Academic medicine : journal of the Association of American Medical Colleges
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Evidence-based medicine, centered on the incorporation of evidence from clinical trials and systematic reviews into the teaching and practice of clinical medicine, explicitly attempts to supplant expert opinion, which is viewed as an antiquated and unreliable form of medical authority. The epistemology of evidence-based medicine categorizes expert opinion as the lowest form of medical evidence, superseded even by methodologically flawed clinical research. ⋯ Input from clinical experts is vital to informing the context of clinical research and an appeal to alternate forms of medical knowledge, including expert opinion, is necessary to overcome the intrinsic gap between clinical research and the care of individual patients. Even when the quality and quantity of empirical medical evidence are ideal, expert opinion will remain an integral part of the multifaceted knowledge required for the optimal practice of clinical medicine.
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To determine the fellowship experiences and career activities of the graduates of a research-intensive general internal medicine fellowship program. ⋯ Graduates of this research-intensive fellowship pursued academic careers with research, teaching, administration, and clinical activities. Directors of similar fellowship programs should prepare their graduates for all these activities.
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This study sought to identify the common stages in the development of capacities contributing to humanistic medical care in young physicians, as revealed by their dreams about medical school and training. Using a databank of approximately 400 dreams dreamt by non-patient students and housestaff at a major academic medical center, the author traces the development of the two components of humanistic medicine: empathy and humanistic attitudes. The "critical episodes" of medical education produce in young physicians emotional and psychological defenses affecting their ability to interact with patients in an empathic and altruistic manner. Medical educators need to reevaluate the traditional curricular milestones and pedagogic style to help foster the development of medical humanism.