. Goldfarb's arguments. @PennMedicine's students are required to rotate in our West Philadelphia EDs. Traditional curriculums do not prepare them to address the barriers (violence, poor housing, addiction etc) that impede good clinical outcomes
— Kit Delgado (@kit_delgadoMD) September 13, 2019
And it appears the University of Pennsylvania agrees, as evidenced by the letter they have sent to students and faculty:
Please know that the views expressed by Dr. Goldfarb in this column reflect his personal opinions and do not reflect the values of the Perelman School of Medicine. We deeply value inclusion and diversity as fundamental to effective health care delivery, creativity, discovery, and life-long learning. We are committed to ensuring a rigorous and comprehensive medical education that includes examination of the many social and cultural issues that influence health, from violence within communities to changes in the environment around us.
Additional Penn faculty quickly weighed in on the editorial, noting that “social and health policies have always determined who gets sick and who gets care, and where, and how.” Unlike in the Wall Street Journal piece, these authors include some clear examples — the Flint Water Crisis, urban gun violence, underdiagnosis of cardiovascular disease in women and depression in African Americans — on how poverty, race, and bias influence individual and public health.
As for Dr. Goldfarb’s opening salvo:
The American College of Physicians says its mission is to promote the “quality and effectiveness of health care,” but it’s stepped out of its lane recently with sweeping statements on gun control.