Sunday, April 24, 2016

Medical doceres and the apprenticeship model

We all know that the meaning of 'doctor' is derived from the latin 'docere' which essentially means to 'teach.' 

Perhaps doctors were able to hijack this title a few hundred years back because they had a lot of teaching to do in the community (not medical students but their own patients)? 
Also none can disagree that patient-care is very important because if we fail in this we cannot set a good example for our students (including patients)? 

The solution is perhaps to integrate teaching with practice such that we utilize our students as our own colleagues to help our patients? Perhaps this is what was practiced in the apprentice-ship model of medical education a few decades back that was systematically wiped out at the UG level due to various reasons (best left alone without further discussion)?

However one of the major barriers to this model is that it will require in our faculty an ability to confront 'medical-uncertainty' which lurks at every corner of medical practice and an ability to admit to our students that we 'don't know but we are willing to work with our students to find out the answers.'

Although not much history is available on the apprenticeship model as practiced in India in the early part of 20th century, there is some Western data to show how it evolved from a generalist training culture propagated by prominent figures such as William Osler (His epitaph says 'I taught medical students in the wards'). 

People of his generation not only practiced clinical medicine but also practiced pathology by doing their own patient autopsies. 
Osler regarded autopsies as a natural extension of the history and examination that helped his developing a deep understanding of disease which he shared enthusiastically with students. He was taught by Virchow who was an equally prominent generalist. (More here:

The apprenticeship model died gradually with the passing away of such people who were keen to learn and document each and every thing about healthcare and was replaced by a new generation of faculty who had more focused goals. 

To revive the apprenticeship model in its true sense we would need faculty who are willing to be generalist learners like Osler perhaps?

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