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The future proof of the pudding

2022; Wiley; Volume: 19; Issue: S2 Linguagem: Inglês

10.1111/tct.13533

1743-498X

J. McLachlan,

Empathy and Medical Education

The conference theme was ‘Future Proof Medical Education: Practical Wisdom and Adapting to Change’, which is less straightforward as a title than it might seem at first. The verb ‘to prove’ originally meant ‘to test’ (hence, ‘the proof of the pudding is in the eating’); hence, the test for many of the ideas put forward will lie in the future. Being the recipient of the ASME Gold Medal for 2022 was not only an exceptional honour but also a chance to reflect upon main strands in my career, both for the plenary itself and in context to the theme of the conference. I chose to discuss three areas: psychometrics, particularly as applied to the trait of conscientiousness; anatomy teaching, without the use of cadavers; and the use of arts of humanities in healthcare education. But the first reflection I had to make was just how indebted I was to colleagues in each of these three areas. If, as you slowly climb the academic mountain, gravity seems to ease, it is because you are being carried aloft by post docs, graduate students and colleagues. And in addition, there are generations of health care students who have been the inspiration as well as the subject of research. Meeting some of those students at the Conference, now well-established in their careers, is one of the perks of a career in medical education research. And these meetings serve as a salutary reminder of the individuality of those we encounter in healthcare education. There is a temptation in psychometrics to treat students as the molecules of an ideal gas: All identical, with no interactions and obeying strict (if stochastic) laws. This is why I chose to discuss arts and humanities in medical education, as a reaffirmation of the essential importance of the individuality both of the learner and the teacher. And while psychometrics is by its nature rather remote from subject teaching, engaging in anatomy teaching grounds theoretical thinking in a place of direct contact with students and their learning. The provisional and tentative conclusions we feel able to draw are that the trait of conscientiousness may be a key attribute in student performance, continuing on into practice in healthcare. The implications are that it should perhaps be used in selection, and certainly monitored in early years, both with the possibility of remediation, and even of redirecting some students to other careers. With regard to anatomy teaching, I have not rescinded from the view that the traditional method of teaching through the cadaver risks inadequate preparation for the essential clinical skill of medical imaging, which for the undifferentiated junior doctor—the iatroblast, as it were—is essential, and that the end of life is far better introduced to students through elderly care and hospice settings, rather than the sepia abattoir of the dissecting room. And perhaps a poem about death or bereavement could be a source of more profound reflection on mortality than the disassembling of a formalin-preserved shadow of where a person had been. Over the centuries, the cadaver has acquired a cultural significance as a rite of passage in healthcare, especially medical, education. That this may be a barrier, rather than a facilitator, of patient centred health care remains a challenging thought. And it is with regard to patient-centredness that we have employed arts and humanities in healthcare education. The outcomes will almost always be qualitative and lie in the word rather than the number. Certainly, the qualitative feedback from students has been highly positive, and many of the events have proved memorable, as discussion with former students shows. But there remains work to be done in all of these areas. Chris McManus, in his own delayed (and outstanding) Medal Plenary, described psychometrics as the reality checker: ‘a great slayer of myths and dreams and fantasies’. Only the tasting of the future pudding will determine if these ideas have lasting value.